Page 10 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
willing to support that program (grocery shopping, etc.) and staff being hard pressed to comply with the rigors it demands. Time marches on. One impact of culture change on an organization is that after 11 years, what is “normal” is what was “unusual” before the change. So, we don't give a lot of thought to transformative happenings, as they don't strike us as anything out of the norm. (Mikelson, 2009)
To be sure, “normal” is different from one individual to another, and to each individual in differing stages of the life cycle, but common elements come together to create a resident- specific quality dining experience at home.
Home is Possible
With food quality a given, several additional elements most often define a quality dining experience at home:
Create Quality Dining through Choice
Simply speaking, it is all about choice. It is as simple as asking, “What does the resident want? How did they do it at home? How can we do it here?” Asking those three simple questions, pushing away “the way things are done,” connecting with the resident and his or her preferences and letting choice rule, you realize the “the way things are done” is certainly not the way you would have done them in your house, and you are on your way to individualized resident- directed care.
Choice of what to eat, when to eat, where to eat, whom to eat with, how leisurely to eat. True choice, not token choice. Not the win-lose choice between a hot breakfast and sleeping to the rhythm of your day. Not simply the choice of hot or cold cereal, but also the raisins and brown sugar that make oatmeal a daily pleasure. For dining, true choice is exemplified in point-of- service choice, for how often do we know what foods will appeal most to us tomorrow, next week, in three weeks? Perhaps we know what we will want for a special celebratory meal or for breakfast if we are a creature of habit, but probably not for lunch and supper on Thursday of next week.
Yet traditionally we define choice in our dining services as the opportunity to express our likes and dislikes during an admission interview, or to circle a menu one day, or week, or month in advance. We may also define choice by the presence of the steam table in the dining room, but it quickly becomes token choice with the use of computerized tray ticket systems which control the food served from the steam table to a specific resident. What could be worse than seeing and smelling a tempting food, only to be served a different food specified on the ticket laying on the pre-set table -- resident autonomy at this particular meal is overridden with preferences stated during an assessment process or a therapeutic diet extension. And sadly, acknowledge to yourself how often the dining and nursing staff expresses their frustration with impossible-to-please residents who select something they have previously asked us not to serve them. Consider the control you personally exercise daily in dining choices, and the pleasure that control brings to you each day with food. While taste and texture and tolerance may change with aging, the
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