Under a federal Medicaid Home and Community-Based, Long Term Care Services Waiver, the Multipurpose Senior Services Program (MSSP) provides comprehensive case management to assist frail elderly persons to remain at home.

Each of the MSSP sites provide social and health case management for frail elderly clients who are certifiable for placement in a nursing facility but who wish to remain in the community. The goal of the program is to arrange for and monitor the use of community services to prevent or delay premature institutional placement of these frail clients. The services must be provided at a cost lower than that for nursing facility care.

The services that MSSP clients may utilize include:

Nutrition counseling as well as liquid medical nutritionals have frequently been provided through MSSP. The dietitian may contract with MSSP through their local Area Agency on Aging (AAA).

Clients eligible for the program must be 65 years of age or older, currently eligible for Medi-Cal, and certified or certifiable for placement in a nursing facility. MSSP site staff make this certification determination based upon Medi-Cal criteria for placement.

Home Health Care Opportunities Expand for Registered Dietitians, According to Practice Paper from American Dietetic Association

June 01, 2009

The American Dietetic Association has released an updated Practice Paper on opportunities for nutrition professionals to provide home health care. The paper has been published in the June 2009 issue of the Journal of the American Dietetic Association. It summarizes the expanding role of registered dietitians in home care, such as counseling patients and families, providing and monitoring nutrition support therapies, educating referral sources on the benefits of home care, lobbying for improved home care coverage and advocating for the home care patient.

Practice Papers are evaluative summaries of scientific information and/or practical application that address topics in dietetics practice of importance to American Dietetic Association members. They are intended to provide opportunities for critical reasoning and quality improvement in dietetics practice and to include peer-reviewed perspectives from experts in the field. Practice Papers generally are written on emerging areas of dietetics and should not be interpreted as official positions of ADA.

“There are unlimited possibilities for professional growth for RDs in the arena of home care not only as providers of nutrition care, but also as administrators, case managers and researchers,” said registered dietitian Mary P. (Trisha) Fuhrman, author of ADA’s home health care Practice Paper. “In particular, home care is an expanding opportunity for pediatric and geriatric nutrition specialists,” she said.

According to ADA’s Practice Paper, home care is a dynamic area of health care. Since its inception in the 1880s, it has grown to provide care to more than 7.6 million people with annual expenditures exceeding $57.6 billion in 2007. Ninety-three percent of home care patients are treated by a Medicare- or Medicaid-certified agency. There were 9,284 Medicare-certified home health agencies in 2007 with a total of 253,162 full-time employees. The total number of home health employees was estimated at 867,100 people in 2006.

“The role of RDs in home care can only expand as RDs are involved in providing safe and effective nutrition services in the home and alternate site settings,” according to the Practice Paper. “RDs must adhere to all laws and regulations while providing nutrition services that meet the unique needs and values of the individual. It is also imperative for RDs to be advocates for inclusion of nutrition in (Medicare and Medicaid) guidelines and accrediting body standards. RDs need to know their state home health agency regulations and work with their state affiliates to lobby their state health departments to insure acceptable language that defines at a minimum a definition of a qualified dietitian and nutrition services in home health.”

The paper concludes: “Home care practice is now established, but the opportunities to demonstrate the benefit of more involvement of RDs in home care and home infusion are abounding. RDs can not only provide the nutrition intervention that augments the medical care provided, but through clinical oversight and emotional support, RDs can enhance clinical outcomes as well as positively impact each patient’s quality of life.”

See ADA article

• Specialized Diet Planning: Home care dietitians create individualized plans to address each patient’s illness and special health needs. The home health care dietitians take into consideration each patient’s unique lifestyle to create a healthy diet plan for their needs. Home health care dietitians can also provide nutrition education for patients and their families that focus on nutrition concerns and each patient’s particular illness.

• Enteral Nutrition: Enteral Nutrition is a nutrition support service for patients who are not able to receive nutrients by mouth but do have functioning digestive tracts. With enteral nutrition support, an individual receives nutrition through a feeding tube placed in the patient’s stomach or intestine. This service is commonly needed by stoke patients who have trouble swallowing, patients with neuromuscular diseases, or patients with head or neck cancer.

• Total Parenteral Nutrition (TPN): Total Parenteral Nutrition is for patients who are unable to receive nutrients by mouth or feeding tube. This form of nutrition support uses IV infusion therapy to supply patients with a balanced amount of calories, vitamins, minerals, proteins, and fats as prescribed by their physician.

• Type 2 Diabetes
• Heart Disease
• Gastrointestinal Diseases
• Kidney Disease
• Liver Disease
• Gallbladder Disease
• Unintended Weight Loss