Page 48 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
menu, a farmer’s market, an intergenerational program teaching children to garden, and celebrations around food.
F-tag 370 is not clear on what is an approved food source. We became certified through the county department of agriculture to sell produce grown in our garden in a community farmers market. Does that certification also qualify our garden as an approved food source, allowing us to include our produce in our meals? No one really knows. Though licensing officials like what we are doing, they cannot state that our county certification qualifies our garden as an approved food source as defined in F-tag 370...and we have not asked them to do so. We have had no issue during survey. After more than two years trying to get clarification from county and state licensing and agriculture officials and from the USDA, we have concluded that our certification through the county to sell produce at a farmers market is the best we can do.
We use F-tag 242 that states the residents’ right to make choices in the facility about aspects of their lives that are important to them. The residents’ right to self-determination supports what we do at Idylwood. All residents have a choice about whether or not to attend cooking groups, and their physicians approve. All our harvested produce goes through a three-step sanitation process. We do this to ensure resident safety and state compliance. (It’s strange that CMS might think it okay to serve our residents tomatoes grown, for example, in Chile, stored and shipped thousands of miles; but not to serve tomatoes we’ve grown on site, cleaned and prepared—all under the oversight of a licensed dietitian.)
Despite all this, we still question whether we are an approved food source. This regulation’s lack of a clear definition of an approved food source causes great confusion for all those trying to do good for people living in nursing homes.
This and OSHPD/fire regulations about the use of stoves and other cooking techniques make it extremely hard to bring the heart and soul of kitchens and gardens to mainstream nursing facilities. For example, when the fire marshal required us to remove a stove from an activity/kitchen area, attendance in our cooking groups dropped 50%. We continue to do what we do with cooking and gardening while trying to demonstrate and inform government regulators how to give people living in nursing homes reason to get up in the morning. In sum, we are trying to make a skilled nursing facility into a skilled living facility. (Diamond, 2010)
Strengthening the interdisciplinary nature of the survey team can refocus the survey process to a more holistic emphasis. Increased representation from all helping professions on both the survey team and in technical consultation roles in the survey office is needed, however it is imperative that each helping profession represent their own specialization and advocate for resident self- determination within their professional expertise rather than merely attempting to adopt the medical or nursing focus of the traditional teams. Simplistically, a resident who expresses satisfaction with food service, demonstrates active choice and self-determination in dining, and appears well-nourished within the basic parameters of weight and hydration should be considered a positive outcome. Frequently facilities are cited for inadequate documentation although required documentation is not defined in regulation or guidelines. Even a resident with weight loss and/or the potential for negative outcomes may be, in the final analysis, a positive outcome if resident rights, including the rights of self-determination and the dignity of risk, have been mindfully considered. As a practical matter, if resident self-determination is to receive increased focus, the role of the resident and/or family interview in the survey process must be increased. Today,
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