Residents in long term care (LTC) have multiple nutrition risk factors, and dietitian services can improve health and enhance quality of life. LTC systems are governed at the provincial and territorial (P/T) level, and differences in nutrition-related standards are likely.

To compare P/T standards for dietitian services in LTC homes in Canada; To describe dietitians’ practice in LTC homes in each P/T.

Standards relevant to LTC dietitian services were extracted from government websites. One focus group of LTC dietitian leaders (n=14) in June 2017 identified issues for developing interview guide. Key informants were identified through DC member groups, and suggested by initial interviewees. Interviews (n=33) were held between August and November 2017 using a semi-structured interview guide, to verify implementation of legislation/standards and dietitian roles within LTC. Dietitians’ practices and challenges to nutrition care were summarized for each P/T.

P/T standards for LTC dietitian services and nutrition care vary widely across Canada. Dietitian services are required in eight jurisdictions, but only one (Ontario) has a specified level of staffing. Assessments and care planning by dietitians is specified in standards of only six P/T but is common practice in all P/T. Funding for food in LTC homes is specifically funded by government in only 2 jurisdictions. Common elements of practice include assessment, care planning, dysphagia management, wound care, menu planning or review, and staff education, as well as broader roles in departmental management.

LTC residents across the country have inequitable access to dietitian services, and LTC standards are inconsistent regarding dietitians’ roles and staffing requirements.

Dietitians’ value in LTC could be enhanced by improved standards for nutrition care and staffing. Recommendations for government, researchers, and dietitians are made to support advocacy for consistent and improved standards for dietitian services in LTC.