What Are the Responsibilities of the Long-Term Care Dietitian?

Long-term care is a variety of services that supports the basic activities of daily living such as bathing, dressing, and eating.

The goal of long-term care is to maximize residents’ quality of life while meeting their needs over a long period of time. It can be provided at home, assisted living facilities, or nursing homes.

Long-term care provides a level of nutrition care from registered dietitians (RDs) who address the multiple chronic diseases associated with aging.

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, 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 a registered dietitian, as allowed by state law (1).

The intent of this rule is to improve the responsiveness to a resident’s needs and provide physicians with flexibility, given the limited time that many spend in a facility.

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 who has type 2 diabetes might be prescribed a therapeutic diet to help control their blood sugars.

Many residents, however, find therapeutic diets unappetizing, leading them to eat less. Overtime, poor food and beverage intake can lead to unintended weight loss and malnutrition (2).

Knowing that therapeutic diets should not be prescribed based on medical condition alone, dietitians 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, also known as undernutrition, is both a medical and nutritional diagnosis that can result in severe consequences.

Consequences of malnutrition include, increased risk of falls and infections, increased healing time, pressure ulcers, increased hospital admission and readmission, and medical costs (3).

Malnutrition often goes unrecognized and therefore untreated, especially in long-term care.

Dietitians can assess and identify the risk factors of malnutrition and intervene with the appropriate individualized nutrition care. 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.

Dietitians embrace person-centered care by involving residents in choices about food and dining, food selections, dinning locations, and meal times (4).

This helps residents maintain a sense of dignity and control in the long-term care setting.

5. They Improve Residents’ Quality of Life

There are two goals that must be met when caring for those in long-term care — maintenance of health and quality of life (4).

Often times, one of these goals suffer at the expense of the other based on the resident’s goals and desires.

Dietitians, however, can ensure both goals are met through individualized nutrition approaches. This includes the use of the least restrictive diet and providing patient-directed care.

The bottom line

Dietitians play a crucial role in the long-term care setting.

They prescribe and liberalize therapeutic diets, prevent and treat malnutrition, as well as improve residents’ quality of life through person-centered care.