The Pioneer Network is an organization that is committed to changing the culture in long term care facilities. Last year they brought together a variety of organizations and agencies to develop food and dining practice standards that focus on personal choice while supporting safety and quality of care. Many of us that work in long term care are aware that a majority of residents leave food uneaten. This can result in weight loss and/or other nutritional concerns. Many residents receive supplements but do not consume them. Therapeutic diets such as: diabetic, low salt or low fat and altered (mechanical soft, pureed) diets can be a reason for a resident’s poor intake. They may say “the food doesn’t taste good”, if they are restricted. Offering foods that the resident likes have been associated with weight gain or stabilization.
The New Dining Standards serve to remind us that residents have a right to choose the type and amount of food that is served to them. The selection that the resident makes may not also be the same as prescribed by the practitioner but who is to say what really the “right” choice is.
The new dining practice standards include the following:
- Inform the resident of his/her choices.
- Determine the diet based on his/her goals and preferences. Do not focus exclusively on diagnoses.
- Assess for quality of life issues such as level of independence, meal time, and satisfaction with food.
- Begin with a regular diet and close monitoring, unless the resident’s medical condition warrants a restricted diet.
- Individualize the plan of care.
- Ensure that the physician and pharmacist are aware of the resident’s dining preferences so that medical issues (timing of medications and impact on appetite) can be addressed appropriately.
- Monitor the resident’s nutritional status.
- Allow the resident to make dining choices, as able.
- Revise the plan of care whenever/if the resident makes “risky” decisions. Show they have made an informed decision and risks have been mitigated.
- All decisions default to the resident.
Current recipes may need flavor enhancements for increased acceptance. It is not unusual to now see a chef with an extensive culinary background as part of the staff in a long-term care facility. They can offer expertise in recipe development and food preparation. Menus offering ala carte items such as grilled salmon, and chicken Caesar salads are now becoming the standard instead of the exception. Chefs and dietitians can work together to create some inspiring and delicious menu items to aid in keeping the residents happy and healthy.