RD’S IMPACT ON PERSON CENTERED

DINING FOR SENIORS

13.8% of the population 1 in 8 people is a senior Fastest growing group, by the year 2030

they will be 19% of population (>72 million) Average life expectancy is 79 years Only 3.6% live in institutions 72% voted in presidential election >age 50 control 77% of all financial assets

& 50% of all credit cards(average annual income $105,000.00)

Seniors Today (over 65 years)

Culture Change Person directed care, practices Short term Rehab Liberalization of therapeutic diet restrictions Move from hospital model to hospitality

model Decentralized dining options / choices Personal choice with full backing of CMS Sustainability

Emerging Trends in Senior Dining

“Culture change" is the name given to the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders & those working with them are considered & respected. Core person-directed values are choice, dignity, respect, self-determination & purposeful living.

All Decisions Default to the Person

Culture Change

◦Often starts in the kitchen as this leads to significant improvements in the quality of life for elders. Food is a powerful symbol of love,nurturing & needs to be served in ways that appeal to people; it has to be attractive & desirable. We need to bring the concept of “home” as much as possible to the dining experience.

Person Centered Care

Flexible meal times Available snacks, beverages 24 hours a day Menu choices Pleasant environment Flexible seating Input into menu design Pleasant dining environment

The Dining Experience

Short-term rehab involves therapy for individuals recovering from a surgery, illness or accident. These programs help residents achieve their maximum functional capacity to return to their homes & community in the shortest time possible.

These residents are demanding improved & flexible dining choices.

Short Term Rehab

Pioneer Network’s New Dining Practice Standards (August 2011) established nationally agreed upon new standards of practice supporting individualized care & self-directed living versus traditional diagnosis-focused treatment. CMS regulations support this new standard of practice & individual choice as seen in F325, F281, F242 & memo dated March 1,2013.

Therapeutic Diet Liberalization

More homelike atmosphere More dining/food choices Staff empowerment Real food vs. supplements Flexibility of schedules Less institutional environment

Move from Hospital to Hospitality Model

The “younger” seniors want “green,” organic/natural foods & local sourcing practices.

They want to eat healthy but not restrictive diets.

More emphasis on allergies e.g. gluten-free options.

Vegetarian options.

Sustainability, etc.

Which dietitian would you listen to?????

RD’s Can Impact Quality of Life by Advocating for Seniors

Self-Determination

Food/Dining choices are a great place to

start.

We are the ones who can educate & train staff (dietary, nursing, activities), residents, & families on healthful eating & various nutrition therapies.

We are also the ones who can give equal support & energy to assisting residents in following their own course of action & what is reasonable & realistic for them.

Person Centered Dining Increases RD’s Visibility and

Impact on Care

We need to embrace the switch to more food choices & flexibility in dining & not insist on restrictive diets without resident input.

A major concern among the elderly is weight loss which often is the result of restrictive diets & dislike of food being served.

As health care professionals we need to be assisting & educating the resident to make appropriate food choices within their abilities & not insisting that they change their eating habits at their age.

Eating should be a positive & healthful event.

Pioneer Network’s New Dining Practice Standards support AND’s position on individualizing the elder’s diet. Evidence based research supports that therapeutic diets are detrimental at worst, neutral at best for the elderly.

It is time to let go http://www.pioneernetwork.net/Data/Documents/NewDiningPracticeStandards.pdf

http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1101

   

What About Diets???

ADA’s Position Papers also support & provide evidence that therapeutic diets may not be helping our residents.

Liberalization of the Diet Prescription Improves Quality of Life for Older Adults In Long Term Care, 2005

Individualized Nutrition Approaches for Older Adults in Health Care Communities, 2010 

Want to know what to eat, not what they cannot eat

How to shop for & prepare healthy food How to read nutrition labels Straight, simple answers to the mass of

nutrition misinformation they see everywhere

We need to put our aprons back on & start cooking

Seniors do have questions -

“Americans are by no means hungry, but they are starving for more

knowledge concerning two things: nutrition & cooking.”

RD’s need to be able to translate nutritional science into food choices. Research

confirms that taste wins out over nutrition when it comes to our food choices.

Take baby steps:Review & evaluate how you are currently serving mealsCan the dining room be made more homelike?Can snacks be made available at any time?Talk to your residents & see what they wantRevamp your menuStaff trainingWork with physicians to limit therapeutic dietsEducate residents & families about changesPromote & embrace informed choice

How can we impact, improve, invigorate our dining programs ?!

Start slow & remember that change is not a threat but an opportunity.

Questions??Nancy Ferrone,MS,RD,LDNDietary Consulting Inc.nferronerd@verizon.net