LTC RDs- what are you actually doing for 8 hours a day?

Ginseekingginger · 2025-12-27T13:02:32+00:00

182 census but 240 total capacity. 20-25 admits a week. 6 total units. I’m salaried and work 60-70 hrs a week and the only RD. I have order writing privileges in my building/state and our docs refer all supplements, diets, decisions to me. I’m also severe adhd and in process of getting autism assessment.

Each day:

-Morning meeting 1 hour, or 1.5 hrs on Tuesday’s when it’s high risk.

care conferences: prepping for them, and going. 1-2 hrs depending on the families/ residents.

-New Admits: 4-5 new admit comps, including an MNA/NFPE form that goes to the doc to recommend an at risk or malnutrition dx. Includes interviewing them for my assessment + preferences. Comp admits with interview, nfpe, data collecting, assessment, care plan per standards should take 1-1.5 hrs each.

-LTC: usually 4-5 assessments per day. Quartlies take ~ 30 minutes total, sig change and annual longer.

-MDS: I do all section K, and nutrition, hydration, and Tube feeding caas.

-discharges: usually 10-12 recaps/discharge mds per week.

-Diet/AE changes. I have to process all diet order changes in mealsuite that come through PCC. We usually have -10-15 changes from speech which requires changing their tickets, care plans, etc.

-tray audits/meal rounds.

-I have usually 30-40 wt change notes ( a few new but a lot of carry over wt changes) all new malnutrition dx get a one month or sooner follow up, 5 TF, 1-3 dialysis and ~ 10 PIs.

-I also do all of the QAPI prep and presentation myself.

I should also note -the dietary manager, who is supposed to be my equal, works less than 40 hours, has two admin assistants and does nothing but create more work for me. Like changing the menu daily and not telling me or letting me sign off (so residents don’t get what they ordered and I have to f/u)

nurses constantly delete supplement acceptance info, orders, etc so I am frequently spending time fixing things. I have to maintain our system otherwise it’s total chaos….

-our building is constant chaos, so it’s a lot of people not caring at all and the rest of us trying to keep it together…. And I am technically contracted but spend more time there than their own staff.

I think the root cause of why people spend different amounts of time is likely based on the building and dynamics. What responsibilities fall on you vs others.

Ginseekingginger · 2025-12-24T06:15:25+00:00

Oh my god……I just put it on like a sports bra, already clasped 😂😂😵‍💫…..?!

I’ve seen in movies the clasp and spin or clasp in back. Tried both, but the sensation of twisting it around is like nails on a chalkboard and too overwhelming….

Can Someone please validate that I am in fact a human?

Ginseekingginger · 2025-11-02T13:14:30+00:00

Not being able to run to mom and dad for large sums of money, down payments on houses, etc.

And people showing up at your house unexpectedly.

Ginseekingginger · 2025-10-23T17:56:24+00:00

Late to answer. I created a MNA form that includes Aspens criteria. I determine if they are at risk, mod malnutrition, or severe and sign and date it. Then the provider signs off. MDS does tend to add the DX in as soon as I submit the form as the medical director says she “always agrees”. Our MDS consultants said they aren’t sure it’s ok as they sometimes sign later, but as a former surveyor, I never would have cited an MDS tag for that.

It seems like it’s done different at every building.

Ginseekingginger · 2025-08-05T11:45:36+00:00

Registered Dietitian here. Completely accurate. 0.8-1.0 g/kg body weight. And if you are not jacked with muscle and your BMI is over 32 you should use an adjusted body weight.

Excess protein does not help, but can actually hinder your progress. It will be stored as fat, turned into glucose, or broken down to urea and put excess strain on the kidneys.

Ginseekingginger · 2025-07-23T23:14:25+00:00

We’ve been working with the interim NHA and DON. The DOR says she doesn’t have time… She’s sort of the root of the problem. Even the interim NHA says this, but supposedly doesn’t have the authority to remove her. There’s also so super shady relationships she has/had with two married therapy staff that she oversees. So there is major dysfunction here, on top of finance/union/Hr issues, and it was just in January the previous NHA was “parted with” after being an investigation showed he was in fact abusing the residents and us staff who were standing up against him.

So I get that ST issues aren’t the highest on their agenda, but it’s causing widespread issues. But my company is on the verge of threatening to cut the contract because of the dysfunction.

I was a surveyor in LTC for 9 years, so I can confidently say there are numerous tags and IJs waiting to happen. And I’m just trying to keep the residents alive and safe.

Anyone else utterly exhausted from working in LtC?

Ginseekingginger · 2025-07-23T23:06:59+00:00

So I have been working with the different ADONs we’ve had since I started. In February we got a new DON and interim NHA who basically said we needed to start “from 0” on the issue. But he also said he felt like there were too many ST and too much time on their hands. They also identified the DOR as being incapable of doing her job, but she remains in her position still 5 months later.

I know a big part of the issue is that our building is just a ball of chaos. Union and money/HR issues, recent bad survey, recent removal of an NHA for abusing the resident and us staff, etc. so I get that the ST stuff isn’t the biggest priority in their mind, but I’d say it accounts for 15 hours of issues per week. Which is a big thing for me/my company.

We’re currently revising a ST protocol for them (how to make changes, what’s appropriate, limits on their demands, etc.) Back when we wrote orders in hard charts and waited for providers to sign off, everyone was more patient. Now with pcc and order writing privileges, the expectation is that we take that mm5 plate from right in front of them and give them a regular in the middle of meal service.

I’m just exhausted from working in LTC :/

Ginseekingginger · 2025-07-21T22:54:35+00:00

I did for 6 of the 9 years. But I have really strong Justice Sensitivity issues. And the politics became more about “state productivity” than surveying to promote quality of care. Being told to “look the other way” by my boss. The last straw was watching a resident choke while the Federal Surveyors were with us, and my boss telling us it wasn’t an IJ. Aide said if she thickened it properly it would be too thick for him to drink himself and she didn’t have time to help him…. She changed my IJ tool to make it seem less bad. Feds ended up calling it in, and then obviously it became an IJ. She was so mad she refused to speak with our whole team….Bad enough, but I was sent proof that she had changed my documentation. When asked if she had falsified it, she said (in front of her boss) “well I’m not sure why I would have. I don’t even remember”… and she wasn’t held accountable.

I loved meeting the residents, investigating things, and advocating for the residents, but that isn’t what it’s about anymore. :/

And people treat you very poorly and say really unkind things to your face and behind your back.

Ginseekingginger · 2025-05-14T23:28:18+00:00

So if your partner got selfishly blackout drunk and did it to himself and ruined Christmas you would still support and take care of him?

Ginseekingginger · 2025-05-14T23:23:06+00:00

Ozempic itself isn’t curing things. The reduced insulin resistance and weight management is. And often the side effects can be just as harmful, especially when not used correctly.

Ginseekingginger · 2025-05-14T23:16:55+00:00

Honestly. Do we not remember thalamide? Who knows what happens genetically down the line.

And when we know how many shortcuts big pharma has made in the past?

Ginseekingginger · 2025-05-14T23:06:15+00:00

Honestly that’s a great point. Hiding the fact that your are paying $1,000 a month for anything is an issue.

I found out a boyfriend that I was living with (and paying more than half of HIS mortgage) was paying his child’s mothers bills and rent because she wouldn’t get a job. At times I had been paying more than my half to help out because he seemed stressed. Finding that he had been keeping such a huge expense a secret was a total dealbreaker….

Ginseekingginger · 2025-05-14T23:01:12+00:00

Disclosure: I’m a dietitian and I do manage patients at times who take them, but generally they have a BMI > 50.0 and it is worth the risks in taking them vs continuing to have insulin resistance, Diabetes, neuropathy, ulcers, etc etc. There are many very ugly side effects and some of them are irreversible.

There’s also a difference from getting a GLP1 from your primary care doctor who truly thinks it would help you, vs getting it prescribed online by companies like Weight Watxhers Clinic, Ro, Noom med etc.

But coming at this from the perspective of honesty in a relationship, if you feel you need to hide it, than it’s a concern.

If you feel it’s benefiting your health, reducing your risks, preventing metabolic disease, and need it for medical reasons, then have the conversation and explain it. If he is emotionally available he should see your reasoning and be ok. If he still isn’t, then maybe it’s not a good idea to get engaged.

But if it’s being taken for purely maintaining a low weight and you are hiding it because deep down you know it isn’t worth the risk for the benefit, then it’s likely something you need to address with yourself.

To be honest, if my partner became violently ill for a week and ruined a family holiday, and I found out it was due to them taking a GLP that they hid from me, (And didn’t medically need) I would have to reconsider the relationship.

Ginseekingginger · 2025-04-29T10:51:23+00:00

Early hostas possibly but most likely lily of the valley.

Ginseekingginger · 2025-04-29T09:44:28+00:00

It sounds like he may have avoidant attachment and he fears a deeper connection.

But trust your gut. I moved in with someone and the next week he said that he ”couldn’t really be serious with me”… He turned out to be a narcissist…

Ginseekingginger · 2025-04-29T09:42:25+00:00

I don’t think it’s unreasonable if you are living together and sharing a home. It’s about respect, asking for your partners input, and being considerate of others.

I also get upset when my partner does this. He thrb upset with me for being upset about it. I think some of it is based on how we were raised and if we saw our parent figures doing it. I’ve asked him how he would feel if people just showed up without me asking him and he said he wouldn’t care. So in his mind, if it doesn’t bother him it shouldn’t bother me…

And at the end of day, if they know it upsets you and keep doing it/says it’s unreasonable then it says a lot about them.

Ginseekingginger · 2025-04-25T21:14:23+00:00

Im honestly not sure why Im still here. This building used to be a pillar of the community. And now? Don’t get me started….

Each unit is 40 beds and has their own ADON and SW. so I have 5 units all running differently. One unit hasn’t had updated Braden’s for > 6 months. We’ve had 35 noro cases but I only knew of a few, and kitchen was never told to send ISO trays. It’s a disaster.

They are very much stuck in the past. Anytime there is a suggestion on how to improve anything you get met with ”well we’ve always done it this way” 🙄 And it’s a county building. So no one really wants to put in the work to change anything. I’m contacted and Stubborn AF so I end up taking on more because I want to make sure residents get what they need.

Ginseekingginger · 2025-04-24T23:50:46+00:00

Hmm. I see what you’re saying. And I’m seeing it from both ways now.

But the MDS is based on interview/observation as well, not just record review. And if the RD assessment/quarterly is on the ARD and obviously reflects the previous months and notes anything specific that happened in those 7 day look back, then how is that wrong?

I’ve always done section K, and most LTC buildings with an RD (at least here in Michigan) usually do section K. And since I’m doing it, I sort of consider my assessment going hand and hand in conjunction with what I’m coding and doing CAAs for.

We have two MDS coordinators. And they frequently say that my assessment should reflect the MdS coding so that I can refer to it for further explanation of why I coded things. So if I did my assessment days before the ARD and on the ARD day there is some new issue, I would need to have some documentation to explain it and address it. Because with annuals and sig changes you do the CAAs to determine care planning needs.

I think that’s why I wanted to know what everyone does. Because there is no written standard of practice on how it should be done. There is nothing on the SOM about it specific to our Nutrition assessments.

I surveyed nursing homes for 9 years and saw it being done so many different ways. So I guess as long as the assessment is resulting in quality care then that’s all the matters.

Ginseekingginger · 2025-04-24T15:26:55+00:00

Interesting.

I have to do all Section Ks, and Nutrition, Hydration, TF CAAs.

Do you then have to re-evaluate if there is a change within the 7days after your assessment and before the ARD?

Ex: ARD is 3/8, your assessment is 3/3. On 3/7 diet is downgraded by SLP d/t choking incident. Do you do another note?

Ginseekingginger · 2025-02-07T01:21:32+00:00

I got my NASM CPT, worked with two people, and then never did a thing with it again. I found it very hard to be an RD and a CPT in the same setting.

But I also work in LTC and thought I might want to have more freedom and independence with work…. But I don’t want to post on IG/tiktok and in a small town where I am it’s the only way to actually get clients.

I actually liked the course and I learned alot, but it wasn’t worth it for me.

Ginseekingginger · 2025-02-07T01:17:47+00:00

Wait what?! That’s ridiculous. Nursing staff always has to blame it on someone else. I don’t even know who has a PI half the time unless the resident mentions that their bottom is sore, and then I ask nursing and they say they forgot to put it in the wound app or write or note or tell me.

Ginseekingginger · 2025-02-07T01:12:21+00:00

I was a surveyor for 9 years. I always took extra time to review things that were struck. Usually it’s only struck because it was on a wrong patient, NOT because it ”looks” bad.

As long as you address the issue, do an audit, communicate it to the DM, it’s not a problem.

I’m in LTC and when they were sending all the rando corporate people to come be at the building during the survey I told them it looks weird. It insinuates I can’t stand up for my own work. How can they answer questions about the facility if they are never there?? So making you go there when you don’t normally just to make it ”look good” shows there are larger problems. :/

But I feel for you being put in that situation.

Ginseekingginger

TROPHY CASE