Chapter 2 Community-Based Nutrition Services

five to seven days a week. By supporting families and caregivers, an adult daycare program enables persons to remain in their home. Services differ from center to center, but these general services are offered by most (42):

● ●

social activities transportation

● meals and snacks personal care

● ● therapeutic activities

There are three typical types of adult daycare centers: ●

Social: providing meals, recreation, and some health services;

●

Medical/health: providing social interaction and more intensive health and therapeutic services; and

●

Specialized: providing services for specific care recipients such as dementia or disabilities

Depending on the assessed needs of the clients, the interdisciplinary team (IDT) providing care may include the RDN. The adult day-services program is designed to maximize the functional levels of the persons served (42).

Meal programs, such as the Congregate Nutrition Services or the USDA Child and Adult Day Care Food Program, discussed earlier in this chapter, may be applicable for adult daycare program participants. The RDN can help with menu development, identification of meal programs to maximize nutrition, and positive budget considerations. The RDN can also direct the client toward other nutrition programs for use in the home (ie, SNAP, food bank, and SFMNP).

Home Care

Home care includes many services delivered to individuals who require help with activities of daily living (ADLs) or who need medical, nursing, social, or therapeutic services. Home care complements care given by family and friends and allows the older adult to maintain some independence while remaining at home (43).

An increasing number of older adults are using home care services. Because the length of hospital stays is decreasing, more patients require skilled ser- vices at home after hospitalization. In other cases, home care allows individuals to avoid being hospital- ized (44).

As the client population continues to transition from acute care to home care, RDNs are taking a more active role in home health. Nutrition services can help to market a home health agency by giving it a competi- tive advantage. Generally, nutrition therapy services

25

are not included in the list of reimbursable services. They are, however, an allowable administrative cost (44). Home intravenous and enteral companies need the expertise of RDNs and are beginning to expand their role. RDNs can assist in preventing complications that result from weight loss and malnutrition, can work with providers and caregivers on cost-effective nutri- tion interventions, and can work with insurance com- panies on reimbursement issues. Other important roles for RDNs and NDTRs in home care include educating clients and caregivers and developing nutrition care maps and protocols (such as nutrition screening and referral procedures).

Knowledge of regulations for home care (nutrition care, education, and equipment use), visibility with direct-care staff, and public relations with administra- tive personnel are essential for RDNs in home care work. To work in home care, dietitians also need train- ing in how to make a successful home visit because this area of practice is unique.

Providing nutrition counseling in a client’s home—whether that is an individual’s apartment or house, in assisted living or in a retirement community — provides an excellent opportunity for the RDN to assess the client and then negotiate interventions to achieve mutually agreed-upon client- centered goals. Communication of the nutrition interventions to other home care team members is essential for ongoing edu- cation and reinforcement. The extent to which the RDN is involved will depend on reimbursement, agency policy, and the number of hours the dietitian is employed.

Home Therapy and Home Infusion Services

Most home health agencies have therapy services avail- able for homebound clients. Physical therapists, physical therapy assistants, occupational therapists and occupa- tional therapy assistants, and speech language patholo- gists visit clients in the home to assess and provide therapies as needed. Nu trition professionals can work jointly with therapy services, including speech language pathologists, to provide information on appropriate food consistencies and suggestions for dysphagia diets. Home infusion is accepted as a safe, effective option compared to inpatient care for many disease states and therapies. Normally, infusion therapy pro- viders are a “closed-door,” state-licensed pharmacy specializing in providing care to clients at home or other alternate sites. This is known as a home infusion therapy pharmacy. The physician overseeing the cli- ent’s care originates infusion therapy with a prescrip- tion order.