CHAPTER Some would say, “If dining isn’t right, nothing is.” 3

The Institute of Medicine proposed sweeping reform, most of which became law in 1987 with the passage of the Federal Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act (OBRA). With the new emphasis on residents’ rights and quality standards for long-term care, a national impetus toward resi- dent-driven care, coined culture change, emerged (1,2). However, 20 years later, a 2007 study investigating the extent to which nursing homes had embraced culture change showed only 31% of facilities could be titled culture-change adopters (1). Given the shortage of facil- ities implementing culture change and a lack of focus on residents’ preferences, long-term care food service continues to receive poor satisfaction scores (3-5). While many factors contribute to this overall low level of satisfaction, a major concern, and an area the facility can control, is food service and dining through the implementation of culture change. Just as there is an emphasis on residents’ rights, facilities must consider the resident’s Five Rights of Dining when moving toward resident-driven care. (See Box 3.1.) Research and literature reviews regarding the

effect and implementation of culture change are abun- dant (6-10). However, very few studies put the resi- dents at the center of the planning process for culture change. Mealtimes are a source of pleasure both for the foods consumed and the social interaction. These are constant events for older adults living within a facility. However, the pleasure associated with eating is often lost after moving into the nursing facility. Public policy fulfillment coupled with the nursing facility’s desire to increase quality of service to meet changes in resi- dents’ expectations and improve marketability warrant a new look at culture change and homelike dining as defined by the residents in skilled nursing facilities (11). The following will become a necessity in the “person first” environment:

Person-Driven Care ●

identifying each person’s daily food/dining pleasures;

● determining how these pleasures can be provided; ●

educating staff about the residents’ needs and expectations; and

●

monitoring and following up to ensure individual requests are being met.

BOX 3.1 The Five Rights of Dining

The right food: the resident’s preferences The right setting: where the resident likes to eat The right preparation: how the resident likes the food made The right time: when the resident wants the food The right to choice: the resident’s choices are honored

Culture change is the common name for a global initia- tive focused on transforming care for those living with frailty and different cognitive, developmental, psycho- logical, and physical abilities. It focuses on more per- sonalized choice in decision-making about the resident’s daily life and being treated with dignity, respect, self-determination, and purposeful living by staff and caregivers (12,13). It intends to transform the long-term care medical model to one that both nurtures and caters to the individual and meets medical needs (14). The California Healthcare Foundation further defines culture change within five points (15):

● ● ● ● ●

establishing inclusive decision-making redefining staff roles

demedicalizing the physical environment redesigning the organization creating new leadership practices