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Professional/Business Questions
What can a dietitian offer to my AL Facility?
A registered dietitian can offer so many valuable services to the AL residents! The dietitian is a crucial part of the Assisted Living environment by educating and providing expert meal planning to the residents to keep them healthy so that they can continue to live in the Assisted Living! The dietitian can plan the menu for whatever suits the resident's needs and desires, as well as educate your residents on the physician ordered diets that will keep them healthy and free of nutrition related complications. The dietitian can provide one-on-one counseling or group programs for weight control, diabetes, or heart healthy diets, just to name a few. The dietitian monitors, supervises, and adjusts the dietary department procedures for the continued satisfaction of the residents. The dietitian can also provide inservices on subjects such as hospitality, food safety and sanitation. The dietitian will provide nutritional assessments and suggest appropriate interventions for the residents to promote optimal health and well-being.
 
What is the difference between a dietitian and a dietetic technician?
A dietitian has completed a 4 year ADA approved program and an internship. A diet tech has completed a 2 year ADA approved progam and fieldwork or a 4 year ADA program without an internship. Both pass a registration exam to be given the title Registered Dietitian (RD) or Dietetic Technician Registered (DTR).
 
I am a public health RD. I was just approached by a long term care facility to consult for them. Fifteen years ago I worked in a long term care facility. What I remember most were the regulations, surveys, and constant complaints about the food. I think I am willing to give it another shot BUT I feel a little out of the loop. Your business seems to offer a variety of resources. What would you recommend for someone with a solid background as an RD but little experience with consulting contracts, current therapeutic diets, and other rules/regs?
We have a number of resources I would recommend to help get you started. Our Diet Manual for Extended Care is a great resource for the diets and includes a lot of additional information that is very helpful. Our Mock Survey book has all the food and nutrition regulations in it, and it's a great way to review all the regs. We carry an MDS 2.0 Assessment Guide that will really help you with all the documentation that has to be done for the government. If you need assessment, progress note and care plan forms, our MNT Made Easy is a great resource. In addition, the Weight Calculator can help you stay on top of essential information for your documentation. We also have a number of CE programs that can help you learn all the essentials of the regulations, care planning, etc. And information such as Policies/Procedures and HACCP information in case you need to brush up on the food service side.
 
What advice can you offer for an RD wanting a career in LTC?
Go for it! We need good RDs in long-term care. I would advise you to consider starting in a single facility and gaining experience in all aspects of the food and nutrition department. Join CD-HCF (Consultant Dietitians in Health Care Facilities, a dietetic practice group of the ADA), and participate in their electronic mailing list. Over 500 members participate, and any and all questions are welcome. Support and help are just an email away. Also, obtain a copy of the federal regulations from CMS, and learn the regulations and interpretive guidelines inside and out. Go to as many seminars as you can read as many articles as you can, and purchase some good resources. Learn how to look at the big picture, put good systems in place in your facility, and work as a member of the interdisciplinary team. Good educational and support systems are necessary, as you may feel all alone out there otherwise. These support systems are a key to success in long-term care. Good luck, and I hope you do choose a career in LTC--our older adults are a treasure that need to be cared for.
 
I'm hoping you might be able to provide some insight for me into hospice care. Specifically: 1) Which resources would you recommend to learn about the role of an RD consultant in hospice care? 2) From your experience in Ohio, what percentage of hospice patients require RD consults--are there regs (ie. Medicare, Medicaid, etc.) that require nutritional assessment of these patients by an RD? 3) Do you have any nonproprietary insight into how hospice organizations bill for nutritional services, and in your experience with the LTC nutrition practice group, do you have any feel for what RDs on the east coast might charge per patient visit?
Hospice care is very different from wellness care (as I'm sure you realize). The goal is comfort care primarily, and a lot of education is often needed to keep the individual comfortable while teaching the family that it is OK if their loved one is not eating and drinking everything they "should". We have a number of resources that would be helpful: our Diet Instructions, and we also carry Peggy Arcement and Kathy McArthur's Resource Guide for Pallieative Care (information available on our website). In addition, ADA has Nutrition Care for the Older Adult, it contains a chapter written by Charlette Gallagher-Allred on Palliative Care. The book can be ordered from ADA at 800-877-1600 X5000. As far as what percentage of hospice patients require an RD consult, I personally believe most of them need one...However, your referrals will depend on how much you interact with the care teams, educating and networking with them so they understand who and when to refer. We attend the care meetings to get our referrals. Often times if the RD is not very involved with the team, referrals come too late to offer any real help. There are Medicare regulations and I believe some reimbursement for RDs in hospice, but I'm not at all familiar with these. You might ask the agency you are working with. We understand that a good part of the funding for our services comes from donations. We charge on an hourly basis and are contracted for a certain number of hours per month. Most of our work is done in the office--attending the care meetings, reviewing charts, calling patients and caregivers, working with nursing on providing instructions, and occaisionally home visits. We can be much more efficient with our time this way.
 
I have only about 1 month to come up with a 30 minute inservice on "Nutrition and Hydration" for both patient care and foodservice staff at a 100 bed nursing home. I'd rather not just lecture, but would appreciate any creative suggestions for how and what to teach. It's hard to figure out how to fit this much in to such a short timeframe and tailor it to such a wide audience, and I am hoping others can share what has worked for them in a similar situation.
A number of great resources have already been offered via the Internet. If you are looking for a pre-prepared packaged program, we offer "Hydration: It's a Splash!" inservice, designed to teach staff and get them excited about hydrating residents. It's prepared in Power Point with CD-Rom and Hard copies of slides, notes, posters, and other resources. Order on our website at http://www.beckydorner.com/tr.php, or by calling 800-342-0285.
 
How can nursing and dietary most effectivley work together to prevent weight loss and intervene appropriately when it occurs?
Preventing and treating weight loss has to be a team effort. I would recommend a multifaceted approach: 1. Education: Understanding the federal regulations, interpretive guidelines and survey protocols and sharing pertinent information with nursing and dietary staff. Do frequent inservice training with both nursing and dietary. Stress the importance of working as a team for the benefit of the residents. 2. Systems: Use the systems you already have in place. The MDS Roster Matrix can help you identify residents at risk (those who have already lost weight, those who are not eating well, those who have difficulty feeding themselves, etc.). Make sure you have a good weight tracking system in place, and that weights are accurate and timely. Be sure there is a good food intake monitoring system in place. Managers should "manage by walking around" at meal time--do mealrounds in the dining rooms and on the wings. Intervene, supervise and retrain staff as needed. 3. Communication: Have weekly meetings to discuss residents who may be at risk. A "Nutrition at Risk Committee" or "Weight Committee" that includes all pertinent members of the team should be included. Be sure that everyone on the team gets a copy of the weekly weight reports, the roster matrix, or other pertinent information. Use good communication tools--in writing, not just vocal messages. Use a communication book or other tools to assure that everyone has access to pertinent information regarding high risk residents. 4. Dining and Food: Maximize the dining experience by assuring that residents receive the food they like at the proper consistency; food that is served in a timely manner and is at the proper temperature. Train staff on hospitality service and customer service. Focus on making mealtime as positive as possible, offering residents as many choices as possible (where to eat, who to eat with, what to eat). Assure residents receive the assistance they need to eat the meal. Call all staff out at meal time and take a "hands on deck" approach to meals: all staff can pass trays, open packages, cut foods, pour liquids, and provide verbal cueing as needed. This frees the STNAs up to feed those residents who are totally dependent. Make the most of the food served by enhancing favorite foods. Add additional calories and protein to food served (create a super cereal, super soup, or power potatoes by adding margarine, half and half and other high calorie/high protein ingredients). Focus on providing food first.
 
I would like to break into the field of speaking at health care professional conferences. My specific interest is in the role of the gut flora in food allergies. I have a few general questions about “how to get started”. 1. Promotions – I will be contacting the planning committees for upcoming conferences (at least one year in advance). To promote my services, I would like to create a pdf resume and a brief “self-running” Power Point presentation that will allow me to introduce myself and the topic. Does this sound like a reasonable plan? I have a lot of experience with public speaking, but not on this topic. My resume will not be that impressive (unlike yours!!). Therefore, I need a creative way to catch the attention of the planning committee. 2. Speaking fees –Are the speaking fees set for each conference or do they expect the speaker to indicate their usual fee? What is a reasonable fee? 3. Expenses – What expenses are typically covered? Do you pay up-front and then submit the receipts after the conference?
I think a power point presentation on your speaking is a great idea! As long as it can be easily accessed and viewed in a user friendly way on your website, this will work. Of course, the key will be promoting it and getting people to visit your site. As far as fees are concerned, you should have an idea of what you want to charge. Keep in mind that you may have to travel distances by car or air, overnight stays are also a possibility. This time should all be built into your fee. I do not know what would be reasonable--this is usually based on your experience, your niche, demand, etc. I started by doing about 12 years of free speaking. My first paid engagement was for about $700, and included speaking over a 2 day period, 3 overnights and a 12 hour one way trip! You might ask what they have budgeted for the presentation--sometimes they will tell you and sometimes they won't. So it's good for you to have a fee in mind that will make it worth your time. If you need to build your resume first, you may want to start low on the price. Expenses are usually paid up front by the speaker, and reimbursed after the presentation. Some speakers do a flat rate that includes all expenses--but you take the risk of losing if flight prices or gas prices go up, etc. Travel expenses usually include mileage, tolls, parking, flights, hotel, meals.
 
We currently are an 80 bed skilled nursing facility we have a full-time Dietech and a part time Registered Dietician was wondering if you had any insight on what the RD was soley responsible for, besides overseeing dietech I attempted to look for soem of this information in the manauals we have gotten from you in the past and really looking for something to narrow the scope.
Does your state have licensure for the dietitian? If so, call the Board of Dietetics for your state to get clear definition of what the Diet Tech's scope of practice is in your state. You can also look at the ADA website for deliniation of duties for RDs and DTRs www.eatright.org. Your RD should also be able to help you with this as the DTR is practicing under her protection and should be involved setting the DTRs scope of practice.
 
Do you know of a consulting RD listserv?
Yes, the Consulting Dietitians in Health Care Facilities, a dietetic practice group of ADA. Members can join the listserv free of charge (ADA membership plus CD-HCF membership). Visit www.cdhcf.org.
 
I just discovered your web site after reading your recent article in Today's Dietitian and look forward to reading some of your clinical articles. I'm about to start working as a dietitian in a nursing home on a part-time basis, after lecturing and private practice for 12 years. The state run facility has presented me with a contract that I do not want to sign and was looking for a sample contract that I could use that would be appropriate. I will be working 16 hours per week and am not questioning the hourly rate. If you have anything or any suggestions I would appreciate it.
The only source I know of for sample LTC contracts are in a book published by CD-HCF: Steps to Success. You can find it on their website at www.cdhcf.org.
 
I need any information on QA forms, QI forms, monthly food cost forms and policy and procedure forms for dietary department.
Please feel free to visit our website at www.beckydorner.com. We have a Policy and Procedure manual that includes forms (there is a whole QA section): http://www.beckydorner.com/publications-details.html?id=16 for the book, or http://www.beckydorner.com/publications-details.html?id=58 for the book plus customizable CD ROM. There are also many forms in our Forms book (including cost control forms): http://www.beckydorner.com/publications-details.html?id=11
 
I am an RD who will be teaching my 2nd semester of nutrition class for a 9 week CNA program. Three of the 4- 2 hour labs are designed to teach about I/O (fluids %meal intake), feeding skills and special feeding skills. I have the opportunity to modify the labs if I choose and I think they need help (me too!)I just ordered your catalog and was given the ok to order new resources, so what specific training materials would be the most beneficial to teach these labs?
I would recommend the books in the middle (blue) section of the catalog under training. There are quite a few that would fit the needs for your training. These are actually set up as Power Point Presentations with presenter notes, slides, handouts, posters to reinforce key messages, and additional resource materials such as policies, forms, etc. You can also find these on our website at http://www.beckydorner.com/publications.html?category=tr In addition, you may find some of our other manuals helpful: Policy & Procedure, Healthy Weights, etc.