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Dining: A Quality of Life Determinate in Residential Care Homes Dining: A Quality of Life Determinate in Residential Care Homes

Dining: A Quality of Life Determinate in Residential Care Homes - PowerPoint Presentation

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Dining: A Quality of Life Determinate in Residential Care Homes - PPT Presentation

Dining A Quality of Life Determinate in Residential Care Homes Cheryl Parsons RN LNHA 1 Food will be attractive palatable and choice driven while maintaining superior nutritional value across all meals and snacks ID: 771854

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Dining: A Quality of Life Determinate in Residential Care Homes Cheryl Parsons, RN, LNHA 1

Food will be attractive, palatable and choice driven while maintaining superior nutritional value across all meals and snacks. Food activities for socializing will increase in offerings through activities. The community the home serves will be aware of the importance of food in our home to the happiness and general well-being of our residents. Dining experiences will be happy, socialized and non-institutional across all meals. Meal service will be tip worthy from all staff serving and attending the meals from preparation, service and assuring quality to the customer at all times. Objectives: 2

We don’t really need a study to tell us that food is more enjoyable when it is prepared correctly, is palatable and looks attractive. Yet, we have evidence based research to support that those areas do indeed result in increased dietary intake and increased dining enjoyment. It also is apparent that getting food and food aroma closer to residents and providing a variety of choices based on regional fare and ethnic food choices is paramount to improved meal enjoyment as well as nutritional intake. (Crogan, 2004; Divert, 2014) Choice and Palatablity 3

We recognize and support the American Dietetic Association Position regarding liberalized diets in health care communities and that forcing modified diets may ignore the resident right to choice and may not outweigh the benefit of allowing more liberalized dietary selections (American Dietetic Association, 2010; Bowman, 2010) Liberalized Diets 4

The foodservice department has more daily encounters with residents than any other function within long-term care. In fact, “foodservice has an average of five opportunities per day to please or displease its residents” (Racho, 2010). Thus food coming out of our kitchen may be our best opportunity to attract potential customers and increase occupancy. Marketing Opportunities 5

We are also interested in exploring new advances in technology to manage client dietary information, ordering, tracking of costs, etc. Technology Adaptation6

Started with a PIP (citation of door being propped open during service from the kitchen) resulting in a $7,500.00 estimate to add the door to the magnetic release fire mechanism. Big Spring Care Center Dining Transformation 7

Leadership team drilled down to why was the door propped open to begin with and was there a way to avoid the $7500.00 expenditure for magnetic release? Take resident orders when they arrived placed with staff serving in the dining room and facilitate communication between residents and dietary staff during meal time.Helped residents smell foods from the kitchen. Dining Transformation 8

Team determined that we could solve the issue with nearly the same investment and gain on our goal to improve food quality and service by moving the steam table and food service out into the dining room. This would eliminate the need to prop the door open, get food aroma closer to the resident and allow us to offer an array of choices in a more timely and efficient manner. Dining Transformation 9

At that point a PIP team consisting of dietary staff, nursing staff, housekeeping staff, activity staff, social service staff, and the administrator was formed.  In that first meeting we explored several ideas and organized our groups further to research and bring back to the committee suggestions for developing our interventions. Dining Transformation 10

The following teams were formed: Resident Input (activities lead), what choices should we offer (dietary cook lead), Decorating (Activities/Housekeeping lead), Budget (administrator lead), Regulatory Issues (administrator lead), Methods to promote socialization at meal time (SS lead), Design (Dietary Manager Lead). Dining Transformation 11

Each team recruited members to help with the research and generation of ideas. The PIP Team then came together two weeks later and laid all the ideas out from each committee on a dry erase board. Dining Transformation 12

The overriding position statement was formulated; “Dining: Is a Quality of Life Determinate in our Home.” Dining Transformation 13

The goal was established; “The Quality of life our residents is a matter of our heart and soul and shall be maximized through improved choice, improved appearance, improved palatability and quality dining service.” Dining Transformation 14

The objectives were established; Improve food appearance and palatability. Improve quality of socialization and dining experience around meals and food.Improve food activity offerings and more hands on food preparation for our residents. Expand choices through buffet or menu selections and the necessary equipment to drive individual choices for food preparation, ingredients and presentation. Assure the outside community knows the importance of the quality of food in our home to the happiness and general well-being of our residents. Remove institutional service attitudes and preparation habits from our dining experience in general. Dining Transformation 15

Choices Food visibilityProperly prepared foods (Overcooked food is a big complaint)Food palatability More social activities around food Resident Input (Activities lead): 16

More voice in menu selection items Choice between daily meal special on a buffet or menu serviceSoup and salad bars Sandwich stationVisibility of desert offerings. Resident Input (Activities lead): 17

Establish a resident food committee to act as a liaison between resident council and dietary services Resident choice meals once a week Omelet or Waffle station for breakfast Liberalized DietsExpanded dining times Resident Input (Activities lead): 18

Happy hour with finger foods Dining style choice (family style, bar style, etc.)Themed dining meals (Mexican, Chinese, etc.) involve activities and all staff (Mystery dinner theater, Senior Prom, ) We really like the recipe sharing that you started for new residents keep it up.Would love for hot food to be on warm plates and cold food to be on cold plates. Resident Input (Activities lead): 19

Don’t lay bread items on the food (absorbs the liquid and changes the texture) Hostess available to help with seating, drinks and menu selection.Resident Input (Activities lead): 20

(Dietary cook lead, activities participated as member):Reviewed Resident Input at first meeting and determined the following: Penne Press for Hot Sandwiches (refer to equipment committee) Omelet station with selections for ingredients on cold bar in morning (refer to equipment committee)Waffle Station with ingredients for add ins driven by resident choice: (refer to equipment committee) Double soup server with house soups daily in fall and winter offered: (refer to equipment committee) Sandwich Bar from cold food offerings (refer to equipment committee) What choices should we offer? 21

Menu of daily offered short order cook items (need to establish a menu design/contents committee) Daily special will be the typical approved dietary consultant menu served either buffet style or menu selection style Liberalize diets (Medical Director, families and RD education/approval) Salad bar at lunch and dinner with salad items and dressings (formulate and adopt a house special dressing) Ice Cream dipping station for additional desert offerings and for activities. (refer to equipment committee) What choices should we offer? 22

Desert display case for special choice, recipe deserts (small selection). Utilize more left over foods for special casseroles, etc. to reduce waste and improve choice selections. Malt/shake equipment, liquor cabinet for happy hour (dr. approval), Sunday dishes, toaster oven so we can bake cookies, bread, etc as an activity (dough’s prepared by kitchen). (refer to equipment committee) Beverage station available all day long (Coffee, tea, juice, soda, ice, water) (refer to equipment committee) What choices should we offer? 23

(Dietary Manager, Administrator, Activities/Housekeeping lead), Residents like the idea of old Humansville pictures and making the dining room feel more like a local café with old memorabilia. Found an individual who will take old photographs, blow them up and frame them for our project. Formed a committee to find old photographs of the history of our spring, the community of Humansville and surrounding communities. Colors selected and voted on by all staff/residents. (Teal and taupe). Tablecloth and napkin selection, curtain selection presented and dinnerware collections and ideas to general pip for final approval. Decorating/Design 24

Signage and Menu design to match (need a committee to develop this) Design will include bar area, serving area, beverage station, cold food offering, hot food offering and variety of desert selections. Name the Dining area Decorating/Design 25

Work with Johnny (maintenance) cost of building serving area, painting, and electrical for new equipment. Keep Construction under $3500.00. Equipment what can we use out of the kitchen? Budget for additional equipment $4000.00Plates, décor, table cloths and curtains under $2,000.00 Add new position hostess at $8.50 per hour must be paid feeding assist certified. Available 12 hours per day. Budget (administrator lead): 26

Access to food service areas need restricted and sneeze guards in place over hot/cold food service areas. Diet Orders and education for surveyors on liberalized diets.Food brought to serving area by simple open and closing door, do not leave door to kitchen open or propped open for any reason. Assure square footage for dining space meets regulatory requirements. Potential second business for take-out dining from new “café” Regulatory Issues (administrator lead): 27

Remove TVMusic Selections during meal times Family Style dining offered as a choiceThemed Meals and specials New Resident Recipe IntroductionResident personal items in dining room hutch. Staff eating with residents and talking to residents at meal time. Methods to promote socialization at meal time (SS lead): 28

Price and compare the following:Cold Food Bar Ice Cream Dipping FreezerToaster Oven Penne Press Soup Servers Omelet StationWaffle Station Desert Display Case Hot Plate warmer Cold Food Plate Server Beverage Station and ice dispenser Equipment (Dietary Manager Lead): 29

The PIP Team then determined to appoint a menu, sign and name committee. Adopted most of the ideas or at least priced them and put some ideas in the “parking lot” for later inclusion or consideration. Selected dish wear, silver ware, class wear, table cloths, napkins and curtains from selections presented and approved the décor theme of “Old Memorabilia from the community of Humansville and surrounding communities. Residents assisted with selection. PIP Review of Committee Reports 30

Construction StartsConstruction started and items were ordered after approval by corporate. At the next meeting the menu was approved, including the design and graphics, signage design and graphics were also approved.

At the next meeting a committee was appointed to develop the job description for the hostess and begin the interview process for start data of September 1, 2015. The group then established dress code for dietary staff and hostess. Social Services assigned to develop a marketing plan for open house featuring our new “Mill Street Café” and coordinate it with the Humansville Fall Festival. Face Book was started featuring the announcement of the open house. Web page needs to be updated featuring what we are doing here. Job Description for Hostess 32

Grand opening was September 7, 2015.  Open house was September 19, 2015We served nearly 400 people at open house. Grand Opening and Open House 33

Open House Members of the Humansville Community enjoying breakfast.Staff and their family members who made open house a success.

Daily special which is the RD approved Menu Breakfast added omelet and waffle stations, cold cereal choices, pastries.Lunch more salad and sandwich offerings seasonally considered. Dinner again more salad and add-ons to menu or specialsMenu service at all three meals What we ended up with offering: 35

Buffet service at all three meals Moved food presentation and service for visual and aromatic impact into the dining room. Added Ice Cream Dipping station with malt machine and dishes for ice-cream sundies Toaster oven for activities to use in café serving area for food activities.Liquor cabinet for happy hour activity What we ended up with offering: 36

Penne Press for hot sandwich making Desert selection increased and is displayed in a case to showcase what is available. Expanded meal times to two hours residents can come when they want to. Added a hostess position to encourage hydration and assist with food selectionWhen new residents are admitted a favorite food/recipe is showcased and added to the recipe pool. What we ended up with offering: 37

Resident Choice meals once a week. Themed Meals around socialization and entertainment.Music in the dining room, removed the TV Beverage station with water, coffee, tea, juice and fountain soda. Staff training on tippable dining service (nursing and dietary) What we ended up with offering: 38

Established a Resident Food Committee Increased ability to help with food prep in activities and with some meals in for the kitchen (meatballs).Added a two soup display for seasonal and house special soups. Expand the resident garden for more home-grown foods.Activities take to farmers market for local fare/produce to be included in meals. What we ended up with offering: 39

Pushed for liberalized diets throughout Added plate warmer to service area New ceramic square plates and matching dish service New drinking cupsNew silverware What we ended up with offering: 40

Cold plates are stored within the cold food table so they are chilled for cold foods. Added bread wrapper to keep bread from absorbing plate/food fluids. Added bread bowls to the table with special house made butters and spreads. Added Menu chalk board at entry to Café with daily special What we ended up with offering: 41

Introduce aroma therapy at meal time. Music therapy at meal timeReview lighting and assure soft but illuminating lighting. Cooking classes for residents Men’s Menu Night and they help cook it Parking Lot Ideas 42

Expand the eating area to overlooking the pond with an outdoor eating area for residents. Women Menu League for Home Cooked recipe selection and assistance prepping. Market takeout meals to community to get exposure to our food quality and service quality. Increase menu to more home cooked, made from scratch recipes. Corporate wide cook-off for the dietary cooks. Parking Lot Ideas 43

Resident judged cooking exhibitions by facility chef and guest chefs Develop a herb garden and use more fresh herbs in cooking. Assess real food preference (foods and cooking method) and routines including rituals (coffee from freshly ground coffee beans, hot coca before bed, a favorite ice cream after dinner. Develop and implement foodservice technology to automate the process of Complete nutritional analysisAccess each resident profile (allergies, likes, dislikes, dietary restrictions) Cost analysis Control production Eliminate waste or reduce Parking Lot Ideas 44

Presentation and food prep education to improve appearance. Menu selection for improved product qualityCold food recipe ideas Educational Material developed for Dr, Family and surveyors on the importance of liberalized diets.Presentation of pureed or mechanically altered foods Resources still needed: 45

Theme and menu ideas Support from food vendors in selection of foodservice management technology.Software or techniques to manage ppd (initially and for the long term against cost of waste, etc.) Resources still needed: 46

Equipment leases, training and or purchase Beverage dispenser leases with products and icePlate service selections and décor Resources that we had to find ourselves: 47

For Quality and BudgetFood PPD Food waste (measure/weigh food disposed of)Cost of beverages in fountain Weight gain, stabilizationFood Complaints Items added to watch: 48

Dietary/Hostess wage ppd (avg for culture change is .45 cents ppd (not counting dietary manager for all food service staff) Supplies PPDNumber of Food related activities offered weekly Number and type of specialized dietsDiet order compliance Consistency compliance Track times of heaviest use for each meal in the expanded time frame for each. Items added to watch: 49

MILL STREET CAFE

American Dietetic Association. (2010). Position of ADA: Individualized Nutrition Approaches for Older Adults in Heath Care Communities. Journal of the American dietetic Association, 1549-1554. doi:10.1016/j.jada.2010.08.022Bowman, C. S. (2010). Creating home in the nursing home II: A national symposium on culture change and the food and dining requirements. The Food and Dining Side of the Culture Change Movement: Identifying Barriers and Potential Solutions to furthering Innovation in Nursing Homes (pp. 1-60). Pioneer Network.Crogan, N. E. (2004). Improving Nursing Home Food Service: Uncovering the Meaning of food through residents' stories. Journal of Gerntological Nursing , 29-37. doi:10.3928-0098-9134-20040201-07Divert, C. L.-R. (2014, October 14). Improving meal context in nursing homes. Impact of four strategies on food intake and meal pleasure. Elsevier, 139-147. Retrieved from http://dx.doi.org/10.1016/j.appet.2014.09.027Racho, C. (2010). Trends in foodservice. Long Term Magazine, 1-5. References 51