Let’s acknowledge that the dining experience many facilities once took pride in has changed.
Over the last few years, life in long term care has changed in noticeable ways. But when we stop to ask “why,” the answers may be more straightforward than we think.
Let’s acknowledge that the dining experience many facilities once took pride in has changed. As a long-term care consultant conducting mock surveys across the country, when I ask, “Why are no residents eating in your dining room?” the answer is usually the same: “They don’t want to come.”
I understand that short-term residents focused on returning home may not be interested in building connections. But what about our long-term residents? Why are they choosing not to come?
Are they bored while waiting to be served? Embarrassed by their physical condition? Do they feel they have nothing in common with others? Or are we not creating an environment that encourages connection, interaction, and a sense of enjoyment?
What does the dining room feel like?
Close your eyes and picture this as we create the dining room atmosphere... Michael Bublé is singing, linen tablecloths complement stemware on the tables, tables are placed at angles to provide clear pathways, and there is someone welcoming resident to the dining room, encouraging conversation and, while waiting for the meal to be served, says “Let’s play Hangman!” or “Let’s play Name that Tune!” or “World Geography Trivia Time!” using a large white board or a large posterboard on an easel. Keep your eyes closed… There’s an actual person offering hot coffee or tea or juice or sparkling water.
At resident council meetings, many residents are sharp as a tack and happy to express their likes and dislikes in every area of their life, including rating the food, rating the services provided, rating the activity outings offered. Again, from a culture perspective, how are we creating one that offers acknowledgement of human existence, human feedback and human interaction?
How does enhancing the dining experience impact Quality Measures, you ask? Think about when a resident lies in bed for breakfast, not moving positionally for about 8-9 hours and we place a meal tray on the over bed table, raise the head of their bed a bit, and say “Breakfast is here.” Lack of movement leads to further decline. So now we have a resident still half asleep, perhaps the milk carton has been opened and placed where they can reach it – perhaps not. Perhaps the sealed fruit cup is opened – perhaps not. Perhaps the lid has been removed from the oatmeal bowl – perhaps not. Then when the resident doesn’t want to get dressed for the day, we say “okay – see you at lunch.”
Not getting dressed is the best way to ensure there is no attendance at activities. So, think of how little the resident has moved since bedtime the previous night. I hear the reason “it’s their choice. It’s their preference.” Absolutely it is. But if we offered fun and interactive entertainment options, would they be more apt to join in? If residents’ families saw their loved one engaged in an activity and smiling, would the complaint surveys decrease? I’ve heard residents tell me how much they miss the children from the neighboring day care sing to them, play with them, read with them. I’ve heard residents tell me the 15-passenger van sits in the driveway because there is no one to drive it and they really miss their trips to Wal-Mart. I’ve heard residents say they miss the Red Hat Society parties, or the Rotarians who used to hold meetings there say hi to them, or the piano recitals that used to take place. Our long-term residents are withdrawing into their own shell for lack of better options.
Getting residents up and out of their room improves circulation, decreases pressure ulcer risk, improves hydration, increases independence, decreases chances of falling in their room, improves their attitude and overall satisfaction, validates their existence as a contributing member of society, decreases depression and medication use, decreases weight loss, improves their overall function/mobility and certainly gives them a purpose for the day. Don’t we all need purpose in our lives? Don’t our residents need purpose in their lives?
I know the question you are thinking is “Where do we find staff for all this?” We barely have enough the way it is.” Let’s be clear. Let’s be honest. You have staff. In many cases, expectations have shifted, and engagement can vary. How do we engage them to realize we care for people with souls, with desires, with preferences? I see employees sitting in the dining room while their residents eat in their rooms. Let’s talk about how many staff it takes to pass trays to 50 residents for each meal, while attempting to open milk cartons, reposition residents, go grab an extra sugar packet, stop to take someone to the bathroom. Let’s talk about how the hot food delivered to the resident on the last hall receiving the final tray. Hot food is not hot, milk is not cold. So now you’ve got food complaints. Now you’ve got disgruntled residents because their meal is 30 minutes late and cold. Now you’ve got angry family members because mom’s food is never to her liking. Do you see a pattern here? Do you see how getting back to the dining room could make a difference?
Consider this: Complaint activity has increased in recent years, and these investigations often receive more immediate attention than standard recertification surveys, which in some areas continue to experience extended timeframes between cycles.
Our efforts to achieve a 5-star rating start with strong quality measures tracked, reported and responded to. These are some of the areas that trigger complaint investigations:
• Weight loss
• Pressure Ulcers
• Loss of Function/Mobility
• Depression
• Inappropriate use of Antipsychotic Medications
• Behaviors requiring pharmacological Intervention
It’s interesting how these are the very same categories to benefit from increased physical movement and additional monitoring. Please consider how a dining room filled with laughter, pleasant socialization, service by top-notch personnel and engaging residents can mitigate your complaints and improve your Quality Measures. Want to improve your 5 Star Rating? Improve the dining experience. After all, who wouldn’t want to be part of Michael Bublé’s audience?
If your organization is looking to strengthen resident engagement, improve dining participation, or better connect daily operations to Quality Measures, Polaris Group can help assess current practices and identify opportunities for improvement. For over 30 years, Polaris Consultants have provided senior care solutions focused on improving resident outcomes by leveraging our skills and expertise to ensure your success.
