Special Diets in California Assisted Living: Medical, Halal, Kosher and More

For a medical diet, yes. Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs), and their food service is governed by Title 22 section 87555. It says that modified diets prescribed by a resident's physician as a medical necessity shall be provided.

The words matter. The duty covers a diet a physician has prescribed, not one the family prefers. The home learns about it from the medical assessment done before move-in, which under section 87458 must identify any medically necessary diet limitations. If your mother needs a low-sodium, diabetic or kidney diet, ask her doctor to write it on that form.

The same regulation sets the baseline for everyone. The total daily diet must be of the quality and quantity needed to meet residents' needs. Where the home provides all food, each resident must have at least three meals a day, with no more than 15 hours between the third meal and the first meal of the next day. Snacks must be available between meals unless a physician has prescribed dietary restrictions that limit them.

Section 87555 says that, where indicated, food shall be cut, chopped or ground to meet individual needs. It also requires adaptive devices for self-help in eating as residents need them, and tray service in case of temporary need.

The regulation does not go further into pureed diets or thickened liquids. If a doctor or speech therapist has ordered a specific texture, treat it as a prescribed modified diet: get the order in writing, and ask the home who prepares the food, who checks it at each meal, and whether staff stay with a resident who needs watching while eating.

There is a hard limit at the other end. Gastrostomy tubes and naso-gastric tubes are on the state's list of prohibited health conditions in Title 22 section 87615, so a home may not admit or keep a person who has one unless the state grants an exception or the condition is covered by a hospice care plan. Details are in our guide to feeding tubes and swallowing problems.

A diet prescribed for diabetes, kidney disease or heart failure falls under the same rule: when a physician prescribes it as a medical necessity, the home must provide it. Who is responsible for the kitchen depends on the size of the home. The regulation sets food service staffing rules by licensed capacity:

• Homes licensed for 16 to 49 residents must designate one person with primary responsibility for food planning, preparation and service, and give that person appropriate training.
• Homes licensed for 50 or more that serve three meals a day must have a full-time employee qualified by formal training or experience in charge of food service. If that person is not a nutritionist, dietitian or home economist, the home must arrange regular consultation with one.
• For homes licensed for fewer than 16 residents, which includes six-bed board and care homes, the regulation names no food service position. Ask who cooks and what they know about your relative's diet.

Menus are a useful check. Homes for 16 or more must write menus at least one week in advance and keep dated copies of the menus as served for at least 30 days. Smaller homes must keep a sample menu on file. Either way, menus must be made available for review by residents or their representatives on request. Related care questions are covered in diabetes and insulin in assisted living and dialysis and assisted living.

Here the law says less, and it is better to know that before a tour than after a move. Section 87555 requires that meals consist of an appropriate variety of foods and be planned with consideration for the cultural and religious background and food habits of residents. That is a duty to take a resident's background into account when planning meals. It does not mention halal or kosher food, certified ingredients or a separate kitchen.

Resident rights point the same way. The Resident's Bill of Rights in Health and Safety Code section 1569.269 gives residents the right to make choices concerning their daily life, to reasonable accommodation of individual needs and preferences in all aspects of life in the home unless health or safety would be endangered, and to food of the quality and quantity necessary to meet their nutritional needs. It also bars a home from discriminating against an applicant or resident based on religion.

So a home must consider a resident's religious or cultural diet and accommodate reasonable preferences. How far that goes in a particular kitchen is a matter of that home's practice. Ask direct questions and ask to see a menu.

Diet needs rarely stay the same. Under Title 22 section 87463, a home must update a resident's appraisal when there is a significant change in condition, and the regulation lists an illness or injury that results in a significant change in the resident's health care or dietary needs as one example. The home must bring the change to the attention of the appropriate medical professional and talk with the resident and the resident's representative.

Where a home offers meals as an optional service, section 87555 says that if a resident's condition changes so that the resident can no longer cook or buy their own meals, the admission agreement must be modified and the resident given full meal service. Ask what that does to the monthly rate. The food questions for a first visit are in our assisted living tour checklist.

Hamssa Benrekia is a senior living placement specialist in Torrance who speaks English, Arabic and Spanish. She helps families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities, board and care homes and memory care. Tell her about a prescribed diet or a religious or cultural one in the first conversation, so she can ask homes about it before you tour. She cannot promise what a kitchen will serve; the home and its admission agreement decide that. More topics are in the California Assisted Living Placement Guide. To start, contact Hamssa.