Author: Linda Bump

Linda is a Registered Dietitian and Licensed Nursing Home Administrator with a passion for resident choice and quality of life with a particular focus on the kitchen as the heart of the home. As an administrator, has guided four organizations through transformations to a social model of care: Northome Healthcare Center, Bigfork Valley Communities, Meadowlark Hills and Pennybyrn at Maryfield. She has extensive experience as both an internal and external consultant in nursing homes and has provided education on culture change to 60+ nursing homes through her work with Action Pact since 1999. Linda leads the Action Pact workshops: Food for Thought, and Life Happens in the Kitchen. She is the contributor and author of Action Pact workbooks: Nourish the Body and Soul and Life Happens in the Kitchen.

Honoring Dining Traditions in the New Year

Published on by Linda BumpLeave a comment

No doubt our thoughts during this past holiday season turned to home and rekindled wonderful memories of special treats, meals, and rituals around the food in our lives. Whether we recreate the memories and carry on established traditions or start new traditions of our own, food remains at the heart of our celebrations.

Recent stories from Action Pact organizations at varying stages in the transformational journey illustrate the unlimited opportunities to start new traditions and honor the old.

Transformational

  • Buffet Breakfast at Roberts Lodge, shared by Judy Apps of Uniting Care-Australia

 Yesterday Linda and I accepted an invitation to visit Roberts Lodge at Peakhurst to enjoy a buffet breakfast with residents.  What a wonderful experience!  Karyn, the Manager at Roberts Lodge, is experimenting with an extended meal service at breakfast time.  She has adapted her dining area to provide buffet style meals in a very simple and effective way that complies with all food safety regulations and offers a large range of choices.   

Walking into the dining room, we are greeted by the aroma of freshly made toast.  The atmosphere is calm and there is a gentle hum of activity as residents come and go at their leisure.  Conversation flows at the tables and residents are relaxed throughout their meal; there is no rushing to finish before plates are cleared.  When we walk out at 9 am, there are still residents who have yet to rise and come for breakfast.  Others are having second helpings.

Staff serve residents who cannot or do not wish to serve themselves, while others are happy to get their own.  Karyn points out a resident who initially was against the idea but now collects prunes and juices for her table. Another resident takes responsibility for making toast for everyone at the table.  Naysayers are being converted.  A member of staff unobtrusively hand out medications that are required to be taken with meals.

We have a choice of different types of bread, with fruit bread being the most popular. There also are breakfast cereals including hot porridge, and baked beans, spaghetti, scrambled eggs, and omelets, if desired.

Karyn says that prior to the launch of the buffet breakfast she spent considerable time educating staff and addressing their concerns, because, as we know, extending the time for breakfast affects the timing for a range of tasks over the course of the day.

Not everything worked perfectly from the get-go.  Initially, we thought that residents as they came to the dining room would take any available seat rather than sitting where they previously were allocated for all their meals.  However, residents have decided they prefer to continue sitting where and with whom they are used to sitting.  

Neighborhoods

  • Resident-directed dining at Virginia United Methodist Homes

Patty Thompson shares Soup Sunday:

Lisa Hammer, a member of the Life Happens in the Kitchen action team and a Medication Technician in assisted living, facilitated our first Soup Sunday on November 1. Residents, family members and staff helped create Italian chicken vegetable soup.  Homemade bread also was prepared and served.  Residents have been encouraged to gather their favorite soup recipes for future Soup Sundays. 

◊

          Joyce Jackson shares “Oh My Yummy”

The residents and I recently talked about “Cracker Pie” in a film portraying life at several different nursing homes. In this scene, a resident fondly describes her memories of making and eating cracker pie.  I asked residents if they remembered that scene.  Right away, Mrs. K. asked, “What is a cracker pie?” I explained it also is called Mock Apple Pie. It is made with Ritz or any buttery crackers.  I made one for everyone to taste and offered it for dessert the next day. Most residents sampled the pie with vanilla ice cream, which ignited a great conversation:

Mrs. K.: “I can’t believe it’s made with crackers. What are the ingredients?”  I showed her the recipe.

Mr. W.: “What did you say it is made of?” It was very good.”

Mr. M:. “It’s good, it tastes like apples. How did you make it?”

Mrs. X: “What is it made of again? Did you make it?”

Mr. K.: “It’s real good, it’s apple pie.”

Anneliese, CNA: “You tricked me! I thought it was apple pie. It tastes just like apples and I could see apples in it.”

Mrs. K commented for several days how good the pie was. It was such a simple thing to do, but it became a part of a common thread that everyone enjoyed and talked about weeks after it happened.  If we can just tease out those memories or enjoyable life moments, we will help our elders truly embrace life at home.

◊

Josh Van Auken shares Resident Dessert Cook-off

This is the big day our residents have been waiting for. Dining services took our Dessert Bakeoff“resident recipe of the month” a step further and turned it into a resident cook-off. Residents submitted their favorite dessert recipes at the beginning of the month. Then they voted for their top seven favorite desserts for the cook-off. This week the cooks were busy preparing the top seven desserts, strictly following the recipes submitted. The residents were very excited to finally get to taste all seven desserts and crown our resident cook-off winner! 

Households

  • Wendy Ager, Administrator at Western Home Communities, Cedar Falls, IA shares:

Since moving into our new cottage households there are so many positive stories to share; like, for instance, the weight gains among residents and how they participate in the daily life of the household – one lady folds the tablecloths and napkins, sets the tables, and helps with dishes; she tells everyone she is a volunteer. Ours is truly an all hands-on-deck approach, with everyone donning their hairnets and helping prepare meals and snacks. And by the way, none of this creates additional costs as some had initially feared. We have much less food waste (despite living with dementia, residents remember to ask for leftovers) and lots more fun. Here are a few of our success stories:

  • In her younger years, our 100-year-old resident would get up at 4 am to make cinnamon rolls and delicious treats for her family.  So, nurses on the night shift assisted her in making Bananas Foster and brownies.  She helped with everything and even licked the spatula clean! 
  • The daughter of a gentleman who lives here says her father was known at home for baking and making fudge for family members and friends.  Our HHC arranged for him to make fudge for the staff and residents while he wore his chef hat.  Another time, he and a CNA also made cupcakes for all the residents and visitors.
  • In resident council, residents tell us in detail the food they want for special events and parties.  One man wants cabbage rolls at Christmas; a wonderful lady asks that HHC make our punch for every party, which, with its blend of sherbet, 7 Up, and pineapple juice, has become a signature item at Nation Cottage; another gentleman requests ham and bean soup.
  • The Hospitality Coordinators [known elsewhere as ‘homemakers’] provide special items at breakfast. Today, we had biscuits with sausage and gravy. One resident wanted a pancake, too, so she made a huge one for herself.
  • We keep special food items on hand that residents tell us they like. For example, one enjoys Nutter Butters and another wants honey buns, so we put those on our grocery list. 
  • Now, anyone approaching the house in the morning can smell bacon frying even before they enter!
  • One resident hosted Thanksgiving for her family.

Thanksgiving the cottages-Western Home2

  • When time came to decorate for Christmas, the residents and Hospitality Coordinator made special treats — pretzel mix, reindeer cupcakes, and more – to share with volunteers who helped decorate.

◊

  • Addie Van Zutphen from The Piper in Kansas City, KS, shares Home for the Holidays

Holidays remind me of being at my grandparents’ house when I was young. I can still smell the pumpkin pies in the oven and see the pure joy on my sweet grandmother’s face caused by her home being filled with the people she loved most. This Thanksgiving I had the opportunity to see that same joy in the face of one of our residents. Norma Jean moved to The Piper recently and very much wanted to have her family over for Thanksgiving. I was so excited that Huron Household was able to host her family. I spoke with her daughter, Phyllis, who was thrilled to be spending Thanksgiving at her mother’s home again this year. Phyllis brought all the traditional dishes and did the final preparations in the household kitchen. I made sure they had enough utensils, plates, and drinks to go around. They invited me to sit down with them, stating that I was now a part of their family. At that moment I looked at our dining room table surrounded by Norma Jean’s family members and realized that this is exactly what home is about.

After Norma Jean had gone back to her apartment, Phyllis pulled me aside and expressed her gratitude. She was so thankful that we welcomed her and her family with open arms. Phyllis said that it was such a comfort knowing that we were in her mother’s home, which Norma Jean showed off with pride. It was incredible to see the joy in her face. At one point Norma Jean’s granddaughter asked if she had an “assigned seat” in the dining room. Norma Jean burst out laughing. She quickly corrected her granddaughter, letting her know that she did NOT have an assigned seat OR assigned meal time, because THIS is her home. Norma Jean retired to her recliner early and I spent time with her family. After many thanks and tearful hugs, they left their mother/grandmother’s home.

Working at The Piper reminds me every day how important it is to serve people in a manner and environment that enables them to be comfortable, at ease and surrounded by people who care about them. This holiday season as we put up our Christmas trees, decorated our mantels, and cuddled up beside our fireplaces, I was flooded with the constant realization that we are all home here at The Piper. May the New Year bring you incredible amounts of joy and laughter.

From all of us at Action Pact, here’s wishing each of you a wonderful 2016.

Let’s all resolve in this emerging New Year to continue bringing the pleasures of individualized, resident-directed dining to each of our elders, whether we are experiencing transformational neighborhood or household life. Let’s further resolve to continue moving forward in our commitment to create home, with all the fond memories of home, with the residents we serve.

Read all recent posts here

Get Back To Normal By Creating Choice In Your Dining Program

Published on by Linda Bump1 Comment

Eating is normal. We all do it everyday. We decide what we want to eat, even down to the moment it goes on our plates. As adults, we eat what we want, when we want to eat it, even if it’s at 3 in the morning.

But in many elder care organizations, that is just not an option. Food is available three times a day, and in many homes, residents choose what they would like to eat three weeks before the food makes it to their plate. Continue reading “Get Back To Normal By Creating Choice In Your Dining Program” →

Dietitians: Who better to Advocate for Residents’ Self-Determination?

Published on by Linda BumpLeave a comment

As you set the New Dining Practice Standards in place, you learn you must know the resident really well to truly honor her right to choice and autonomy – that a bowl of rice is not just a bowl of rice for “Mrs. Chu,” the subject of my last post.  She’s told you her entire rice ritual including her favorite type of grain, cooking method, accompanying condiments, and way to have it served … all down to the traditional china bowl.

Continue reading “Dietitians: Who better to Advocate for Residents’ Self-Determination?” →

Rice Is Not Just Rice When It Comes To Resident’s Rights

Published on by Linda Bump5 Comments

Hopefully, your organization has by now embraced the New Dining Practice Standards introduced through a CMS-cosponsored process in 2011 and is firmly committed to honoring residents’ choices. You as the dietitian dutifully interview them about their food preferences and try to give them what they say they want.

So what’s up with Mrs. Chu? She said she wants rice at every meal and you make sure it is always on her plate. Yet she never touches it. Why not?

Simply put, a bowl of rice is not just a bowl of rice when you truly honor residents’ rights to autonomy and self-determination. Had you gotten to know more about Mrs. Chu ’s life at home, her rituals, her daily pleasures, you may have learned that she likes to spice up her rice with a little vinegar or soy sauce from a small carafe on the side; that she uses a particular type of grain of rice cooked a certain way and served, sticky and steaming hot, in a decorative china bowl. What comes on her tray in the nursing home bears no resemblance to the rice Mrs. Chu enjoyed at home.

riceI can relate to Mrs. Chu’s disappointment (which is based on an actual resident’s experience) through my moments with coffee while traveling. At home, my day doesn’t start right without a first cup of coffee served just the way I like in my favorite cup and lightened with a little whole milk. For me, the ritual is at least as important as the coffee, which I drink with the morning paper spread before me, the cat in my lap and my feet warmed by the rising sun filtering through the east window. The lukewarm, barely palatable coffee served on the airplane in a small plastic cup with little containers of artificial creamer simply doesn’t measure up. But that’s okay because I know I will soon be home and can enjoy coffee the way I like.

But the nursing facility is Mrs. Chu’s home, and we’re mandated to honor her preference and choice as laid out in the OBRA regulations implemented in 1987. Until now, most nursing homes have taken that mandate to only a very superficial step. The New Dining Practice Standards call for a more meaningful effort, stating: “Residents’ individual choices are actively sought after, care planned and honored, as Tag F 242 requires, based on life patterns, history and current preferences (italics added).

To know details like Mrs. Chu’s rice preferences and my coffee ritual, the dietitian must learn how we live(ed) at home, and that usually necessitates changes in staff behavior, operational systems and social environment.

But it need not require an additional step in the process we already undertake to learn residents true desires – we already interview and assess residents and observe their eating habits in the dining room (or we should). Rather, it’s about adding depth to that process. It’s about building personal relationships to the extent that staff members know the resident’s patterns and moods; what he truly wants and when. When she lived at home, what time in the morning did she normally take her first bite of breakfast? Did he have coffee before, during or after eating? Black or with milk or half-and-half? Sugar or honey? Did she eat alone or in fellowship? Did he watch TV or read the paper at breakfast? What were his favorite recipes? Being this well known by her care providers allows the resident to achieve the same degree of autonomy and self-determination (key words in the OBRA regulations) she’s always enjoyed at home.

Of course, we should not assume that Mrs. Chu won’t someday change her mind and choose something else in place of rice. But we need to know how she did things in the past, and continue working with her to see if she wants to continue in the future. That leads into the issue of the dietitian as advocate on behalf of the resident’s right to self-determination, which is the subject of  a future post.

Linda Bump, MPH is a Registered Dietitian and Licensed Nursing Home Administrator with a passion for resident choice and quality of life with a particular focus on the kitchen as the heart of the home.  As an administrator, she has guided four organizations through transformations to a social model of care.  She has extensive experience as a consultant on the Household Model and has provided education on culture change to 60+ nursing homes through her work with Action Pact since 1999.

What a Difference a Decade Makes…Transformation of Dietetics in Long-Term Care

Published on by Linda BumpLeave a comment

As the new millennium dawned, the household model introduced resident-directed dining. Visionaries in the field began to promote new approaches to dining in long-term care as part of the shift from institution to home, by focusing on relationship instead of task and offering point-of-service choice instead of tray service.

Continue reading “What a Difference a Decade Makes…Transformation of Dietetics in Long-Term Care” →