Are you wondering what it is really like to work as a long-term care dietitian…and how to get started? This comprehensive guide is for you!
In this post, you’ll discover what kind of work is included as a long-term care dietitian, as well as the benefits of working in this field. You’ll get to pack your virtual toolbox with our top long-term care dietitian resources. Not only that, you’ll be able to boost your skills – and confidence – with our recommended resources for getting started and staying sharp with the latest research.
We’ve also included suggestions and quotes from two dietitians working in this field: Stefanie Wilkerson, RDN, and Moushumi Mukherjee, MS, RDN. These remarkable long-term care dietitians each have decades of experience in the field. We are grateful to them for sharing their wisdom and expertise!
Let’s jump in at the beginning. What exactly is long-term care (LTC)?
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What is Long Term Care?
Long-term care, abbreviated as LTC, includes working in a nursing home for people who are no longer able to stay safely at home. And while this is what you probably picture when you think about long-term care, there is more diversity in the work than that.
A long-term care dietitian can also be providing care to people who are recovering from a serious injury or illness and may eventually go home, as well as care for people in substance-abuse rehabilitation, those with dementia, and people who are younger, but for a variety of reasons are not able to care for themselves safely at home.
The work of a long-term care professional can take place in different settings. Let’s cover those next.
What are the different kinds of long-term care facilities?
If you’re new to the field, you might be surprised at just how many different types of long-term care facilities there are (1). These include:
- Skilled Nursing Facilities (SNF) – provide the highest level of care available in a long-term setting; have skilled nursing available around the clock.
- Extended Care Facility – also known as a nursing home; provides care to those with less complex medical needs than an SNF.
- Rehabilitation Units – provide 24/7 care to those recovering from a serious medical event such as a car accident, stroke, or invasive surgery.
- Group Homes – smaller LTC facilities providing care to those with mental illness, those recovering from substance abuse, or a halfway house, empowering people to integrate into society following incarceration.
- Memory Care Units – provide care to those with dementia, including Alzheimer’s.
- Hospice – provides care for those who are terminally ill
- Assisted living facilities – residents live in their own room, apartment, or home but are under supervision and have access to help with activities of daily living (ADLs) such as bathing, getting dressed, and eating.
How big are these facilities? Long-term care facilities can range from a group home with a few people to large facilities with 100s of residents.
Note: more than one type of long-term care can take place in one building, such as having a memory unit for those with dementia or Alzheimer’s disease within an assisted living facility.
So what does a long-term care dietitian actually do? That’s our next section!
What are the responsibilities of long-term care dietitians?
While not a hard sell to tell a fellow dietitian that nutrition is impactful, the RDN’s expertise is becoming increasingly appreciated in the LTC community at large. Moushumi explains that “these days, more and more LTC residents are asking for a consultation with a dietitian and that is absolutely wonderful.”
While the long-term care dietitian’s responsibilities will vary from one facility to another, you can be pretty confident that your duties will include the following:
- Conduct nutrition assessments for all residents.
- Assign appropriate diets to optimize and liberalize meals for residents based on their health and goals.
- Coordinate care with the interdisciplinary team to ensure that all residents have the best possible nutrition intervention. This includes working with the speech-language pathologists to determine the safest texture of foods and liquids for each resident.
- Calculate enteral and parenteral nutrition recommendations as needed.
- Audit the kitchen to ensure that the trayline is meeting sanitary standards.
- Work closely with the Certified Dietary Manager, your colleague who is responsible for all food service operations in your long-term care facility. Some facilities call this colleague the lead chef or head chef or the kitchen manager.
- Host in-service training for staff as needed.
Your recommended dietary plans have the potential to build up a resident’s nutrition status as they recover from an illness, injury, or neglect. The nutrition interventions can support and maintain their health as long as possible, providing the energy to enjoy the days and the hydration to stay mentally clear and focused.
Meals can be the highlight of a resident’s day. And as many residents have a decline in appetite over the years, dietitians in long-term care are charged with planning menus that are appealing, and nutrient-dense, all while meeting the various diets and texture requirements of the residents. Plus, you know that your work will be scrutinized by state surveyors. That is a lot to juggle!
Be ready to welcome state surveyors…at any time!
One thing that can make working in a LTC facility more intimidating is knowing that your work must be compliant with a web of rules and regulations. Keep in mind, however, that these regulations are to protect the resident – that’s your goal, too.
If this level of responsibility feels intimidating, especially with the thought of state surveyors checking your work, know that you can do it. You know more than you think you do now and additional training is available. We recommend Stefanie’s course, Be a Survey Ready RDN to be empowered to take great care of your residents and earn almost 25 CEUs to boot!
With the many responsibilities of working in long-term care as a dietitian, who is a good fit for this work?
What makes an RDN a good fit for LTC?
Working with geriatric residents is a different kind of work than working in a clinical or community setting. How do you know if your personality is a good fit?
Stefanie Wilkerson says that the top two attributes of an LTC dietitian are to be compassionate and independent.
Compassionate: “Keep in mind that your geriatric resident used to be young and vibrant. For many of them, an enjoyable meal is the highlight of their day. When meals don’t go well, it can negatively impact their day, and how they interact with you, and with their other caregivers. Your compassion to make their meals as enjoyable as possible has a huge impact on them.”
Independent – Stefanie shares that “most of the time you will be the only dietitian at your facility/facilities. It’s not like at a large hospital where there is a team of RDNs that you can consult and talk things over with. For this reason, it’s important to be involved in a network of RDNs either from your local dietetic’s group, a Facebook group, a DPG, or a previous preceptor, so you have some support and feel less alone.”
Loves variety – Moushumi adds that working in LTC is a great fit for those dietitians who don’t love doing the same thing every day. “For all those young, aspiring dietitians out there, I’m going to say, if you are like me and love variety, challenges, and you like to go into different settings, this is your field.”
Benefits of working in LTC
There are many benefits to appreciate in your work as a long-term care dietitian; these include your impact, potential income, and flexibility of scheduling.
Unlike working in a clinical setting where your patients may be under your care for a short amount of time, in a long-term care setting, your work may impact patients for months or even years!
The salary may be higher than what you’re offered working at your local hospital.
Working in LTC may also offer a more flexible schedule than a traditional clinical role.
You may also be able to work independently as a contractor, not an employee, and have a higher income (more on the pros and cons of that decision in a bit – keep reading!).
How can an RDN get started working in LTC?
Ready to take the next step towards securing your role as a long-term care dietitian? Here are our top expert-recommended strategies for being able to apply to opportunities as soon as they’re available.
- Be active in your local dietetic association.
- Join Facebook groups specific to LTC as they often post available positions.
- Network with other healthcare providers in LTC.
- Stefanie suggests contacting your local LTC facilities and asking if they have a current RDN. It may surprise you, but “many do not have a dietitian on staff but are looking for one. They may not be sure how to go about it, especially smaller facilities that are privately owned.” This is a great opportunity for you to demonstrate your expertise to them!
Employee or contractor: which is best?
As a long-term care dietitian, you may have more flexibility to choose to work as a contractor instead of an employee if you wish. What’s the difference? Let’s explore the pros and cons of each option so that you can advocate for the scenario that works best for you.
Working as an employee
Working as an employee comes with a few benefits. These will probably include:
- A regular, predictable paycheck
- Benefits, such as health insurance
- Paid time off
- Contribution matching for retirement
- The employer is responsible for deducting taxes and social security
Some of the cons might include:
- Less flexibility with work schedule
- Less control over the rate of pay
Working as a contractor
If you are working as a contractor, you are your own boss – wahoo! That can be both exciting and nerve-wracking, especially at the beginning.
Some of the pros of working as a contractor include:
- More autonomy over your time and schedule
- Can set your own rates and these are typically higher than paid to employees
- Can deduct expenses related to your business
Some of the cons might include:
- It is your responsibility to set aside income to cover your taxes and social security
- You’re responsible for contributing to your own retirement
If becoming your own boss is sounding better and better, you’ll want to watch the Building a Long-Term Care Consulting Business RD2RD Live Show episode with Moushumi Mukherjee, MS, RDN. Grab a pad of paper and be ready to take notes!
No matter which route you choose, be sure to negotiate the best possible rate before you begin. The Dietitian’s Guide to Negotiating Pay offers valuable tips and strategies to tackle this conversation.
In addition, Moushumi shares her process for determining her rate while working as a contractor.
Whether you work as an employee or contractor, you’ll be ready to tackle your changing days with the right training. Be sure to check out Stefanie’s course, Be a Survey Ready RDN, so that you’re confident from day 1!
Now that you’re ready to begin your role, here are some expert tips for getting started
Expert tips for success in LTC
What do our experts recommend to be successful in LTC?
Stefanie – creator of Be a Survey Ready RDN – says “flexibility is key – LTC is always changing.”
Now is the time to be thoughtful about their offer and what you will counteroffer. Here are a few tips for those of you who may not feel comfortable negotiating, or who have never done so before.
- Stay up-to-date on the rules and regulations that govern your LTC facilities.
- Stay up to date on common conditions including
- Wound healing – in LTC, this will include optimizing nutrition to help your residents heal from surgical procedures as well as bedsores and wounds related to being bed-bound.
- Alzheimer’s disease – dementia is common in LTC, including Alzheimer’s disease. With dementia typically comes a decreased thirst and risk of weight loss. While nutrition cannot prevent Alzheimer’s disease, it can improve the quality of life for your residents (4).
- Understand your resident’s rights. Residents have the right to choose to be weighed or to skip; they can accept recommended treatment, refuse or discontinue. They also have the right to privacy; do not post public signs about a resident’s health at their door where anyone can read it.
- Familiarize yourself with MDS – which stands for Minimum Data Set – and know who is responsible for which section in your facility. The MDS survey is required in all nursing homes that are funded by Medicare and Medicaid (5).
How to stay up to date? Let’s cover our expert-recommend resources next.
Long-term care resources for dietitians
What are the best long-term care resources for dietitians ready to kick off their careers? Here are our top choices.
4 Week Cycle Menu – an easy-to-customize menu that you can tailor to your LTC facility. This RD2RD product was created by Moushumi and allows your menus to be compliant with government regulations and guidelines that require your menus to offer a variety of food choices as well as balanced, nutritious, palatable meals.
Long-Term Care Dietitian Consultant Book – Moushumi’s starter kit for RDNs ready to launch their own LTC consulting practice. This resource collection includes the forms and contracts that Moushumi wishes she’d had when she was getting started!
Key Takeaways: Long-term care dietitians
As a long-term care dietitian, you have the opportunity to make a positive impact on the lives of your residents during their golden years. Meals have the potential to influence not only their health but also their morale and enjoyment of the day. This is important work!
Before you go: be sure to download your long-term care cheat sheet! This is your complimentary PDF ready to download, print and pack in your work binder. With this cheat sheet, you’ll have a list of common LTC lingo…along with what they actually mean. This means that as you’re chatting with your new co-workers, you are all speaking the same language.
Plus, the cheat sheet has a checklist of first day activities so that you get started on the right foot (and stay there). So whether you’re getting ready to start your LTC rotation, your new job or pitching to start a new contact, this cheat sheet will boost your skills and confidence. Download right here.