Nutrition Interventions In Wisconsin

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Nutrition Interventions In Wisconsin

• Jennifer L. Keeley, MS, RD
• Nutrition Coordinator
• Wisconsin Bureau of Aging and Long Term Care
  Resources

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The Past, Present and Future

• But first, a little about our state.

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Funding and Resources for ENP Meals
Average meal cost in 1998 5.40
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6 AAAs 71 counties 1 tribal county 10 tribes
AgeAdvantAge 24 counties, 1 tribe Bay AAA 16
counties, 3 tribes Dane County 1 county Milwaukee
AAA 1 county Northern AAA 23 counties, 7
tribes SoEast AAA 6 counties
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Wisconsins Magic WAND

• Training
• Advocacy for state funding
• Advocacy on federal level
• Leadership opportunities
• Newsletter
• Web Page
• List Serve

Wisconsin Association of Nutrition Directors
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1995 RDs in WI Aging Network
WI State Office 1 WI AAAs (7) 1 Nutr Prog
Directors (82) 3
Role of RD
8 hours per month minimum Menu approval Oversee/ev
aluate sanitation
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Informal Campaign to Increase Nutrition Time in
Network
Battle cry You cant afford NOT to have an RD!

• EXPANDED ROLE OF RD
• Manage food cost, menu savings
• Meal contract, quality assurance
• Menu planning taste, texture, color
• Aging plans, program outcomes
• Nutrition education planning
• Nutrition screening, follow-ups

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How do I pay for an RD?

• Title III funds
• State dollars
• Local county funding
• Donations
• Grants - local and community foundations
• HMO - become a service provider
• MNT

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Where do I find RDs, CDs, DTRs?

• Nursing Home Consultant
• County Nursing Home
• Public Health/WIC
• Hospital
• Caterer, food contract
• Clinics
• UW Extension
• Universities, colleges technical colleges

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Other Ways to Increase Nutrition Time

• Students
• Internship practicum, CUP rotation
• outreach to programs for special projects
• Who will supervise?
• AAA RD is adjunct instructor
• Activities
• Nutrition education activities
• Make Nutr Ed materials
• Menu nutrient analysis
• Screening results tabulation

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How to Keep RDs Once You Have Them

• Annual Orientation and Refresher
• AAA or State RD visit within first week
• Provide resources
• Buddy system
• On-going training - offer CEUs
• Get them on committees
• Have them speak at training

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Nutrition Screening Tool
More than a Meal? - More than a Form 1.
Nutrition problem awareness for participant 2.
Information to Aging Unit about problem areas for
participants as a group - to target nutrition
education and other services 3. Required
reporting to AOA
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Nutrition Screening Tool

• In Wisconsin we call it Nutrition Check
• It has evolved over the years to meet the needs
  our network.
• As Nutrition Intervention Program has taken
  off, we developed a Nutrition Check Plus for
  more extensive information gathering.

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The Past

• THE PIONEERS
• The Birth of the
• Nutrition Intervention Program

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Marathon CountyNutrition Intervention Program

• 1996 Aging/Nutrition Director working on
  Masters Thesis
• Observed need for more than a meal
• Contracted with hospital and clinic RD
• Some grant
• Now RDs do ALL of the HDM assessments and
  follow-ups

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Eau Claire CountyNutrition Intervention Program

• Task force formed in 1997
• Began targeting recent hospital discharges
• Retired volunteer RD on advisory council,
  contract consultant dietitian and AAA dietitian
• Most tools and forms used in the state today
  for NIP were developed in this project

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WI Nutrition Intervention Manual - NIP

• Over 1,000 pages of resource support for RDs
  doing interventions
• Developed by Pam VanKampen, RD Northern WI AAA
  in 2000
• www.WisNutrition.com (incomplete)
• Available on CD Rom

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Goals

• Participant's goals should be specific and
  measurable.
• Broad actions are difficult to measure.
• Specific support should be given to assist
  participant to achieve goal.
• Examples of "acceptable" and "unacceptable" goals
  are listed below.

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Goals-Oriented Approach

• Goal Increase fruit and vegetable intake
• Unacceptable- I will eat more fruits and veggies.
• Acceptable- I will have fruit juice with
  breakfast, a vegetable with lunch and dinner and
  fruit as a snack in the afternoon.

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Goals-Oriented Approach

• Goal To obtain good foods regularly
• Unacceptable- I will take public transportation
  to the store.
• Acceptable- I will take the D4 bus or call the
  senior center for a ride to the Wonder Mart on
  Main Street once a week to buy food.

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Spreadsheet Personal Info
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Profile of Intervention Participants

• 80 female
• 70 live alone
• 33 low income
• 81 years old ave.

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Interventions Received (2001)

• 99 meals
• 2 second meals
• 19 liquid nutritional supplements
• 48 counseling
• 30 nutrition intervention
• 22 refused interventions

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Spreadsheet - Assessments
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Nutrition Problems Identified
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The Present

• Outcomes from a successful Nutrition Intervention
  Program

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Outcomes

• GOAL At least 80 of individuals shall maintain
  their current health status / nutrition risk or
  progress toward the optimum nutrition goal /
  lower nutritional risk rating.
• EXCEEDED GOAL 93 of those reevaluated
  maintained or progressed toward goal.
• 30-35 withdrawal / drop-out rate

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Nutrition RiskBefore and After Intervention
1998 2001
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Outcomes

• GOAL Community agencies and individual
  participants shall view this service as valuable
  by making voluntary contributions toward the cost
  of this service.
• RESULTS 23 of suggested donation has been
  received (407 of 1790)
• Cost of service is 40/hour , Suggested donation
  15

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Outcomes

• GOAL At least 85 of older adults receiving
  in-home nutrition counseling and intervention
  will express satisfaction in the service and
  information provided.
• EXCEEDED GOAL 100 have expressed satisfaction
  in the service and instruction

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Nutrition in WI ENP - History
1995 2002
WI State Office 0 1 WI AAAs 1 of 7 4 of
6 Nutr Prog Directors (82) 3 14 Aging Unit
Directors (82) 0 2 Nutrition Intervention
(82) 2 23
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The Future

• Expanding Nutrition
• and the Nutrition Intervention Program

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The future

• Next Aging Unit Plan Cycle
• Congregate
• baby boomer focus, new name, advisory groups,
  chef menu, cooking class, nutrition counseling
• Home Delivered
• enhanced assessment for HDM, falls risk
  assessment, Alzheimers support

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The future

• New menu requirements and nutrient analysis
  policies will increase demand for RD time
• RDs will help develop sanitation training
• RDs using PDAs (palm pilots)
• Nutrition Interventions in 82 of 82 Nutrition
  Programs