Transcript Rhythms of Daily Living

Rhythms of Daily Living
Dining & Choice
©
Aligning Expectations – Resources – Outcomes
Why Do 65% Of NH Residents Eat
Less Than 75% Of Most Meals* ?
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Primary Factors That Contribute To Malnutrition
In Nursing Homes
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An Inappropriate Dining Experience For The
Resident.
Meal Delivery Methodology and Systems Not
Conducive To Eating.
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
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Must Rising Acuity Levels Mean Lower
Dining Quality ?
©
Independent Living
Nutrition Quality
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Assisted Living
Food Quality
Memory Enhanced
Service Quality
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Skilled Nursing
Life Quality
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The Simple Answer Is No!
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What Are Factors of a Quality Dining Experience?
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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
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Skilled Care Dining Today
Restricted Service Times, Too Short For Quality & Assistance
Loading Time
Transport Time
Waiting Time
< 20 Minutes
For Dining
Service Time
Dining Time
Extra Assistance
The Quality Gap
Food Quality Zone
Temp. Integrity
0
10
20
30
40
50
60
Minutes
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Bridging The Quality Gap
Serve The Resident, Not The System
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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
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Rhythms 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.
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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.
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Balancing the Natural Rhythms of Resident
Living and Care Work
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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
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What are the Attributes of a Quality Dining Experience?
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Quality of menu item presentation
Appetizing
Taste
Variety
Atmosphere, environment
Pleasant service
Choice
Consistency
China/glassware
Timely
Appropriate temperature & consistency
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The Main Thing For Senior Care
Choice
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“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.
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Outcomes
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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
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What Are Your Experiences?
Benefits
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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
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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
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RDL Is Real
Reported Results From Ten Communities That Have
Implemented RDL
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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
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Choice Dining Alignment
Process Overview
PLAN & DEVELOP
Evaluate
Organize
Define
Plan
Codify
Implement
Assess
Alter
Train
Improve
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Choice Dining Alignment
Plan and Develop
Evaluate “Readiness” With Leadership, Managers & Residents/Families
Define Outcomes Baseline and Expectations
Evaluate
Organize
Organize For Culture Change
 Establish “Experience” Alignment Teams To Define/Implement Transition
Define
Plan
Codify
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Define Service Functions and Outcomes For Each Experience
Identify Beneficiaries/Benefits and Diagram Service Functions
Plan Transition Process and Commit Resources
Write Program Transition Budget and Operating Narrative
Codify Policies/Procedures and Training By Function
Write & Task Procedures/Training Using RDL© Base
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Program Intersects Grid
PROJECT
COMMUNITY OF
DISTINCTION
FINANCIAL
ENHANCEMENT
QUALITY OF LIVING
OPERATIONAL
EFFECITVENESS
QUALITY OF WORK
COMMUNITY
POS System
MOW
Campus Dining Program
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Increase presentation of
McLean Brand into the
community
Continuity of standards
throughout the community
Improved management of
production controls, improved
tracking of billable supplies
Increased revenues and
improved efficiencies of the
existing resources
Increased cost efficiencies
Ability to implement DBP
Improve QoL for MOW clients
Increased operational
effectiveness for facilities
Improved QoL for all residents
and work environment for staff
Increased effectiveness in all
appropriate operational areas
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Program Intersects Grid
PROJECT
COMMUNITY OF
DISTINCTION
FINANCIAL
ENHANCEMENT
QUALITY OF LIVING
OPERATIONAL
EFFECITVENESS
QUALITY OF WORK
HEALTH CARE CENTER
3 & 4 Modification
RDL
RDL Dining
MDR Service Modifications
MOW Capacity Increase
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Creates a signature service for
the Memory Support
neighborhood
Creates a signature model of
resident service for the HCC
Reduce costs with the
implementation of RDL
Compliment service model of
RDL, grille options and service
venues
Increased accessibility to dining
program increasing revenue
options
Increase presentation of
McLean Brand into the
community
Increased revenues and
improved efficiencies of the
existing resources
Reduce costs with the
implementation of RDL
Improved resident QoL and
improved staff working
environment
Improved resident QoL and
improved staff working
environment
Increased selection and choice
improving QoL
Improve QoL for MOW clients
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Operational benefits of RDL
Operational benefits of RDL
Increased productivity while
increasing services reducing
neighborhood service
requirements.
Increased operational
effectiveness for facilities
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Assessment Points for RDL
Implementation
Stages 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
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STAGES of RDL
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Readiness GAP Analysis
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Culinary Capacity
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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
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Establish the opportunity for the resident to choose alternate items from a menu during meal service.
Schedule Choice I[1]
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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
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Establish a servery on the resident floor where all meals can be finished, plated and served.
Individualized Service
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Establish clear understanding among all constituents (residents, staff and administration) as to the program
impact on 6 principle areas.
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)
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Establish the opportunity for residents to choose alternate places to dine.
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[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.
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Choice Dining Alignment
Continuous QualATIsm Alignment
Assess
Improve
Effective
Practices
Alter
Train
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