Resident Centered Dining Dianne Buckley, Dietary Director Holy Trinity Eastern Orthodox Nursing & Rehabilitation Cen

1. Resident Centered Dining Dianne Buckley, Dietary Director Holy Trinity Eastern Orthodox Nursing & Rehabilitation Center, Worcester, MA Long Term Care Medicine – 2011March 24-27, 2011Tampa, Florida

2. Faculty Disclosures: Dianne Buckley has disclosed that she has no relevant financial relationships which would present a possible conflict of interest.

3. Learning Objectives: By the end of the session, participants will be able to: • Identify the positive clinical and social outcomes that can be achieved with resident centered care. • Identify if their facility is ready to embrace resident centered care philosophy. • Create a plan to involve all disciplines in the process of achieving a resident centered dining program. • Implement steps towards achieving this using a detailed work plan.

4. Culture Change =Resident Centered Care • Residents are given the opportunity to make basic choices such as what they want to eat and when they want to eat it. • We do not “wake” them to eat, they eat when they awaken, just like home. • Sometimes those choices can be “AMA”… • When they are…education, informed consent discussions, and documentation are the keys to maintaining regulatory compliance.

5. Sample Menu Ticket

6. Survey Says….. • Greater resident satisfaction based on survey results… improved to 4.50 out of 5.00! • ”Choices” increased by 9%...residents order off of menu, course by course. • “Quality of Food” rating increased by 8%...toast and grilled cheese are a few of the items that are made to order and served immediately. • Improved clinical outcomes… use of nutritional supplements decreased by 31% without further weight loss!

7. …Improved Satisfaction

8. Buffet Dining Cart Dietary Aide & C.N.A.

9. Return to “Normalcy” • More meaningful social interaction between staff and residents… conversations occur. • Meals became less “task-oriented” & more resident focused. • Food is served to order with some items “prepared to order”, which contributes to maintaining temperatures. • The dining rooms smell like bacon and toast at breakfast!! • Diets were liberalized…contributing to increased intake. • Family interactions changed positively, with families choosing for their loved ones, if they are not able to. • Salt & pepper shakers were added to the Main Dining Room…unimaginable in an institutional setting.

10. “Change always comes bearing gifts.” ~ Price Pritchett • Document identified areas needing change using Resident & Family Councils, Satisfaction Surveys, observations, trends, and anecdotal feedback. • To change the paradigm and the “culture” of the organization…build a new box if necessary. • Create a plan including all disciplines; don’t forget to include the residents. Ours was written in February 2006, updated as needed & still ongoing! • Prepare for implementation by continually meeting, brainstorming, answering questions & training. • Embrace the resistors…use their concerns to identify opportunities for improvement.

11. Things to consider……. • Physical layout limitations and solutions, i.e. electrical, space, storage, work flow, etc… • Disaster planning…what if the elevator is out of service, will equipment run on generator? • What is the financial impact? Both initial capital expenses and long-term. • Reallocation of resources and assignments will need to be reestablished and rewritten. • Identify ongoing training, provide as needed. • Dietary software compatibility and support? • Regulatory compliance and food safety must remain as most important filter for elements.