Some residents in nursing homes don't have the same sense of thirst, and they must be encouraged to drink. If they aren't encouraged to drink and monitored, they can become dehydrated very quickly. Most good nursing homes simply monitor their intake. It only takes a few seconds for a CNA to write down the amount the resident drank. These amounts are then totaled. The resident dietician will have calculated the basic fluid needs for each resident. An average amount of fluid may be around 1800ccs a day. The nursing staff then will compare the amount required to the amount actually consumed, and this will give a good idea of the fluid status of the resident.
Even though this process of watching fluids is simple, many nursing homes don't take the time to do it. Some facilities are so understaffed, the CNAs will either not perform this charting or will just write false numbers down. Since many of the residents can't communicate fully, they will become dehydrated right under their noses. Family of residents need to constantly look out for this problem. Make sure there is a water pitcher in the room, within reach, and that it actually has water in it. Go to the facility right after lunch time, and look at the food tray before the staff picks it up. Was the food eaten, were drinks consumed, and estimate the percentages. Write down what you see. Do this for a few days. Then, ask to look at the resident's chart if you suspect lack of fluid intake. I can't tell you how many times CNAs write the patient is drinking right, while the truth is they don't know.
I have had cases were CNAs were told by their managers to simply write something down whether they actually did it or not. I have had many CNAs chart things on days they did not work. I have seen nurses chart the delivery of care for days after patients have died. I have seen nurses chart "drinking fluids well" for a week and then die the next day from dehydration. In a nutshell, you can't always trust the medical chart in nursing homes. The staff there can be so over-worked, they will simply write down anything at the end of their shift. Most nursing home chains run their facilities so under-staffed, the nurses and CNAs are set up for failure while the chains literally make millions of dollars.