In-Service Training
Food Safety & Sanitation
Adults aged 65 and older are more likely to be hospitalized from food-born illnesses. This increased risk is due to organs and body systems going through many changes, and the immune response to disease grows weaker as people age. This is why food safety and sanitation are consequential for preventing food-born illnesses in our facility populations. To accomplish this, we require all kitchen employees to train in food safety as well as acquire a Serve Safe Food Handler certification through the National Restaurant Association. We also ensure that the Certified Dietary Manager’s licenses and training are up to date as all CDM’s are required to have an active Serve Safe Manager Certification. These certifications are recognized by both ACHA and the Joint Commission. The RD and CDM also work together to make sure all menus provide tasty and nutritious meals, and meet all state nutrition requirements for long-term care.
Therapeutic Diets
There are many different therapeutic diets that can be implemented to address chronic illness. The most common used in the long term care setting are the following: Consistent Carbohydrate, Heart Healthy (Cardiac), Renal, and Sodium Restricted. Other diet types and preferences can also be honored such as Vegetarian or Lactose-Free. A Fortified Foods diet may also be implemented upon the Dietitian’s request to address poor appetite and weight loss. Recent changes to CMS laws now allow facilities to be reimbursed for Fortified Foods as a therapeutic diet if it is being implemented to address significant weight loss or a malnutrition diagnosis. MDS coordinators should work with their facility RD to put this change fully into practice. It is also important to recognize resident autonomy. If a resident does not wish to be compliant with a therapeutic diet, their preferences must be honored and documented appropriately. The resident’s individual needs and desires always take priority.
Modified Textures
There are currently two standardized systems for modified diet textures in the United States. Training is offered for both: The National Dysphasia Diet (NDD) and the International Dysphagia Diet Standardization Initiative (IDDSI). The NDD is, as its name suggests, a national system that is solely used in the US. The IDDSI standard is a global initiative to streamline diet and liquid textures with simpler terminology that translates well across all languages. It is not currently mandatory in the US. However, it is strongly encouraged by the global medical community to transition to IDDSI. Many institutions in the acute care setting have already transitioned to the new standards as it is becoming more common practice. Your facility Speech Language Pathologist can also work with the RD to implement IDDSI training. IDDSI differs in that it offers additional levels and details, which creates a more individualized approach to nutrition. This helps to address the unique needs of each resident.
