Long-term care refers to a variety of services that support the basic activities of daily living such as bathing, dressing, and eating.
As part of the interdisciplinary health care team, registered dietitians (RDs) play a crucial role in maximizing residents’ quality of life with good nutrition.
This article lists five of the most important long-term care dietitian responsibilities.
1. They prescribe therapeutic diets
Since 1989, federal regulations have required that diets — including therapeutic diets like a low-sodium or renal diet — be prescribed by the attending physician in long-term care.
In 2016, however, the Centers for Medicare and Medicaid Services (CMS) announced a final rule that changed this requirement, allowing the attending physician to delegate the task of prescribing a resident’s diet to an RD, as allowed by state law (1).
This rule intends to improve the responsiveness to a resident’s needs and provide physicians with flexibility, given the limited time that many spend in a facility.
As nutrition experts, RDs are the most qualified to prescribe diets based on a resident’s current health, needs, preferences, and goals for care.
2. They liberalize therapeutic diets
As part of the treatment plan for a specific disease or condition, a therapeutic diet is typically prescribed to residents upon admission to a long-term care facility.
For example, a resident with type 2 diabetes might be prescribed a therapeutic diet to help control their blood sugars.
Or, a resident with a history of heart disease may be prescribed a low-sodium diet to reduce the risk of future cardiac events.
However, many residents find therapeutic diets unappetizing, leading them to eat less.
There is also a lack of data to support strict therapeutic diets for improving health outcomes in long-term care residents (2).
Knowing that therapeutic diets should not be prescribed based on medical condition alone, RDs can decrease the risk of other health complications by liberalizing residents’ diets based on their individualized goals, preferences, and informed decisions.
3. They prevent and treat malnutrition
Malnutrition is both a medical and nutritional diagnosis that can result in severe complications.
Complications of malnutrition include (3):
- increased risk of infections
- pressure injuries
- increased risk of falls and fractures
- increased hospital admissions and readmissions
Unfortunately, malnutrition often goes unrecognized and therefore untreated, especially in long-term care.
Fortunately, RDs are skilled in identifying malnutrition risk factors and can implement early nutrition interventions to reduce the risk of or prevent malnutrition.
RDs are also trained in diagnosing and documenting malnutrition and identifying the root cause or causes to allow for individualized nutrition interventions and care plans.
As such, dietitians play an important role in not only the prevention of malnutrition but also its treatment.
4. They embrace the philosophy of person-centered values
Person-centered care — also referred to as person-directed care — promotes choice, dignity, respect, self-determination, and purposeful living.
In person-centered care, the goal is to keep residents at the center of care planning and the decision-making process, which can help improve residents’ health and well-being (4).
RDs embrace person-centered care by involving residents in choices about food and dining, food selections, dining locations, and mealtimes (5).
This helps residents maintain a sense of dignity and control in the long-term care setting.
5. They improve residents’ quality of life
Two goals must be met when caring for those in long-term care — maintenance of health and quality of life (5).
Oftentimes, one of these goals suffers at the expense of the other based on the resident’s goals and desires.
RDs, however, can ensure both goals are met through individualized nutrition approaches.
This includes the use of the least restrictive diet and the practice of patient-directed care.
RDs can also help steer long-term care facilities away from an institutionalized feel by creating a home-like dining environment and implementing flexible mealtimes with restaurant-style dining.
The bottom line
RDs play a crucial role in the long-term care setting.
They prescribe and liberalize therapeutic diets, prevent and treat malnutrition, as well as embrace person-centered care.
RDs also can improve residents’ quality of life — which by, far, is the most important responsibility of a long-term care dietitian.