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Donna Manring

As we are in the holiday season we look forward to all the fabulous foods of the season. We also look forward to the wonderful times to enjoy good food, good conversation and the company of family and friends. The aroma of food tempts your taste buds and can make you hungry. Your mouth begins to water and you begin to anticipate the taste of the foods being prepared. Eating is one of life's greatest pleasures.

The American Dietetic Association (ADA) estimates the incidence of malnutrition in institutionalized elderly to be between 10 percent and 85 percent, making it one of the most serious problems in long-term care today. When we begin to think of the dining experience as more than just nutrition we take the first step in reaching our dining goals. As you think of the dining room in your facility do your residents look forward to gathering around the table? With hectic schedules it is easy to forget that eating is a social event. Sure the dining experience cannot be a holiday every day, however by keeping the focus of dining as a social experience you will find that outcomes will be less painless for your residents and your staff.

Ask yourself these simple questions.
  1. What is the resident's attitude on dining? Do they look forward to coming to the dining room? What is the ratio of dining room attendance to in-room?
  2. What is the staff attitude on dining? Do the team members talk to the residents or discuss what is going wrong on the floor?
  3. What is the atmosphere in the room? Do the residents interact with each other? Do you hear conversation or laughter? What does the dining room smell like?
  4. Is there adequate assistance?
  5. How is the dining room decor? Is the room inviting?
  6. Do you call the garment protectors bibs?
  7. Are the residents greeted as patrons or consumers?
  8. Does the resident feel like they are being herded in, rushed to eat, and then herded out for the next shift?
Discuss the answers with your team.

Resident council is a place to start to talk about resident's attitude or feelings of the dining service experience or process. However resident council can be a limited focus. Expand on Resident Council by conducting interviews or surveys with the residents and their families and possibly visitors. I realize that staffing and time is limited so you may wish to consider preparing a survey that can be conducted by competent volunteers. Questions on the survey should be opened ended to be able to gather as much information as you can with the survey process. Keep the survey short in order not to loose interest.

It is the entire teams responsibility to observe obvious displeasure by residents. Are you able to see conversations taking place and wow was that laughter in the dining room? Think about what you hear and see when you are eating out or at your own family table. Are tablemates getting along with each other? What may have been a good match originally may not always work out later. Do they have similar eating/feeding abilities, personalities or interest? Does the resident need assistance with eating or tools to assist them in eating independently? We get in a hurry and can give very large bites or not alternate liquids and solids. What would you do if someone was pushing large bites of food in your mouth? Be the resident and put yourself in their chairs. Observe if there are changes in independence in eating? These factors will influence outcome. Reassessing table matches and eating ability should be done continually.

Having worked in dining services for many years I have observed the attitude of mealtime to be a burden. Attitude can show before someone even opens his or her mouth. Body language and facial expressions are a give away. There are times we may not even be aware of the signals we are giving off. Rolling of eyes or frowning faces are obvious, however what about crossed arms or a look of "I am too busy". Smiling faces help soften any attitude and can even set the stage. In fact smiling may even ward off other bad attitudes. We all know that smiling can be very contagious and it is free! What is the conversation of the team members? Are they talking to the residents or giving the low down on what is happening on the floor? I will admit that the residents enjoy some outside conversation. Knowing the boundaries of those types of conversations will need to be decided upon with each facility. A pleasant dining experience will cut down on residents choosing to eat in their room. Studies indicate that those that e at in isolation become more depressed and may become less enthusiastic about eating.

I am sure we can all recall a time when we have walked into a room and you could cut the tension with a knife! What do you feel, hear or see when you walk into the dining room? Make mental notes or written notes that you can build on later. A room that is filled with sense of well being will be a place people will want to be. Build on an atmosphere that is inviting and warm.

Have you ever walked into a grocery store and smelled baking bread, cookies or something smelling really good? Modern grocery stores vent from the bakery to the entrance of the store to entice your sense of smell immediately upon entering the store. When selling your house you may be advised to bake cookies or have a pot of soup on the stove to give that "home" feeling. Digestion begins with the sense of smell. Our saliva glands can be stimulated with smells. Let the nose be the guide when possible to the dining room. Some facilities use a bread machine once or twice a week to give the dining room that fresh baked bread smell. Candles that have warmers without flames could be an option. I have a candle smells like cinnamon rolls. Caution however that there can be disappointment that there will not be cinnamon rolls. Buffet style dining may be an option for some facilities. Can the food be served from steam tables in the dining room? Take the dishes off the trays when serving. This is not a food court.

How the dining room is decorated will also impact attitude, intakes and attendance. Sometimes we decorate with plastic plants or flowers. Is it time to replace those for a fresher look? Does the decoration promote the look and feel of the room you are working for? Decorate the room in warm colors and patterns. Warm colors give a feel of richness and can be soothing. There may be some local florists willing to donate bright fresh flowers for your dining room. Soft music adds some ambiance to the room too. Types of music your residents would like to listen to could be a survey question. Check to make sure there is adequate lighting in the dining room. Vision can certainly be a problem and lighting will improve that challenge.

The word dignity is thrown around a lot. We all have accidents where we spill food on ourselves. When it happens to us we get disgusted with ourselves. Imagine how it feels to have this happen frequently. As food service director we had a policy in our facility that the garment protectors could not be called bibs. Bibs are used on babies. Our residents are not babies. Sure there may be decline in function, however these folks deserve respect not degradation. My Grandma when she went into a rehab facility for a knee replacement found it very disturbing when someone walked up to her in the dining room and asked her if she wanted a bib. She could not believe it. Small words can have a big impact on feelings.

The facilities that are keeping their census up knows the key to success is treating our residents as customers or consumers. Sure it is also their home but we all like to be treated with respect, kindness and a feeling of belonging. Many residents will not consider a long-term facility as a home. The resident still has the option of going somewhere else. Don't think that incoming Medicare patients and families do not consider dining as well as nursing care.

Administrators that see dining associated with cares are on the cutting edge. The seniors of today demand choice and mealtime must be considered a social event. Studies indicate that the level of comfort in the dining room determines how much a person eats. By addressing the issues we have discussed; food intake increases, the mood of the resident is improved leading to increased dining room attendance. Increased food intakes along with a sense of well being will have positive effects on the residents over all health. Some facilities were able to decrease supplementation for those that were just not consuming enough calories. Set up costs may go up at first however once the dining program is in place evidence shows the dining program to be cost effective in outcomes. Even small changes can make a difference.

Remember eating is and should continue to be one of life's greatest pleasures. You can make a difference for your residents and in turn your facility.

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