Page 9 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
WHAT IS POSSIBLE: QUALITY OF LIFE – QUALITY OF CARE IN DINING
QUALITY OF LIFE IN DINING – What is Possible?
Normalcy is Possible
The Pioneer Network phrase, “rampant normalcy,” aptly defines the goal to continue the dining experience that is “normal” to the resident, whatever that might be, with the transition from community home to long-term care home. Steve Shields, in Restoring “Rampant Normalcy”: the Power of Small Moments, describes those small moments in normal dining, “the little choices and rituals that make up the fabric of our lives.”
“Our residents control the rhythms of their own lives now. First meal schedules were expanded; now they’re being replaced by ‘continual dining,’ meaning people eat what they want when they want. We still have the standard menu options, but there’s a meal being cooked somewhere in this place at any given hour – and anybody at all might be cooking it – to order. We’re still discovering what choice means, how deep that word goes, but we’re getting there. Spontaneity has found its way here in ways it would never have before. Relationships are deeper. True friendships have formed. And the small moments flourish.” (Shields, 2004)
The Minnesota pioneer of deep culture change, the Service House at Lyngblomsten Care Center, was patterned after the Swedish Service House system. The Swedish model focuses on autonomy and self-determination by maintaining normal life routines in the transition from community to Service House living. Service Houses have individual apartments, each with a full bath and kitchenette where breakfast and supper are prepared by staff with each residents’ own food, allowing them to get up in the morning and go to bed at night when they choose, and take meals of their choice at times of their choice. Lyngblomsten’s first Service House opened in 1997 as a demonstration project and served as the catalyst for culture change in Minnesota. It was described in detail in “A Case Study Brief” by Paul Mikelson in Culture Change in Long- Term Care, 2003. Today, Mikelson reports:
All 14 of our "neighborhoods" use most of the features of the original Service House program, though the one truly wonderful aspect of having your own food for breakfast and evening meals has largely disappeared due to families not being
A note of appreciation: Stories, concerns and comments in italics throughout this paper were shared by others in informal communication in response to the author’s commitment to address the topic through the eyes of providers, professionals and others working to improve resident quality of life through culture change, specifically through resident-centered dining in long- term care. A sincere thanks to Lori Madalone RD, for her invaluable challenges to the status quo and to all who shared their expertise with a special indebtedness to the following organizations for their encouraging stories that provide insights into the possibilities of dining transformation in households: Bigfork V alley Communities (formerly Northern Pines Communities), Bigfork, MN; Meadowlark Hills, Manhattan, KS; Pennybyrn at Maryfield, High Point, NC; Garden Spot Village, New Holland, PA; Perham Memorial Home, Perham, MN; Nielson Place, Bemidji, MN; Lyngblomsten Care Center, St. Paul, MN; and the Cottages at Brushy Creek, Greenville, SC.
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