Page 11 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
pleasure of control likely remains the same. Challenge your service to the residents: If you pre-pour it or pre-dish it – stop it, as you are limiting true choice.
When dining at home, we all have the right of point-of-service choice, and our residents are dining in their home; they deserve true point-of-service choice. The challenges are being met by dining professionals in homes committed to resident-centered care. They are proving to be cost effective with skilled forecasting, elimination of waste (food, supplies, tasks and time, not to mention supplements) and creative service system re-design facilitated by a hospitality perspective. Trained chefs are joining the dining services team in long-term care (not just CCRCs, but frequently small, rural homes), bringing their culinary experience to support resident satisfaction with dining.
The first day of breakfast in the dining room, Miss S asked for eggs. The aide serving her panicked, saying, “She never gets eggs, she can’t have eggs.” We checked her allergies and preferences sheet and sure enough, eggs were listed under dislikes, so she hadn’t been served them on the breakfast trays. We talked to the dietary manager and learned that a couple of years ago, she had mentioned she was tired of scrambled eggs on her tray. The dietary manager charted them as a dislike, and with our efficient tray line, she never received them again. But to our delight, when she asked for them, we served them, and she ate them all on the first morning, and on many mornings to follow. Pennybyrn at Maryfield
During survey it was noted on a meal card for Sister R that she had “soup” listed as a “like.” Observing the meal, the DON panicked and stopped service, insisting the elder needed soup because her card stated she liked soup, so the elder was served soup at every meal until, on the last day of the survey, the elder motioned to a staff member. She said she was frustrated with always being given soup on the demand of the nursing staff. The best intentions to merely state a resident’s “like” and for her to receive it whenever it was planned and available or when she was unhappy with other meal choices had instead become an absolute. It created confusion, waste, and frustration for the elder. She stated that our best intentions for efficiency created doubt about our ability to care for her. (Madalone, 2009)
Create Quality Dining through Accessibility
Foods of choice are available whenever residents are hungry, not just at scheduled meal times. And when they long for a specific food, it is available. Foods of choice are available 24/7 and someone is available 24/7 to prepare it.
One lady who will soon be 101 years old is eating whenever and whatever she wants. Prior to this, staff had a very difficult time getting her up and having her eat anything. Now she does it her way and everyone is happy. There is no doubt she will make it to 102. Garden Spot Village
A resident moved into Starkey House from another facility. The resident had significant weight loss and was stated to have very poor appetite. The first morning after he arrived, the caregivers asked what he wanted for breakfast. “I can have anything I want?” the resident asked. “Yes,” the caregivers responded. He ate everything he ordered and when asked if he would like anything else for breakfast his eyes got wide. “I can have more?” he asked. In the first week he started eating two or three breakfasts each morning. At first, caregivers were
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