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Part I Introduction to Nutrition Care in Older Adults

Dining Room and Meal Service Organization

How meals and food are delivered in a congregate dining setting is critical to all but especially to the eat- ing-disabled client. The goal is to provide a calm atmo- sphere and prevent client frustration. Well-planned meal delivery and distribution con- tributes to the positive atmosphere in a dining room and enables staff who are assisting to maximize time spent with residents. This helps to prevent the individ- ual requiring assistance from becoming discouraged, which may result in diminished appetite. The following considerations may affect dining room and meal service delivery:

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Ensure table placement and table height are correct for mealtime. If dining rooms serve as multipurpose rooms, tables and chairs should be correctly arranged and at the proper height (if adjustable tables are available) before meals.

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Established seating assignments should honor res- idents’ seating preferences.

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All residents seated at a table are served meals at the same time. Meals should be delivered from the kitchen to the dining room in order, so that facility staff can serve residents in the order in which they are seated.

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Independent diners may be served first, but this is determined by the dining environment and system set up within the facility. Staff can then serve and assist more-dependent diners who require greater staff time.

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Ensure the dining area is not crowded and staff and residents can maneuver among tables.

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Staff who provide one-to-one assistance are seated during the meal.

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Before the meal is served, an activity is conducted while residents wait for their food.

● Meals are provided on time. ●

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Adequate staff is specifically assigned to each dining room.

Alternates or substitutes for meal items are readily available.

Physical Plant and Equipment The physical structure and equipment in the dining room affect all residents, but the eating-disabled person is espe- cially impacted (10). The following are considerations to review in evaluating the physical plant:

● ● The lighting is indirect with no glare.

There is sufficient space for residents and staff to maneuver.

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There are sufficient furnishings—tables, chairs, and storage units.

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Table heights accommodate wheelchairs. The dis- tance from the plate to the mouth should be within 12 to 18 inches, or individualized as needed.

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Dining room chairs have armrests and a sturdy base to allow for correct positioning.

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Chairs are available for staff to use while provid- ing assistance.

● ● Space for storage of needed supplies is available.

Staff wash or sanitize their hands before and while assisting each client to eat.

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There is space to allow for carts, steam tables, or other equipment needed to deliver and serve meals.

● The dining room is neat and without clutter. ●

The dishware contrasts with the tablecloth or placemat, to overcome vision deficits.

Personal Considerations Consideration of basic personal needs before meal service provides for comfort and basic infection- control measures (11):

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The resident’s hands and face are washed before the meal.

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Personal assistive devices, such as proper den- tures, eyeglasses, and hearing aids, are in place.

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Assistive devices and adaptive eating equipment, as identified in the resident’s plan of care, are available.

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Residents are appropriately dressed, with hair combed.

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Incontinence care and toileting are provided before meals.

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Residents are properly positioned in chairs and wheelchairs.

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Residents are positioned at an appropriate dis- tance from the table.

CONDITIONS AND DISORDERS AFFECTING EATING ABILITIES

Physical Deficits

Difficulty with independent dining can have multiple and complex causes. Poor oral hygiene can lead to gum disease, resulting in pain when eating, and to an increased risk of aspiration due to food particles that remain in the mouth following meals or accumulation of excess secre- tions (12). All older adults should have good oral hygiene care following each meal (see Chapter 9).