Want to see the same patients on a regular basis without the ultra clinical feel? Maybe dietetics in a long term care or rehab facilitiy is for you! I spent two weeks in a facility that had 100 beds of both skilled nursing rehabilitation and long term care. We had patients who had just taken a bad fall and needed some help walking again as well as residents who needed regular help with daily activities. Dietitians see residents as needed or requested and work to make sure the correct texture and theraputic diet orders are placed. This facility also required quarterly assessments on all residents for a 'MDS' form that is submitted to the state. The form asks questions about weight gain or loss, amount of meals consumed, and if the patient is on a therapeutic diet. Dietitians also participate in weekly care plan meetings with physicians, nurses, speech pathology, physical therapy and activity co-ordinators.

And because I know you want a flavor of my experience, here are the top three quotes you will hear as an intern:

  1. "You're so tiny!"
  2. " Oh my gooooshhh! I remember when I was thin..."
  3. "I don't like the food-why is my hamburger chopped up-I want a put together hamburger!"
Followed closely behind by my tips for success in long term care dietetics:
  • Speak loudly and clearly. Repetition can be good with this population.
  • Read the file to see if your resident has communication difficulties such as hearing aids, blindness, or paralysis on one or both sides of the body.
  • Morning meals do best. The majority of our residents eat their biggest meal as breakfast. Dinner intakes are lowest. So consider timing. If you need to boost intake, maybe offer the supplement in the morning.
  • Be okay with side tracked conversation. Getting your work done is important, but so is being a caring medical professional! Let the resident tell you about how they won Wii bowling (true story). Sometimes what they really need is a short visit.
  • Realistic diet values are appreciated. Let's say you have a 95 year old resident who is on the heavy side. Not obese, or to the point where it is medically detrimental, but yes, overweight. Relaxing diet to encourage intake vs putting them on a very strict, no added salt, no dessert, no eggs diet? Think about quality of life.
Yet another avenue of dietetics to consider! What's your experience with these facilities?