Nutrition: Therapeutic Diets for Long-Term Care

In the early 1980’s when I finished my dietetic internship and started working as a food service director and dietitian, it was still common to see strict therapeutic diets in long-term care. There were some residents who probably benefited from this, but for many weight loss was a bigger issue.

As the residents in long-term care became older with more issues related to being able to consume adequate nutrition and maintain weight, it made sense to go with more liberalized diets. Often the goal was just to get the person to eat, so why make it more difficult by eliminating many foods she would eat.

Liberalized diets still make sense for most of the elderly-elderly from nutrition as well as quality of life and resident choice stands. However, many facilities now also have younger residents (50s and 60s) for rehab or other reasons.

Many of these residents follow a therapeutic diet with good results, often related to health conditions. It is usually in their best health interests to continue to follow their diets. Or, if they are not following a therapeutic diet, they are young enough to benefit from one.

Because of this, facilities need to reevaluate the diets they offer. Options include:

• Offering strict therapeutic diets again in addition to the liberalized diets.
  
• Using food preferences to meet individual needs, such as having fat free or reduced fat options available and seasonings other than salt.
  
• Modify the existing menu so it is more “heart healthy” and address individually those that may need more concentrated calories. Be sure to follow the diet manual for heart healthy, and do not just “make it up.”

A tool that will assist with the decision is an accurate nutritional analysis of the menu. This allows you to determine what changes you would need to make in the menu and in the recipes to achieve a heart healthy diet.