In recent years, many skilled nursing facilities (SNFs) have experienced a shift in focus toward shorter-term, higher-acuity, and more medically complex residents. These older adults typically have a higher risk of hospital readmission due to issues such as chronic diseases, weakened immune systems, malnutrition and limited mobility. 

Rehospitalization is not always avoidable for this fragile group; however, SNF leaders continue to seek out and implement successful strategies to reduce the stress associated with transfers between care facilities and improve residents’ quality of life. 

One such strategy is nutritional interventions, which have emerged as a crucial approach in preventing hospital readmissions and promoting overall health and well-being among this vulnerable population.

Common causes of hospital readmissions 

There are many reasons a resident may need to be readmitted after a recent discharge from the hospital. Two of the most common factors that increase the risk, however, include: 

  1. Multiple comorbid conditions such as heart failure, chronic obstructive pulmonary disease, and diabetes. According to the National Council on Aging, nearly seven out of 10 older adults have two or more chronic conditions. Not surprisingly, the more chronic conditions a person has, the more likely he or she is to be readmitted to a hospital within 30 days.
  2. Poor nutritional status, especially among residents who were malnourished prior to their first hospital stay, is another important readmission risk factor. It’s estimated that as many as half of long-term care residents have (or are at risk of having) malnutrition, which can result in delayed recovery and higher vulnerability to infection. In addition, one-third of residents who were well-nourished before a hospital stay may develop hospital-acquired malnutrition. Malnourished residents are 23% more likely to be readmitted after hospital discharge.

Nutritional interventions in skilled nursing facilities 

In SNFs, implementing targeted nutritional interventions can have a profound impact on residents’ health outcomes. Person-centered menu planning, nutritional supplementation, fortified meals and nutrition counseling can lead to a significant reduction in hospital readmissions.

These interventions not only improve nutrient intake but also help manage chronic conditions and promote faster recovery. Moreover, individualized nutrition plans tailored to each patient’s needs and preferences are essential for ensuring compliance and better outcomes. 

It’s imperative in the skilled nursing setting for registered dietitians to be actively engaged not only in the community’s nutrition plan overall, but also in individual residents’ ongoing evaluation and care plans. A dietetic professional who implements a proactive model of medical nutrition therapy on an individualized basis and is attuned to residents at higher risk of readmission can make the difference between life and death.


The person-centered approach that registered dietitians employ helps address the multifaceted factors contributing to malnutrition, ultimately reducing the risk of hospital readmissions. As part of this approach, SNFs should implement a comprehensive malnutrition platform (CMP). The CMP is a succinct process, following consistent protocols with recognized guidelines for identifying, treating and documenting malnutrition. When implemented fully, communities not only reduce the risk of hospital readmissions due to malnutrition, but they also significantly boost the probability of appropriate reimbursement (see sidebar). 

There are a variety of nutritional strategies that can be implemented to address malnutrition and — most importantly — understanding the root cause(s) of nutrient deficiency. These include (but are not limited to): 

  • Offering delicious food that meets the cultural/religious preferences of the resident 
  • Providing nutrition supplements to quickly increase calorie and protein intake 
  • Modifying diet texture; consulting with a speech-language pathologist (SLP) 
  • Fortifying foods and beverages 
  • Scheduling individualized dietary counseling 
  • Serving meals with adaptive feeding devices such as high-sided dishes, non-skid plates, etc. 
  • Ensuring oral care is adequate 
  • Referring residents to psychiatrists, dentists, and other relevant professionals

An interdisciplinary approach 

To help prevent the occurrence of hospital readmissions, there is a growing emphasis on care coordination among interdisciplinary team members to address nutrition issues.

Registered dietitians are critical as principal members of the SNF interdisciplinary care team because they are the only ones on the team: 

1. Educated in nutrition therapy, the therapy of diets and how that plays into residents’ chronic disease states and recovery; 

2. Using the most recent advances in nutrition science to reduce residents’ risk of readmissions and mortality; and 

3. Experienced in collaborating with interdisciplinary care and food operations teams to provide an exceptional resident experience.

Strengthening the partnership between dietitians, clinicians, culinary staff, SLPs, occupational therapists or any other healthcare professional involved in the case can contribute to reducing readmissions and improving health outcomes for vulnerable patients. 

Phyllis Famularo, DCN, RD, FAND, LDN, serves as a Senior Manager of Nutrition Services for Sodexo Seniors and has worked with the older adult population nutrition in the Northeast for over 30 years. Her primary duties include training of dietitians and regulatory compliance. She is an RDN with a doctorate in clinical nutrition from Rutgers University.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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