Chapter 3 Person-Driven Care

regulatory agencies are supportive of individualized, resident-centered care that provides options for resi- dent choice” (14).

RESIDENTS’ EXPECTATIONS The 2009 National Survey of Consumer and Workforce Satisfaction in Nursing Homes found that resident choices/preferences, quality of dining experience, and quality of meals are all listed in the top 20 factors that drive consumer recommendation of a skilled nursing facility (34). Dining location, dining room ambiance, and socialization with other residents were also import- ant (39,43,44). Several researchers have conducted focus groups or personal interviews with residents and have concluded that food is vital to the residents’ well-being and satisfaction and that a focus on resi- dents’ preferences increases food intake (4,10,45-53). Researchers Kane et al found that older people want, but do not get, the same chance that young people have to choose autonomy in long-term care: control, individuality, and continuity of a meaningful personal life (6,54,55). Older people want to live in a setting that is homelike and allows them to make deci- sions they are accustomed to making for themselves. Kane et al also found that these older adults would prefer to stay at home or in a homelike environment and receive care where they live, rather than live in an institution that focuses on care (6,54,55). In a 2005 publication, Linda Bump, MPH, RD, NHA, Pioneer Network member, and culture change leader with Action Pact, emphasized resident-centered dining and encouraged “excellence in individualiza- tion.” She indicated that in order to accomplish such excellence, each facility must provide choice, accessi- bility, individualization, liberalized diets, food first, quality services, and responsiveness (56). Bump defines each term as follows:

Choice is the choice of what, when, and where to eat; whom to eat with; and how leisurely to eat. Choice should be true choice, not token choice—that is, choice of what the resident wants without facility-imposed limitations.

Accessibility is the access to foods of choice available when hungry or when just longing for a specific food. Food should be available 24 hours a day, 7 days a week, and someone should be available to help prepare it.

Individualization is specific attention to older adults’ favorite foods, comfort foods, ethnic foods, foods pre- pared from their own favorite recipes, and foods they choose to eat in their own home. The foods offered should make them look forward to the day, warm their heart and soul, and nourish their bodies (54).

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Liberalized diets should include the older adult’s right to choose whether or not to follow a restrictive diet. The diet should not be based solely on diagnosis but on the individual.

Food first is the ability to choose food before supple- ments and medication. This is a natural decision and should be fostered.

Quality service focuses on relationships that are the key to quality caregiving and quality service in dining. Knowing older adults, their choices, their preferences, and their daily pleasures in dining results in quality service that encourages optimal intake.

Responsiveness refers to relationship-based services, resident access to the refrigerator whenever desired, and quiet attention to every need.

Regardless of the method of delivery, Bump concludes that “food is the heart of the home. The ideal is to have what the residents want to eat available 24 hours a day, 7 days a week, with the opportunity to eat with whom they wish, in places they choose to be” (56).

CURRENT FOOD SERVICE

ATMOSPHERE In another study, registered dietitian nutritionists (RDNs) and licensed dietitians (LDs) from the central Texas area were interviewed in a roundtable format to determine what they felt was the current food service atmosphere. According to attendants A. Chilton, J. Dietze, A. Elliot, M. Emerson, C. Piland, H. Regetz, and L. Roberts, the professionals were asked what culture change food service practices they had seen implemented, what barriers they felt they might encounter in implementing culture change, and what they would like to know about residents’ preferences regarding culture change (oral communication). Additionally, the dietitians provided anecdotal infor- mation regarding experiences in adopting culture change within their facilities. In summary, this group determined that barriers to culture change included having too many procedures and systems to implement but no direction as to where to begin.

If the wrong choice was executed, there was the potential of tremendous cost at no additional benefit to the resident. This was validated in two examples pro- vided by the group: implementing room service with minimal users of the program, which resulted in no change in customer satisfaction, and initiating crystal glassware that was beautiful but too heavy for the resi- dents to comfortably lift.