The Commission on Dietetic Registration (CDR) has released the 2025 Revised Scope and Standards of Practice for Registered Dietitian Nutritionists (RDNs) in Post-Acute and Long-Term Care (PALTC) Nutrition.
These updates reflect the evolving role of RDNs in these settings, emphasizing enhanced competencies, interdisciplinary collaboration, and a stronger focus on person-centered care.
The benefit for you is I reviewed this incredibly wordy document so that you don’t have to. I’ll give you a clue as to what to expect, it doesn’t appear that much has changed. I didn’t see any ground breaking expansions on scope of practice, more just a polished update.
But the following still serves as great reminders about the areas that you need to focus on in your practice, so here’s my breakdown.
Key Updates
1. Expanded Role of RDNs in PALTC
The revised standards recognize RDNs as integral members of the healthcare team in PALTC settings, highlighting their involvement in interdisciplinary collaboration and quality improvement initiatives.
- Interdisciplinary Collaboration: RDNs are now expected to actively participate in care teams, working closely with physicians, nurses, speech-language pathologists, therapists, and administrators to ensure comprehensive patient care. This collaboration enhances the development of individualized nutrition plans that align with overall treatment goals.
For the most part I think all RDNs are a part of the care teams, though this does depend on how often you’re in a facility and able to participate. - Leadership in Nutrition Initiatives: Dietitians are encouraged to take on leadership roles in nutrition-related quality improvement projects within PALTC facilities. Their expertise is vital in developing policies and procedures that improve patient outcomes, such as implementing strategies to reduce malnutrition and enhance meal satisfaction.
Quality Improvement Plan Initiatives (QAPIs) are becoming incredibly important especially in the audit/survey process. We’ll have more articles coming out on this soon so stay tuned.
2. Alignment with the 2024 Scope and Standards of Practice
The 2025 revisions align with the broader 2024 Scope and Standards for RDNs, integrating recent research, regulations, and evolving patient needs specific to PALTC settings. After reading through I’m genuinely not seeing a ton of changes in the scope, but there are some that I’ve highlighted.
You can also check our relevant articles and links I’ve included throughout on how you can implement these changes in your practice.
- Consistency Across Practice Settings: This alignment ensures that RDNs in PALTC settings adhere to the same high standards as their counterparts in other areas, promoting uniformity in practice and facilitating professional mobility.
- Integration of Current Research: By incorporating the latest evidence-based practices, the standards ensure that RDNs provide care that reflects contemporary scientific findings and best practices.
3. Increased Focus on Person-Centered Care
The updated standards emphasize the importance of individualized nutrition interventions that respect each resident’s preferences, medical conditions, and cultural considerations.
As an RDN you’ve likely always worked on person-centred care. You simply can’t develop a nutrition care plan without making it individualized so this one isn’t a revelation to anyone currently in practice.
- Individualized Nutrition Plans: RDNs are encouraged to develop nutrition care plans that honor the unique needs and desires of each resident, enhancing satisfaction and adherence. We’ve always been doing this so I’m not sure how this is an ‘update’ for the CDR, maybe it’s news to them?
If you want guidance on how to build a nutrition care plan, check out the ‘Nutrition Care Plan’ section where I have tons of free resources for you. - Liberalized Diets: The standards advocate for reducing unnecessary dietary restrictions to improve quality of life. Implementing liberalized diets can enhance food intake, reduce malnutrition risk, and increase resident satisfaction.
This one is incredibly important, if your facility isn’t currently encouraging liberalized diets and moving away from restrictions it needs to.
Check out this article ‘Beyond Restrictions: The Advantages of Liberalized Diets’ to find out more.
4. Enhanced Guidance on Malnutrition and Frailty Management
The revisions provide detailed protocols for identifying, preventing, and managing malnutrition and frailty in older adults, recognizing the critical role of nutrition in maintaining health and functionality.
You can find a full section on our website dedicated to Malnutrition and treatment here.
- Nutrition-Focused Physical Assessments (NFPAs): RDNs are now expected to conduct comprehensive physical assessments to detect signs of malnutrition and frailty early, allowing for timely interventions.
We have a full breakdown of the Nutrition Focused Physical Exam for you to review here. - Collaborative Care Plans: Dietitians are encouraged to work closely with other healthcare professionals to develop comprehensive care plans that address the multifaceted needs of residents at risk of malnutrition and frailty.
5. Updated Competency Expectations for RDNs in PALTC
The updated standards outline enhanced competency expectations, reflecting the increasing complexity of care in PALTC settings.
- Dysphagia Management: RDNs are expected to collaborate with speech-language pathologists to assess and manage swallowing disorders, ensuring safe and adequate nutrition for affected residents.
We’ve always worked with our wonderful SLP professionals, so I encourage you to keep this up. As a Dietitian you always need to brush up on your Dysphagia management skills, look at our full Dysphagia section here to help! - Enteral and Parenteral Nutrition: Dietitians should be proficient in managing alternative feeding methods, including tube feeding and intravenous nutrition, to support residents who cannot meet their nutritional needs orally.
- Wound Care Nutrition: The standards emphasize the importance of nutrition in wound healing, encouraging RDNs to implement protocols that support tissue repair and recovery.
For more on wound care and how you can improve the wound care protocols in your facility, find more here!
6. Quality Improvement and Regulatory Compliance
The revisions highlight the role of RDNs in quality improvement initiatives and ensuring compliance with regulatory requirements in PALTC settings.
It can be tough to know what the standards are around surveys and audits, lucky for you, I wrote an entire eBook about it. You can find it here!
- Facility-Wide Quality Initiatives: RDNs are encouraged to participate in or lead projects aimed at enhancing the overall quality of care, such as initiatives to improve nutritional status or reduce the incidence of pressure ulcers.
- Regulatory Compliance: Dietitians must stay informed about relevant regulations and ensure that nutrition services comply with federal and state guidelines, contributing to the facility’s adherence to standards.
7. Technological Advances in Nutrition Care
The updated standards recognize the growing importance of technology in enhancing nutrition care delivery in PALTC settings.
- Telehealth Services: RDNs are encouraged to utilize telehealth platforms to provide nutrition counseling and support, especially when in-person consultations are not feasible.
This will all depend on where you work and the tech that your facility carries, so this one is largely dependent on your workplace, not yourself. - Electronic Health Records (EHRs): The integration of EHRs is emphasized to improve documentation, facilitate interdisciplinary communication, and enhance the continuity of care.
Again, this one is highly dependent on where you work not you as an independent healthcare worker.
8. Ethics and Professionalism Updates
The revisions reinforce ethical considerations and professionalism in the practice of RDNs in PALTC settings. Ethics in healthcare will never change really, but brushing up on the skills required is essential.
- End-of-Life Care: RDNs are guided to navigate ethical dilemmas related to nutrition and hydration at the end of life, balancing clinical recommendations with respect for the resident’s wishes and quality of life.
I HIGHLY encourage all RDNs to brush up on their end of life nutrition care skills if they’re working with patients at the end of life.
If you need help, check out this webinar and eBook I wrote on end of life nutrition care here! - Cultural Competence: The standards emphasize the importance of cultural competence, encouraging RDNs to deliver care that respects and aligns with the diverse backgrounds and beliefs of residents.
Final Thoughts
The 2025 Revised Scope and Standards of Practice for Registered Dietitian Nutritionists in Post-Acute and Long-Term Care Nutrition reflect the evolving role of RDNs in these settings. I’ll be honest, when I reviewed them I really didn’t see too many changes.
I think that this document more than anything was a review of what we’re already doing as Dietitians practicing in the field. But every few years they ‘update’ them. If you have time you can browse and review the full document here, but it is very wordy.
I think the document simply emphasizes interdisciplinary collaboration, person-centered care, enhanced competencies, and ethical practice, these standards aim to improve the quality of nutrition care provided to residents in PALTC facilities.
Something we already are pros at.
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
