DIETITIANS IN-HOME CARE - A SURVEY OF CURRENT PRACTICE

Objective To determine current practice patterns of dietitians who wor k in home health care. Design A mail survey was sent and a reminder po stcard was mailed 2 weeks later. Subjects Registered dietitians (1,305 ) who returned a postcard indicating employment in home care. A total of 660 questionnaires (50.6%) were returned; of these, 252 were usable for data analysis. Statistical analyses performed Descriptive statist ics for summary data and a paired t test to compare level of importanc e and level of expertise needed for nutrition care skills. Results The typical respondent was a consultant, relatively new to home care, wor king fewer than 10 hours a week, and paid an hourly wage (mean=$61.45/ hour). Most agencies did not bill separately for nutrition services bu t 28.2% received third-party payment for services. Primary diagnoses o f home care patients were diabetes and cancer. Many dietitians worked with patients receiving enteral tube feedings (55%), total parenteral nutrition (29%), or both (17%), but most made fewer than two visits pe r week to these patients. Areas of skill rated highest in level of imp ortance for dietitians working in home care were patient counseling, c aregiver education, documentation, and dietary history. These plus the ability to develop a care plan received highest expertise ratings. Di sparity between skill importance and personal expertise was greatest f or activities in the clinical and administrative categories. Most resp ondents expected growth and role expansion for dietitians in home care , but lack of reimbursement was the greatest deterrent. Applications T o expand their role in the home care field, dietitians need to develop additional skills, improve outcome documentation, diversify roles, an d create new relationships with home care providers and case managers.