by Karen Sandusky
Home health… so much to teach, so little time! An understatement, right?
As a homecare registered dietitian for the past 20 years, I have acquired an immense respect for what you do as clinicians; in fact, I don’t know how you do it! Medication management would be enough, but then to throw in diet teaching! It’s a lot for you, but as we know, it is overwhelming for our patients and their caregivers.
How can I help? Through this blog post, I hope to assist you by providing helpful hints regarding “coaching” your patients toward making positive diet changes. Remember, a Registered Dietitian referral should always be made as per your agency’s policy.
So… where do you begin? Let’s start with you and your expectations.
BE REALISTIC. The goal is improvement, not perfection! You will not be able to completely overhaul your patients’ diet during the home care service. You may even find that it’s necessary to work on just ONE diet change. WHEW! Now don’t you feel better? The success that your patient has with making that ONE diet change is going to be the motivator for making more changes down the road.
MAKE IT SIMPLE. Remember, our patients are exhausted from their illness and will not have the physical and mental strength to consistently follow a complex disease management program of any type, diet included. Start with the simplest diet change possible, which should be a change that the patient decides they WANT to make and feels they CAN make in the short term.
What’s next? Well, to “cast” a different light on this, I thought I’d relate this next section to a “Fishing Trip.”
SET THE BAIT! (Before Start of Care) Engage your patient/caregiver prior to your visit by simply asking them to pull out any diet instruction materials they have received, as well as their insurance cards and medications. Also, if appropriate, request that they review those materials ahead of time. This promotes the concept of self-management and lets the patient know that they are expected to take responsibility in this “partnership”. It also puts diet right up there in importance with medications as part of their disease management program, and it may even save you some time.
- HOOK ‘EM! (At Start of Care) Get their buy in. Do they agree to be educated on their diet? Give a very brief lecturette. For example, “Lowering your sodium intake is one way to improve blood pressure control, and better blood pressure control will help prevent another heart attack or stroke. Is lowering your sodium intake something you would like to learn more about? Yes? That’s great, Mr. Cardiac!” Compliment the patient on wanting to learn more about their condition and how to stay out of the hospital. If they don’t have diet information in the home, provide them with your agency-approved materials.
- REEL ‘EM IN! (At Start of Care if time permits or at 2nd visit) “It’s wonderful, that you want to learn more about your [fill in the blank] diet. To help you with this, can I tell you about an activity that has worked really well for my other patients who are a lot like you? It is called a Diet Diary (Food Journal/Food Record/Diet Log). Write down everything you eat and drink for 2-3 days. Write the time of day and be as specific as possible with the amount. Will you do this? That’s great! When I come next time, we can look at it together. I will help you problem solve to find a diet change that you decide you want to make and can make. You are managing your medications so well (or something else you can compliment them on) that I know you will be able to do the same with your diet. Can you have this ready for me at our next visit?” Again, this promotes self-management and responsibility. Journaling is an effective tool for behavior change. Many patients in the Medicare age group have never done anything like this and find it extremely eye opening. It also serves as an objective tool and again, may save you time. Note: At United Home Health Services, we put food record forms in all of our Start of Care folders. If your agency does not have a form, you can download a sample here.
- NET ‘EM! (Remainder of visits) Your patient or caregiver has completed a food record. A compliment is again in order because Mr. Cardiac has just made a big step toward a behavior change that will help him manage his disease and keep him out of the hospital. Now from looking at the food record, Mr. Cardiac can choose (with your guidance) ONE diet change he (not you) WANTS to make. The change should be a specific action such as eating breakfast five mornings per week or switching from salt to Mrs. Dash. The change should be achievable in a short time; one week works well. Mr. Cardiac should also decide that he CAN do it and have a confidence level of at least 7 out of 10 that he can make that change. You want your patients to be SUCCESSFUL in making the change by your next visit. So make sure the change is realistic for the patient and simple to carry out. Success in making this one positive diet change is very important. You have just gotten your patient to become an active self-manager by making an ACTION PLAN, and you will build on this one successful action during the remainder of your visits.
So this is a start with diet education in the homecare setting! Be realistic with goals and expectations; keep your information and presentation simple. Then there’s that “Fishing Trip”… Bait them with calling for action even before the start of care by having them pull out their diet materials. Hook them by getting their buy in with agreement to be educated on their diet; then initiate a food record, and use it to help your patient decide what they CAN and WANT to change.
Remember, the goal is not perfection but rather improvement toward living the happiest, healthiest lifestyle possible. And that goes for you, too!
See you next time!
Karen Sandusky is a Registered Dietitian Nutritionist with the Commission on Dietetic Registration. She has been “nourishing” her passion for adult nutrition as staff Dietitian for the past 20 years at United Home Health Services** in Canton, Michigan. Karen is a member of The Academy of Nutrition and Dietetics and Healthy Aging Practice Group; she is a Trained PATH (Personal Action Toward Health) Leader through the National Kidney Foundation of Michigan and is currently working on her Health Coach Certification with the National Society of Health Coaches. Karen is also a member of HHQI’s Home Health Cardiac Council (HHCC).
**United Home Health Services is a not-for -profit, Medicare Certified, CHAP accredited homecare agency that has been serving its community for over 30 years. United also offers caregiver, companion, and private duty services.