Rhythms of Daily Living Dining & Choice Rhythms of Daily Living © Dining & Choice Aligning Expectations – Resources – Outcomes.
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Rhythms of Daily Rhythms of Daily LivingLiving© Dining & ChoiceDining & Choice
Aligning Expectations – Resources – Outcomes
April 28, 2004 IAHSA - a celebration of age 2
Why Do 65% Of NH Residents Eat Less Than 75% Of Most Meals* ? Primary Factors That Contribute To Malnutrition In
Nursing Homes 1. An Inappropriate Dining Experience For The Resident.
2. Meal Delivery Methodology and Systems Not Conducive To Eating.
3. Good Nutrition is of no value if it is not consumed
*Excerpted From Ch 14 Of Report To Congress “Appropriateness of Minimum Staffing Ratios In Nursing Homes” Authored By J. F. Schnelle et al, Borun Center For Gerontological Research
April 28, 2004 IAHSA - a celebration of age 3
Must Rising Acuity Levels Mean Lower Dining Quality ?
©©
Independent Living Assisted Living Memory Enhanced Skilled Nursing
Nutrition Quality Food Quality Service Quality Life Quality
April 28, 2004 IAHSA - a celebration of age 4
What Are Factors of a Quality Dining Experience? Relaxed service Choice of what, where and when you eat Participation in the definition of generational experience
expectations Reputation – consistency of service Timeliness Presentation & Taste of meal Do not rush me Neighbors, Atmosphere, aroma, friendliness cleanliness Residents eat when hungry & personal eating habits are
accommodated
The Simple Answer Is NoNo!
April 28, 2004 IAHSA - a celebration of age 5
Skilled Care Dining TodayRestricted Service Times, Too Short For Quality & Assistance
< 20 MinutesFor Dining
0 10 20 30 40 50 60
Minutes
Loading Time
Transport Time
Waiting Time
Service Time
Dining Time
Extra Assistance
Food Quality Zone
Temp. Integrity
The Quality Gap
April 28, 2004 IAHSA - a celebration of age 6
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
April 28, 2004 IAHSA - a celebration of age 7
Rhythms of Daily LivingRhythms of Daily Living
The 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.
April 28, 2004 IAHSA - a celebration of age 8
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.
April 28, 2004 IAHSA - a celebration of age 9
Balancing the Natural Rhythms of Resident Living and Care Work A “More Normal” Pattern of Living and Work
Residents Eat What And When They Want Over A Longer Meal Service Pre-Meal Medications, Bathing and Other Activities Are Less Pressured Staff Provides Assistance As Required
24 Minutes Is Average Optimal Feeding Assistance Time With A Range From 5 To 70 Minutes Depending On ADL Status*
48% Of Nursing Home Population Require Some Degree of Assistance* A Dining Experience, Not A Feeding Period
Shift Dining Service Focus From Trays To Residents and Quality Collaborative Service Support Aroma Therapy Course Presentation Minimal Distraction Environment
*Excerpts From Ch 14 Of Report To Congress “Appropriateness of Minimum Staffing Ratios In Nursing Homes” Authored By J. F. Schnelle et al, Borun Center For Gerontological Research
April 28, 2004 IAHSA - a celebration of age 10
What are the Attributes of a Quality Dining Experience? Quality of menu item presentation Appetizing Taste Variety Atmosphere, environment Pleasant service Choice Consistency China/glassware Timely Appropriate temperature & consistency
April 28, 2004 IAHSA - a celebration of age 11
The Main Thing For Senior Care
Choice
April 28, 2004 IAHSA - a celebration of age 12
“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.
April 28, 2004 IAHSA - a celebration of age 13
Outcomes No complaints Socialization Weight stabilization Improved I/O’s Less plate waste Smiles Reduced staff turnover Improved skin integrity Reduced use of supplements Congenial and pleasant environment – warm & inviting
April 28, 2004 IAHSA - a celebration of age 14
Benefits better interaction with staff & residents freedom of choice residents more social amongst themselves better presentation Food is hot/cold Better texture POS selection for menu items Better I/O’s Resident choice of time to eat/when hungry
What Are Your Experiences?
April 28, 2004 IAHSA - a celebration of age 15
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
April 28, 2004 IAHSA - a celebration of age 16
40% of Residents Gain Weight In The First Few Program Months
50% Reduction In The Number Of Residents Losing Weight. Consistent Improvement In Resident Satisfaction $0.18 – $0.21 Reduction In Food Cost Per Meal From Less
waste. 85% Decrease In Use of Supplements Higher Job Satisfaction Improved Hydration Outcomes Exceed Regulatory Requirements
RDL Is RealReported Results From Ten Communities That Have Implemented RDL
April 28, 2004 IAHSA - a celebration of age 17
PLAN & DEVELOP
Organize
Alter
Codify
Train
Improve
Choice Dining AlignmentProcess Overview
Plan
Evaluate
Define
Assess
Implement
April 28, 2004 IAHSA - a celebration of age 18
Plan Transition Process and Commit ResourcesWrite Program Transition Budget and Operating Narrative
Organize
Codify
Organize For Culture Change Establish “Experience” Alignment Teams To Define/Implement Transition
Codify Policies/Procedures and Training By Function Write & Task Procedures/Training Using RDL© Base
Choice Dining AlignmentPlan and Develop
Plan
Evaluate “Readiness” With Leadership, Managers & Residents/FamiliesDefine Outcomes Baseline and Expectations
Evaluate
Define Define Service Functions and Outcomes For Each ExperienceIdentify Beneficiaries/Benefits and Diagram Service Functions
April 28, 2004 IAHSA - a celebration of age 19
Program Intersects Grid
PROJECT COMMUNITY OF DISTINCTION
FINANCIAL ENHANCEMENT
QUALITY OF LIVING
QUALITY OF WORK
OPERATIONAL EFFECITVENESS
COMMUNITY
POS System Improved management of production controls, improved tracking of billable supplies
Ability to implement DBP
MOW Increase presentation of McLean Brand into the community
Increased revenues and improved efficiencies of the existing resources
Improve QoL for MOW clients Increased operational effectiveness for facilities
Campus Dining Program Continuity of standards throughout the community
Increased cost efficiencies Improved QoL for all residents and work environment for staff
Increased effectiveness in all appropriate operational areas
April 28, 2004 IAHSA - a celebration of age 20
Program Intersects Grid
PROJECT COMMUNITY OF DISTINCTION
FINANCIAL ENHANCEMENT
QUALITY OF LIVING
QUALITY OF WORK
OPERATIONAL EFFECITVENESS
HEALTH CARE CENTER
3 & 4 Modification RDL
Creates a signature service for the Memory Support neighborhood
Reduce costs with the implementation of RDL
Improved resident QoL and improved staff working environment
Operational benefits of RDL
RDL Dining Creates a signature model of resident service for the HCC
Reduce costs with the implementation of RDL
Improved resident QoL and improved staff working environment
Operational benefits of RDL
MDR Service Modifications Compliment service model of RDL, grille options and service venues
Increased accessibility to dining program increasing revenue options
Increased selection and choice improving QoL
Increased productivity while increasing services reducing neighborhood service requirements.
MOW Capacity Increase Increase presentation of McLean Brand into the community
Increased revenues and improved efficiencies of the existing resources
Improve QoL for MOW clients Increased operational effectiveness for facilities
April 28, 2004 IAHSA - a celebration of age 21
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
April 28, 2004 IAHSA - a celebration of age 22
STAGES of RDL Readiness GAP Analysis
Establish clear understanding among all constituents (residents, staff and administration) as to the program impact on 6 principle areas.
Culinary Capacity Establish a servery on the resident floor where all meals can be finished, plated and served.
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. Point of Service Menu Choice
Establish the opportunity for the resident to choose alternate items from a menu during meal service. 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.
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.
[1] Schedule choice is the last and most difficult stage to implement because it affects the scheduling of all resident activities from bathing to medication and activities.
April 28, 2004 IAHSA - a celebration of age 23
Choice Dining Alignment Continuous QualATIsm Alignment
Improve
Train
Alter
Assess
EffectivePractices
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