Page 17 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
QUALITY OF CARE AND QUALITY OF LIFE COME TOGETHER WITH RESIDENT CHOICE
While researchers evaluate, residents benefit! As a registered dietitian, it was professionally and personally rewarding to me to confirm a 69% reduction in the prevalence of weight loss during the first three months in Northern Pines Communities (currently Bigfork Valley)—from 15% to 3% in the first quarter, and to NO “unavoidable” loss within six months—concurrent with a 50% reduction in nutritional supplementation through fortified foods. (Bump, 2003, p 20)
Repeatedly around the country, weight loss is replaced by weight gain as residents respond to individualized care with positive clinical outcomes. Improvements in clinical outcomes are now becoming expected outcomes of the journey to individualized care. While the residents cited below live in households and neighborhoods, similar stories abound from transforming facilities around the country. We might ask: Coincidence? Chance? Repeated observations would suggest not, but rather, that clinical improvements are now the anticipated outcome of individualized care.
Miss K came to us several years ago. She was on a pureed texture diet with nectar liquids, assisted with meals by staff, underweight and very unhappy. She did not enjoy meals and would tell us we were giving her way too much food, and that this overwhelmed her. The CNA started encouraging K to try assisting herself. We started open dining, allowing elders to make their own food choices from restaurant style menus. Elders are also able to choose when they want to get up for meals. K is a late sleeper and the choice of when to eat really started making a difference. Her meal intake started improving and she got stronger. Before long, K was able to upgrade her food texture to mechanical soft, then to regular, while also drinking regular liquids. K makes her own food choices and usually orders off the menu at supper and occasionally at lunch. She loves grilled cheese sandwiches. She eats a big breakfast, small lunch and very little supper. She does not feel overwhelmed by the food served to her on her plate now that she is in control of what she is getting. This has helped K put on several pounds. We met our goal for weight gain and were able to take her off all supplements. Holly Nursing Care Center, Holly, CO
Mrs. L had been basically in a vegetative state with end-stage dementia for several years. As we moved into households, the staff in her house began bringing her out to the living room to be present when the staff and the other residents were playing games, and they always included her in conversations, whether she responded or not. They always baked a cake for the resident on their birthday, and when they brought her chair up to the table, put her cake in front of her and they sang “Happy Birthday” to her, she joined in and sang every word along with them. Prior to moving into the Household Model, Mrs. L was on a pureed diet, fed totally by staff and supplemented with Resource due to poor appetite. When staff had a chance to know her and find out what her day was really like, things started to change. She started to feed herself, converse with staff and become aware of her surroundings. She was able to answer questions such as, “Would you like your scrambled eggs and toast separate or should we make it into a sandwich?” We discovered that scrambled egg sandwiches were one of her favorites and she could eat them all by herself. On one doctor’s round, she greeted the doctor when he entered the room. After her check-up, he
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