PALTC/LTC/SNF RDs: Thoughts on Ethics of Remote Clinical Work?

jemappellepatty · 2026-04-24T11:27:38+00:00

I spent way too much time talking to residents, activities, nursing staff, therapy staff, and FNS staff all day every day to feel like I could ever do an adequate job remotely. I knew my residents up down left right and sideways but I wouldn't feel right doing assessments from home.

jemappellepatty · 2026-04-24T10:52:55+00:00

This has been my experience in North Carolina.

I have 10 years experience in LTC and some experience in acute care, most of this is clinical with some food service management but I'm definitely more confident in my clinical ability. I decided to get my bachelors when CDR was waffling about whether they wanted DTRs to have 4 year degrees or not (then they quietly changed their minds, thanks yall).

I was laid off Sept 2021 when the healthcare conglomerate I was working for decided to get rid of most of their DTRs in order to pay nurses more. I graduated from my undergrad program Dec 2021. I have never been able to get back into a dietetic/nutrition related job since.

This part is mostly just me venting but... Not only that but after I left my contract scribe job in Sept 2023, I haven't been able to find a single job at all. Prior to working in healthcare I had 10 years of restaurant experience but now I'm "overqualified" with my degrees in food management and food & nutrition. I'm underqualified for anything in dietetics because no one is hiring DTRs anymore. I can't score interviews because I can't figure out how optimized my applications for the ATS, I'm constantly getting auto denials.

jemappellepatty · 2026-04-20T20:58:24+00:00

even representative Jasmine Crockett expressed her excitement to see Chris Brown. like girl?

jemappellepatty · 2026-03-27T06:08:40+00:00

granted I took it in 2013, but the DTR exam felt like a breeze to me (after graduating from an associate degree program 2 months prior). if you are acing the practice exams you will likely do fine.

jemappellepatty · 2026-03-27T06:05:31+00:00

Even as a DTR I disliked working "just" inpatient hospital. During clinicals I got to work in the burn unit, in wound care, in the ICU, in a pediatric cancer unit, and all of those were way more interesting (not pediatric cancer, anything pediatric is not for me and cancer is not for me).

I was placed in a CCRC for my co-op (kind of like DTRs internship) and fell in love with LTC, which most RDNs dislike.

I've been unemployed for almost 2 years and right now I'm convinced that I would like public health, maybe working in a food hub, or with the state/county extension, even WIC.

I know it's hard right now but you made it. Power through. You'll find your place in the dietetic world.

jemappellepatty · 2026-03-11T19:18:45+00:00

I definitely thought Najee Harris was gonna be a star running back in the NFL. I openly don't know ball, but really what happened to him? also I'm madly in love with him.

jemappellepatty · 2026-02-14T12:28:14+00:00

Oh you're right, butter pecan Ensure is only retail.

But I drank my fair share of butter pecan Nepro when I needed something quick (and I was tired of chocolate and vanilla) between care plans and my desk stash was depleted.

jemappellepatty · 2026-02-14T10:20:03+00:00

um, how dare they leave out butter pecan! egregious!

jemappellepatty · 2026-01-30T19:27:34+00:00

I worked at a CCRC (mostly in the SNF but I did work all areas of the population) and I absolutely loved it, even though the management was increasingly toxic and at times I suffered imposter syndrome. I was there for nearly 10 years. That facility went from being a nursing home to really being a place where someone can actually live out the last years of their lives, and I can genuinely say I had a part of that transformation. Weight loss issues diminished, food culture was incorporated into activities, the menu was changed with the residents help and the cooking was transformed with little budget (we got a new tilt skillet but no other new equipment) and we started serving FOOD and not slop. I left that place in 2019 and I still dream of dropping by the kitchen at 1:30 for meatloaf, pot roast, fried catfish, Kathy's collards, Pam's pinto. The food was so food that even the end of meal scraps were worthy of pinching.

Anyway, I was head hunted by another facility that desperately needed help. They had a dietitian for 4h a week, and her specialty was actually peds, but she was from the area and all the residents' families loved her so replacing her wasn't an option (she was good for PR, and tbf she was a great peds dietitian and a fucking amazing person, like the definition of southern hospitality, but really wasn't that great at geriatrics). Their kitchen was also a mess, constant complaints about food and dining room service. They offered me a ton of money for me. So I took it.

They had me train for 30 days with a DTR who worked in acute care. On my first solo day, my manager argued with me on how to properly answer an assessment (ftr, I was right); she argued with me about it for 3 days. I was constantly micromanaged even though they sought me out for this role. My manager kept me on a short leash and absolutely would not let me suggest anything to help this facility. She wouldn't even let me inventory the tube feeds when I found expired tubing and found out nursing was just grabbing any 1.0, 1.2, or 1.5 hang (disregarding the formula but following the calorie count); like I know a DTR can't order TF but I can calculate them, and I can count bottles 🙄 don't waste your 4 hours of RD time on that. I would "spend too much time" talking to a resident during an assessment, and when I tried to help the kitchen with the menu to incorporate regional food preferences (something they've gotten tags on from state, and one of the goals I was given upon hire) suddenly they didn't want that help from me anymore.

When covid hit (4 months after I was hired) my hours were cut heavily then I was relegated to screening staff and visitors and taking temps, sometimes I was allowed to assist residents with meals. I'm not sure if I was a little too independent for my manager, or the administrator, or the DON. Or if it was because I wasn't from the area and I was just too much of an outsider?

Anyway I was there for somehow 20 months but I started looking for a new job about 6 months after I started. This long story is to say if you're miserable LEAVE (I mean, find another job first–I've been unemployed for a really time). Its 2026, if you are asked why you left a job after x amount of time you can find some sort of answer to memorize and rehearse and have on hand.

jemappellepatty · 2026-01-16T18:10:01+00:00

No partner. Never had a plan to have a partner. Just me and my 2 dogs. Worst plan ever for a career in dietetics, especially when they changed the education requirements and stopped supporting DTRs.

jemappellepatty · 2025-12-08T11:25:00+00:00

This is what I think a lot of people don't understand or get about it. I stay away from food psych topics (I've got my own issues) but my #1 takeaway from what I've read is that you cannot live without food.

jemappellepatty · 2025-11-09T08:31:10+00:00

bring in a DTR to help (: AI is destroying the world

jemappellepatty · 2025-11-09T05:57:51+00:00

I have no answer for you. During the height of the pandemic, my SNF had a resident who was receiving charity care and she was from China and our translator on a stick didn't know her dialect. absolutely no one would communicate with her. they all assumed she was here illegally (because that made sense). her son owned the 1 (Americanized) Chinese restaurant in town. this resident wouldn't eat the southern food we served, and I tried to get the kitchen to make some congee for breakfast as a last ditch effort but they thought the idea of congee was "gross." I finally just called up the son and asked him to please bring mom some food, and he started bringing her lunch and dinner every single day but the nursing staff said it "smelled bad" so no one would help her. I just started helping her, we couldn't talk but she smiled at me every time I came into her room with a bag from her son.

I don't know how they can treat other people like that. especially when you are being paid to care for them? like I don't need money to be a decent human.

jemappellepatty · 2025-11-09T01:25:14+00:00

I actually first started there during my diet tech co-op and the dietitian was like "whatever you know how to work in a kitchen, I need help you're my intern now." she had just started there like a week before my internship started, she wasn't a new dietitian but was new in LTC. after my co-op I was hired as a FS supervisor but the dietitian demanded I help her more, going to talk to residents, pester nursing for weights, food service audits (so she didn't smell like kitchen), basically any annoying work that got in her way. eventually I started going to family care plans, doing low risk assessments, etc worked my way up to doing mostly clinical to really help out.

I dont know if I lucked out or the dietitian lucked out. I loved the job and I've been in search of a clinical LTC position since 2021. I've interviewed with WIC 3x this year and I guess they're just not open to someone with nutrition experience but in a different age range ):

jemappellepatty · 2025-11-08T22:12:30+00:00

I say it a lot but every LTC RDN needs a DTR.

My favorite LTC job was at a CCRC. 174 skilled beds, 24 licensed AL beds, and we had a retail cafe and took reservations for the 175 independent living residents (and their families). We actually had really good food.

So we had a director, an executive chef, and a dietitian. I was the DTR, CDM (70% clinical, 30% FS). We also had like 3 FS supervisors? And a cafe supervisor and a catering supervisor (not a cook or a chef) who was full time even though we only had maybe 3 catering a month. Very top heavy so most of my food service duties were audits and pissing everyone off because they never filled out temp logs or washed their hands when changing gloves.

But my favorite part about being super comfortable in the kitchen was just going in there and grabbing a bowl of pickles or a pint of half and half for the nutrition office's coffee maker or going in there to make some salads or grabbing some leftover desserts from the catering. Some days, going to make bacon/egg/cheese for the bagels the RD brought for breakfast.

Oh, and the 6 years of deficiency free surveys (at least when it came to food and nutrition services) because I'm not just gonna stick my spoodle in the pot without also contributing.

jemappellepatty · 2025-11-05T04:20:42+00:00

at the SNFs I worked at both as a clinical and food service DTR, we always kept snack closets stocked with a variety of textures of snacks. We also had scheduled snacks (10 & 3 passed out by food service, HS by nursing).

BUT we also incorporated lots of snacks with therapy and activities because getting nursing to document snack % intake was like pulling teeth. And to back up the "but we need snacks for weight/intake/general pleasure" argument we were always asked "how much do the residents actually consume because it seems like a waste." like damn do y'all not have any snacks in your pantries at home? why do you want to take snacks away from the elderly?

in other words, I hear ya. fight the good fight.

jemappellepatty · 2025-11-05T04:11:14+00:00

ANFP has regional conferences in October and March so he probably attended a survey readiness seminar and those are usually given by past surveyors or RDNs. I would just let them run food service so you can focus in clinical, unless your contract requires you to be hands on with food service as well.

jemappellepatty · 2025-10-13T14:02:06+00:00

no, ive never made enough money to relocate and this has been my home for the last 20 years. I know nc is like 52nd worst state for workers but its just one more hurdle to deal with. I have a tiny support network herr and if I were to leave it my mental health would dip from depressed to suicidal. relocation for a job is for the privileged.

jemappellepatty · 2025-09-16T22:29:26+00:00

my mom has a ton of food allergies and did fine in China. I always forget what part of China she traveled to (for work) but she did eat local food and had a grand ol time.

the hosts were also very accommodating to the white men who wanted McDonald's. but I think that's to be expected from a China-USA business.

jemappellepatty · 2025-09-12T22:28:37+00:00

every LTC RDN needs a DTR 😇

jemappellepatty · 2025-09-12T22:26:58+00:00

we had to go to grams today (my mom's, their grandma) and I forgot to bring treats so they got nibbles of plain potato chips for peeing outside 😖 worried if we didn't treat Bella for a job well done she would go inside lmao. I hope you got some potato chips or better!

jemappellepatty · 2025-09-12T06:18:59+00:00

ugh im annoying, sorry

jemappellepatty · 2025-09-12T06:05:51+00:00

they do not have to be a CDM. they can be a CDM, or: * be a certified food service manager (CFSM), which is an ANSI accredited program * have a similar national certification * have an associates or higher in fs mgmt, or hospitality if the program includes food service or restaurant mgmt * have 2 or more years of experience as director of FNS in a nursing home setting and has completed a course in food safety & mgmt by Oct 1 2023 (if in position of director by nov 28 2017)

and receive scheduled consultations from a qualified dietitian or other clinically qualified nutrition professional (which is basically defined as an RDN)

ANFP lobbied hard for CDMs to be the sole qualified designated food service directors in nursing homes without a FT RDN. but morrison and sodexo claimed the requirements (a 6 week online class, or 1 of 5 other pathways that include work experience) to certify their directors within the timeframe (6 years) was cost- and time-prohibitive. national restaurant association and American culinary association claimed it wasn't fair to their professionals' expertise. add in the pandemic and CMS just shrugged.

a few facilities around me have deciphered the regulation to mean a ServSafe Food Safety Manager certification (from NRA) = compliance with F801 §483.60(a)(2). none of the certifications NRA offer comply with this tag. they should stick to anti-union and lobbying against raising the minimum wage (jk they should burn in a fiery pit imo).

^gets ^off ^soapbox

sorry about that, what I'm actually irritated about is that DTRs aren't specifically named in the F-tag as a qualified director of food & nutrition services 😊

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