Regulations at both state and federal levels mandate that nursing facilities (NFs) must have either a full-time employed or contracted Registered Dietitian (RD) on staff. In NFs, RDs have an essential role in maintaining the health and overall well-being of the people living in the facility.
The RD is a key member of the interdisciplinary team (IDT), working collaboratively with other team members to ensure high-quality care is provided to each person living in the NF. The RD assesses each individual’s nutritional status, taking into consideration their medical history, medications, and other factors that may impact their dietary needs. Based on this assessment, the RD develops person-centered care plans that include specific dietary recommendations, such as:
- The type of foods the person prefers
- Portion sizes
- Frequency of meals
- Fortified meal plans, and nutritional supplements
For those who require enteral nutrition, the RD determines the type of formula and feeding method that is most appropriate for each person based on their medical history, nutritional needs, and digestive capabilities.
The RD collaborates with food service personnel to develop menus that are nutritionally balanced, appealing, and culturally appropriate. The RD also reviews and approves the menus to ensure that they meet the dietary needs and preferences of the people living in the NF. The RD may make recommendations for modifications to the menu based on feedback received or changes in the nutritional needs of the people served by the facility.
The RD also conducts kitchen rounds as part of their role to ensure food is being prepared and served according to the dietary department’s policies and procedures. This includes:
- Checking food temperatures
- Observing food preparation techniques
- Observing the meal service process
- Monitoring portion sizes
- Monitoring any specialized diets, such as pureed or fortified meal plans, to ensure they are prepared and served appropriately
- Identifying areas of improvement in food quality and/or service
Resources Developed by HHSC
Best Practices – Role of the Registered Dietitian (PDF) provides a summary of key elements of best practice for RDs working in the NF setting.
Commonly Used RD Comparative Standards in LTC Settings (PDF) provides examples of the reference data and standards used by the RD to estimate nutritional needs, as well as recommended body weight, BMI and desired growth patterns.
Five Domains of Nutrition Assessment (PDF) outlines key elements of a nutritional assessment, including the nutrition-focused physical examination (NFPE).
Medical Nutrition Therapy ADIME Note (PDF) provides a template and an example of nutrition assessment documentation using the ADIME format.
Nutrition Diagnosis PES Statement (PDF) discusses the format of a PES statement: Problem “related to” Etiology “as evidenced by” Signs and Symptoms.
Resources Developed by Other Organizations
Academy of Nutrition and Dietetics is an organization representing food and nutrition professionals. According to their website “the Academy is committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy.”
Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Post-Acute and Long-Term Care Nutrition
This resource describes the levels of practice for registered dietitian nutritionists working in long-term care settings, including NFs. It also outlines the standards of practice and professional performance for these professionals.
Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings, 2018 addresses the importance of an individualized approach to nutritional care for older adults living in long-term care settings. Note: available for purchase or through subscription.
Nutrition Care Manual is an evidence-based resource for registered dietitians and other nutritionists. Note: membership required.
Pocket Guide to Nutrition Assessment provides guidance to RDs in completing a comprehensive nutrition assessment. Note: purchase is required.
Nutrition Care Process Terminology (NCPT) is the standardized terminology used by RDs as they move through the steps of the nutrition care process.
ADIME Documentation (assessment, diagnosis, interventions, monitoring and evaluation). This toolkit provides resources to assist RDs in documenting the nutrition assessment, nutrition diagnosis, goals, planned interventions and monitoring/evaluation of outcomes.
Texas Department of Licensing and Regulation (TDLR) is the state agency responsible for the licensing of dietitians in Texas.