Dietitians play a vital role in long-term care – so much so that in 2016, the Centers for Medicare & Medicaid Services updated its regulations, requiring every long-term care facility to have a licensed registered dietitian or certified dietary manager on staff. Regulations also stipulated this food and nutrition specialist must be an integral member of the skilled nursing facility’s interdisciplinary team.
An on-staff long-term care dietitian is important because of the role nutrition plays as we age. A good nutrition plan created by a dietitian in a long-term care setting helps delay or prevent certain health conditions in skilled nursing facility residents, including unintended weight loss and dehydration, thereby improving residents’ overall quality of life.
In addition to helping healthy residents continue to eat well-balanced diets, long-term care dietitians must create diets from scratch for residents who are recovering from injury, illness or other medical conditions. Dietitians in long-term care facilities have to consider a variety of factors that affect an older adult’s interest or ability to eat:
Decreased taste and loss of appetite: Some medications can change the taste of food; dentures may make it difficult to chew. Taste buds also shrink in size as we age, and our taste and sense of smell decrease.
Depression: If an older adult has lost a spouse or long-time partner, eating alone may not be appetizing, so they choose not to eat. They also may forget to eat if no one is around to remind them to cook or sit down for a meal.
Nutrient absorption: Vitamins and nutrients aren’t absorbed as well by our bodies as we age, which can lead to malnutrition and vitamin and mineral deficiencies. Foods high in some nutrients and vitamins may no longer appeal to older adults’ palates due to the food’s texture or perceived lack of flavor.
Financial issues: Some older adults may have been very frugal over their lifetimes, eating cheaper meals that were over-processed, pre-packaged, lower in nutrients but higher in salt, fat and sugar. That can result in poorer overall health or the earlier onset of specific diseases, such as diabetes or high blood pressure, that they have struggled to manage through diet.
There are four key ways a long-term care dietitian overcomes these challenges – and improves the quality of life for your loved one living in a skilled nursing facility.
1. Prescribing therapeutic diets. As part of the 2016 regulation changes by the Centers for Medicare & Medicaid Services, a skilled nursing facility’s attending physician could delegate the job of prescribing a resident’s nutrition care and diet to the registered dietitian. The goal of this regulation change is to improve the responsiveness to each resident’s unique needs.
For example, if a resident has diabetes or high blood pressure, the dietitian may prescribe a specific diet that omits sugar or salt. However, these diets can be overly strict, less palatable and limiting in variety, which is why nutrition professionals in many skilled nursing facilities are embracing an approach called a liberalized diet.
2. Offering liberalized therapeutic diets. Registered dietitians can craft the therapeutic diet while taking into consideration each resident’s goals, informed decisions and preferences. The idea is to keep the resident healthy while still providing them with foods they prefer.
That could include being served a smaller cut of red meat once a month or eating a reduced portion of their favorite dessert. This approach allows the resident to enjoy the foods they love instead of having them removed from the diet entirely. And the greater benefits can be seen in reduced malnutrition and improved quality of life.
3. Promoting person-centered care. The focus for the nutrition professional is on ensuring the resident is at the center of the decision-making process so that they feel more in control of their choices. Registered dietitians may promote person-centered care by giving the resident the choice of food selections, meal times and dining locations.
The Centers for Medicare & Medicaid Services encourages skilled nursing facilities to implement person-centered care. Not only does this approach give residents a voice in when, where and what they eat, but it can also decrease overall health care costs.
4. Preventing malnutrition and dehydration. Malnutrition can have terrible consequences for older adults, such as increased falls, increased healing time and increased hospital admissions. Yet it often goes unrecognized in some long-term care facilities, which is why having a nutrition professional on staff is so crucial.
Older adults often have difficulty swallowing, and may not get as much hydration as they need. Some medicines can cause dehydration as well. And as people age, sometimes their sense of thirst will decrease. All this can lead to serious health issues like urinary tract infections, kidney stones and even kidney failure.
A registered dietitian or other nutrition professional can recognize the signs of dehydration quickly and add foods into the resident’s diet that have a high water content, like melons, cucumbers or broths. Skilled nursing facility residents may also be served a wider selection of liquids, in case they don’t like drinking water – something a good nutrition professional would already know about your loved one.
Meeting these four responsibilities ensures a community successfully maintains both the resident’s health and quality of life. And a long-term care dietitian is key to that success.
Skilled nursing services at The Waterford include a full-time dietitian skilled in therapeutic diets, liberalized diets, person-centered care, and preventing malnutrition and dehydration. Discover all the ways in which our long-term care dietitian can play an essential role in your loved one’s health care and quality of life. Simply complete the form on this page or call us at 888.672.7494.