Massachusetts Culture Change Coalition
Dining Culture
Culture Change
The only thing that should change when someone moves
into a nursing home is their address
Culture Change
It is a journey, not a destination– Residents, Family & Staff
Goals OBRA supports Culture Change
– 483.15 - Quality of Life
Culture Change
By identifying and implementing the Resident’s wants and needs you will
meet OBRA Regulations
“each facility provide care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident…”
Culture Change - Massachusetts
Conferences in Massachusetts –2006 Consistent Assignment2010 Dining Experience
– Benefits to Residents– Benefits to Staff and Facility– DPH
Culture Change – Consistent Assignment
Considerations:– Waking and sleeping– Meals– Food Preference– Daily Routine– Bathing frequency, time & method– ADLs– Activities
Culture Change Defining Dining …It’s About Me
Pioneer Network.org
Creating Home in the Nursing Home II -- A National Symposium on Culture Change and the Food and Dining Requirements 2010
Culture Change - Nutrition
CMS Interpretation: Culture Change Input and Questions Survey and Certification Group:
S&C-07-07 S&C -08-09 and S&C-09-39– Time between meals – Food brought in from other sources
Culture Change - Nutrition
S&C-07-07 F-Tag 368 and 370
– These are regulatory questions sent from culture change groups and the CMS answers
– Questions 1, 2, 11 & 15 relate to food
Culture Change - Nutrition
S&C -08-09 and S&C-09-39– 09-39 clarifies 08-09
F-Tag 371 and 242– Food Procurement and Self Determination and
Participation
Culture Change - Nutrition
DPH & regulations OBRA 1987
– Survey process– Participates in MCCC and conferences– May require waiver of some regulations– Contact DPH with questions– Refer to references
Culture Change - Nutrition
Dietitians - Nutrition Educators Residents & families:
– Assessing and care planning– Increase nutrition education opportunities
Identify risks vs. benefits of choices
– Have the right to make bad decisionsdignity/rights
Culture Change - Nutrition
Dietitians – as Nutrition Educators– Liberalize diet
Ask preferencesMonitor for changesRe-evaluate with residentDocument
Culture Change - Nutrition
Dietitians - Nutrition Educators Staff
– Clinical – DON, CNAs, Therapies– Dietary/Nutrition – Increase communication among all areas
Culture Change - Nutrition
Goal is to reduce incidence of
Weight loss Pressure sores Supplement use Dehydration
Culture Change - Dining Experience
How to achieve goal :
Choice in foods Choice with meal times Consistent assignment
Culture Change- Dining Experience
Resident Rights’ Week- October 2010– Massachusetts programs’ activities
Cooking contestsLuncheonsDPH speakersDining ScarvesArc-ct.org – Dining with friends video
Culture Change – Dining Experience
Mass facilities that are a work in progress:
St Camillus in Whitinsville- Bill Graves Loomis House – Lori Todd Holy Trinity in Worcester – Diane Buckley
Culture Change- Dining Experience
National resources for Culture Change: Eden Alternative Pioneer Network Consumer Voice (NCCNHR) Picker Institute Advancing Excellence Campaign
Culture Change – Dining Experience
Culture Change in Massachusetts
Mass Advocates for Nursing Home Reform- MANHR: 800-988-4450
Mass Senior Care: 617-558-0202
Mass Aging Services: 617-244-2999
Long Term Care Ombudsman: 617-727-7750
Culture Change – Dining Experience
Welcome to the table. Bon appétit
Elizabeth M. Bradley, MEd, RD/LDN
Long Term Care Ombudsman Program