The Rise and Push-Back of Feeding Assistants

Mark Shalloway
2 min readMay 3, 2022


Rightfully so, nursing homes are heavily regulated by federal, state, and local laws in order to keep its attendants safe and cared for. This became far more regulated after a study in 1986 from the Institute of Medicine showed that nursing home residents were often inadequately cared for, abused, and neglected with the federal Nursing Home Reform act.

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On top of providing residents a “Bill of Rights,” this act set strict standards and procedures for training nurse’s aides designed to evaluate their competency. This means being a licensed health professional, or completing 75 hours of training and a competency test.

However, as nursing homes face staff shortages, one solution has been to relax training requirements for “assistant” and allow them to perform certain tasks such a feeding. The role of “feeding assistant” was designed to help lessen the workload of qualified staff members. They are usually part-time workers who are paid minimum wage. The requirements to become a feeding assistant are much lower than the requirements for other professionals.

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To become a feeding assistant, one must:

  • Complete an eight-hour state-approved training course
  • Work under the supervision of a registered nurse/licensed practical nurse

They are not authorized to feed residents who have difficulty swallowing/other feeding issues, and the selection of residents fed by assistants must be confused by a professional nursing staff.

With these limitations, the use of feeding assistants has sparked mass criticism by many groups. Many fear limited training could lead to more problems, as feeding is not as simple a task as it might seem at face-value. Assistants have to ensure proper positioning and avoid choking and aspiration issues.

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Ultimately, a lawsuit in July 2004 changed things. Resident Councils of Washington v. Thompson stated that these new regulations were invalid under the Nursing Home Reform Act. Plaintiffs in Michigan joined the fight soon after. After a three year battle, a court of appeals ruled in favor of the government, insisting that the language was “sufficiently ambiguous” enough to allow for feeding assistants. While the concerns about feeding assistants are valid, being supervised by qualified professionals does help with the worries.



Mark Shalloway

Mark Shalloway is an elder and special needs care attorney in West Palm Beach, Florida.