The Role of the Registered Dietitian in Home Health Care: Definition and Efficacy

OLES of nutrition specialists in home care have not been well defined. This is especially true for the registered dietitian (RD) R and is largely because of (1) lack of regulations within home care for services provided by specific disciplines and (2) limited reimbursement of dietitian services. Definitions of job duties and descriptions for dietitians in home care have been accomplished through modifying those for other disciplines (nurses, pharmacists) or those for hospital dietitians, neither of which reflects what the home care dietitian does or should do. Therefore, a survey was conducted to determine what services RDs were providing for a large provider of home nutrition support, including infusion services. Twenty-six branches were surveyed, with information obtained from 25 dietitians employed as either fullor part-time home care clinicians. Twenty-eight separate job functions were delineated from this survey in addition to those described in the corporate job description. Most of the job duties that were not listed as a part of the standard job description would be considered advanced practice skills, such as clinical management of total parenteral nutrition (TPN) patients, support and assistance to the reimbursement staff, sales support for joint sales calls, development of presentations for patients and customers, and community involvement in both professional and patient-oriented activities. This survey has assisted in developing a more inclusive and accurate job description for the RD. In addition, such a study allows the clinical and sales staff as well as the dietitians to better coordinate and delegate the functions required to achieve successful patient outcomes with quality Medical Nutrition Therapy (MNT) (Ireton-Jones C. Duties of the registered dietitian in a national home infusion company. Unpublished study. Dallas, Tex, 1997.) The Joint Commission for Accreditation of Health Care Organizations (Joint Commission) has had good rationale for including MNT provided by the RD in its new standards. Outcome data have been collected from numerous studies substantiating the need for and efficacy of providing MNT in home care services. ’ The new requirements include a revision in the approach to patient care and identification of physical characteristics sensitive to change. The revisions allow for more measurable outcomes. The new Joint Commission standards have closely integrated MNT with other essential therapies to enhance the healing process. The RD in home health care can delineate how nutrition can be integrated with these therapies to meet recommendations for compliance with the interdisciplinary approach currently mandated. The Joint Commission mandates that quantifiable nutritional goals will be generated for each patient. The RD can provide suggestions for the establishment of these goals through nutrition screening and assessment parameters as they relate to specific disease states (Fig 1) (see box, “Typical Nutrition Therapy Programs Currently Contracted”). Regarding monitoring and follow-up , reassessment must be provided at specific intervals and goals for quantifiable changes evaluated at this time. The RD