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In 2016, the Centers for Medicare and Medicaid Services (CMS) updated the regulation requiring long-term care (LTC) facilities to hire or contract with a qualified dietitian or another clinically qualified nutrition professional.

As a result, dietitians now play a critical role in LTC settings — especially when it comes to compliance, cost savings, and overall resident health.

Heidi McCoy, RDN, LD, CEHCH, Clinical Director of the Ohio Health Care Association, has witnessed significant changes in the field over the last decade. During her 27-year tenure in LTC dietetics, she’s seen the role of dietitians evolve to what it is today. She says it is a win for both nutrition professionals and residents.

“The biggest catalyst for this change is the CMS guidance. They believe — and rightfully so — that someone’s nutritional status shouldn’t decline as they age. It’s great to see CMS emphasizing nutrition as a major factor in a resident’s health and quality of life,” she notes. “The change in mindset has elevated the dietitian’s role and improved resident nutrition levels.”

Whether they are part-time, full-time, or contracted, there are a variety of tasks and responsibilities a LTC dietitian takes on. And McCoy says an interdisciplinary team well-equipped with a registered dietitian realizes many benefits.

Improved Resident Health

Nutrition and hydration levels play a significant role in the overall health of LTC residents. Nutritional intake impacts healing from an illness or injury. Dietitians work closely with facility nurses and other clinical staff to promote an optimal nutritional status in each resident.

“Dietitians sometimes do things like prepare menus, but what a lot of people don’t understand is that we are playing a part in helping heal resident injuries,” says McCoy. “You can do wound treatments, but if that resident isn’t eating enough calories and protein, the wound won’t heal.”

Dietitians help improve residents’ cognitive health as well. Alzheimer’s disease and related dementias are prevalent in LTC settings, and dehydration can heighten dementia symptoms. Dietitians work with caregivers to create personalized interventions to keep these residents hydrated and improve their quality of life.

Lower Rehospitalizations Rates

About one out of four patients discharged from an acute care hospital to a skilled nursing facility (SNF) will be readmitted within 30 days. The average cost of each readmission is a staggering $10,352, and the readmission puts residents at risk for complications.

McCoy says dietitians help facilities lower occurrences of rehospitalization, resulting in cost savings and better preventive care.

“I think one of the biggest reasons residents are rehospitalized is dehydration. Interdisciplinary team meetings are critical in those first four weeks as a resident transitions from the hospital to a SNF. During that time, they are at an increased risk for weight loss and dehydration,” she explains. “Along with the other care team members, dietitians review the resident’s intake records and put in specific interventions to reduce their risk of rehospitalization.”

CMS Guideline Compliance

Dietitians handle a web of rules and regulations handed down from CMS. McCoy says wading through these guidelines and making sure a facility is survey ready is one of the most challenging aspects of LTC dietetics.

“Surveyors want every resident to maintain or improve their nutritional status. Nutrition and hydration in the last five years have been a big focus of compliance surveys,” she notes.

High rates of sarcopenia, malnutrition, dehydration, and weight loss can be red flags for CMS surveyors. McCoy says LTC dietitians become investigators to keep resident nutrition and hydration levels optimal.

“Dietitians look at all aspects of a resident’s well-being to determine why they aren’t eating well. It could be anything from losing their dentures, having difficulty swallowing their food, or an underlying disease suppressing their appetite.

We must identify what’s going on and implement interventions to ensure residents aren’t dehydrated or rapidly losing weight. Yes, it is great to comply with CMS guidelines, but one of the most rewarding aspects of the job is helping residents feel better and improving their quality of life.”

Enhanced Dietary Team

Food can make or break anyone’s day — and it’s no different for LTC residents. That’s why it is so essential for dietitians to form a positive relationship with the dining team, collaborating on menus and recipes.

McCoy says she is seeing more dietitians get into the kitchen, helping out when needed, and testing the food coming out of the kitchen.

“LTC dietitians form vital relationships with dietary managers, cooks, and the dining staff. It’s part of having a well-rounded dietary team,” she says. “Also, we must know what the food coming out of the kitchen tastes like — including pureed food. Residents needing a modified diet are at risk of malnutrition, and we must know what that food tastes like when we are serving it to them.”