culture change: current culture in ltc resident centered ... · culture change: resident centered...

Resident Centered Dining

©2008 Becky Dorner & Associates, Inc.1-800-342-0285 www.BeckyDorner.com 1

Culture Change: Resident Centered Dining

Becky Dorner, RD, LD1-800-342-0285

www.BeckyDorner.com©2007 Becky Dorner & Associates, Inc. ©2008 Becky Dorner & Associates, Inc.

Current Culture in LTCResidents are told when

to get up/go to bed, they will eat, they will have a bath, they will take their meds, who they will eat with, etc.

Choices are limitedactivitiesmeals/snacksschedule

©2008 Becky Dorner & Associates, Inc.

What is “Culture”?Thesaurus:

CivilizationSocietyCustomsWay of lifePhilosophyTraditions

In LTC, “culture” captures the way of life in the facility (the environment)


Culture Change is Here to Stay!Consumers are demanding change…To allow people to thrive in their later years– to live in more home-like

atmospheres with fewer people, more privacy,

– and more control over their lives


Improved Quality of Life

The primary focus of culture change is to Promote a better quality of life; byImplementing strategies that support person centered care


Striving for Change

Restrictive institutional

care

Community ofpeople

working together, focused on Resident-

centered care & decision making




Basic Principles: Person Centered Care

1. Maintain stable staff 2. Attempt to maintain a more

normal living atmosphere3. Allow people to have more control

over their every day lives4. De-institutionalize the setting as

much as possible5. Using participatory leadership6. Implement systems to support

relationships & choice©2008 Becky Dorner & Associates, Inc.

Benefits of Culture ChangeWithout increasing costs, facilities can have fewer & less serious state survey deficiencies and increased resident censusImproved quality measures, reduction in staff absenteeism & turnover


BenefitsImproved quality of care & life for all involved Significant improvements in customer satisfaction, family & staff satisfaction ↓ staff turnover & improved interaction with the community (more rewarding work)↓ morbidity & mortality rates ↓ incidence unintended weight loss, reduction in restraints, use of psychotropic medications, pain, pressure ulcers, depression, number of bedfast residents, and number of behavioral incidents


The Eden Alternative™

Encourages variety and spontaneity that exists in every day life. Research shows that these things can succeed where pills and therapies fail: “Contact with the living world is a major factor in both quality of life and improved clinical outcomes.”


Culture Change Program Commonalities

Change from institutional to homelike—neighborhood living, community of caring and familyResident centered decision-makingAllow people to live the way they want to: Provide assistance without having that become the focus of their daily lives


Main Goal

Transition LTC from an institutionally

based system

to person centered & consumer driven

model






Food is a Major Part of our Daily Lives


Question Everything We Do!

“If you keep on doing what you’ve always done, you’ll keep on getting

what you’ve always gotten!”

Must think “out of the box”

Get rid of old ways of thinking


Goals ofDining/Food Service

Provide:nourishing, palatable,

attractive meals meet daily nutritional

& special dietary needsmaintain/improve

eating skillsenhances quality of

life, supportive of needs


Food at the Center of Home

A small & friendly kitchen is often the center of home -- & the gathering place for many activities. – Food is easily accessible – People eat together & socialize

around the kitchen table. – Food is part of everyday

celebrations, socialization & comfort.


ChoicesIn other words, individuals should be offered

more control over who, what, where and when: who they eat with, what they eat, where they eat, when they eat, & how they are served




Making Meal Time SpecialThe dining atmosphere should

be visually pleasant, & noise levels should be comfortable.

The attitude of the staff is especially important: staff should make residents feel comfortable, socialize with them, and assure that residents receive the help they need at meal time.


Improving Customer Satisfaction

What do customers want? Ask, & then listen!

What do customers value?CourtesyRespectTimelinessFollow throughFeeling important


Improving Satisfaction

1. Was staff courteous?

2. Was food at proper temperature?

3. Were preferences honored?

4. Does food taste good?

5. Were alternates offered?

6. What would you like to see changed? ©2008 Becky Dorner & Associates, Inc.

Start with a Vision & a Plan

1. Get your whole team together

2. Discuss your vision of an excellent dining program

3. Review the total operation 4. Brainstorm everything you

want 5. Set some goals and start a

plan of action


AttractiveFunctionalHome-like or Restaurant-likeRoomyComfortable– Décor: Plants, Window treatments– Contrast colors in dishware & tablecloths– Music

“Personality”

Dining Environment


Types of ServiceRestaurant StyleBlue Plate StyleBuffet Style DiningFamily Style DiningNA’s change into colorful aprons for service of mealHost/hostess for seating, refillsSelect/Non-select




Move Beyond the BasicsMusic, linens, centerpiecesSelective menusWaiter/waitress serviceDessert cartsSnack cartsPlate presentationSoup de Jour

Remember, it’s the total

experience that counts:

Sights, sounds, smells, tastes,

ambiance(Think Cracker

Barrel, Olive Garden, etc.).


Food Service

Institutional versus Non-institutional

Restaurant-like or Home-like


Have a Passion for FoodKeep cooking skills up to date:– Watch cooking shows & read cooking magazines– Take cooking classes or bring a chef in to work with

staff – Swap ideas with other facilities--allow cooks to

network with othersListen to what Residents say about food and dining—about what they want The more you know about food quality the better off you (and your residents) will be!


“We eat with our eyes first”

What can we do to make the meal more attractive?What can we do to make the dining experience special?


Assess the KitchenEvery Bite Counts!

Liberalized DietsMenu PlanningProper Cooking & PresentationChoices


What is Quality food?Served attractivelyTastes goodIs at the right temperatureHas a pleasant smellIs nourishingMeets cultural/religious & food preferencesMeets special diet needs




“We Eat with Our Eyes FirstWhat makes food attractive & desirable/tasty?– Color, shape/size, texture, taste, temperature,

freshness, plating, portions, garnish, aroma, moistness, presentation

Fresh foods– Proper storage/temps, clean/organized storage

areas (FIFO), clean hands, utensils, surfaces. Proper cooking – Follow menu, standardized recipes– Well seasoned food cooked properly


“We Eat with Our Eyes First

Little touches make food more attractive in its presentation– How do restaurants make

food look & taste more appealing?

How the food is presented is most important. It has to: – Look Good– Taste Good – Be Offered Courteously


Get CreativeBasics – Side dishes where needed, avoid spills, use

garnishes, careful arrangement of foods on plate/tray

Garnishes– Vary colors, shapes & textures– Try fresh herbs (dill, thyme,

rosemary) or carrot curls, radish roses, etc.

– Books & tools available to make this easier/quicker


Always Taste Before Serving!

This seems like common sense, but frequently it doesn’t happen Everyone should taste--especially manager/supervisor, cooks


Communications…Share what you know about each residentCommunicate concerns to the rest of the teamIdentify high risk residents: – Weight Tracking– Food Intake/Meal Rounds– Nutrition Screening – Referral to an RD – Special Attention at Mealtime


Do Something Special for Residents Who Eat in Their

RoomsLinen Napkins

Flower on the tray

Table tents with cheery messages

Group for socialization if possible




Enhanced Foods

For residents who need extra calories and protein:Food First! Every bite counts– Pack in more nutrients per bite– Enhance favorite foods– Offer at times the resident prefers

Calorie & protein boosters – Super cereal, soups, gravies, casseroles, baked

goods Real FoodSupplements next line of defense


Dining StrategiesProvide assistance as needed & Allow adequate time to eatPromote independence:

Assistive DevicesAssist to Open, Cut, PourCueing—Verbal & PhysicalFinger FoodsHand Over HandFeeding


Assistive Devices

built up utensilsplastic coated spoons divided dishesscoop plates, bowlsskid guardssip cupstwo handled mugsvelcro devices


Consistency Altered Diets

©2008 Becky Dorner & Associates, Inc.Level 2 Photo courtesy of Novartis Nutrition

Mechanical Soft: How it could look…

©2008 Becky Dorner & Associates, Inc.Photo courtesy of Novartis Nutrition

Pureed food: How it could look…




Presentation Pizzazz

Constantly ask:“What can we do to make the meal more attractive?”

“What can we do to make the dining experience special?”


How about some of the things we enjoy in everyday life…

Fresh baked bread or cookiesSoup potFancy coffeeFast food/fun foodBirthday celebrationsBreakfast in bed


A New Hydration Program?

Fresh juicespresented beautifully

Juice bars

Popsicles

Jello fingers

Soda pop

Ice cream floats

Slushies ©2008 Becky Dorner & Associates, Inc.

Server’s Attitude is Most Important“Mmm…good!”

vs. “Aughhh…mystery meat again?!”


Get residents involved

in mealtime as much

as possible

Sometimes food just

tastes better

when you fix it

yourself!©2008 Becky Dorner & Associates, Inc.

Get Staff involved

in the operation as much

as possible

Be open to their ideas

and suggestions

Even something as simple as a uniform can make a big difference!




Where to Begin …


Ask Residents"What changes would you like to see?"


Quick Ideas to Get You StartedMeet with the team, family, residents firstFlexible dining services – Restaurant style, buffet-style or family-style dining

Flexible sleeping and waking schedules Peer mentoring programs for new workers Consistent assignment of staff members to specific groups of residents Improved/expanded – staff orientation practices – employee recruitment/retention processes

Supportive/respectful practices for death/dying©2008 Becky Dorner & Associates, Inc.

Open Dining

Offer Open Dining Times (24-7 plus formal dining hours)– B 7-9 am – L 11:30 am-1:30 pm – D 5-7 pm

Allow residents to choose from a standard daily menu (restaurant menu)– Have a “special of the day” (that is based on the

cycle menu)– If they are unable to choose, provide the “special

of the day”


ChoicesMade-to-order Eggs: offer one day/week“Grill" day: Offer foods that can be grilled: grilled cheese, grilled chicken, fried egg sandwich, hamburgers, paninis, grilled salmon, steak, etc.Special of the day + 10 items to choose fromSelf serve: Salad bar, soup kettle, ice cream machineBuffet dining: main meal, the alternate or a 2nd alternate at lunch and dinner


Resourceswww.Becky Dorner.com CEU Programs:

-If Momma Ain’t Happy…-Making Care Plans Live-Resident Centered Dining CD/handouts

What Do You See? Short film. www.amandawaring.comhttp://www.culturechangenow.com/Putting Patients First: Designing & Practicing Patient-

Centered Care; Susan B. Frampton, Laura Gilpin, Patrick Charmel

Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care; Margaret Gerteis, Thomas L. Delbanco, Jennifer Daley, Susan Edgman-Levitan

Patient Centered Care: A Model for Restructuring; Mickey L. Parsons, Carolyn L. Murdaugh

Essential Practice in Patient-Centered Care; K. W. W. M. Fulford, Tony Hope, Steven Ersser




SummaryCulture Change often begins with resident centered diningSystems must be in place to assure success Be involved in all aspects of caring for food and nutrition needsTailor services to new models that focus on individual choices, homelike or restaurant style meal service, and personal serviceHave fun with it!


We CAN Do This! Our Residents will Celebrate!

culture change: current culture in ltc resident centered ... · culture change: resident centered...

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