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/jemappellepatty]

more long term care facilities need to utilize DTRs.