Culture change is making its way throughout nursing homes and other long-term care settings across the nation and one of the most exciting innovations in culture change is in the dietary department. Some people believe that the kitchen has been one of the most forgotten and underrated place within long-term care. But, not any more! Many facilities that implement person-centered care as a part of their culture change start in the kitchen because it can lead to significant improvements in the quality of dietary services. Everyone looks forward to great food and how food is served, and these changes are highly visible to residents, their families, and staff. Also, there are endless possibilities and opportunities for change in dietary.
Hippocrates made the connection between food and health over 2000 years ago. He said "Let food be your medicine". Food is a very important part of health and in addition to its nourishing aspects, food has the power to heal and comfort people. Food is also a powerful symbol of nurturing, love and celebration. But, food has to be attractive and desired. It has to be served in ways that appeal to people. Uneaten food has no nutritional value and does nothing but go to waste. Remember, meals many times are often the highlight of our resident's day.
One goal of making dietary changes is to bring in the concept of "home" as much as possible to the dinning experience. Think of your own homes. You can find and have a snack anytime you want. You can make a meal for yourself or for your entire family. You can drink what you want when you want. You can put on a fresh pot of coffee, make tea, have a glass of ice water or whatever else you wish. You can eat with your family, in front of the television, while reading, or chatting on the phone with friends. You make a grocery list, hang it on the refrigerator, anyone can add to it, and then you go shopping. Just as we choose foods to eat, resident councils choose their own menus. Ethnic food choices are also important to consider.
Another goal when making changes in dietary is to offer flexible meal times. In person-centered care, the point is to de-institutionalize meal times and the dining experience. To facilitate residents sleeping in later in the morning, we must develop systems to serve meals to our residents at the times they choose to eat. We will have to become more flexible in how we think about food service. And as residents come and go we may have to further tweak our dining services. Many long-term care facilities have decided to implement flexible meal schedules such as the following: breakfast will be offered between 7:30am to 9:30am weekdays and maybe slightly later on the weekends; lunch will be served between 11:30am and 1:30pm; and dinner will be served between 4:30pm (for the "early birds") until 6:30pm for those who prefer it later. Flexible meal times offers choice and freedom to residents and simply makes the meal experience better, because they can choose when they prefer to eat.
Another goal of change in dietary services is to be innovative and creative in how food is served. Some of the more common dinning styles utilized in long-term care facilities include buffet-style dinning, restaurant-style dinning, 24-hour room service, and open access to food. These styles offer more choice to residents and can make meal times more enjoyable. Buffet-style dinning involves a hot steam table in a central area (dinning room) or placed in multiple sites within the facility (i.e. on each unit or wing). Many facilities have indicated that the buffet works very well for breakfast. Restaurant-style dinning can be used in the main dinning room and those employees working in the dinning room can wear chef coats and black pants, to create a restaurant atmosphere. A restaurant-style menu is placed on each table and residents order whatever they wish from it. The menu can be changed once a month, quarterly or seasonally. Many facilities have always offered room service, but perhaps never called it "room service" and indicated that it was available 24-hours a day. This is a nice feature for residents who are up at night and prefer to sleep throughout the day. It is also a nice option for family visitors who work odd shifts and visit their loved one during late evening hours. And finally, all residents, family and staff may have access to snacks 24-hours a day by creating or building small, kitchenette areas in the facility. And, don't stock it with just healthy snacks. Stock it with what residents and families want.
Other innovations in dinning include a private dinning room for special occasions, dinning areas that have a warm and comfortable appearance, bread- and cookie-baking throughout the day to create a more homelike atmosphere and to stimulate the diet, replacing 4-top tables with larger dinning room tables that seat 8 or more people, natural lighting or attractive lighting, salt and pepper shakers, hot sauce, and sugar bowls placed on each table, and kitchenettes complete with microwaves, small refrigerators, coffee pots, and storage space for snacks.
Dietary services are important in long-term care and culture change is providing great ideas concerning how to become more innovative and creative with food and how it is served. Food is vital to life and the kinds of food and how it is served should enhance the quality of life for residents in long-term care.
James H. Collins, Ph.D.
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