Page 18 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
came out to the nurse and asked, “What are you doing to Mrs. K? She’s talking!!” Perham Memorial Home
Mrs. K was not alone in her personal transformation after moving to households at Perham Memorial. Their dietary director shared: “We alter the (food) texture for very few individuals since the household model became the norm. Previously about 25 of our 100 residents had food texture altered to some extent. Currently, we have six residents on mechanically altered diets. When residents are able to sleep in the morning, are rested and ready to eat, they can tolerate most textures of food...which also greatly reduces the need for supplements.”
Their DON affirmed: “We also experienced a significant reduction in the risk of choking. It’s amazing what a good night’s sleep will do for a person!! When residents come to the dining room well-rested, they are ready to eat instead of sleeping at the table. I remember having to rouse a resident from sleep for every bite of food – when they are awake the risk is much less. We do alter the texture of food, but it is regular food that is altered. For example, we had waffles one morning. The staff knew that one of the men couldn’t eat a regular waffle with syrup, so she added strawberries and cream and mixed it to a texture that worked for him. He was able to enjoy a ‘real’ waffle, fresh from the griddle, with the rest of the residents around the table. We find that residents’ diabetes are much better controlled even though we don’t adhere tightly to a restricted diet. We have had residents whose HgA1C is so low the physician considered taking them off insulin...We have found that as long as we assess the situation, discuss the risks and benefits with the residents, care plan the approaches and ‘follow’ the care plan – we have been able to do what the resident wants.” (Krumwiede and Oelfke, 2009)
Oelfke summarized Perham’s expected and unexpected outcomes in Household Model’s Impact on Quality of Care Impresses, noting, “We never expected to see improvements in quality of care – our focus was to improve the residents’ quality of life. We have been amazed at the outcomes...Historically, we have used our Quality Indicator reports as a measure of quality of care...The average percentile ranking has improved from 47.4 percentile in 2002 to 27.3 percentile in January 2008...Indeed, quality of care improves as we work to enhance quality of life for our residents.” (Oelfke, 2009)
Again, we must ask - is this just a coincidence? The recent Pioneer Network Case Studies series on Providence Mount St. Vincent noted similar outcomes, citing “improvement of quality indicators from pre-to post-implementation” as one impact of quality. (Elliot, 2008) Repeated observations would suggest it is not chance or coincidence, but rather, the now anticipated outcome of individualized resident-directed care.
Put into a historical food and culture perspective by Kittler and Sucher:
Food, as defined in the dictionary, is any substance that provides the nutrients necessary to maintain life and growth when ingested. When animals feed, they repeatedly consume those foods necessary for their well-being, and they do so in a similar manner at each feeding. Humans, however, do not feed. They eat. Eating is distinguished from feeding by the ways in which humans use food. The term, ‘food habits,’ refers to the ways in which humans use food, including how food is obtained and stored, how it is prepared, how it is served and to whom, and how it is consumed. (Kittler and Sucher, 1989, p 3-5)
15