workforce
A dieticians role
Confusion about dietitians may lead to fewer referrals .
By Elise Hartevelt
Lack of clarity among aged care workers around the role of dietitians may be the root cause of their limited use in the sector , a new study says .
Practicing dietitian Karly Bartrim says many people working within residential care don ’ t fully understand what a dietitian does , influencing the number of referrals they receive from providers .
“ Sometimes it takes six months before I get called to visit an aged care facility ,” says the lead researcher .
“ We ’ ve just got a long way to go on using the full potential of dietitians in these settings .
“ The role dietitians play in aged care is very limited at the moment .”
After the Royal Commission ’ s 2021 report unearthed alarming numbers of malnourished residents and poor-quality food , the watchdog advised more dietitians should be placed in aged care homes .
But Bartrim says the limited use of dietitians in aged care is linked to a lack of mandated requirements for providers .
“ Currently , Australia has no set requirements for a dietitian to attend a facility ,” she says .
“ We might get called in if a resident has lost some weight or they have nutrition concerns .
“ But the problem is that it ’ s happening too late – it ’ s either happening a month down the track , after they ’ ve gone to the hospital , or other issues have occurred .”
Countries like Canada have mandated dietitian requirements of 30 minutes per resident every month so that residents will have regular reviews by dietitians .
While regulations might improve the uptake of dietitians in aged care , Bartrim ’ s study also reveals dietitians themselves are hesitant to work in aged care .
“ They recognise their contribution to the profession , but they did voice many challenges ,” she says .
“ There was uncertainty around their role – they felt that all staff members in aged care facilities have a role to play in nutrition care , but not all parties acknowledge that .
“ Dietitians also have some assumptions and biases about older adults and working with them , which I imagine comes down to ageing and our healthcare system .”
Of over 1200 dietitians surveyed , only one-third perceived older people as capable of making wise dietary choices on their own .
But they also felt not everyone on staff supported the role of dietitians in providing nutritional advice .
Bartrim ’ s study underlines that improving nutritional care for residents is a team effort .
“ Some said that nutritionists are totally ineffective without nurses behind them ,” Bartrim says .
“ But dietitians faced challenges , such as the timely provision of nutrition care or not feeling residents and staff respected them .
“ Plus , if staff aren ’ t trained , and they aren ’ t able to feed a resident , then we can ’ t get food into them .”
When dietitians are called in , they often only have enough time to address a resident ’ s symptoms but not to further enquire about their food practices . The Maggie Beer Foundation Malnutrition research also found that
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The number of malnourished residents is too high .
screening is done in an ad-hoc way or sometimes not at all .
Bartrim agrees dietitians are not given the time and freedom to determine what led to the resident ’ s nutrition-related health issues .
The government ’ s Aged Care Amendment ( implementing Reform ) Bill 2022 that passed the lower house last week aims to enhance regulations around the sharing of data by providers to authorities .
“ We ’ ve had more referrals with unplanned weight loss estimates because they ’ re now mandating reporting standards about that ,” Bartrim says .
“ But regarding the whole question about , ‘ how much protein are residents receiving ?’ – I ’ m not sure how facilities are answering that when they aren ’ t regularly consulting dietitians .”
Robert Hunt , chief of the peak body for dietetic and nutrition professionals , says that despite the major reform bills ’ passing , there ’ s still much to do to save older people from malnutrition .
“ The transparency bill under its current form is still allowing a situation where the fox is in charge of the henhouse ,” he says . “ It still relies on self-reporting by aged care providers .” Recent research estimates that 15 per cent of residents are malnourished , and between 25 and 50 per cent are at serious risk .
While Hunt welcomes the commitment of the Albanese government ’ s five-point plan to improve food and nutrition , he says data coming out about what is being spent on food is unreliable .
“ Receptionists or admin officers are doing templates being completed on the spend of food .
“ If we ’ re going to get this data done properly , we have to make it mandatory and give the homes support .
“ Right now , there is no structured plan to support this vulnerable group to receive nutritious food . End of story .”
Hunt recommends mandating malnutrition screening of providers and allocating a specific amount of minutes per resident to see a dietitian .
“ The solution ’ s quite straightforward – they need to engage the right health professionals in the homes working collaboratively .
“ Because now , the number of malnourished residents in aged care is too high .
“ Any malnourished resident is too high .” ■
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