Dining as a Catalyst Liberating Care & Navigating

Change

Rhythms of Daily LivingRhythms of Daily Living©

A Service of Choice

Aligning Experiences – Expectations – Resources – Outcomes

November 7. 2005 AAHSA - Quality Through Community

2

Session Objectives Present

Concept of Dining as Catalyst Key Factors for Transition

Discuss Transition Experience Integration of Key Factors Tradition & Transition

Provide Process for Transition

Outcome Create Documented Process for Community Program Transition

November 7. 2005 AAHSA - Quality Through Community

3

Assumptions

Envision the Future, Honor the Tradition Imposition of Dining Until the Experience Dining is Resident Centered,

a New Culture will not Take Deep Root What is Current Does Not Work As Well As It

Can & Should

November 7. 2005 AAHSA - Quality Through Community

4

Presentation Points

Review Changing Factors of Environment & Constituencies

Review Demographics Define Assumptions Introduce Choice Dining Concept &

Implementation Process Discuss Culture of Service, Leadership, Choice Identified Measurable Indicators

November 7. 2005 AAHSA - Quality Through Community

5

Changing Demographics More Couples More Choice & Selection More Control More Flexibility Experience Consumers More Knowledgeable of CCRC Living Healthier – Wellness Important Seamless Experience Broader Constituencies

November 7. 2005 AAHSA - Quality Through Community

6

Assumptions

Imposition of Dining Transition is for All Levels of Living Choice is a Key for Quality of Living/Work Operational Evolution Enabling Culture

Transformation Requires Servant Leadership

November 7. 2005 AAHSA - Quality Through Community

7

Must Rising Acuity Levels Mean Lower Dining Quality ?

©©

Independent Living Assisted Living Memory Enhanced Skilled Nursing

Nutrition Quality Food Quality Service Quality Life Quality

November 7. 2005 AAHSA - Quality Through Community

8

Bridging The Quality GapServe The Resident, Not The System The System – Individual Preparation, Bulk Service

Prepare Individual Menu Items For Storage Place On A Tray For Transport To Feeding Area Transport and Leave In Cart Distribute and Unwrap At Scheduled Meal Time

The Alternative – Bulk Preparation, Individual Service Prepare Menu Items In Bulk Transport To Dining Room Servery Plate Individually and Serve Upon Request

November 7. 2005 AAHSA - Quality Through Community

9

How Do You Individualize Care? What Are Community Strategic Objectives? What Is The Vision for Community Dining

Experience? What Is History of “Transformation” Projects? What Are Constituency Most Important

Experiences?

November 7. 2005 AAHSA - Quality Through Community

10

Rhythms of Daily LivingRhythms of Daily LivingThe core of RDL is the opportunity to exercise choice –

residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination.

RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.

November 7. 2005 AAHSA - Quality Through Community

11

Choice Is The Way We Live

“Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.”

Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.

November 7. 2005 AAHSA - Quality Through Community

12

STAGES of RDL1. Readiness GAP Analysis

Establish clear understanding among all constituents (residents, staff and administration) as to the program impact on 6 principle areas.

2. Culinary Capacity Establish a servery on the resident floor

where all meals can be finished, plated and served.

November 7. 2005 AAHSA - Quality Through Community

13

Stages of RDL3. Individualized Service

– Establish a service program without the tray system. Meals are plated in the servery when the resident is in the dining room. Choice is based on pre-ordered menu items, however time of service is not flexible.

4. Point of Service Menu Choice–Establish the opportunity for the resident to

choose alternate items during meal service.

November 7. 2005 AAHSA - Quality Through Community

14

Stages of RDL5. Schedule Choice I[1]

Establish the opportunity for residents who are self-sufficient and independent to dine at a time of their choosing, within established service times.

6. Schedule Choice II Establish the opportunity for residents who require

assistance with dining but are able to determine when they would like to dine to do so within established service times.

7. Venue Choice (If Appropriate) Establish the opportunity for residents to choose

alternate places to dine.

November 7. 2005 AAHSA - Quality Through Community

15

Assessment Points for RDL ImplementationStages are defined against the requirements of: Administration: fiscal, management and leadership

considerations Regulatory: compliance criteria (grouped by clinical and

operational considerations) Systems: software programs, forms, policy & procedures,

protocols Personnel: staffing requirements, training, HR. The impact

on each care disciplines is identified by department PP&E: Property, Plant & Equipment necessary to perform

the tasks and functions Community: Communications, Resident & Family

education; community collaboration

November 7. 2005 AAHSA - Quality Through Community

16

What Are Your Experiences?Obstacles

Structure of ordering Staff resistance to change Inadequate staffing Training of staff to new tasks Management of change (fair process) Need to educate the staff in the process of change Clear explanations of the reasons/outcomes of changes How changes will impact staff security and knowledge

of job tasks and resident served

November 7. 2005 AAHSA - Quality Through Community

17

The ROI Of A Dining ExperienceBuilding “Experience Equity”Dining establishes the daily quality of life for all members of a senior living community.

The culture defined by the dining experience resonates with and dictates that of the entire community. The dignity and joy of making self-determined choices are at the

core of any good dining experience.

BAD DINING

EXPERIENCE

GOOD DINING

EXPERIENCE

High Staff Turn-Over/Contract Labor = High Costs & Poor Morale/Service

High Staff Retention = Lower Labor Costs

High Food Waste/Use of Supplements = High Food Cost

Low Food Waste/Elimination of Supplements = Lower Food Costs

Low Appetite/Unanticipated Weight Loss = High Care Costs

Healthy Appetite = Lower Care Costs

Poor Image = Higher Marketing Costs and Lower Income

Great Dining Program = Lower Conversion Costs & Higher Occupancy

November 7. 2005 AAHSA - Quality Through Community

18

Contact Information

Dan Look 3605 Sandy Plains Road Suite 240-269 Marietta, GA 30066

dcl@dm-resources.com www.dm-resources.com 770-565-4006

November 7. 2005 AAHSA - Quality Through Community

19

"For every complex, difficult problem,There is a simple solution.And, it is probably wrong!"

H.L. Mencken