Box With Sandwich Fruits And Chocolate And Bottle Of Juice

As we think about what our residents are facing in our long-term care facilities, we know many are likely not eating or enjoying meals as they did before. No more going to the dining room for communal meals, coffee hour, having family and friends stop in, or attending cooking classes with the activity department. Our kitchens may also be struggling at times with spikes in COVID cases and keeping up with staffing shortages. Now more than ever, with the on-going pandemic and upcoming holiday, focusing on our residents’ dietary needs is essential for their health and wellbeing.

In the past few years, the move to more liberalized diet approaches in long-term care facilities is being embraced. Along with new guidance from the Centers for Medicare and Medicaid Services (CMS) for individualized dietary approaches in provision of person-centered care for our residents, supporters for liberalized diet approaches in the long-term care setting include the American Medical Directors Association (AMDA) and The Academy of Nutrition and Dietetics (AND). Using liberalized diets has been shown to increase meal acceptance and intakes, improved nutritional status, and aid in reducing the instance of malnutrition. Most resident benefit from liberalized and regular diets, with changes in blood sugar or blood pressure being managed through medication. Facilities can choose to move from more restrictive diets such as cardiac and carbohydrate-controlled diets to no added salt diets (NAS) and limited concentrated sweets diet (LCS), while continue texture modifications as needed. Those with more restrictive dietary needs, such as with a renal diet for dialysis dependent patients, facility intradisciplinary teams can coordinate with their renal care team to review considerations for liberalized diet approaches, especially around the holidays.

Liberalizing diets is both beneficial to our residents and staff. It will allow residents increased choices at meals, and to feel more in control of what they are being served, and when. This also provides some relief to the dietary department, as it can reduce the burden of making several different menu options depending on the diets offered and restrictions, along with reduced plate waste from untouched food.

With the concerns of COVID lingering and continuing to impact our residents’ daily lives, additional ideas, especially during the holidays, can improve mood and nutritional intakes. Staff can continue to speak with residents individually regarding their food and beverage preferences, ensuring diet cards are up to date with any changes made as necessary. Also, relaying any specific requests for special holiday or resident choice meals to boost morale and keep residents feeling involved. Coordination with the activities department for additional snacks or socially distant group activities can also be utilized along with requests for donations from the community.

This year as proven to be an extreme test of our strength and perseverance. Taking care of each other and focusing on meeting the unique needs of each of our residents will help to ensure their quality of life as well as meal satisfaction. Liberalizing diets in our long-term care facilities has been shown to be beneficial for many residents, and we often see increased meal acceptability, decreased plate waste, decreased supplement usage, and ultimately better overall nutritional status. Considerations from the intradisciplinary team, including your Registered Dietitian, should be evaluated when making the decision to liberalize residents’ diets.


Shiba, D. (2018, October 31). Supporting Diet Liberalization in Health Care Communities. Retrieved from

Carlson, D. (2019, January 29). Importance of Liberalized Diet for Older Adults. Retrieved from

Nutrition Care Systems, Liberalizing Diet Toolkit.