Administrators' perceptions of nutrition services in home health care agencies

Ascertain views of home care administrators regarding the need for nutrition services in home care, current status and gaps in dietitian services, and obstacles toward expansion.

Mailed survey.

Members of the National Association for Home Care residing in California, New York, Pennsylvania, Ohio, and Texas. Of the 1,992 questionnaires sent, 402 (20.1%) were completed and used for data analysis.

Descriptive statistics.

Respondents gave high importance to nutrition (6.2 on a 7-point scale), and 39.6% estimated that more than half of their patients were malnourished. Most respondents reported using dietitian services, either as consultants (45.5%) or full-time (5.8%) or part-time (11.9%) employees. Nurses (85.5%) were listed most often as providers of nutrition services; also listed were dietitians (70.6%), pharmacists (17.2%), and physicians (11.2%). More than half of the respondents did not have, but would like to have, a dietitian serve as a nutrition consultant, prepare nutrition care plans, and provide nutrition counseling for patients and caregivers. Primary deterrents noted were lack of reimbursement by third-party payers and lack of physician request. Dietitian services ranked as having the highest value were patient education and counseling, medical nutrition therapy for specific conditions, development of nutrition care plans, staff in-service training, and nutrition assessments. Most home care administrators expected dietitian hours, services, and staff to increase during the next 5 years.

The growing home health care market is fertile ground for dietitians. To expand their role in home care, dietitians can position nutrition services as being vital to cost-effective, high-quality care; augment their skills in consultation, training, nutrition support, and outcomes research; strengthen collaborative ties with key home health care professionals; and advocate for Medicare coverage of medical nutrition therapy.