FAQ

According to Australian standards and regulations, a dietician is an accredited professional with a tertiary qualification whose roles include dietary management of clients with a medical condition and providing general nutritional advice to individuals and services. A nutritionist in Australia may have a tertiary qualification in their field or be a person with an interest in nutrition but limited training or knowledge.

(Source: https://dietitiansaustralia.org.au/what-dietitans-do/dietitian-or-nutritionist/)

Yes. If you have extras you will be able to claim a portion of your appointment with your private health insurance. If you have a Chronic Disease Management Plan from your doctor, you can claim back $53.80 back. The full amount is paid on the day of the appointment and you will need to claim back the portion by your health insurance company or medicare.

It is dependent on your problems. Sometimes one to two sessions are all that are needed to get you back on track. Typically if you are placed on a FODMAP diet, it can take 5-6 sessions over 6 months to get your diet in place and challenge.

Dietitian assessments look at all aspects of the residents care. This includes, medications, diet, eating assistance supplement or special diet requests, bowels, skin. Assessments can vary in time and it is dependent on the information available, resident availability, RN availability and the need for observation. Some reviews can be quick to evaluate the effectiveness. They work well for supplement checks, review of nutrition plans etc. Having staff that know the residents and all documentation available can enable a number of residents to be reviewed and checked quickly.

It is the use of menu items and foods normally available in the kitchen which can be provided to encourage oral intake. This may include working with kitchens to fortify foods. A structured HEHP diet works well. Fortification works with the facility and dietitian. Both should agree on the program that will be put in place, how it will be put into actions, and how it will be evaluated. Lisa’s Structured HEHP diet has been well received and implemented in many facilities. It is cost effective but relies on catering staff to make the recipes accurately and staff to implement and monitor. This means staff have to evaluate the care of their residents. Many options can be worked on over time.

Food can be fortified with milk powders, butter, cream, oils, nut butters, nut meals, as well as supplementary commercial powders to make the meals more nutritionally dense. Food first fortification is only using food ingredients to density the food and the food first approach offers foods such as sandwiches, custard, yoghurt, desserts, soups, additional snacks, cakes and biscuits in addition to the recipe fortification.

Projects can vary from food service style projects to clinical projects such as bowel, probiotics, hydration, medications or meal enhancers. Should we be looking at the CAUSED model for addressing eating and dementia? In the past I have worked on programs for reducing aperients, reducing cost of supplements and improved nutrition with texture modified diets.

If trends are identified, these projects can be collaborative. Lisa had access to students for food service projects once a year (typically in October). These projects can be incredible sources of information as they students are on site for 4 weeks. Ethics approved studies can be sort for publication of projects.

Ethics approved studies in the past

• HEHP diet introduction and weight change.
• Comparison on intake with traditional scoops of puree meals and moulded meals.
• Serve sizes: evaluation of the amount of food consumed and the nutrition intake in comparison to the menu and nutrition guidelines.

Reporting and Benchmarking is a way to assess where improvements can be made. Reports typically are Quarterly. The quarterly reports include:

• Weight change (±2kg, >2kg, <2kg) over 3/12.
• Malnutrition risk (should BMI be available)
• Significant weight loss trends. It will identify those residents with a <5% weight loss trend and those with >5%, >7.5% and >10% Significant weight loss.

The time taken to complete this task is dependent on how easily the information is accessible and quick to calculate. Monthly reports can be provided: summary of the residents seen, initial/review, reason for seeing, if the program was implemented /successful/unsuccessful/partially successful with goals, supplement or food first options and any comments.

Typically audits can be done on food service. Meal waste and taste audits are conducted. Information on how well the residents received the meal can be collected too.

Other audits on supplements, HEHP diet, snacks and other quality activities can be conducted.

Weight % change audits are helpful to monitor effectiveness if programs, pick up areas that have unknown issues or monitor residents using categories (more assistance, less assistance, dementia, texture mod diets, BMI etc)

Reporting can look at the meals as a whole, look at residents with supplements/HEHP and their intake, compare diet textures etc.

A meal waste audit can be done in a dining room rotated each visit. It give the facility ongoing quality data, the dietitian observes the dining room and eating issues of residents can picked up quickly. When picking up issues, it is learning opportunity for staff.

Mealtime experience quality audits can be conducted as well to review the meal experience.

Yes. We can offer a toolbox session and longer sessions depending on your needs, staff, allocated time. WE call these out ToolBOK sessions as they are “Booster of Knowledge”. We are happy to talk to you about our topics or design a session specific to address your needs and gaps. The more upskilled your staff, the better information we can gather to make a more informed holistic assessment of the residents.

• Costs are only for the residents referred
• Education on demand (a paid service)
• Reporting on weight, malnutrition, monthly stats and quarterly reporting (a fee is charged for large reporting)
• You are paying for well utilized time. Our dietitian use every minute effectively.

• Overall higher cost per hour due to being ad hoc.
• Costs can be high one month and low in others.
• Service may not be within the week of referral due to time constraints.
• Time to travel between facilities can make up most of the day which prevents more assessments to be conducted.
• Dietitian does not have a good sense of programs working and not working as they may only come in randomly and maybe even once to twice a year.
• Possibility of residents missed when smaller weight loss occurs. More difficult to regain weight loss after large weight loss has occurred.
• Less likely for a review of the program unless called. Residents may not have program implemented or working well for many months.
• Diet programs and information constantly changed on each visit.
• Limited work on the Quality standards can be implemented well when only called in to see a specific resident.
• Difficulty getting information if RN not available to provide information.
• No time for informal education if Dietitian pick up an important improvement process.
• Not always clear on kitchen processes as these may change with no communication to Dietitian; often limited time to find out details, discuss and determine any changes
• Lack of additional monitoring by Dietitian of a program and its effectiveness.
• RN would need to be available to the dietitian at the time dietitian is on site for information on resident and handover.
• Little flexibility for families to meet with dietitian.
• Dietitian may need to make multiple trips each month if staff are identifying residents each day. Seeing only one resident in a visit may also limit the ability for a holistic program to be implemented as only one element is seen and it may not fall over a meal or snack time. These times are very useful to observe. Many small changes can be made to improve intake but observing a meal time.

• Staff get to know the dietitian and form good working relationships.
• Informal education occurs as staff and dietitian discuss issues.
• Issues are identified and solved quickly.
• Program implementation problems are quickly fixed.
• More can be achieved in the regular visit such as an audit, education, observations of dining environments. Any problems identified can be managed quickly.
• More residents reviewed in a block of time.
• Dietitian can check programs quickly and ensure they are effective. Small adjustments can be made.
• Minimum cost known each month.
• Projects can be monitored easily while on site.
• Various nutrition relevant information can be gathered in a regular block which can formulate or affect the implementation of a program.
• RN can be available for a short time on the specified day. This can make the assessments go quicker.
• Diet information is adjusted once a month and not at all times of the month.
• Better pricing per hour for the facility.
• You are paying for well utilized time. Our dietitians use every minute effectively.
• More flexible times for families to meet with the dietitian if the dietitian is on site.
• A list can be made ahead of time and all residents seen.

•  A longer length of time between assessment which means a longer wait for a resident to be seen.  However, should this be urgent a visit can be arranged.