Page 6 - The Deep Seated Issue of Choice

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THE DEEP SEATED ISSUE OF CHOICE
WHERE DO WE START?
understanding and cooperation from all involved – residents and their families, nursing home directors, geriatricians and nursing home staff and government regulators.
Not only may malnutrition and dehydration result in readmission to the acute hospital—a stressful event for frail elders—but they also contribute to a decreased quality of life, morbidity, and mortality. In addition to these physiological, psychological, and pathological consequences, nursing home residents who do not receive adequate nutrition and hydration during the last months or years of their lives are denied one of life’s greatest pleasures—the enjoyment of food and drink of their choice in a pleasant, social environment.
Two of the nine specific approaches they recommended in 2000 are uniquely descriptive of nursing homes that have adopted the culture change movement, specifically the neighborhood and small house or household, and all nine approaches are compatible with it. Specific to the neighborhood/household model are:
- Utilization of all nursing home personnel to assist at mealtime; cross-training of administrative and other indirect care staff as CNAs; supporting and training family members to help residents to eat; training volunteers in tray set-up and mealtime socialization...
- Creation of an environment conducive to eating, including the provision of homelike surroundings at mealtime, smaller social neighborhoods, attractive food, choice in food, attention to ethnically sensitive/appropriate food choices, and making foods available 24 hours a day.
Among their conclusions: “Some nursing homes have already discovered that creating small neighborhoods within larger nursing units to increase the social aspects of dining, and instituting cross-training of other nursing home staff to help at mealtimes are effective in preventing malnutrition and dehydration.” (Burger, Kayser-Jones, and Bell, 2000)
CULTURE CHANGE – SUPPORTING QUALITY OF LIFE AND CARE
According to a recent survey, Culture Change in Nursing Homes: How far have we come? Findings from the Commonwealth Fund 2000 National Survey of Nursing Homes, “Although The Nursing Home Reform Act, passed in 1987, established residents’ rights and quality standards for nursing homes nationwide, serious concerns remain about quality of care and quality of life for nursing home residents. The culture change movement is working to radically transform nursing home care, and help facilities transition from institutions to home.”
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