ADMINISTRATORS PERCEPTIONS OF NUTRITION SERVICES IN-HOME HEALTH-CARE AGENCIES

Objective Ascertain views of home care administrators regarding the ne ed for nutrition services in home care, current status and gaps in die titian services, and obstacles toward expansion. Design Mailed survey. Subjects Members of the National Association for Home Care residing i n California, New York, Pennsylvania, Ohio, and Texas. Of the 1,992 qu estionnaires sent, 402 (20.1%) were completed and used for data analys is. Statistical analyses performed Descriptive statistics. Results Res pondents gave high importance to nutrition (6.2 on a 7-point scale), a nd 39.6% estimated that more than half of their patients were malnouri shed. Most respondents reported using dietitian services, either as co nsultants (45.5%) or full-time (5.8%) or part-time (11.9%) employees. Nurses (85.5%) were listed most often as providers of nutrition servic es; also listed were dietitians (70.6%), pharmacists (17.2%), and phys icians (11.2%). More than half of the respondents did not have, but wo uld like to have, a dietitian serve as a nutrition consultant, prepare nutrition care plans, and provide nutrition counseling for patients a nd caregivers. Primary deterrents noted were lack of reimbursement by third-party payers and lack of physician request. Dietitian services r anked as having the highest value were patient education and counselin g, medical nutrition therapy for specific conditions, development of n utrition care plans, staff in-service training, and nutrition assessme nts. Most home care administrators expected dietitian hours, services, and staff to increase during the next 5 years. Applications The growi ng home health care market is fertile ground for dietitians. To expand their role in home care, dietitians can position nutrition services a s being vital to cost-effective, high-quality care; augment their skil ls in consultation, training, nutrition support, anti outcomes researc h; strengthen collaborative ties with key home health care professiona ls; and advocate for Medicare coverage of medical nutrition therapy.