M EM O R A N D U M
TO: D.C. Delegation to the Ryan White Planning Council
FROM: D.C. Nutrition Alliance
DATE: July 20, 2000
RE: Ideal Ratio of Registered Dietitians (RDs) to Clients
In response to your request, the D.C. Nutrition Alliance
respectfully recommends as ideal a ratio of 1 Full Time Equivalent (FTE)
RD to 350 unique, unduplicated clients in Ryan White-funded community-
based AIDS service organizations and meal provider/food bank programs.
The number 350 is based on the following assumptions and
the existing American Dietetic Association HIV/AIDS Medical Nutrition Therapy
Protocols (ADA Protocols.) The ADA Protocols were distributed at the July
18 meeting as an attachment to our remarks.
1. A full time RD in a community-based setting or meal/food
program works approximately 80% of the time (the equivalent of 4 days/week)
on counseling, and the remaining 20% on education (development and delivery
of materials and workshops,) outreach, menus (in the case of food programs,)
paperwork and reporting.
2. The maximum number of client interactions per day is
6 to 8, varying between initial visits of one hour and follow-up visits
of 15-30 minutes, which times are suggested in the ADA Protocols.
4 days/week x 50 weeks/year x 6-8 interactions = 1,200-1,600 interactions
per annum.
3. The ideal number of interactions per client per annum
is four, based on the average number of visits prescribed in the ADA Protocols
(2 to 6 visits per annum) depending on the stage of the disease.
4. The ideal ratio of RDs to clients is therefore 300
to 400, or an average of 350 unique, unduplicated clients.
1,200 interactions divided by 4 per client per
annum = 300 clients
1,600 interactions divided by 4 per client per
annum = 400 clients
5. RDs in smaller Ryan White-funded organizations often
have many additional responsibilities involving the administration of the
entire dietetic program, such as grant writing, fund-raising, day-to-day
operations. These RDs are able to spend only 50% to 60% of their time (the
equivalent of 2.5 to 3 days/week) counseling. The ideal ratio would change
to 1 RD to approximately 250 clients in these cases.
Thank you once again for the chance to address you, and
for your interest in this very important issue. Please feel free to contact
either of us if you have further questions.
Deane Edelman, MBA,
DTR
Katie Mackrell, RD
202/333-0945 202/638-0750
