Proof In The Pudding

It seems obvious that if we want to improve the lives of elders living in nursing homes, our dining practices would be a great place to start. I don’t know about you, but I like choosing what I have for dinner. I graduated from plastic trays when I graduated from high school, and when I feel like having a snack from my fridge I don’t reach for a canned nutritional supplement. Our residents probably all feel the same way, and that should be a good enough reason to make changes in dining practices.  But there are more positive outcomes involved – and now there’s proof.

The folks at The Health and Wellness Center at Moravian Hall Square in Nazareth, PA have been tracking those outcomes as they make changes in dining. Data gathered between 2012 and 2013 shows decreased therapeutic diets, decreased supplement usage and decreased unintended weight loss. Resident satisfaction in dining increased 10% between 2008 and 2013.



Inspired by the New Dining Practice Standards, the dining team aimed to make changes that honor residents’ choices and their right to refuse dietary restrictions and eat just as they would if they were living on their own, like they’d been doing all their lives. Dining service that started as a traditional tray line now offers restaurant style service for lunch and dinner and includes “always available” options such as pizza and grilled cheese, two daily hot entrée options, two daily homemade soups, fresh fruits and vegetables, and a deli bar. Items higher in salt and carbohydrates are noted on the menu to help residents make informed choices. Made-to-order breakfasts are offered once a week.

Many of the positive outcomes are due to changes around supplements. “The thought is if residents are eating real food, they won’t need supplements,” said Cara Hillenbrand, RD, LDN, CNSC at Moravian Hall Square. So now, there are more choices of “real food” for snacks including half sandwiches and peanut butter crackers. “We have ten to twelve items available anytime,” said Cara. Other items may be available too. “If we have it in the building, we can provide it,” she added. In addition to the snacks, the dining staff is making homemade milkshakes and fortified pudding to replace commercial cans of supplements, saving the organization $2700 a year.


Some of the most positive outcomes cannot be expressed in numbers. Residents living with dementia who are keeping to their own internal clock and may not be interested in eating at meal times are snacking at 3 a.m. when they are hungry. Cara has seen a change in a resident who, before the changes, rarely left his room. With the restaurant style service, he now eats lunch and dinner in the dining room and has been attending more activities and becoming more social in general. He has gained 14 pounds. Another resident, who had a non-healing wound, has been enjoying the new dining changes and eating more, Cara said. Her wound is now resolved.

Action Pact consultant, Linda Bump, whose paper The Deep Seated Issue of Choice helped influence the New Dining Practice Standards says, “The New Dining Practice Standards are supported as best practices by CMS because they are endorsed by 11 best practice standard-setting organizations. They are not mandated, but organizations that choose to implement them and honor resident choice are supported in doing so by CMS and the survey process.” Resident satisfaction should be enough, but regulatory support is the cherry on top.

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