Healthcare facilities that provide care to three or more adults in British Columbia are required to be licensed and comply with the Community Care and Assisted Living Act and Regulations. This legislation, which includes a food and nutrition component sets the minimum standard for health and safety. Under the Community Care Facilities Licensing program, licensing officers are delegated the responsibility of inspecting and monitoring these facilities for compliance, and investigating complaints. In some health authorities, licensing officers are registered dietitians.
As the longest serving licensing dietitian in BC, if not Canada, I have much to reflect upon as I transition into retirement. As a licensing dietitian, I inspected the food and nutrition services of facilities, and investigated complaints pertaining to these services. The legislation and program responsible for enforcing these regulations have changed a lot since I started in 1982. The health needs of our residents, our own knowledge, research, technology, administrative law, and the ever-present politics of the day have driven much of the change. What has not changed, and what has kept me focused during those bleakest of inspections, is that our community’s most vulnerable have the right to be respectively served good, nutritious and safe food.
As a licensing dietitian, I was in the unique position to effect change to regulations and standards. If there is anything my colleagues and I fought to retain, and trust me there were times it was a battle, it was to keep dietitian staffing, and our counterpart, nutrition managers, named in the regulations.
Even with the best operators, when budgets are cut, it is too often that the dietitian’s meagre hours are reduced. Administrators and policy makers have a difficult time understanding the cost benefits of our work. It is not as tangible and measurable as hard data, such as the number of falls. Legislation that defines staffing based on the number of residents is prescriptive but measurable. It is easier to enforce compared to the vague “outcome based” philosophy, which works well in theory but not so well in practice.
The reduction in licensing dietitians, from a strong hold of 10 plus full-time equivalents (FTEs) to the current provincial two FTEs, has been a great loss to the licensing program, and a disservice to our residents. Our specialized knowledge and skills allows us to conduct a comprehensive inspection of complex food and nutrition services, identify and measure risks early enough to prevent problems from escalating, and provide support to the lone facility dietitian who too often struggles without it. The licensing dietitian’s role used to extend to the routine inspection of smaller facilities and homes that provide care to adults with physical and mental challenges, psychiatric illnesses, addictions, and those with brain injuries. Many of these adults are at nutritional risk and have little to no access to dietitian services. Coupled with the challenges of staff with no formal training in health care, and, more often than not, minimal cooking skills, the licensing dietitian was valued as a much needed resource. Most of this coverage has now been lost; although I was comforted to learn that Vancouver Coastal Health had the wisdom to replace me, thus ensuring nutrition expertise in their inspections and investigations.
Dietitians working in community care facilities, in particular long-term care, can no longer be complacent, working under the mistaken assumption that their jobs are secure. The regulation requiring dietitian staffing can be too easily eliminated. We need to be politically active and be the squeaky wheel that gets the politicians’ support. Too many of the big decisions are determined by who we know. I worry that without our voice at the ministry level, where decisions on regulations and standards are made, dietitians are going to be left out. More importantly, our residents’ nutritional health will be seriously compromised. The enjoyment of dining will be reduced to feeding the masses, with token recognition of individual requirements.
With advancement in medicine, our residents are living longer. Our job is to help make sure their quality of life is the best it can be. I do not think anyone would dispute that good food, that smells, looks, and tastes good – served in a manner that respects one’s dignity and individuality – is one of life’s greatest pleasures.
Editor’s note: What a great role Christine has played in our profession! The decline in FTEs in this area of dietetics is concerning. Have you been involved with this issue? How can we work together to ensure this important role is maintained?
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