Why is it beneficial for long-term care communities in the senior living industry to have a Certified Specialist in Gerontological Nutrition dietitian on staff?
According to 2015 data collected by the Centers for Disease Control and Prevention, 1.3 million elders reside in nursing homes throughout the United States.1 Dietitians are essential members of the interdisciplinary team in the long-term care realm, providing specialized recommendations for residents with multiple comorbidities and varying acuity levels. As a dietitian in long-term care, I speak from experience when I say many of these residents require specialized nutrition care that expands far beyond the “cookie-cutter” recommendations outlined for many medical conditions. Many older adults in long-term care facilities live with one or more medical condition, such as hypertension, as well as limiting factors such as decreased mobility. A dietitian must take all of this into account when formulating a plan of care. Dietitians are also trained to identify and make recommendations for a malnutrition diagnosis. Despite an estimated prevalence of 52.6% at risk for malnutrition, residents in long-term care facilities are often underdiagnosed which can lead to more serious health problems.2 It is extremely beneficial to have a CSG dietitian on staff due to their specialized knowledge in this population and their ability to identify malnutrition risk.
The Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics, offers five specialist certifications for providers to attain throughout their career, dependent upon their passions and skillsets. The Certified Specialist in Gerontological Nutrition (CSG) is a certification specific to nutrition in the older stages of life. This practitioner possesses expert-level knowledge on all matters relating to enhancing the nutrition care of the older adult.
Dietitians who attain this specialty certification need to meet specific requirements outlined by CDR. All applicants must have had their RD certification for at least two years. In addition, the applicant must have documentation of at least 2,000 hours of practice experience in gerontology. Up to 800 hours of education can be substituted for in-person practice experience. These hours are verified by the dietitian’s supervisor or transcripts, after which the RD is provided eligibility confirmation which allows them to register for the exam. The exam tests an RD’s knowledge in the nutrition care of the older adult as it relates to chronic disease states, laboratory assessment, nutrition support, end-of-life care and drug-nutrient interactions.3 As an applicant for this exam myself, I feel as though my years of hands-on experience have helped me exponentially in my preparation. If I were to attain my specialty certification, I would feel very confident in my knowledge knowing that I also had years of experience to support my new credentials.
Leah LaFrance, a Clinical Nutrition Manager for Unidine, took the CSG exam “for a challenge and to gain a specialty in the geriatric field.” LaFrance found exam preparation difficult yet beneficial. She reported that the CSG exam helped her become more confident in a long-term care setting. She says, “I now have evidence behind me when I make my recommendations and teach other RDs [and] interns in the future.”
Dietitians who hold a CSG approach patients with a higher level of comprehensive care for complex conditions, allowing the provision of high-quality nutrition care. CSG dietitians can use their knowledge to make a clinically supported decision about when it is appropriate to implement interventions such as fortified foods or oral nutrition supplements into a resident’s nutrition regimen. Unidine has implemented the Fresh Benefits program in many communities, which emphasizes a “food first” mentality for elders who require a diet higher in calories and protein. By using specially crafted recipes to prepare fresh foods with a higher calorie content, the addition of commercial supplements can be delayed and used as a second line of treatment. Unidine offers a variety of Fresh Benefits recipes, from mashed potatoes to oatmeal. The CSG dietitian possesses the knowledge to make the most informed clinical judgement of when it is appropriate for a resident to receive these foods, and how often they should receive them.
As I prepare for this exam myself, I can personally attest to the fact that it has helped me to provide more enhanced nutrition care to my residents. I have learned specialized nutrition recommendations and interventions as they relate to the older adult, a population that I work with exclusively. I feel more confident in my interactions with other members of the interdisciplinary team when communicating my recommendations. Because nutrition care of the older adult is often multifactorial due to disease and mental state, medications and resident participation, there has been a lot of ground to cover in terms of preparing for this exam. However, I feel as though this has helped me to provide more refined nutrition recommendations for my residents. CSG dietitians provide expert-level care in long-term care facilities throughout the United States. Their extensive knowledge and experience evaluating and providing treatment recommendations for long-term care residents showcases their important role in the interdisciplinary team and reimbursement process. Through their preparation and maintenance of this specialty certification, CSG dietitians offer the highest level of care in their facilities.
Mariah Drake, MA RD LDN, is a registered and licensed dietitian with over two years of experience working clinically and supporting food service operations in skilled nursing facilities. She is working towards attaining a specialty certification in Gerontological Nutrition.
Unidine’s network of on-staff nutrition professionals draw on their certified expertise and clinical specialties to develop innovative nutritional programming. At Unidine partnered facilities, 450+ Registered Dietitians work in collaboration with culinarians to foster a holistic approach to regulatory compliance, improved health outcomes and wellness education.
- “FastStats – Nursing Home Care”. Centers for Disease Control and Prevention (CDC), 1 Mar. 2021. FastStats – Nursing Home Care (cdc.gov)
- Pezzana A, Cereda E, Avagnina P, Malfi G, Paiola E, Frighi Z, Capizzi I, Sgnaolin E, Amerio ML. “Nutritional Care Needs in Elderly Residents of Long-Term Care Institutions: Potential Implications for Policies”. J Nutr Health Aging. 2015 Nov;19(9):947-54. doi: 10.1007/s12603-015-0537-5.
- “Board Certification as a Specialist in Gerontological Nutrition”. Commission on Dietetic Registration (CDR), 2021. Certifications: Board Certification as a Specialist in Gerontological Nutrition – Commission on Dietetic Registration (cdrnet.org)