Something I get asked ALL the time is “what does a dietitian do?”, and secondary to my answer, the response goes two ways: “wow, I had no idea!” or “THAT took you 6 years of school?” LOL. About 3 months ago, I started working in a long term care facility - ICYMI read my “Good Things Come to Those Who Hustle” post - and while I have learned SO much, I am EXHAUSTED and SO BUSY in the 24 hours per week I am there. Here’s what a typical day in the life of a Clinical Consulting Dietitian in long term care during a global pandemic is like ↓ ↓ ↓
6:05am - Alarm #1 disturbs me from my slumber.
6:20am - Coffee brews. The smell strategically entices me out of bed.
6:30am - Alarm #2. Not happy about it, but I get up. Siri gives us a “friendly reminder to drink a glass of water” when Sam unplugs his phone in the morning, and we love it.
7:00am - Morning stroll, coffee in hand.
7:30-8:15 - Get myself together with the basics: hair, makeup, outfit, breakfast. Hopefully with enough time left for a selfie.
8:15-9:00 - Karaoke commute from London to Strathroy; takes me about 45 mins. Always accepting podcast recommendations.
9:00-9:05 - Get “Screened In”. You know the drill - sanitize your hands upon entering, put on a mask. We require everyone to wear a mask provided by the home to limit risk of cross exposure to the residents, so a new mask everyday is needed. Then, I get my temperature taken and answer the COVID Q’s. Next is the best part - a swab in/up not just one but BOTH nostrils - GOOD MORNING! I get rapid tested every time I enter the building and within 15 minutes will know if I am negative (or positive, in which case the screening nurse will come to my office and get me to send me home).
9:05-9:20 - Emails/wait for COVID test results. In the event I tested positive, it is safest for me to only have exposed my office buddy, so I try to stay at my desk as long as possible. Sometimes I arrive to 5 emails, and others I arrive to 50. Depending on my workload, I like to review progress notes for residents I have recently assessed to monitor their condition and learn of any pertinent updates. I get notified via email of skin integrity concerns like pressure ulcers or skin tears, and will make a list of all the chart numbers to review. These usually require a relatively quick intervention, such as protein, zinc, and/or vitamin C supplementation, so I try to get my order in and get them off my to do list ASAP. Yay for enhanced wound healing!
9:20-9:30 - Top up coffee (FOR FREE IN THE STAFF ROOM!!!) and check in with my supervisor to receive consults. I get referred for consultation on SO many different things from food preference, to choking episodes, to *ahem* bowel function. G L A M O R O U S.
9:30-11:30 - It’s time to get down and dirty. When I’m out of my office and in direct contact with residents, the PPE ensemble debuts, complete with a face shield. I try to organize my mornings so that I tend to the most urgent referrals first, continuing with my list of skin integrity concerns and onwards. The facility I work in is separated into five home areas depending on level of care, such as a locked unit for exit seeking residents with dementia and another for those with a higher level of function and independence. It’s a whole process to order an intervention, so I like to compile all the data I need per home area and do everything in the EMR (electronic medical record) all at once. I will write it in the chart, verbally communicate it to the charge nurse, write it in a note to inform the dietary staff for the next meal time, update the care plan, add it to my daily records, and if necessary, inform the resident’s family/power of attorney. The odd intervention will require a doctor’s order, such as adjusting insulin levels or ordering bloodwork, in which case I submit a recommendation and follow up on the order. We have four doctors, and each one is in once per week.
11:30-12:00 - Investigate upcoming quarterly assessments. I have a big, LONG list of all of the residents (160 of ‘em) that tells me the order in which to assess and the date in which that assessment is due. I will prep a short list of all the assessments coming due that week and compile all the data I need each day while I’m on the units doing consults. I am trying to break my PB of 14 assessments in one day, but its usually more like 6-8. 14 was a GRIND.
12:05-12:45 - Swallowing assessments!!! Breakfast is early and supper is late, so the most common mealtime I observe is lunch. I am super fortunate to have had extensive experience in my internship to perform swallowing assessments with a speech language pathologist (SLP), which is extremely relevant to providing long term care. Thickened fluids, such as nectar/MT2 or honey/MT3 viscosities, are common, as are mechanically altered solids like chopped, minced, or puréed. The thicker the fluid, the lower the risk of choking or aspiration, and the more cohesive the texture of the meal, the easier/safer to eat. As my partner Sam likes to say, “liquids are too liquid and solids are too solid, so make the liquids more solid and solids more liquid” and honestly, he sums it up pretty well!
1:15-2:30 - After my lunch break, I chart the findings of my swallowing assessments and implement any interventions. The outcome and associated diet changes often involve a conversation with the family/POA to discuss the risk of aspiration and the safety of diet textures. When I get to go “up” in texture, such as going from minced to regular, which doesn’t happen often, it’s a highlight of my week! Then, I finish reviewing the progress notes I probably didn’t get to in the morning to check up on all the residents with new interventions to assess their tolerance.
2:30-4:30 - Slowly but surely, I make my way through inputting the data I compiled for due quarterly assessments into the EMR. If I have an admission assessment, this is where it happens. These require a more comprehensive chart review, including medical histories and even further investigation by speaking with the family/POA. If the resident is high risk and coming from hospital, I will call the dietitian or SLP involved in their treatment for more information. The residents are isolated for 2 weeks upon admission, which has made the admission process less than smooth. The admission assessment is based heavily on anthropometric data (height, weight, BMI) to assess baseline nutritional status. The first quarterly assessment is most useful to determine how well the resident is adjusting to care, and is where I am most thorough in my review. Everything that is consumed is tracked, and I can review a percentage of the resident’s mealtime intake and fluid consumption down to the mL. If poor intake is trending, an oral nutrition supplement (like Boost or Ensure) may be considered. In cases of chronic poor intake with significant weight loss, Resource 2.0 is my go to order as it is very energy and protein dense. No frailty in the elderly on my watch!
5:20-5:30 - Finish up by compiling all of my daily changes and activities into stats for record keeping. Since I only work part time and the environment is very dynamic, communication is KEY. I write an email to our Foodservice Supervisor and Dietary Manager highlighting all the key interventions I made. This helps fill the gaps when I am not there, so they can follow my train of thought and ensure my interventions are being administered as ordered. Then, I put it all into a spreadsheet which tracks the level of nutritional risk of the residents, any supplement changes, the reason for the change, and an hourly breakdown of my time spent. According to the Long Term Care Act, each resident is to take a minimum of 30 minutes of my time per month. This is how I ensure that happens.
5:30-6:15 - Karaoke commute from Strathroy to London.
6:15 - Figure out what the FORK to make for dinner!!!
If you are interested in my role or journey to this job, please send me a DM on Instagram or an email through the “Inquiries” section in the top right. I would love to chat more!
For the love of carbs,
Emily Paige