Whitney Harms is a seasoned Registered Dietitian who has spent the majority of her career helping to improve the nutrition of the elderly! Today she gives some fantastic information on how COVID has changed the way we practice, advice for new Dietitians, and the value of working in Long Term Care! Find out what it’s like to be a Dietitian in Long Term Care below!
Whitney Loves Spending Time Cooking for Family & Friends
Hi Whitney! Thanks so much for joining me on the Long Term Care RD Website today! Can you tell me a little bit about yourself?
I’ve been practicing as a dietitian since 2015 and started working in LTC early on in my career while I was building up experience and working on figuring out where I really wanted to lay roots as a dietitian.
I’ve been doing work as a clinical dietitian ever since receiving my Bachelor of Human Nutritional Sciences from the University of Manitoba and graduating from the Manitoba Partnership Dietetic Education Program.
I took a 1 year maternity leave in 2017 – 2018 when I had my son who will be turning 5 in just a few months! Although I grew up in Southern Manitoba, my husband and I now call West St. Paul Home where we live with our son and our very big, hairy dog Murphy.
We love spending time outside in our backyard or hiking together on the many beautiful trails around Winnipeg. I love cooking for my friends and family and have missed having dinner parties and gatherings at my home during the most severe waves of the pandemic.
I am happy to be back trying new recipes for others and have been working through the cookbook Mennonite Girls Can Cook. My goal is to make every recipe it contains before the end of 2022!
Can you tell me how you got started working as a Dietitian in Long Term Care?
I have to be honest, when I graduated from my internship program I had no intention of ever working as a Dietitian in Long Term Care. I didn’t feel it was exciting enough or that dietitians working in this area always received the same funding for adequate coverage and that there weren’t many ways I could effect change. Boy, was I wrong!
My feelings on this area of practice have changed and I now love to advocate and educate about the importance of LTC nutrition in both my personal and professional life.
I was encouraged to take over a small EFT covering some LTC facilities by a friend and colleague who was moving on to another position. I was looking for something part time to supplement my income and give me some additional experience in dietetics, so I agreed to apply and try it out.
Little did I know this would be the beginning of a huge passion for LTC.
I very clearly remember my friend saying at the time, “You’re going to love it! I think I’m going to convert you to a LTC Dietitian soon enough!” She was absolutely right!
That’s so fantastic, I think so many of us don’t intend to start out as a Dietitian in Long Term Care, but once we start and see the beauty of it, it’s so hard to leave.
What do you find most rewarding about working in Long Term Care?
There are so many things I LOVE about working in LTC.
One of the things that continues to stand out to me in my day-to-day routine is that I get to work in my resident’s homes.
Every day while I’m charting, running orders to the kitchen, doing wound assessments, or meeting new families when resident’s move in, I get to experience small bites of home. Whether it’s the smell of apple pies baking in recreation, hymns being sung in the chapel, the ‘Oohs’ and ‘Ahhs’ when a resident gets a new perm, the laughter of little grandchildren pushing their loved one around in a wheelchair or testing out their shiny new walker, I cherish these moments within my workday and it motivates me to serve the residents as if they were my own family.
Of course, some of these things have been severely limited over the past 2 years, and I long more and more for the safe return to these activities and make a point to look and listen for the sounds of home every day at work.
The second thing I find rewarding is what I can offer residents and families as the dietitian that really highlights the important and unique work that we do.
For many families, this may be their first interaction with a dietitian and many of them are surprised at what we actually do and how we can help their loved one.
Whether it be helping adjust a resident’s diet order to include more of their favorite foods and therefore improving their quality of life, brainstorming with staff and families to help optimize intake for a specific goal such as stopping weight loss or healing a pressure injury, to the more humbling experience of educating and supporting those on the journey of nutrition decline and dealing with nutrition when nearing end of life, these experiences only serve to add to the meaning I find in my work.
Finally, working as a Dietitian in Long Term Care provides unlimited opportunities for learning and professional growth.
I have so many opportunities to work with others and expand my skills and knowledge. For example, I often work with occupational therapists to determine how we can position a resident safely for meals while also ensuring they don’t develop pressure injuries.
I also frequently collaborate with Speech-Language Pathologists to ensure a resident is receiving the most appropriate food texture and fluid viscosity to balance safety and enjoyment of meals.
Daily interactions with nurses, health care aides, physicians, recreation staff, and many others deepens my appreciation for the collaborative approach to LTC required to best serve our residents.
I love hearing all of that! People often overlook how amazing the little things that you highlighted mean to us working as Dietitians in Long Term Care. I love the relationships you develop with your patients, their loved ones, and your coworkers.
There are still difficult parts working in this area, can you tell me what you find difficult?
For all of the many benefits afforded to those of us working in LTC, there are certainly no shortage of challenges. COVID-19 outbreaks across our province have revealed many of these challenges and has highlighted the need for more funding, better staffing ratios, and new buildings to optimize the care we provide our elderly.
There are many things I find difficult as a Dietitian in Long Term Care such as:
Working within the constraints of a limited food budget when costs continue to rise, Finding enough time to follow-up care plans with part-time work hours, and
Doing a lot of work without access to some of the new technology that may streamline my workload.
Most of all, I think the challenge for many LTC health care professionals is that the limited value our society places on our most vulnerable and aged population becomes very apparent.
Our culture unfortunately often values a person based on what they can contribute financially to the economy or to our workforce. When individuals age, are no longer working, and become more and more dependent on others for their daily living, there is a shift that can happen in the value placed on that person.
I believe this is one reason we often struggle with under-funding, poor staffing, and lack of technology and equipment. The money required to improve the life of our elderly does not always come with a direct financial return on investment.
I am a firm believer, however, that prioritizing the care of the elderly only enriches society and strengthens our empathy, compassion, wisdom, and insight. Plus, if we are one of the lucky ones, we too will grow old and one day walk in the shoes (or roll in the wheels) of our residents.
How have you found COVID changed the way you practice?
COVID-19 has placed a burden on all levels of health care and LTC is no exception. I would like to say that I have learned to work well within the constraints that COVID-19 has placed on my professional practice. But I still feel that I am learning how to navigate the additional challenges and compensate for the negative effects the pandemic has had on the residents I work for.
Some of the major impacts have been a shift in prioritizing my case load. With so much new and ever-changing information, some of the time I would normally allocate to follow-ups or ‘check-ins’ has had to be sacrificed to deal with the additional workload and learning needs COVID-19 has placed on my position.
Additionally, much of my project and policy work shifted from various projects to COVID-19 outbreak planning and prevention. This has put many important projects on the ‘back burner’ that I am hoping to revisit sooner rather than later.
Generally speaking, COVID-19 has forced me to focus on quality of life indicators more than ever.
This is perhaps a silver lining, as I think with anything in health care we can get caught up in quantitative measures such as weights, labs, and numerical indicators of health. But forget to take that step back and focus on the big picture which includes resident satisfaction and comfort.
During the worst of the COVID-19 outbreaks and resident isolation, there were no nutrition interventions that could address the fear, loneliness, and hopelessness that accompanied many resident’s experiences. Sometimes all we could do was offer food for pleasure and comfort and focus on small ways that nutrition could be used to brighten their day.
Those are excellent points, policy makers should really listen up!
Now let’s move on to something a little brighter! Is there anything that you wish you had known when you started out as a Dietitian in Long Term Care?
There are two areas I wish I had had more experience in when I first started working. One is dysphagia, and one is experience working with individuals with Dementia.
I look back on how I solved issues with texture tolerance and communication in these populations and I wish I knew then what I know now. The experience I have gained over the years would certainly have benefitted some of those residents.
Some things are only learned through time and practice however, so these are things I make every effort to expose my interns to so they will have a higher degree of confidence than I did if they enter the workforce in a LTC setting.
I also wish someone would have warned me how much I would bond with certain residents. Although resident’s passing on becomes part of the job – it never really gets easier. There are times when we will lose several residents in a short period of time and those are always the most difficult.
I agree, I find it never really gets easier losing a patient that you’re trying to help. But it’s a natural thing in our area I suppose.
I love asking this question to Dietitians, do you have any cool initiatives or things you’re proud that you’ve changed in your homes?
I am so fortunate that some of my work as a Dietitian in Long Term Care involves education and policy development.
I have worked with many incredible leaders and management professionals that have fostered my desired to improve LTC for resident’s and have given me the freedom to explore different projects.
One project that comes to mind that I recently led was a mealtime management committee where our mission was to compile all of our mealtime management resources into a library or toolkit of sorts
The toolkit addressed all the different aspects required to optimize mealtimes and address challenges for resident’s intake and nutrition status. Everything from who to consult, food safety, the role of recreation, volunteer education for assisting at mealtimes, modified textures, adaptive utensils, positioning, and how to discuss nutrition at end-of-life was reviewed, updated, and included in a toolkit for all sites in our health region to use as a reference tool.
It has allowed all of our best resources to live in one place and we were able to engage our Clinical Resource Nurses and Mealtime Champions at sites across the region to improve the mealtime experience for residents.
This topic is forever a work in progress, but I am pleased to feel that I was able to contribute to moving the needle to a more proactive and holistic approach. I think I even got some of my non-RD colleagues excited about nutrition and that is always a win!
Those are fantastic!
Lastly, do you have any advice for new Dietitians coming into Long Term Care?
The best advice I could give is to spend time with a dietitian already working in LTC. Learn how they prioritize their caseloads, how they track nutrition indicators, where they go for support and education.
It’s also so important to learn to interact with the older generation and with those who may have challenges with cognition or communication. I highly advise LTC RD’s to take initiative when they see a gap in care or an education need. We are often covering multiple units and working within various teams both frontline and administrative.
We as RD’s we have a unique perspective and an important voice in advocating for resident care. Remember that your role as the RD in LTC is invaluable and you are needed!
Thanks to Whitney Harms RD for joining us at the Long Term Care RD today!
Whitney gave such valuable insight into what it truly is like to be a Dietitian in Long Term Care. It’s not always an easy road but it is the most rewarding job!
If you want to get better organized in your practice like Whitney spoke about, you can find some easy to implement strategies on our website! You can find one here and here!
