The Role of the Registered Dietitian in Long-Term Care
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Registered Dietitian (RD) in Long-Term Care
A Registered Dietitian (RD) plays a vital and irreplaceable role in long-term care, focusing on resident quality of life alongside their evolving nutritional needs. Building positive relationships with residents over time is a rewarding aspect of this career. While specific duties may vary by facility, here are some core responsibilities:
Collaboration is Key
The RD works closely with the nursing staff, including the Director of Nursing (DON), Resident Care Managers (RCMs), floor nurses, and Certified Nursing Assistants (CNAs), and additional members from the care team. This interdisciplinary team approach ensures coordinated nutritional support for residents.
Nutrition At Risk (NAR) Meetings: These meetings typically involve the DON, RCMs, the dietary manager, and other relevant members of the care team, such as members of the therapy department. During this meeting, the RD addresses residents with significant weight changes, wounds, nutrition support (such as IV nutrition or tube feeding), dialysis, or any other high-risk needs. The nursing staff updates the team on medication changes, lab values, changes in care plan, changes in food and fluid intake, and other pertinent details. The RD analyzes this information to identify potential nutritional factors contributing to the resident's condition and recommends interventions to address them. These interventions may include adding/reducing supplements, requesting labs, diet changes such as therapeutic or texture-modification, or requesting medication changes. Resident care plans are personalized outlines of resident’s goals of care which also may be updated during the NAR meeting, with some facilities assigning this task to the RD or a designated staff member. The care plan is reviewed and updated regularly to reflect the resident's changing condition or progress towards goals.
Therapy Staff Collaboration: Dietitians additionally collaborate with therapy staff such as speech language pathologists (SLP) and social workers in several ways to ensure a well-rounded approach to patient care.
SLPs play a multifaceted role, evaluating swallowing function, recommending texture modifications and safe swallowing techniques, while also suggesting adaptive equipment like specialized utensils, cups, or feeding assistance to improve mealtime safety and efficiency. The RD works closely with the SLP to ensure a consistent care plan for residents in order to meet their nutritional requirements in a safe and effective way.
Social workers act as advocates for residents. They assess emotional and social factors impacting diet (e.g., depression, cultural preferences). They then communicate these factors to the RD who translates that into a practical and enjoyable dietary plan for the resident to meet their nutritional needs.
Nutrition Department Collaboration: The RD also works closely with the dietary manager to ensure residents receive nutritionally adequate meals and snacks. They continuously refine the menus to ensure they offer a variety of appealing options that meet the overall nutritional requirements of the residents. The RD and dietary managers work together to make necessary changes to resident tray cards based on individual preferences to promote adequate mealtime completion. They additionally may co-create personalized supplements such as smoothies, fortified foods, or additional dietary add-ons to address specific resident needs. Additionally, the RD plays a crucial role in assessing various aspects of the kitchen operation to ensure they meet sanitation protocols, this can be done through in-service education and sanitation audits. The RD may conduct in-services for the dietary staff. These meetings cover various topics related to resident safety and well-being, including therapeutic diets, food textures, and proper sanitation practices. In addition to in-service training, the RD often takes a lead role in conducting sanitation audits of the kitchen. These audits involve a thorough inspection of food storage and handling procedures, kitchen equipment cleaning practices, and other areas to ensure compliance with protocols. By actively participating in both in-service training and sanitation audits, the RD plays a vital role in ensuring the kitchen staff has the knowledge and skills necessary to prepare safe, nutritious, and appealing meals for residents. This focus on hygiene helps ensure readiness for the annual Department of Health survey.
RD Documentation
RD Assessments: The RD conducts in-depth nutritional assessments for residents, focusing on several key areas. Weight changes are monitored for significant fluctuations (like +/- 5% in a month), with interventions or referrals to Nutrition and Activity Review (NAR) meetings initiated as needed. Additionally, the RD assesses meal completion and toleration of existing nutritional support. Food and beverage preferences are reviewed, communicated to kitchen staff, ensuring residents enjoy their meals. Current supplement use is evaluated to assess effectiveness and potentially adjust or add supplements to address deficiencies from wound care, dialysis, malnutrition, or inadequate oral intake. The assessment also evaluates a resident's ability to chew and swallow their current diet texture, self-feeding abilities, and any gastrointestinal symptoms. Finally, the RD provides nutrition education, guiding residents on managing chronic conditions through dietary strategies. This comprehensive approach ensures residents receive optimal, individualized nutritional support.
MDS Completion: The RD's involvement with the Minimum Data Set (MDS) in long-term care facilities can vary depending on the specific facility and its policies. The RD may be responsible for completing Section K and Section V (on admission) of the MDS, which focuses on the resident's swallowing and nutritional status. This information is crucial for developing a personalized care plan that ensures residents receive adequate nutrition and hydration while minimizing risks associated with swallowing difficulties.
Overall Care Plan Involvement for Registered Dietitians in Long-Term Care
The RD plays a significant role in resident care plans. Through collaboration with the care team, residents, and families, they develop a comprehensive understanding of each resident's nutritional needs and what requires monitoring. The RD manages resident weights, wound care, supplements, lab values, and gastrointestinal issues, all while considering resident goals of care and overall quality of life.
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Summary
Registered Dietitians are essential members of the long-term care team, ensuring residents receive optimal nutrition while considering their evolving needs and quality of life. They collaborate with staff like nurses and therapists to personalize care plans, from monitoring weight and lab values to managing special diets and providing nutrition education. By thoroughly assessing residents, overseeing kitchen operations, and maintaining accurate documentation, they play a key role in resident health and happiness.
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