Nutritional guidance for home health patients
by Dr. Mark Pettus
May 18, 2017

While most Americans can expect to live longer than previous generations, this longevity has come with the price of a greater burden of chronic complex disease.

The Centers for Disease Control and Prevention (CDC) estimates that 50 percent of American adults are dealing with at least one chronic health issue and 25 percent with multiple issues.

Home health patients often need specialized diet and feeding considerations. In some cases, patients are transitioning from oral nutrition to tube feeding and vice versa. A variety of nutrition formulas have been developed to nourish people in care. Below are some considerations for the caregivers who serve them.

Nutrition Strategies for Caregivers

1. Assess the client’s overall ability to manage and prepare his or her meals. Some people may overestimate their capacity for fear of losing their independence. The less capable a person is, the more likely they are to rely on packaged, processed foods. A food journal helps reveal eating patterns and serves as a useful guide in determining where nutritional needs are and are not being met, such as insufficient protein or plant-based foods.

2. Target approximately 1 to 1.5 grams of protein/kg of body weight or around 70 to 100 grams/day will meet the needs of most, whether taking orally, requiring enteral tube feeds or some combination of the two. Fish, poultry, eggs, lean meats, dairy and abundant vegetables are good protein sources in addition to providing other important vitamins, minerals and sufficient fiber. If an individual is receiving enteral nutritional support, the macronutrient content can guide, as tolerated, how much volume is necessary to meet these targets.

3. Encourage the reading and understanding of food labels as a guide to meeting daily nutritional needs. Take inventory of what your patient or client likes and has available in the home to help guide “healthy likes.” It is possible to both satisfy nutritional goals and eat for pleasure.

4. Don’t be afraid to get creative, unless an individual is on a special diet where certain foods are prohibited. Green smoothies or shakes with added whey protein can include fruits and vegetables. These colorful, flavor-rich shakes make it easier to incorporate more nutrient-dense servings each day. Clients may find them refreshing and easier to manage on a bad day than a traditional meal.

5. Engage with others in your client’s support network. Communicate and coordinate with a fellow caregiver, friend or neighbor who spends time in the home, to better understand your client’s likes, dislikes and nutritional needs.

Think of Food as Medicine

Sugar and flour-based foods work against weight management, pain control, energy levels and blood glucose control.

Reducing poor quality carbs (bagels, chips, pasta, granola bars, wheat bread, soft drinks, desserts) and consuming better quality carbs (fruits, vegetables, beans and legumes) generally helps people feel better.

For many years, saturated fats have received a bad reputation. Research in recent years has shifted thinking about the benefits of many fats, particularly when sourced from quality ingredients.

Healthier fat sources include butter and full-fat dairy, including preferably organic cheese. Full-fat dairy is no longer believed to be so detrimental when consumed wisely. Prepare foods using olive, coconut, macadamia nut and avocado oils; incorporate nuts such as macadamia and almonds, which can also be ground and added to other foods. If your client is receptive, plan a couple of meals per week with fatty fish such as salmon, trout, herring, mackerel and sardines. Grass-fed meats and eggs, avocados and ghee are also good options.

If you are interested in serving more organic foods, I like the Environmental Working Group’s “Good Food on a Tight Budget” found at

We are also seeing greater evidence that the diversity of the gut’s microbial ecosystem is critical to promoting health, improving metabolism, reducing inflammation, lowering the disease burden and improving quality of life. Incorporate fermentable-fiber foods: These include the cruciferous family of vegetables (broccoli, kale, brussels sprouts) and the allium family (onions, leeks and garlic). Other good choices include apples, berries and pears, as well as beans and legumes.

In addition, fermented foods such as yogurt, sauerkraut, kimchee, miso, tempeh and natto (a fermented soy dish), contain microbes thought to promote a healthy gut. Bone broth may help in joint and connective tissue health as it contains many minerals and amino acids that support bone, cartilage and soft tissues.

Avoid sudden, significant changes in diet. Since a client’s nutritional needs vary based on condition and medications, understanding more, reporting changes in condition and discussing concerns among care team members can help prevent malnutrition and dehydration.

Other Considerations for Caregivers

Physical activity as able. Find out what is most appropriate for the patient. In addition, specific breathing techniques can be helpful in dealing with certain conditions.

Plants to enhance the healing environment. Interaction with nature is known for working wonders.

More natural light. Some amount of direct sunlight is beneficial; however, limit exposure and avoid the sun at its most intense times.

Connection to others (and pets). Social and positive emotional connections are essential for living well, regardless of health condition.