environment and through compensatory strategies and skills or adaptive equipment. A restorative dining program, which

allows residents to eat independently with supervision and assistance as needed, is a great step for residents after therapy or to be used concurrently with it, she says. “Now, we're adapting to the challenges

that COVID presents, because restorative dining might not be an option in some of these communities – communal dining might not be an option,” Ellison says. “So, we're trying to find ways to meet the

needs of these individuals with the staffing ratio that we've been operating with.”

Effects of isolation Based on polling she has done during webi- nars in recent months, Roche believes that residents in senior living communities are seeing an increase in unintentional weight loss. She says the culprit is social isolation. “The challenge that caught us all off

guard has been the social isolation,” Roche says. “Up until COVID, our communities

have been the antidote to social isolation. We have been learning that even though we are providing enough nutrition, many have been eating less because the dining experi- ence has changed so drastically.” Ellison says communal dining plays an important role in inspiring general motiva- tion to eat. She noted that residents eating isolated in their rooms also don’t have someone there to notice if they’re not eating and to encourage them. “So, what some of the clinicians are describing is that these patients are in their rooms and they've been so isolated that the depression rates are going up and the intake is going down,” Ellison says. “The challenges for meal delivery from

room to room is far harder than delivering meals in a dining experience, so maybe the food isn’t in its optimal state by the time it’s delivered to a resident. It just seems like a perfect storm.” One of the other risks of isolation is that

residents with swallowing disorders may not eat sitting at a table. “Proper positioning from a swallowing

dynamics perspective is really important,” Holterman says. “If somebody is lying in their bed eating most of their meals, they're not in a good


position to support the function of swal- lowing. Then if you have somebody with active COVID or even recently recovered, they may have a compromised respiratory function. “Breathing and swallowing is this very

intricate balance and lying down, or even slumping, can place pressure on the dia- phragm. So, you have this lack of socializa- tion, this lack of kind of sensory input, and now you also are possibly putting difficulty on the mechanics of swallowing.”

Teamwork helps Holterman says it’s essential to work as a team to identify the needs of residents and to track the fluctuating patterns of how they’re functioning day to day, including for identifying the early onset of COVID through symptoms such as loss of appetite, loss of taste, and loss of smell. With staffing limitations, Ellison says,

increasing training to make sure direct care staff understand the importance of moni- toring intake and weight can be crucial, so that “we can start to identify an issue sooner rather than later if someone should begin to lose too much weight or not have adequate hydration.” Roche agreed that socialization is a key

element to increasing motivation to eat, and communities should take any opportunity they can to “increase the coordination of dining services and resident engagement programs to take full advantage of any opportunities to provide extra calories and hydration to residents.” Some with swallowing disorders depend

on texture-modified foods and thickened liquids, and Roche, who has consulted for Kent Precision Foods Group, Inc., producers of the Thick-It brand family of products, says ensuring there are appropri- ate options in those categories for residents is important. Many recipes can be adjusted for texture- modified diets, she says, and she suggests building themes around food and socializa- tion, selecting foods that offer nutritious calories and hydration. “Coordinate with your dietitian to keep

monitoring your residents with chewing and swallowing problems even after the dining rooms are open,” Roche says. “It will take some time and focus to gain back losses in nutritional status.”

Monitoring intake and weight can be crucial, so that “we can start to identify an issue sooner rather than later if someone should begin to lose too much weight or not have adequate hydration,” says Adrienne Ellison, regional director of operations, Legacy Healthcare Services.

A lasting impact? According to Kazandjian and Boczko, “it is unclear what lasting impact the virus has on managing swallowing disorders.” “We know that endurance and fatigue

contribute to recovery of function,” Ka- zandjian and Boczko note. “We also know that breathing and swal-

lowing coordination can be disrupted for patients with respiratory compromise. An individualized treatment program created to maximize swallowing safety and oral intake of food and liquid is necessary.” Ellison, Kazandjian, and Boczko each

noted that adjusting for those with swal- lowing disorders who are in recovery from COVID could include a shift to smaller, more frequent meals that are less tiring to complete. In addition, a meal plan with calorie-

dense portions could reduce the effort required to breathe during meals, and Holterman says senior living communities may need to extend dining hours to ensure residents are not rushed to eat. “We'll adapt and we’ll learn from this,”

Ellison says. “We'll come up with some great, new strategies and solutions to support those residents and keep them as healthy as possible.”

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44