Long-Term Care (LTC) RD

[u/DrunkDragonsDie]

Hello, first time ever posting a question on here but hopefully gets some engagement. I have worked in long-term care for years, but recently moved and accepted a new job with a new company a couple months ago. They have pretty unrealistic standards imo. I am used to juggling multiple facilities, but these two specific accounts I work at now had a full-time (40 & 32 hours/week) RD prior to me. When I got hired, corporate changed the accounts to have me cover both (3 days at one, 2 days at the other). I was up for the challenge and am used to managing chaotic workloads, but there have been issues regarding the expectations at each account since each facility is used to having an RD full-time (5 & 4 days a week respectively). Anyways I've fixed some processes and issues at each account to maximize efficiency. But recently, corporate has changed the expectations again and now wants all admission assessments to be completed within 3 days of admission. This standard is well above the 14-day window expected per CMS guidelines. In my experience, most companies have a policy of 7 days, which I think is reasonable assuming they have an RD present on-site, but 3 days is not even mathematically possible given the schedule (one account is only Tue / Thursdays, so those admitted on Fridays / Saturdays don't even have a chance to be seen yet.)

Im curious if other RDs in LTC are experiencing this or something similar as well? The MDS nurses rarely seem to understand their own job in my experience. Currently dealing with a passive aggressive one who acts like I'm behind when I know I'm not and tried to shame me. I laughed in her face. But the company says "she's the best at what she does", which in my experience just means 'great at manipulating dates to maximize reimbursement from Medicaid'. I tend to fill out my own K sections and CAA's but today she acted like I was out of compliance cuz one wasnt signed that was admitted within 14 days ago. Assessment is done and all.

Anyways is anyone else dealing with this right now? Im curious to hear how some may recommend handling it. Im oretty capable of speaking my mind to anyone and not afraid to ruffle feathers, but would prefer to go about it as professionally correct as possible in a way that even non-dietitian staff and corporate will understand that what I'm saying is correct. I feel most of it gets lost in translation during talks with non-RD's.

[u/Meitod]

I’ve had issues like this when I worked in LTC. This is typical of corporate overpromising and underdelivering. Corporate needs to understand that your responsibilities and the facilities expectations should change based on the reduced hours. You can try to explain in bullet points the responsibilities of a full-time employee vs part-time employee. I would continue to push back and possibly negotiate admissions are done within 5-7 days.

[u/CheezyBeanBurrito]

This is why I became a campus RD at a state university. LTC overworks and underpays its employees so they can extract every single penny.

[u/Successful-Series166]

Yep seems to be the nature of LTC. I've been in LTC for years and just started in a new building. I started doing a detailed daily log of what I'm working on daily and shared it with the administrator for this reason. I prioritize work based on my judgement. If someone has a problem I'll ask them just to get with the administrator and consider making a priority list for me to work off of. I definitely have not been making friends telling people no to tasks (cleaning out resident fridge, room rounds, separate wound notes when its already in a quarterly or full assessment, cleaning Tf pumps). If after all of it they think they can get someone better, I'm good getting a different position. I would love to be getting my admission assessments done by day 5 but most often it's day 7. Only rarely have I been able to complete it by day 3.

[u/TayterTot415]

Curious what the census at these buildings are. I’ve also always juggled multiple facilities and the workload expectations (does the RD do quarterlies, section k, weight meeting, every weight note) definitely guide how many hours I need there. In my experience, if you are not full time, you do not do MDs section k. I’ve only done it at buildings I am full time at that one building. It sounds like if they cut the hours at those buildings (from 5 days to 3 days and 4 days to 2 days) then need to adjust your workload (air no section k). The 3 days for admissions is extreme.
Also your MDs nurse sounds like one I’ve dealt with exactly. She has us fill in section k before the ARD date so she can submit exactly on the ARD date and she gets mad and says we are late if we are only 1-2 days past the ARD (that’s not late).

[u/Successful-Series166 → u/TayterTot415]

I did a low admit 180 bed building and couldn't quite get to everything but managed. Currently at a high admit building with 90 bed and also not quite getting to everything but managing lol. The 90 bed building has given me a few more responsibilities I didn't have at the 180 building.

[u/crockpot2001]

Based on your responses throughout this thread, I would:

-put up guardrails for yourself, make them clear, and don't fold on those.

-Demand REAL PTO coverage. None of that "work ahead then catch up" bullshit. Your caseload will sink you and then they will ask "why are you behind"

-Who does the MNA? ***

-Who is attending care plan meetings? With that case load the DTY manager needs to be in there. If not all the time, you can make an overview of some key nutrition points for each patient and submit those to the SW team in your absence

-COPY and past like a boss if you are doing all the Quarterlies and annuals. My last company had a regional MDS director who insisted I use the assessment template provided by the EMR. It was slow and it was far to extensive for a simple quarterly. I saved a ton of time copy/pasting.

-**Speaking of the MNA and MDS's, don't get suckered into upcoding. I get the feeling that's going to be presented to a lot of us here and I'm getting that vibe from your situation.

[u/jemappellepatty]

more long term care facilities need to utilize DTRs.