F-807: Are You Keeping Residents Hydrated—or Risking a Deficiency?

Dehydration is one of the most preventable causes of hospitalization in long-term care—and one of the easiest deficiencies to cite.

F-807 requires that each resident receives drinks, including water and other liquids, consistent with their needs and preferences and sufficient to maintain proper hydration and health. That means:

  • Offering fluids routinely throughout the day

  • Monitoring intake for those at risk

  • Intervening early when hydration is inadequate

When clinical changes like weight loss, confusion, or UTIs raise questions about whether residents are being offered—and accepting—adequate fluids, surveyors may cite both F-807 (sufficient drinks) and F-692 (quality of care – hydration), depending on where the breakdown occurred.

What Does F-807 Require?

Facilities must:

  • Provide drinks sufficient to maintain resident hydration and health

  • Ensure fluids are consistent with resident needs, preferences, and diet orders

  • Offer fluids between meals, during medication passes, and with meals

  • Identify residents at risk for dehydration and monitor their intake

  • Intervene and update care plans when intake is poor or clinical changes occur

Note: When a resident experiences actual decline — such as dehydration-related hospitalization, significant weight loss, or acute confusion — surveyors will also review F-692 (§483.25(g)(2)), which addresses the facility's duty to prevent dehydration as a quality of care issue.

Common Survey Triggers for F-807

  • No hydration monitoring in place for high-risk residents

  • Fluids offered only at mealtimes with no between-meal hydration program

  • Residents reporting they are "never offered drinks" between meals

  • Lack of documentation for fluid refusals or consistently poor intake

  • No care plan update or clinical follow-up when weight loss, UTIs, or signs of dehydration develop

Smart Tips for F-807 Compliance

Implement Hydration Rounds
Create a structured hydration schedule — mid-morning, mid-afternoon, and before bed at minimum. Assign staff responsibility and document delivery.

Track Intake for High-Risk Residents
Use a fluid intake record or EMR documentation to monitor residents with dysphagia, dementia, diuretic use, or fluid restrictions. Flag anyone trending below goal.

Involve CNAs and Activities
Encourage water or juice during activities, therapy, or in common areas. Hydration is an interdisciplinary responsibility — not just a dietary task.

Offer Variety Based on Preference
Not everyone wants plain water. Fruit-infused water, herbal tea, popsicles, broth, or preferred juices are all recognized in surveyor guidance as appropriate alternatives to encourage intake.

Follow Up on Weight Loss or Confusion
If there is no obvious clinical cause for a change in condition, ask: When was hydration last formally assessed and documented?

Did You Know?

CMS expects hydration care plans to be individualized, proactive, and interdisciplinary. Offering fluids only at mealtimes is unlikely to be sufficient for high-risk residents — surveyors will look for evidence of a consistent, documented hydration program that reflects each resident's assessed needs and preferences.

Stay Ahead with Smart Bites

Next up in Issue 12: F-809 – Frequency of Meals: Are You Meeting the Daily Minimum?

Need help assessing hydration protocols or documenting fluid refusals? Reach out at info@dietarysolutions.net or visit www.dietarysolutions.net.

Amanda Smith