​Registered dietitians (RDs) already play a crucial role in senior living communities. By bringing specialized knowledge in medical nutrition therapy to assess residents’ nutritional needs, they create individualized care plans and establish themselves at the core of person-centered care. They are often the first to identify subtle but debilitating conditions like malnutrition and collaborate with interdisciplinary teams to address common conditions among the senior population like heart disease, diabetes, kidney disease, dementia, dehydration, and anemia.

RDs act not only as clinical consultants, but also educators by providing counseling to residents, their families, and staff members on healthy eating habits, rehabilitation, and disease management. Their role as the communications liaison among interdisciplinary team members helps communities deliver both well-being and hospitality seamlessly.

Practically speaking, dietitians wear many hats in most senior living communities. Monitoring weight, evaluating nutritional lab values, supporting nutrition-related diagnoses, planning menu extensions, managing foodservice operations, documenting cases to meet reporting requirements, and budgeting all fall within the RD’s scope of work.

A licensed practitioner is required to provide services in senior nursing facilities, but with staffing shortages at an all-time high, some communities find themselves at risk of penalties for not following federal and state laws. Without an RD on the payroll, communities may expect Centers for Medicare and Medicaid Services (CMS) deficiencies and civil financial penalties.

More concerning, though, is the risk of putting resident health and safety in jeopardy through:

• Lack of individualized care, preventing proper nourishment for residents that need special diets.
• Inadequate representation of documented resident nutritional needs.
• Inadequate training of staff to assist residents who need support eating and drinking.
• Inferior foodservice practices, leading to unappetizing or unhealthy foods.

The Value Is in Health Outcomes

Skilled RDs apply evidence-based practices, making the most of scientific research to inform decisions regarding resident nutrition and its impact on health outcomes. Evidence-based nutrition in senior living communities is important to ensure recommendations are grounded in scientific validity, rather than personal beliefs or anecdotal evidence.

As individuals age, their nutritional needs change, and their bodies become more vulnerable to various health conditions. According to the National Council on Aging, 80 percent of adults over the age of 65 have at least one chronic condition.¹ By practicing evidence-based nutrition, RDs can help:

• prevent and manage chronic conditions.
• promote healthy aging.
• enhance immune function.
• support cognitive health.
• heal wounds.
• maintain optimal weight.
• reduce the risk of falls.
• prevent hospital readmissions.
• and more.

Proper diagnosis and documentation of certain nutrition issues can even result in increased Medicare reimbursements for skilled nursing facilities.2 In fact, with the roll out of PDPM, RDs can directly impact skilled nursing facility reimbursements through nutrition, nursing, speech therapy and non-therapy ancillaries (NTAs).

With all this to their credit, it’s easy to see the value of skilled nutrition professionals. An investment in dietitians with advanced knowledge, experience, and interprofessional leadership skills who practice at the top of their credentials is an investment in the quality of clinical care delivery for organizations.

An Alternative Model for Future Support

It’s not news that staffing shortages are rampant at all levels in senior care. Many registered dietitians working in senior living are spread thin, working at multiple facilities to provide even the minimal services required by law. This significant gap in the nutrition workforce is compelling communities to re-think their approach to dietary support for residents.

According to CMS, if a qualified nutrition professional (i.e., RD) isn’t employed full-time, the facility must designate a person to serve as the director of food and nutrition services. This role can be filled by nutrition and dietetics technicians, registered (NDTRs) or certified dietary managers (CDMs).

NDTR is a relatively recent credential from the Commission on Dietetic Registration. The number of technicians in the job market compared to RDs and CDMs is very low, but the opportunity for employment is high. NDTRs are trained in food and nutrition and are an integral part of health care and foodservice management teams. This role requires a minimum of a two-year associate degree with 450 hours of supervised practice experience. They can provide clinical support to a lesser degree than RDs (such as care conferences and weight monitoring), but don’t replace the need for at least a part-time RD on staff in skilled nursing facilities.

Although the CDM designation has officially been around since the mid-1980s, the role is emerging as a complementary profession to oversee operational tasks that some RDs previously undertook.

The path to obtaining a CDM credential is much less rigorous than that of an RD; no college is required, but passing a nationally recognized CDM Credentialing Exam is. Although not specialized or certified to practice medical nutrition therapy like a registered dietitian, adding CDMs to the dining staff is often easier for HR professionals, and they can support an evidence-based nutrition program in numerous ways. Led by the Association of Nutrition & Foodservice Professionals (ANFP), this certification is a widely respected title and a symbol of competency in the industry.

Unlike RDs, CDMs don’t provide clinical counseling. Rather, they’re typically responsible for the day-to-day foodservice operations in senior living communities. For example, they manage menus, working closely with chefs to provide options that meet individual resident needs. CDMs also ensure compliance with state, county, and local health regulations; schedule and supervise kitchen staff; and maintain high standards of food safety and quality. They are also pivotal in business operations such as budgeting, maintenance, procurement, and inventory management.

Most importantly, both NDTRs and CDMs support person-centered care plans when RDs are otherwise engaged. By ensuring meals are nutritionally balanced, flavorful, and meet the specific needs of residents, their expertise helps provide the dietary support needed for residents’ well-being. And by backing the long-term development of these roles, employers will undoubtedly help ease the pain of the workforce gap.

Reducing Turnover

Let’s face it: nutrition professionals are in high demand and with more stringent education requirements on the horizon, it’s not likely to get easier any time soon. RDs have their pick among jobs, and those certainly aren’t limited to senior living.

Below are some tips to help reduce turnover and recruit new talent.

• Cover the basics. Salary is important, but competitive benefits, flexibility, and work-life balance are becoming non-negotiable.
• Go one step further with robust benefits. Employers who cover continuing education and specialty certification costs, allow time off for attending conferences, and pay for registration renewal are more likely to win the talent race.
• Define and employ a career development ladder. One of the primary reasons RDs leave a job is for a “new opportunity.” Document meaningful steps for advancement and review progress on a regular basis.
• Encourage networking. Involvement with trade associations such as the Academy of Nutrition & Dietetics and ANFP promote innovation and professional support.
• Give them a voice. As some of the most educated associates on the team, RDs often provide a fresh and intellectual perspective to strategic and clinical concerns.
• Recognize exemplary work. A kind word is always welcome, and formal recognition in front of other staff or a board can boost morale during long stretches with understaffed teams.

References
1.    Aging, https://www.ncoa.org/older-adults/health/physical-health/chronic-disease. Accessed June 6, 2023.
2.    “Nutrition-Related Conditions: Recommend Medicare Preventive Services.” Centers for Medicare & Medicaid Services, https://www.cms.gov/outreach-and-education/outreach/ffsprovpartprog/provider-partnership-email-archive/2023-03-09-mlnc#_Toc129184588. Accessed June 6, 2023.

Tracy Blazer is the regional vice president, West/Midwest region, at Sodexo Seniors. She is a registered dietitian with a master’s degree in public health nutrition and has been a nutrition professional in the senior living segment for more than 20 years.