Registered dietitian GAYE PHILPOTT gives an insight into her busy and varied workload as an independent dietitian for a number of aged care facilities.

A typical day in the life of … Gaye PhilpottIt’s Friday and I’ve just got off the phone from talking with a cook who had a query about whether a resident, who is lactose intolerant, can eat mashed potato, when a fax comes in telling me that a gentleman with a PEG in a care facility on the other side of town has lost two kilograms over the past three months. I’m thinking, can I squeeze in a visit this afternoon as well as complete the audit report for the rest home I visited on Monday and whom I promised I would have the report completed before the end of the week because they have a cooks’ meeting at 1pm on Tuesday?

I work independently for a variety of aged care facilities. This includes large providers like Bupa, who have facilities in many different towns, to the family-owned 30-bed hospital situated four corners down the road from where I live.

Planning menus, carrying out menu audits, undertaking nutritional assessments and preparing nutrition care plans for individual residents, providing staff training, and writing or advising on nutrition and food service policy is what I do working as a dietitian in aged care facilities.

Recently dietitians in New Zealand gained prescribing rights and can apply for Special Authorities for nutrition supplements, so a registered dietitian can truly now be the ‘one-stop shop’ for all nutrition and food service matters.

What I like most about working as a dietitian in aged care facilities is the people – both residents and staff. I enjoy listening to the residents I’ve been asked to review, reading their medical and social histories, identifying their needs and providing a realistic plan.

I also enjoy working alongside both the care and catering teams. With knowledge and training in both clinical nutrition and food service, dietitians cross that divide, helping ensure the finite resources available are used to meet evidence-based guidelines and are not wasted on outdated or unnecessary practices.

It’s nearly 20 years since I was approached in my dietetic practice to work a few hours a month in a War Veterans’ home. Back then, the residents I was asked to review were those who were gaining weight; cooks were sweetening custard with Sucaryl and fluids were thickened with Colset or guar gum.

Today, older adults in care are more likely to be at risk of weight loss and more have complex medical issues. Many in care may need access to foods which provide extra calories and those with wounds may benefit from extra protein. Where possible, foods should provide such extras, but supplements may be appropriate in certain circumstances. Other residents may need the texture of their foods to be modified so that they are at less risk of choking or aspirating. Still others may need to restrict certain foods because they have particular intolerances or allergies. All, however, need to be able to meet their nutrient needs and be provided with attractive, appetising meals.

Always the menu is the cornerstone of any facility’s nutrition and food service. Whether planning or reviewing a menu I check that residents are able to choose sufficient serves of each of the four food groups (breads and cereals, fruits and vegetables, milk and meat items) and that enough key foods such as meat and milk are purchased. Providing a variety of meals over a week and during a cycle is important if residents are not to tire of the choices, and of course, finding the right balance between new dishes and old favourites so that residents look forward to and enjoy meals, can sometimes be challenging. But satisfied customers are always the motivation and the reward.

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