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Nutrition

Evaluations Report

IV. TITLE III PROGRAM ADMINISTRATION AND SERVICE DELIVERY

C. NUTRITIONAL EXPERTISE OF PROGRAM STAFF

The 1992 amendments to the OAA included several provisions about agency functions that are to be carried out with advice from dietitians or "individuals with comparable expertise in nutrition and older people" (henceforth denoted as "comparable individual"). For example, Section 307 (a)(13)(L) of the OAA states that SUAs should plan, coordinate, and monitor nutrition services under their state plans with the advice of a dietitian or comparable individual.

The legislation authorizing the current study highlighted the need to look at levels of nutritional expertise among officials who oversee and operate the ENP. In order to address this research issue, survey data were obtained on the numbers of staff with nutrition credentials and their duties, for each level of program administration. These findings are reported next.

1.Nutrition Credentials of SUA-Level Staff

A substantial majority of SUAs--85 percent--have at least one staff member that is an RD or has other nutrition credentials (Table IV.18). The current study did not ask for a breakdown of how SUAs obtain the services of the staff with nutrition credentials. However, a recent AoA study found that the majority of SUAs with at least one RD or comparable individual use state nutritionists, while the others have contractual or other arrangements for the use of dietitians from other agencies or organizations (for example, other state/local government nutrition staff or university-based dietitians; see U.S. Department of Health and Human Services, Administration on Aging 1995). That study also found that most state-level RDs or staff with comparable qualifications do not work full-time. In SUAs with at least one RD or comparable individual on staff, the hours for this staff member average about 29 per week, ranging from full 40-hour schedule to an as-needed and voluntary basis. In some instances, the individual is shared with another agency or a university.

TABLE IV.18

NUMBER AND DUTIES OF REGISTERED DIETITIANS IN TITLE III ENP

(Percentages)

Characteristic

SUAs

AAAs

Nutrition Projects

Have Access to Staff with Nutrition Credentials

85

73

60

Registered Dietitians (RDs)




Number of RDs




0

31

39

59

1

51

50

31

2 or more

18

11

10

RDs in Positions Requiring RD

52

52

35

Duties of RD




Perform management or administrative duties

54

29

20

Provide technical assistance or training

69

60

37

Develop materials, procedures, or standards

63

54

33

Monitor or assess services

61

51

33

Provide services

--

--

36

Staff with Other Nutrition Credentials




Number of Staff with Other Credentials




0

60

64

59

1

31

23

18

2 or more

9

13

23

Types of Other Staff Credentialsa




Dietitians but not RDs

4

5

8

Nutritionists but not RDs

13

6

18

Certified dietary managers

*

5

21

Dietetic technicians

2

2

2

Graduates of four-year nutrition programs

7

9

5

Graduate home economists

15

8

17

Certificate or training in food handling, service, or sanitationb

2

6

15

Course work in nutrition or food serviceb

4

3

4

Graduate of other related four-year programb

2

1

1

Other

4

4

7

Staff in Positions Requiring Nutrition Credentials

15

15

15

Unweighted Sample Size

55

401

242

Source: Elderly Nutrition Program Evaluation; SUA, AAA, and Nutrition Project surveys; weighted tabulations.

a Percentage may add to greater than percentage with staff having other credentials because of multiple answers.

b Category was not an option on questionnaire. Frequencies are based on verbal responses to "other--specify" option and therefore may not capture all staff who possess those qualifications.

* = Less than 0.5 percent.

The majority of SUAs--about 69 percent--have one or more RDs on staff (Table IV.18). The median number of RDs at the SUA level is one. For about three-quarters of the SUAs that have an RD on staff (or 52 percent of all SUAs), the RD occupies a position whose job description requires the job holder to be a registered dietitian. Staff with RDs perform a variety of functions at the state level. At all SUAs with an RD (69 percent of all SUAs), the RD provides technical assistance and training to AAA or nutrition provider staff. At 92 percent of SUAs with an RD (63 percent of all SUAs), the RD develops procedures or standards to be implemented and followed by AAAs and service providers. Similarly, 89 percent of SUAs with an RD (61 percent of all SUAs) use the RD to monitor and/or assess nutrition services provided by AAAs and projects. Somewhat fewer (78 percent of SUAs with an RD, or 54 percent of SUAs overall) give RDs management or administrative responsibilities. Other job responsibilities for RDs reported in the SUA survey include advocacy work for aged people, fundraising, public relations, and serving as liaison with other state agencies.

Approximately 40 percent of SUAs reported having staff with expertise in nutrition other than an RD degree (Table IV.18). At SUAs with these staff, 38 percent (or 15 percent of all SUAs) have staff with home economics degrees, and 33 percent (13 percent of all SUAs) have staff with advanced nutrition degrees but not RDs. In somewhat more than one-third of SUAs with other credentialed staff (15 percent of all SUAs), the individual is in a position in which the job description requires these credentials.

2. Nutrition Credentials of AAA-Level Staff

Seventy-three percent of AAAs have at least one staff person with nutrition credentials (Table IV.18). Compared with SUAs, a slightly smaller proportion of AAAs--61 percent--have an RD on staff. Half of the AAAs have one RD, and 11 percent employ two or more. The median number of RDs at the AAA level is one. The duties of virtually all RDs at the AAA level include providing technical assistance ortraining to nutrition projects or meal sites (98 percent of AAAs with an RD; 60 percent of all AAAs). High proportions of AAAs also reported that their RDs develop procedures or standards (89 percent of AAAs with an RD; 54 percent of all AAAs) and monitor or assess service delivery (84 percent of AAAs with an RD; 51 percent of all AAAs). A much lower proportion of AAAs--48 percent of AAAs with an RD or 29 percent of all AAAs--reported that their RDs routinely perform management or administrative duties. Other reported job responsibilities for RDs include providing nutrition education and counseling, conducting menu planning or review for compliance with USDA or Title III standards, developing fiscal reports, and promoting community relations.

Slightly more than one-third of AAAs employ staff with other nutrition credentials, in addition to RDs (Table IV.18). Most commonly, these staff are home economists or graduates of a four-year nutrition programs. In about one-third of the AAAs employing staff with other nutrition credentials (15 percent of all AAAs), these staff are in jobs that require the specific nutrition credential they possess.

3. Nutrition Credentials of Nutrition Project Staff

Sixty percent of Title III nutrition projects are staffed by an individual with nutrition credentials (Table IV.18). However, compared with SUAs and AAAs, nutrition projects are less likely to employ RDs and are somewhat more likely to employ persons with other nutrition credentials. Forty-one percent of nutrition projects have access to an RD. Eighty-six percent of projects with an RD (or 35 percent of projects overall) have RDs in positions in which an RD degree is required. The most frequently reported RD duty at the nutrition project level is providing technical assistance or training to meal site staff (91 percent of projects with an RD, or 37 percent of all nutrition projects). In addition, 87 percent of projects with an RD (or 36 percent of all projects) have that staff member provide nutrition education, nutrition counseling, or other nutrition-related services.

About 40 percent of nutrition projects have a person who is not an RD but has other nutrition credentials performing project-level nutrition-related functions. Many of these staff have multiplecredentials. Certified dietary managers are used at 51 percent of projects with these staff (or at 21 percent of nutrition projects overall). About two-fifths of projects with these staff (about 16 percent of all nutrition projects) employ nutritionists or graduates of home economics programs in this role.