Most long term care organizations include food and dietary assistance as a facility service. This is a significant advantage for residents because it removes the responsibility of preparing balanced and nutritious food from seniors to the responsibility of the long term care dietician or Registered Dietician (RD), a qualified nutrition expert.
A long term care dietician is a popular career choice for those interested in health, nutrition, and wellness. The compensation is attractive, with an average annual salary of $63,090 in 2020. To become a qualified long term care dietician, people must complete the following five steps:
- Obtain a Bachelor’s or Master’s Degree in nutrition from an accredited Council for Education in Nutrition and Dietetics (ACEND) program
- Complete a dietetic internship that ranges from eight to twenty-four months to gain practical experience. While it is preferred to complete an in-person internship, there are also distance and online options available if this is not possible.
- Pass the Commission on Dietetic Registration (CDR) Exam, a crucial step towards becoming a qualified dietician. The exam consists of one hundred and forty-five questions that are categorized into four sections:
- Principles of dietetics
- Nutritional care for individuals and groups
- Managing food and nutrition programs
- Understanding food service systems
- Obtain a State License from the chosen state to practice in. Each state has different requirements for state licenses and certification. Therefore, long term care dieticians must research what is required according to their chosen state.
- Maintain a State License and Registration by completing seventy-five education credits every five years. Registered dieticians must also pay a yearly, registration maintenance fee to continue their verified credential with the Academy of Nutrition and Dietetics.
Long term care dieticians play a crucial role in a resident’s health, not only because a healthy diet improves a senior’s general health but also on account of the nutritional benefits of eating a combination of fresh fruits, vegetables, whole grains, lean meats, legumes, and low-fat dairy products, which reduce the risks of diabetes, blood sugar spikes, high blood pressure and help maintain healthy body weight. These foods also keep the residents more cognitively focused, improving their mental clarity and memory over time.
In recent times, long term care dieticians have also been the driving force behind moving away from institutionalized, cafeteria-style dining. The trend now is toward providing more home-like and restaurant-style dining with flexible mealtimes. The dietician’s goal is to provide a nutritional and healthy diet while improving the resident’s quality of life.
Nursing Home Dietary Guidelines
In 2018, the Academy of Nutrition and Dietetics revised their Standards of Practice for Professional Registered Dietitians working in post-acute and long term care. The Standards of Practice (SOP) gives a long term care dietitian a self-evaluation guide outlining three levels of professional skill: competent, proficient, and expert. A dietician must enter their qualifications and experience, stating their competency level and how they manage their professional development toward their goals.
Meanwhile, the Standards of Professional Performance (SOPP) identifies six professional performance measures that nursing home dieticians must meet in their everyday standards of practices:
- Quality in Practice
- Competence and Accountability
- Provision of Services
- Application of Research
- Communication and Application of Knowledge
- Utilization and Management of Resources
Using both the SOP and SOPP guidelines, nursing home dietary plans are based on research, applying the appropriate knowledge and skills, and resident preferences following industry standards and expectations.
Furthermore, a long term care dietician can also refer to the Healthy Eating Index (HEI) tool used to measure the quality of resident diets and how well-aligned they are with the Dietary Guidelines for Americans. The structure uses a scoring system between zero to one hundred to evaluate various food groups.
There are thirteen components representing each distinct food group and key recommendation. An HEI score of one hundred indicates that the food group completely aligns with the critical dietary recommendations. The guidelines offer an additional resource for long term care dieticians to effectively plan a healthy and nutritional diet.
It is of utmost importance that seniors have a balanced and healthy diet. They need a higher nutritional intake due to changes in their metabolism, muscle mass, and age-related memory loss. For this reason, nursing home dietary needs are very focused on meal planning and nutritional requirements to meet each resident’s needs.
Facilities that use a long term care EHR will have built-in features like a nutrition planner to allow dieticians to access resident data when needed. More advanced long term care software systems will have real-time alerts for new orders, weight loss or gains, admissions, and discharges. They will also have streamlined processes that enable dieticians to identify and track resident food preferences with resident meal cards. These features allow the dietician to work more directly with the residents to improve outcomes and satisfaction.
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The Role of a Nursing Home Dietician
As mentioned earlier, when seniors age, their dietary needs also change depending on their individual needs or concerns. According to a study from Tufts University, there are three ways a senior’s dietary needs to change:
- As seniors age, they become less active, causing their metabolism to slow down and their energy levels to decrease, reducing the amount of food they consume.
- As people age, their bodies become less efficient when absorbing and utilizing nutrients. Therefore, they need to increase their nutrient intake to supplement this change.
- Seniors with certain chronic illnesses and conditions take medication to manage their illnesses. One side-effect of the medication is that it negatively impacts their metabolism and their nutritional absorption. They will need more nutrients to counter the nutritional imbalance in such cases.
A nursing home dietician knows the importance of nutrition and the significant impact food has on the physical body, bone health, cognitive health, and the immune system. According to Dr. Luigi Fontana—a physician-scientist specializing in healthy longevity, calorie restriction, endurance exercise, and metabolism—aging is “the progressive accumulation of cell/tissue/organ damage with time.”
Therefore, aging happens over a lifetime rather than starting at age sixty-five. That is why it is important to be mindful during your youth about what you eat to minimize the damage later in life. Of course, a long term care dietician will be able to delay or prevent certain health conditions in several ways:
- Creating Therapeutic Diets – Long term care dieticians customize therapeutic diet plans following a resident’s health goals, preferences, and specific disease or condition, such as designing a low-sodium diet for residents with a history of heart disease to reduce future cardiac events or creating a personalized low-sugar diet for residents with type two diabetes. The goal is to improve the quality of care for each resident’s unique needs while giving them a balanced and delicious diet to stimulate their appetite and metabolism.
- Encouraging Person-Centered Care – The role of Registered Dieticians in long term care is to provide person-centered care, as their dietary plans often involve speaking with the resident to determine their food and dining preferences. This allows residents to select food options, state their preferred dining locations, and specify their mealtimes. This information is then carefully documented in the care plan software to give residents respect, choice, and dignity in choosing their food.
- Preventing Dehydration and Malnutrition – Malnutrition has severe ramifications on seniors, as it can result in increased falls, hospital admissions, and healing time. Therefore, a nursing home dietary plan must ensure residents have a nutritional diet to minimize these risks. As people age, it is also common to develop problems with swallowing, which impacts their sense of thirst. The dietary department in a nursing home will regularly monitor hydration levels, as dehydration can lead to urinary tract infections, kidney stones, and kidney failure.
If a long term care dietician needs further guidance on what critical components they should focus on when creating resident care plans, they can refer to CMS’ Food, Nutrition, and Dining for further information.
How a Long Term Care Dietician Utilizes Long Term Care Software
Many facilities have onsite food preparation stations, which allow the long term care dietician to monitor residents’ weight (loss or gain), nutrition changes, and food preparation services, such as cleanliness, sanitation, equipment, and service procedures.
It is the responsibility of the dietician to ensure that all food and preparation requirements are reported with proper documentation in the long term care software, which is accessible to other facility staff members. This allows for improved communication between clinical staff and other colleagues should a resident’s condition change.
According to Kim Rodriguez, a registered long term care dietician with over twenty years of experience, many residents’ diets improve dramatically when they move into a facility because they eat less pre-packaged and processed food.
The strict nursing home dietary requirements provide residents with more nutritious food that promotes longevity through customized care plans catering to their personal tastes and preferences. Modern care plan software systems also allow facilities to meet CMS requirements better due to more efficient practices when tracking food budgets, reducing food waste, revising food inventories, and buying more in-season food products.