Dietitians in all fields rely on interprofessional collaboration, and this is clearly necessitated in long-term care (LTC) settings. LTC RDNs utilize ongoing relationships with allied healthcare providers to deliver comprehensive and effective patient care. The outline below describes the ways in which these professionals work together.
Foodservice Manager (FSM)
The FSM is the person with whom the RDN works with most closely. The FSM is in charge of all menu planning, ordering and inventory, oversight of kitchen staff and meal service, adherence to special diets, and maintaining care plans as they relate to dietary concerns. The FSM is typically the person who conducts an intake interview to ascertain the basic information upon which the RDN begins their nutrition assessment. They are also the point person for all food-related concerns, so the RDN has many ongoing discussions with them about changes in nutrition status, needs for special diets, and special resident requests.
This includes registered nurses (RNs) and certified nursing assistants (CNAs). The nursing staff are the people who interact with and assist residents with most of their needs. As such, they are often the best sources of information about residents’ recent behaviors, eating patterns, and other pertinent information. The nurses are also tasked with recording vital information like anthropometric measurements, PO intakes, medication and supplement delivery, etc. The RDN relies on the nursing staff to record this information in the EMRs for their assessments and monitoring.
This includes speech-language pathologists (SLPs) and occupational therapists (OTs). The RDN works mostly with SLPs, as they assess and treat speech and feeding issues. If a resident shows signs of dysphagia, the SLPs are the ones to diagnose it. Sometimes the RDN will alert SLPs to a suspected issue, and sometimes the SLPs will alert the RDN.
OTs and RDNs work together less often, but may communicate about residents with motor/movement disorders or mobility issues that affect their feeding abilities. Examples would be a resident with Parkinson’s Disease that needs adaptive silverware, or a resident recovering from joint replacement surgery who needs assistance until their mobility is improved.
Medical Doctors (MDs)
The MDs at a LTC facility are the overseers of all patient care. MDs conduct regular visits with residents to assess, diagnose, and treat a variety of health conditions. When one or more of these health conditions involve nutrition, the MD and the RDN work together to agree on appropriate treatments. Some of these conditions include: diabetes, heart disease, kidney disease, malnutrition, dysphagia, and dementia. As you can see, this covers nearly all of the common conditions found in older adults living in LTC facilities. The RDN gains valuable information about residents’ health by reviewing labs ordered by MDs, and they can also offer guidance to MDs based on their assessment of residents’ weight changes.
Putting It All Together
To provide consistent, comprehensive patient-centered care, the entire healthcare team must work together. One of the primary tools to facilitate this is the Patient-At-Risk (PAR) meeting. At the facility I interned with, this meeting is done on a weekly basis. It includes the resident MD, the head of nursing, the administrator, the foodservice manager, the RDN, the activities director, and a social services manager. Each employee has a turn to review all of the residents currently of concern due to health decline, weight changes, skin/wound changes, falls, behavioral issues, socio-environmental concerns, and more. This meeting is a way to keep all departments abreast of the current happenings of the facility and it guides the team in identifying which residents may need extra attention or monitoring.
As the LTC RDN works to provide quality care to residents, they are never doing so alone. By maintaining relationships with people from every department within the facility, the RDN cements their place as a vital piece of the healthcare system.