Office Space
Today’s Dietitian
By Lynn Grieger, RD, CD, CDE
Vol. 6 No. 5 p. 42

What’s your definition of a professional office? Most people immediately think of a room or suite of rooms in a hospital, medical office building, or physician’s practice. Other nutrition professionals open their own office in a variety of locations, including professional office buildings, sport clubs, or universities.

But what about dietitians who have a professional office in their home? Or those who use their living room or kitchen table as their office? Can a professional office location include a client’s home, a restaurant, grocery store, or even the local walking path? You bet!

According to Webster’s New Collegiate Dictionary, an office is “a place where a particular kind of business is transacted or a service is supplied; the place in which a professional (physician or lawyer) conducts professional business.” As many nutrition professionals are demonstrating, the “office” is wherever we want it to be.

When “Home Office” Really Means “In My House”
“I like using my home because there is no rent, I can deduct part of my mortgage and my bills through my business, I work on my own terms, I can get things done around the house, and my clients seem very comfortable sitting at my kitchen table and discussing their needs,” says Tawna Scantlin, RD, LD, of Ponca City, Okla. Her reasons for practicing out of her home echo the comments of many other dietitians, who cite the flexibility and monetary aspects as positive reasons for choosing this location.

Of course, there are also negative aspects to running a business out of your home. Christine A. Palumbo, RD, MBA, of Naperville, Ill., states, “There are just too many challenges to overcome, as well as real and perceived dangers. I happen to live in a ‘nice’ area, but I screen my clients—especially male—before any appointment is made. For example, I love to hear a personal or doctor’s recommendation when they call to schedule an appointment.” Palumbo’s private practice is a small part of her overall business. And while maintaining a home office isn’t her first choice, it works in her situation.

Kathy Wise, RD, LD, LDN, of Canton, Ohio, used to maintain a home office but has since moved to an outside location near physician office buildings and a long-term care facility. She feels her current office is more professional, and therefore, clients are willing to pay a higher fee. Wise and other dietitians also mention better organization and less stress as two other benefits of an outside location.

Other drawbacks to a home office include having to keep your home looking clean and professional at all times, lack of personal privacy, security concerns, separating work from the rest of your life, managing space for office materials, client perception that you are not as “professional” as someone in an outside office, and client difficulty in locating your home.

“I Make House Calls”
Thirteen years ago, I worked part-time at the local community hospital when I started seeing a few private clients on the side. I didn’t accept insurance, saw at most five people per month, and didn’t want this part of my work to grow. There was no need for the expense of an outside office, and because I live in a rural area, it’s not practical for clients to come to my home. So, I started seeing clients in their homes. It was an “aha” moment for both myself and my clients. After all, if you’re going to talk about food habits, portions typically consumed, and label reading, why not go to the source: the client’s kitchen and pantry?

Dietitians who work in home healthcare, community programs for children and adults with developmental delays, and those who combine personal training with nutrition regularly visit clients in their own homes. Deborah Turl, MS, RD, LDN, BSN, RN, occasionally makes a home visit for a client who is too ill or incapacitated to travel to her office. She prefers to follow up with phone or e-mail instead of continuing home visits.

Other dietitians prefer home visits over the traditional professional office or an office in their home. Colleen Gill, MS, RD, has a contract to assess developmentally delayed adults who live in host homes. “I have come to appreciate the benefits of being able to help people by looking at what is in their cupboards and fridges and directly showing them how to look at the labels of the foods they buy,” she says. “I think you get a much more accurate picture of how your client lives and shops by being in their home, and rapport is quite easy to establish since they feel comfortable.” Maryann Meade, MS, RD, CDE, CD-N, of Wallingford, Conn., consults with two home health agencies. Meade uses clients’ cups, glasses, and plates to estimate the usual amount of food they typically eat and demonstrate appropriate servings, which she finds far more effective than a handout describing recommended portion sizes.

Susan Krantz, MA, RD, of Somers Point, N.J., adds, “You can pick up a lot of information by seeing someone in their home. You can help them read labels of the foods that they usually use. You can see their exercise equipment and if they use it or if the treadmill is a storage place.”

Sheila Flavin, MS, RD, CDN, recalls, “I was a homecare dietitian for 10 years. One of the first requests I made of each patient was, ‘Show me the drawer where you put all your discharge papers from the hospital.’ I then was showed a … diet instruction packet that was never looked at after discharge. Thus started my journey as a dietitian using the nondiet approach.” Flavin and others note that you have a much better feel for the client’s individual needs and challenges when you work with them in their own home. You can more easily talk to the family members who do the cooking and shopping, and clients can show you the supplements and nonprescription medications they routinely take.

Dietitians who combine personal fitness training and nutrition education often work directly in their clients’ homes. “All my clients tell me they prefer to see me in their homes,” says Marjorie Geiser, RD, NSCA-CPT. “Not all—but many—enjoy the fact that they can ask me about this or that food or product that they have in their cupboards. For that reason, I am currently creating a pantry/refrigerator assessment.” Lisa Cooperman, RD, CPT, feels that her clients love having her come to their home—on their own scheduling terms. It’s a personalized service she enjoys providing.

Sanna Delmonico, MS, RD, editor of Tiny Tummies, a food and nutrition newsletter for parents, notes that going to a child’s home is extremely worthwhile and, even with travel time, is more efficient than seeing kids in her office. Delmonico says, “At the client’s home, I was able to assess the parent/child feeding relationship much better, assess barriers to healthier eating and make more useful recommendations, demonstrate healthy cooking ideas, make very specific suggestions for stocking the cabinets, and look at their supplement labels.”

Marion Groetch, MS, RD, CDN, of Port Chester, N.Y., notes, “These children frequently have global delays that require therapy sessions with other therapists—such as physical, occupational, speech—and if they had to travel for these sessions, it would leave little time for anything else.”

I also work with children through an early-intervention, home-based program. From the family’s perspective, not having to schlep your medically fragile child out to appointments is a time saver and a stress reducer.

But then there are those days when I have to deal with a home where the electricity was turned off due to lack of payment, the child is on oxygen and a continuous tubefeeding, and none of the phones work because they don’t have electricity. Or the days when I’m afraid to get out of my car because of the presence of a very large, angry dog. Or when I ask for directions, the mother’s first words are, “Do you have four-wheel drive?”

Other downsides to visiting clients in their homes include distractions from visitors, the phone, and other children; travel time (often unpaid); wear and tear on your car; no access to medical records; needing to bring a large variety of handouts and information with you at all times; and your personal safety.

My Office Is Anywhere You Want It to Be
When my children were young, they loved the book A House Is a House for Me by Mary Ann Hoberman. It describes a variety of locations that are “houses”: “houses for rabbits are hutches … a husk is a house for a corn ear,” and “a rose is a house for a smell.” Dietitians like to believe they think outside the box, and finding alternative office locations is no exception.

Kathryn Fink, RD, LD, of Dallas, focuses her business on weight management, eating disorders, and fitness. Fink uses a variety of locations to counsel her clients, including restaurants where she can talk about the menu and meal selection, which is important for clients struggling with disordered eating; individualized grocery store tours that not only demonstrate healthier choices, but also help deal with store anxiety common in people with disordered eating; and Starbucks, which she likes for its open and comfortable lounging environment, more like friends sharing coffee that an impersonal education session.

Monika M. Woolsey, MS, RD, president and CEO of A Better Way Health Consulting, Inc. and After the Diet Network, uses a walk in the park as a variant of a house call. She says, “For anxious clients, clients who need to slow down their exercise routine, clients who just don’t sit well, it can help focus them on their thoughts.”

I used to meet one of my clients at the local park, where we would sit in the bleachers and talk. The location and time worked for both of us, and happily she made enough progress that we were finished before the cold and snowy weather set in. I’ve also met with parents before our kids’ soccer games and with senior citizens after the congregate meal program. So, nutrition education doesn’t have to take place in a professional office—or even a building.

The Future of Alternative Office Locations
Palumbo believes that while having a home office or working with clients in their own home may work well for other types of businesses, it’s not the wave of the future for nutrition professionals. She cites personal security and difficulty screening clients as the major reasons for her opinion. Many other dietitians purposefully left established offices and opened a practice in an alternative location, typically for increased flexibility and to carve out a niche in their community. Setting appropriate fees that account for travel time to clients’ homes is one area in which many dietitians struggle. However, others find they make more money practicing in alternative locations that have low or no overhead costs.

I must admit that sometimes I’d love to go to work in a “real” office, with professional colleagues just down the hall, a cafeteria so I don’t have to rely on leftovers or a peanut butter sandwich for lunch, and coworkers to handle scheduling and billing. But the times that I get to play a rousing game of Ring-Around-the-Rosy with the preschool class of a child I’m working with or when an older client shares a cup of tea with me on a wintry morning win out in the end.

— Lynn Grieger, RD, CD, CDE, has a private practice without walls in southwestern Vermont and is also the healthy eating expert for iVillage.com.

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