Page 51 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
We had a nursing home that came up with a special dining program that would encourage residents to come out of their rooms to eat. It was a great idea to encourage social activity among the residents. It was set up buffet style and included such things as real fried chicken, buttery corn on the cob, yummy mashed potatoes and hand-dipped ice cream. The residents who stayed in their rooms to eat were served the old stuff – baked chicken, canned corn, potato flakes and cups of ice cream. The state agency received a complaint from a woman whose room was close to the buffet. Every evening she smelled the wonderful aroma of the buffet. She liked to stay in her room and eat her dinner while she watched the evening news, so she wasn’t served the buffet meal. Instead she received a tray from the kitchen with the traditional institutional food. The surveyor investigated and then wrote a mammoth deficiency citing a violation of civil rights! The IDR was wild. The nursing home, which was a really good nursing home, said, “We’re trying to do a good thing! Why is it a deficiency?” And the surveyor was just as passionate, “Why does this lady, who is alert and bright, have to smell this wonderful food and then be denied because she wants to stay in her room and eat when she watches TV?” Finally reason prevailed. We acknowledged the positive aspects of the program and the good intentions of the nursing home. However, you can’t use food as punishment and so it was a resident’s right deficiency, reduced from a G to a D.
We implemented ‘made-to-order’ breakfast in our nursing home in May 2007. Breakfast is served between 7 and 9:30 AM. A cook from the kitchen would come to the dining room and prepare made-to-order eggs (scrambled, over easy omelet, poached), French toast or pancakes. Bacon, ham, cream chipped beef, danish, toast, hot and cold cereal juices and regular and decaf coffee were also served by our nursing staff. Nursing staff took orders and the breakfast was prepared when the resident was ready to dine. If the resident wanted to eat in their room, the tray was delivered as soon as it was completed. If the resident chose to come to the dining room, they could see their food cooked right in front of them. Cooking was limited to eggs (boiling water for poached eggs) and pancakes, using induction cookers and a residential griddle. French toast was toasted and all meat items were cooked in the kitchen and brought over to avoid the chance of grease fires. We were surveyed by the Department of Health in mid-May 2007 and received no dining deficiencies. A complaint survey initiated by a family member was not substantiated in the fall of 2007 as the surveyor agreed that the made-to-order dining was a great improvement (we had already fixed the problem, which was related to a space issue, by implementing a two seating arrangement – we preferred open dining, but too many residents were coming at the same time, which was overwhelming our ability to provide residents with made-to-order meals). So after being surveyed twice on the new dining, we thought we were in good shape with DOH...until the May 2008 survey. One surveyor noted that she could smell breakfast throughout the nursing home and that ‘residents shouldn’t have to smell that...’ We noted that the aroma of food cooking is normal in a home and that it stimulated the desire to eat, which is critical for good nutrition. She didn’t accept that. She said we needed better exhaust systems. As she looked at our setup she noted that there was no exhaust and no fire suppression system. Remember we were only cooking eggs and pancakes – a process that many culture change-focused nursing homes were and are still doing. The surveyor called Life Safety and reported her findings. I received a call from DOH Life Safety telling me to cease cooking immediately. Did I understand? I told him I did. No deficiencies were given. We have not cooked in the dining room since that time and all food is carted from the kitchen in small batches. The breakfast program has not been the same since that time. In fact, it set back our whole culture change mindset and focus for many months, and nursing home residents have not enjoyed a freshly made breakfast in over two years.
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