Nutritionist home visit on a budget?
May 15, 2012 8:33 AM   Subscribe

I'd like to hire a nutritionist or a student nutritionist (there is a nearby college that offers degrees in Nutrition Science) to visit my mother a few times a week to create meal plans and give instruction. Is this (a) insanely expensive, (b) legal, considering a student would not have any legal standing to give health advice?

My mother is in dire need of food education. She is diabetic and cannot drive. She has a host of diet-related health issues, including congestive heart failure. She needs to cut down on salt dramatically. My father travels for work and leaves her for weeks at a time. A neighbor checks in on her every few days. Since she cannot stand for more than a few minutes at a time, she eats a lot of convenience food. That's where the salt comes in. She called 911 for "asthma" a few weeks ago. It was fluid in her chest cavity pressing on her lungs. She almost died. I cannot afford a lot, maybe $300 a month. I have offered to have her come stay with me for a while, but it would be temporary and with her health the way it is, she does not want to be away from her doctors. I live 6-7 hours away. What can I do?
posted by domo to Health & Fitness (15 answers total)
In the US at least, the title "nutritionist" does not imply any legal qualification for anything. Anyone can call him or herself a nutritionist with no qualification or certification whatsoever.
posted by tylerkaraszewski at 8:48 AM on May 15, 2012

Do you think your mother would be able to implement food education and/or meal plans? I see that she cannot stand for more than a few minutes at a time -- would she be willing to cook and assemble foods? Learn about nutrition? The reason I am asking is I wonder if what your mother needs more immediately is simply prepared (healthy) meals. She might qualify for a "meals on wheels" kind of service or there are other ways to get prepared food to people in need.
posted by ClaudiaCenter at 8:50 AM on May 15, 2012 [7 favorites]

My wife, a dietitian, responds:

First off, I think it is great that you are taking such care of your mother even from 6-7 hours away. If you are seeking consult, my first recommendation would be to make sure that you are seeking out a dietitian. Going to the nearby college is a great idea for cheaper services and dietitians have to complete a didactic internship so a student may be able to use that time as their hours towards a community, public health, or even long term care rotation in which you would get those services for free! If that is not an option after contacting the school make sure you see a dietitian, anyone can use the term "nutritionist" but for licensing purposes and credibility look for the RD/LDN (Registered Dietitian/licensed Dietitian Nutritionist). There are many consulting companies that do home visits for patients like your mother. I work for a consulting group that does this exact thing, and they can spend an hour on diabetic education as well as portion control, meal planning, and healthy choices for low sodium diets. The kicker is, that the dietitian can come in, work with your mother ask if she has any questions, review and revisit as she requests or is required, but ultimately she has to want to make those healthy decisions. Some people like to play the blame game of saying they saw a dietitian but it didn't work or they failed them when in actuality they provided the knowledge and tools needed, but a behavior change has to start with the desire to change. It isn't as simple as making the choice of "I want to eat better." Especially with food it is a constant consious decision and food plays so many roles not just nutritionally, but emotionally, socially, and in effect physically. I am not discouraging seeking consult, I think it is a great idea, but I would have conversations with your mother, see if she wants to make the change as well. If she does not want to make the change, my next question would be who does her grocery shopping? Either sit down with her (even over the phone) to formulate the list and meal ideas, if she uses Peapod or something similar see if you can review her list first encouraging fruits and vegetables (just watching portions on fruits in terms of diabetes), and if she does a meal service ask them to change the meals to low sodium, etc. such as a Seatle Sutton. It may be easier and more worth your money to have meals prepared and preportioned as well.
posted by MustardTent at 9:00 AM on May 15, 2012 [7 favorites]

If your mother is in the United States and has insurance, she can likely see a dietician through a referral from her primary care doctor and have it covered by insurance.

It sounds like part of the problem is, even if she knows what she's eating is unhealthy, she doesn't have the means to eat other things. What about arranging for home delivery of healthy groceries, including things that can be easily eaten without much preparation? What about Meals on Wheels?
posted by treehorn+bunny at 9:16 AM on May 15, 2012 [1 favorite]

My mother lives in rural Mississippi. The "nearby" college is about an hour away. There is no service that I know of that delivers that far out in the county. The town where she lives isn't even on the map. There's no post office or town services. Just a highway patrolman and a gas station. I would gladly pay the mileage for anyone who can help her, it's just not likely that there is a preexisting service that goes out there. My father buys her groceries when he is home, which is also a problem because shelf life = bad for you most of the time. My mother says she is ready to make these changes, "if only". If only it were easier, if only she knew what to do, if only someone could teach her, etc. She has met with a dietician at the hospital, but they just gave her a pamphlet and told her to eat more veggies. She needs hand-holding. She needs to know that she's not alone and it is doable.
posted by domo at 9:38 AM on May 15, 2012

Looking around, it seems like I can order frozen foods to be delivered to her in the mail, but that isn't exactly a permanent fix. Also, she has in the past pushed back against "cardboard meals". She wants to eat healthy, but she still wants good tasting food.
posted by domo at 9:44 AM on May 15, 2012

You should pardon the expression, you have a lot on your plate.

The situation is hard but not unsolvable. Check into her insurance and see if a Registered Dietition is available for a home consultation from the nearest hospital, if the university isn't a viable solution.

As for the availability of food, there are lots and lots of varieties of frozen veggies out there. It seems like the things your mom should be eating are veggies, lean meat, very little fruit and whole grains.

Veggies, meat and fruit shouldn't be that difficult. Most can be stored in freezers and there are easy recipes and preparations. Invest in a crock pot for stews and soups. My dad, who is diabetic, has eaten oatmeal for breakfast every day since he's been diagnosed. That can be prepared stove top or microwave.

So if she really wants to change, the hurdles you describe are really not that big of a deal. I suspect that she's resistant to making the change. Perhaps a bit of therapy would be in order as well. A behaviorist who can break down the resistance and funnel her energy into positive changes.

It sounds like you're buying into her feelings of hopelessness. You've suggested quite a few things, and when she poo-poos them, you agree and take that on board. Who's to say that the delivered frozen meals will be unpalateable? Is convenience food that much better?

You might also want to check with a local church for outreach. Perhaps they have someone who can assist with getting groceries, or preparing a few meals in advance for her? Perhaps you can advertise for someone to do this for a few bucks extra?

Just some thoughts.
posted by Ruthless Bunny at 10:02 AM on May 15, 2012

Just to add onto MustardTent's wife's excellent advice, the difference between a nutritionist and a dietician is like the difference between a toothologist and a dentist. Dentists are licensed by the state and reviewed by their peers to ensure adequate ethics and competency, whereas a toothologist would not only be unvouched for but would be conspicuously so. Nutritionists are the same way, anyone can call themselves a nutritionist, all the way up to the hydrogen peroxide injecting and laser reikii ends of the woo spectrum.
posted by Blasdelb at 10:38 AM on May 15, 2012

I wonder whether you could just find someone to come cook for her twice a month and fill the fridge with healthy foods. I'm thinking someone who would charge $150/visit, where each visit involves going shopping from a list and filling the freezer with portioned batches of good healthy food. Like:

* bean soup
* spinach "creamed" with skim bechamel instead of cream
* chicken soup with plenty of good white meat chicken and veggies still in it
* turkey and veg chili

In my experience the elderly are not open to being trained to think differently about food; and the energy involved in prep can be prohibitive. (Even for myself, honestly, when I'm tired and hungry, I'm probably not going to stand there and make a healthy meal when there's a tasty salty fatty frozen lasagna just waiting to be defrosted.) But if it were already prepared and portioned and she just had to microwave it, it'd be easy.

My guess is that you could open any diabetic food website and find five or ten usable recipes.

As for where to find someone, maybe the same college kids you were thinking of paying for their consults would do this instead.
posted by fingersandtoes at 12:00 PM on May 15, 2012 [1 favorite]

Oh, I just saw that college is an hour away. But even a neighbor might be willing to do this; someone could surely use the money.
posted by fingersandtoes at 12:02 PM on May 15, 2012

fingersandtoes: "I wonder whether you could just find someone to come cook for her twice a month and fill the fridge with healthy foods. I'm thinking someone who would charge $150/visit, where each visit involves going shopping from a list and filling the freezer with portioned batches of good healthy food."

This is an excellent idea, this being rural Mississippi you might have the best luck finding someone in religious circles. Making these kinds of connections is part of the job description for pastors, just make sure your mother is involved in the finding.
posted by Blasdelb at 12:10 PM on May 15, 2012 [2 favorites]

I agree, surely you could find someone to fill her fridge once a week or twice a month with good food, for labor plus the cost of food. LOTS of people are looking for work or extra income these days. You might have luck with Craigslist, if the religious circles don't work out.
posted by vignettist at 1:08 PM on May 15, 2012 [1 favorite]

It sounds like you are looking for a Diabetic Clinic, which has dietitians who do exactly what you are looking for. I googled 'diabetic clinic mississippi" and got this.
posted by pintapicasso at 2:06 PM on May 15, 2012

I have made her an appointment at the nutrition clinic at the college, hopefully it will help. I could ask her neighbor to cook for her, but I'm not sure she knows how to make a healthy low sodium diabetic safe meal. As for the church thing...Mom's kind of a militant Atheist. If she was starving to death but all she had to do was listen to someone talk about God to get a meal, I think she'd sooner starve.

Oh, and she's not elderly. One of the sad things about this is she's only 47.
posted by domo at 7:20 PM on May 17, 2012 [1 favorite]

If she wouldn't be willing to hide her atheism or to never hear the end of blathering about God, then, your right, churches are probably not the route for her. It is a shame because this is, like exactly, what they're for.

There will probably be a local hospital, you might try stopping by and seeing if the receptionist would be willing to pass a flyer around for the nurses or have any other ideas.
posted by Blasdelb at 7:33 PM on May 17, 2012

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