Page 12 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
worried he was eating too much. The resident told us that where he was living before, caregivers would bring in a room tray, sit it next to his bed and leave. They did not help with set-up and the food would become cold. The caregiver would return and take the tray without asking if he needed anything. I told the caregivers not to worry too much about the resident eating two to three breakfasts, because when choice is given back to someone, they might indulge at first and then taper off. As the weeks went by, the resident did decrease how much he ate because he knew we would always provide the breakfast items he requested whenever he wanted them. (Generali, 2009)
Recently, a new resident was admitted to our French Country House. She had been in another nursing home awaiting a room with us. A household staff member was conducting the initial tour of the house with the resident. When she got to the kitchen, the staff member began explaining how this was the residents’ kitchen and for her to let us know what kind of things she would like to keep in her refrigerator so she could have them anytime she wanted. The resident asked the staff member ‘Do you mean I can come to the refrigerator and get anything I want whenever I want?’ When the staff member said ‘Yes,’ the resident said, ‘This is heaven.’ (Hollingsworth, 2010)
Create Quality Dining through Individualization
Favorite foods, comfort foods, foods prepared from residents’ favorite recipes, foods they chose to eat in their own home, foods that make them look forward to the day...foods that are good for them, from a therapeutic perspective, or foods that they have enjoyed for their whole life even though they may not be the best choice from a medical perspective...for most elders, these foods will not come wrapped in individual snack packs, but rather from real kitchens, from caring staff. But for some, a candy bar and soda, or chocolate chip cookie and milk may be the “supplement of choice.” Knowing what specific foods tempt specific residents can make the difference between weight loss and gain, and between supplement and food first. Knowing the residents, their choices, their preferences and their daily pleasures in dining leads to optimal intake and optimal quality of life in dining.
We had a lady who was dying and her daughter felt that she wouldn’t last through the night, and neither did the MDs. We found out that she ate breakfast really well and started feeding her breakfast several times a day over that weekend. She perked up and is still with us happily eating breakfast almost a year later. The Cottages at Brush Creek
Lori Madalone, RD, confirms, stating: “The majority of our successes lay in the fact of residents’ choice and control in dining, and that liberalization is huge with regard to outcomes. Consider the story of one gentleman from a Metro Denver home with Alzheimer’s care and his choice to dine ‘at leisure’ – while not meeting conventional needs of a traditional nursing home.”
Norman was frustrated with having to share a meal table. When staff brought him to the dining room, he would show his frustration by refusing to eat, yelling and becoming disruptive. Staff attempted to 'cue' him, but meal time would end in disappointment with Norman wanting nothing to eat. Open dining was implemented with the hours of meals flexible to allow for early and late diners. Staff’s education about making meal time more flexible was far reaching. Choice was offered and selections made. This process took a year before its impact was realized. The choice process was still not acceptable to Norman because his food items were chosen from the planned menu and the planned alternate — all in
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