Op Ed: Why Long Term Care Dietitians Quit

I’m sure you’ve seen the trend that there is a high turnover of long term care Dietitians.  We tend to see a significant number of new graduate Dietitians hired in the area, but not many stick around in the long run.

So why do long term care Dietitians quit so often?

A severe lack of education, investment and pay. In this article I’m going to talk about the three big areas that long term care homes are doing wrong and how they can improve to retain their Dietitians. The biggest beneficiary of a Dietitian staying is the patient, and that’s what we’re all here for, isn’t it?

Education, Investment and Pay:
The Long Term Care Dietitians Big Problems

A facility is only going to be as successful as the staff that they hire.  If a facility doesn’t place a high value on their people, they can expect to see a low return on investment.

It sounds crass to say, but healthcare facilities like long term care, are still a business at the end of the day.  A high turnover rate among long term care Dietitians, and other healthcare professionals doesn’t indicate a successful venture.

It is more costly to continually hire new Dietitians than it is to invest in the ones you currently have.  The goal of all long term care homes should be to fix the issues below.

Education Provided

I don’t mean the education level that long term care Dietitians have going into the job.  I mean the education provided to the Dietitian when they get hired.  

I’ll share my personal experience with the countless jobs I have had working as a long term care Dietitian.

My first job fresh out of internship was in a long term care home.  I was so excited to get my first crack at being a real Dietitian.  The problem was, I had ZERO training in long term care.  I never had a rotation during my internship in long term care.

I had 2 days with the current Dietitian before she was off on maternity leave (she had the baby just 1 day after she left).  I tried to go in with an heir of confidence about me, but in reality I had no clue what I was doing.

I tried to do my research online on how to treat various conditions but there was nothing applicable to my area. Almost every resource I could find online was more focused on acute care or guidelines for a younger population.  Not applicable to long term care nutrition.

The day to day responsibilities of a long term care Dietitian are huge.  From initial assessments, urgent consults, regular consults, MDS and care planning, care conference meetings, keeping up with standards, and the list goes on.  It’s near impossible to keep up if you don’t hit the ground running knowing what you’re doing.

Most long term care Dietitians will receive adequate training on MDS and care planning.  But all the other stuff the Dietitian is somehow just expected to know.  After all, most Dietitians working in long term care are the sole Dietitian in the facility.

One of the biggest problems Dietitians run into is how they keep up with standards/regulations?  A Dietitian doesn’t want to be the reason a facility gets cited, but sometimes they just don’t know what to do.  

At the end of the day I hear the same thing time and again from long term care Dietitians.  “I was provided with no training and just thrown into the job.”

So who can a Dietitian turn to when they’re the only one available?

The onus is on the long term care home to provide education to the Dietitian on what is expected of them.

Dietitians working in long term care need training on EVERYTHING that is expected of them.  They need to know day-to-day what is their caseload, who to turn to when they have problems, support from management, how to do their job, deadlines they are expected to keep, and much more.

Dietitians need to know that they have allies in their facility that will support them.  If a long term care home cannot provide this from a staff member, they should reach out to a Dietitian consultant to support.  

A consultant Dietitian like myself provides extensive training to new Dietitians about what their job is.  Each long term care home may be slightly different but overall long term care Dietitians have the same regulations.  

I don’t expect each long term care home to have an in-house Dietitian that provides the training. But they should have someone like myself available that onboards each Dietitian. It helps a new Dietitian out a lot if they know they have someone to contact when they have a clinical question.

If you want to know exactly what your job is as a long term care Dietitian, click here.  I developed a manual for Dietitians to keep up with regulations which will help a lot of newbies out!

Investment in Long Term Care Dietitians

Investing in a long term care Dietitian is both a financial and time commitment.  

Investing in a financial sense is the ability for the Dietitian to purchase things they need to better do their job.

This can include courses, books, products, education content, and sending them to events.  A Dietitian having the ability to keep up with current practices costs money, and the facility should bear this cost.  

Investing in a Dietitian time wise means that the management team spends time not only getting to know the Dietitian.  It also means training them up to be a part of the team.

I have had the good fortune of being a part of both great team environments and really bad ones.  I have learned so much from both.  Without knowing how a bad facility runs, I may not have gained the insight on what to NOT do.

From my good experiences I have learned that regular meetings with the Director of Care/Nursing as well as CEOs is invaluable.  

Having a CEO set biweekly or monthly meetings allowed me to voice areas where I saw improvements needed.  It made me feel like a great part of the team and allowed me to try out lots of new initiatives.  

If your facilities management team does not make themselves visible to the staff, they need to rethink their processes.  The positive experience with a previous CEO made me feel like she was investing her time in me.  

Building a relationship with your CEO will typically result in them trusting you more.  The more trust you can build, the more they will buy into ideas you have to change things.  But I believe the onus is on the CEO to make an effort to set meetings.

Long Term Care Dietitians Pay Scale

We all pay for in this life what we place value on.  As most Dietitians hired in long term care initially are new graduates, I see far too often the low pay they are being offered.  

I do believe that Dietitians should be paid based on years of experience, but there does need to be a minimum that we don’t fall below.  

The median salary for a long term care Dietitian in the United States is $57,5891According to the Salary website it falls between $25-$30 per hour.  How pathetic.  

Most Dietitians have the same if not more education than Nurses (more with the Master’s Degree requirement coming up).  Yet we aren’t on the same pay scale, how can that be?

Why would a Dietitian stay at a job paying that, when they could make just as much working a job that is far less work?

It costs far more to constantly hire new employees than it does to retain and maintain your current ones.  If long term care homes started evaluating their hiring processes for Dietitians, they may see more success in the long run.

Long Term Care Home Dietitians

I don’t think you can place enough value on a long term care Dietitian.

With rising Dementia rates and our long term care population we’re admitting being much older and sicker, a team member like a Dietitian is vital.

If a patient has Dementia, their nutrition care plan needs to be individualised to meet their specific needs.  A dietitian can assess the exact method of eating assistance that will increase food and fluid intake.

Constantly replacing a long term care Dietitian breaks that cycle of continuity of care and leaves a new Dietitian to try to put the pieces together again.  Leaving the patient to suffer every time.

It’s time that long term care homes started placing a higher value on their Dietitians.  

Advice to Long Term Care Managers

Long term care homes need to provide education, investment of both time and money, and pay a higher salary to maintain the Dietitian.  

Dietitians can play such a vital role in a long term care home.  Having a Dietitian on staff can:

  1. Work to treat and prevent Malnutrition reducing costs associated.
  2. Play a pivotal role on the Wound Care Team to aid in prevention and treatment of wounds.
  3. Contribute to a well balanced menu that manages taste, quality, and budget consideration.
  4. Help to prepare and pass State Surveys.
  5. Provide education to the staff to improve the quality of life of both the patients and staff.
  6. Improve food and fluid intake among patients, which can aid in reducing comorbidity complications.

I could go on and on about the benefits of having a Dietitian in long term care.  But all you need to do is ask a Dietitian what their job is, and I’m sure you’ll find out more.

If you found this article beneficial, please like and share it with other Dietitians and your management team!  I’d love to hear your feedback.

We’re still taking names for the waitlist for our upcoming two courses, sign up below!

The courses to be offered are:

Dementia & Nutrition: Understanding the Root Causes and Medical Nutrition Therapy!

Becoming a Wound Care Nutrition Expert: Be the Most Valuable Dietitian You Can Be!

As always, let me know your thoughts in the comments below!

About The Author

4 thoughts on “Op Ed: Why Long Term Care Dietitians Quit”

  1. Great article. In addition to all the items you pointed out, I see RDs becoming frustrated with the amount of work put upon them. Once a FT RD has started at a center, often they now are put in charge of the kitchen, doing all the QAPI, all meetings, clinical work, in charge of getting weights, on and on. Then, when the kitchen is short staff, we are assisting in the dishrooms, trayline and food prep!
    It’s become very stressful! I feel all of these things are important, however, we must be careful to not “dump” everything on one RD!

    1. You are absolutely right, and I’ve been in your position. It’s important that management understands there is a clear line between hiring a Clinical Dietitian and Nutrition and Food Services Manager. The roles need to be distinct and they don’t cross over. I have been in both positions before and the single jobs alone are massive. It would be similar to having a Director of Care providing Medpass on a daily basis, it would never be acceptable. This is where communication between a Dietitian and CEO is SO important. It can be a biweekly session where the CEO better understands the role of the Dietitian because I don’t think they fully grasp how much work a Dietitian actually does. If they do they may be more apt to quickly hire and replace in the food services department.

    2. I agree. I feel like one of the biggest reason that LTC RDs quit is because so much is expected of them with no higher pay. For example, I’ve been full-time at my building and new management says they only need 0.6 FTE for a dietitian and the rest of my time should be as a food/nutrition manager. More responsibilities, no more pay, and high stress.

      1. I’m sorry to hear they feel that way. They clearly don’t understand the workload of a Dietitian and how much they can contribute to the health of the patients. I would try to put together a proposal on why a 0.6EFT is not sufficient. A Dietitian and Food Service Manager are two very separate positions and one shouldn’t take away from the other!

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