Cost-cutting measures in nursing homes, particularly food budgets, have been a concerning underlying issue in the industry, with more than a quarter of facilities in the country spending under $10 per day on food per resident.

An investigative report by NJ Advance Media, in collaboration with Rutgers University and data experts at SNFdata Resources of Louisville, delved through more than 10,000 cost reports filed with the Centers for Medicare and Medicaid Services (CMS) found that a severe underfunding of food – with some operators spending as little as $4 to $6 per day per resident – meant meals were nutritionally inadequate, unappetizing, or inedible.

Half of all nursing homes spend less than $12.03 for three meals a day per resident, according to 2023 data pulled from by digital media and marketing group Advance Local.

Food-related deficiencies tripled between 2021 and 2024, the report found, as dietary complaints and outbreaks of foodborne illness also rose.

There are surprisingly no federal spending mandates for food in nursing homes, and some operators have diverted funds to themselves or ancillary businesses while leaving facilities under resourced, according to the report.

Jodi Eyigor, senior director of nursing home quality and health regulation for LeadingAge, told Skilled Nursing News that while the association hasn’t seen data mentioned in the analysis or the analysis itself, its members are “committed to providing quality care and ensuring resident well-being.”

That includes access to nutritious meals, in compliance with regulations established by CMS.

Harvard University professor of health care policy David Grabowski told NJ Advance Media that the issue of low food budgets is often an issue that flies under the radar, but is incredibly important. Rates of malnutrition and dehydration range from 30% to 85% of residents, the Journal of the American Diabetic Association found.

Grabowski co-authored a study on staffing regulations, which found that adding staff as required by the government meant operators cut costs in areas not scrutinized by regulators. While there are no requirements for how much money should be spent on food, CMS has standards for prep and nutrition.

CMS surveyors dedicate a portion of their observation time to food safety, nutrition, preparation, storage, and distribution of food, the agency said.

Holly Harmon, senior vice president for the American Health Care Association and National Center for Assisted Living, told SNN that nutrition and food safety is an important focus area for the industry as an essential component of a resident’s care plan.

She noted that facilities comply with stringent food safety regulations, and that the vast majority of food-related issues identified during inspections are corrected.

Soaring inflation in recent years has impacted the cost of food in nursing homes as well, she said, with facilities already being underfunded.

“The major challenge is that nursing homes have limited government resources and are chronically underfunded,” said Harmon. “Properly funding long term care benefits all aspects of care delivery, including food and nutrition. We encourage policymakers to uphold their commitment to our nation’s seniors through ongoing investments in long term care.” 

The investigation pointed toward privatization and consolidation – and private equity ownership – as an underlying link to subpar food budgets.

The analysis calculated daily spending on dietary expenditures, based on annual figures reported by operators. In-patient days were also factored into calculations, according to the report. Nursing homes reported the amount of money going toward “related entities,” or ancillary businesses, associated with the owners, as well as costs the federal government deemed “allowable” for such services.