Although it has now been over a year since the Ohio Residential Care Facilities Licensure Rules were updated, there is still some confusion regarding what is and what is not a therapeutic diet that needs to be supervised by a dietitian. And if you do have a therapeutic diet that needs to be supervised, what does that even mean? Although the rules were updated to “make it less confusing”, more confusion was the outcome. Dietary Solutions is here to make these rules crystal clear! Although caring for your residents is the #1 priority, avoiding a survey citation is also very important. Here are some highlights regarding the updated rules as it applies to supervision of therapeutic diets:
To read all the rules for Chapter 3701-16 click here.
Under Definitions
“Special diets” means a therapeutic diet limited to:
- Nutrient adjusted diets, including high protein, no added salt, and no concentrated sweets
- Volume adjusted diets, including small, medium and large portions
- The use of finger foods or bite-sized pieces for a resident’s physical needs
- Mechanically altered food
“Supervision of therapeutic diets” means services, including, but not limited to, the following:
- Monitoring a resident’s access to appropriate foods as required by a therapeutic diet
- Monitoring a resident’s weight and acceptance of a therapeutic diet
- Providing assistance to residents on therapeutic diets as needs or requested
- Providing or preparing therapeutic diets
Under Dietary Services; supervision of therapeutic diets
Each residential care facility that elects to prepare special diets other than therapeutic diets shall:
- Prepare and provide the special diets in accordance with the orders of a physician or other licensed health professional acting within their scope of practice, or a dietitian (in other words, the resident must have an order for the special diet)
- Adjust special diet menus as ordered by the resident’s attending physician or other licensed health professional acting within their scope of practice, or a dietitian (in other words, special diets need to have spreadsheets)
Each residential care facility which elects to supervise therapeutic diets shall make available three daily meals and provide or arrange for a dietitian to plan, direct and implement dietary services that meet the residents’ nutritional needs and for residents on therapeutic diets on an ongoing basis:
- Determine that the diet ordered is appropriate according to the resident’s individual nutrition assessment (in other words, the dietitian must assess the resident to make sure the diet is appropriate)
- Monitor the resident’s nutritional intake and acceptance of the diet
- Evaluate the home’s compliance in the provision of the diet
- Adjust nutritional assessments and diets as needed
- The dietitian shall oversee, monitor and assist in the training of food service staff in the preparation and serving of foods for therapeutic diets and consult quarterly with the food service staff.
The following would be considered “special diets”: NAS, NCS, Carb Controlled, Carb Consistent, Mech. Soft, Pureed, small portions, large portions, finger foods. These diets would NOT need to be supervised per the licensure rules. And that the following would be considered “therapeutic diets that need to be supervised”: 2-gram sodium, any fluid restriction, any thickened liquids, 1500 calorie diet, any tube feeding.
