Short Stories That Make Us Feel Good!

Brewing Up LIFE!

The photo shown here represents an amazing transformation for one resident of Unitcarboy-brewinging Caroona Yamba, and his story brought joy and tears to a group of staff there.

Why?

This gentleman was deemed as having a rapid decline in cognition, being lost and not doing well in the open Household. Pressure was being applied to relocate him to a smaller more secure Household, as he was not enjoying the one he was in. He was never doing anything purposeful, only moving from sleeping in a lounge chair to table and back to sleeping in a chair. He hadn’t initiated any outdoor activities for months. His conversation was disappearing and he was withdrawn – never joining in activities. Sad, lonely and lost are the words that come to mind.

And then the miracle-working staff went to work. After only a couple of weeks of focus on him, persuasive staff were having success involving him in the village garden, picking the new beans, watering plants and then, “Let’s get the beer-brewing up and running.” He slowly joined in more and more until he decides where he wants to be and what he wants to do. And there’s no fooling him now. “Hey this is yesterday’s paper. What about today’s?” Picture this: a quiet man watching the first fermenting bubbles in a beer brew kit he helped set up yesterday. Tonight was a first! He went on his own to make sure the beer was bubbling as it should. He was observed by staff who were overjoyed at this new interest in life after many months of solitude and inactivity. A real transformation!

This man had been declining rapidly, but now has interest and enjoyment in his life. Two staff in particular fought to keep working with him, as they believed they could retrieve him from his decline. They literally prevented his relocation to what we now know would have been an inappropriate household.

Both of the staff members involved in the resident’s renewed interest in life have recently won awards for their work. They are wonderful examples of inspired care giving that is infectious among the staff.

This story was shared with us by Debra Smith of Uniting Caroona Yamba, a community within Uniting in Australia


 

Just a Few Knick-Knacks…

The following Community Circle occurred during recent dinners with the residents…

Several residents laughed when Joyce Jackson called the figurines around the dining area ‘knick-knacks’. The figurines were then brought to the tables and the residents examined them, asked questions, and expressed their like or dislike of them.

pig-unicycle-2-editThere was a pig riding a unicycle, a rooster also riding a unicycle and a ceramic horse with a clown riding on his back. The horse had dogs on each side.

Mrs. A. said, “When a horse’s ears are pinned to his head, he’s agitated. You better not mess with him.” Mrs. W. then asked Mrs. A. if she likes horses.  A new conversation was started.

Mrs. A. talked about her brother loving horses and she pretended to like them. She admitted she learned a lot, the hard way.

Mr. K. declared, “I wouldn’t want them in my house.”

There were also two dolls, Amish, with no facial features. Mr. K. said, “Where is the face? They don’t look right without eyes.”

There was laughter and smiling faces during the conversations.

We continued the activity the following week during dinner. Residents were asked about the earlier discussion on the figurines. Mrs. A. stated, “If I had a clown riding on my back, I’d be agitated, too!” And then she told this story. “One time my brother was walking a horse with me on its back. My brother got distracted and let the reins go. The horse started running and my foot got stuck in the stirrup and dragged me. I was only 8 years old. I think that’s when my back troubles first started.”

Mrs. K. shared another horse story. “A horse bit my shoulder when I was young. My father had horses and once a horse was being stitched up after jumping a barbed wired fence and he bit me. The vet poured a quart bottle of Methylate on my body. “ (Ed.: Yeow!)

Everyone enjoyed the sharing of the objects and the good conversations around the dinner table.

This story was shared with us by Joyce Jackson of Windsor Meade, a community within Virginia United Methodist Homes


Diet Liberalization Program Makes a Positive Difference for Residents

Sentara Chesapeake Nursing Center has embraced New Dining Practice Standards by initiating a diet liberalization program for its residents as part of their culture change journey. Research has shown that providing more options in long term care settings provides positive resident outcomes. It can also lead to a better quality of life by allowing residents to choose the foods they enjoy eating. Lastly, this initiative can lead to improved nutritional status and a reduced prevalence of weight loss that ultimately is a better experience for our patients.

How does it work? 

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Choices, choices…

Once a resident who was receiving a modified diet is identified as a candidate, a Bedside Swallow Evaluation is performed by a Speech Therapist to ensure that a diet upgrade is clinically safe for the resident. Over the last three months since Chesapeake began diet liberalization in the facility, therapeutic diets have decreased to less than 27% of residents as compared to an average of 51% in other Life Care sites. Conversely, the number of residents receiving regular texture diets have increased from 49% to 77%.

The new diet option has been well received by Chesapeake residents and their families. The new dining practice standards have also allowed the opportunity for Sentara Life Care to move away from other more typical institutional nursing homes practices that limit resident choice. Liberalized dining enables a culture that fosters resident’s right of choice, by allowing residents to eat what they want. This program is only the beginning of Life Care’s culture change journey as these initiatives will be rolled out to other Life Care sites very soon.

Story shared with us by Sentara Rehabilitation and Care Residence – Chesapeake, VA. From their November newsletter.

Get Back To Normal By Creating Choice In Your Dining Program

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?

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?”

The Struggle With Choice

Resident choice is a cornerstone of culture change. As we transform our organizations, we are constantly asking ourselves, “How does this promote or honor the residents’ self-determination, preferences and daily pleasures?” This awareness, however, does not mean we don’t still struggle with how to balance these choices against other important concerns, such as resident safety. Continue reading “The Struggle With Choice”

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. Continue reading “Proof In The Pudding”

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

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.

CMS Supports New Dining Practice Standards

The Centers for Medicare & Medicaid Services recently published a memorandum to surveyors regarding long-term care organizations’ implementation of the New Dining Practice Standards. CMS also provided a training video to its surveyors on new recommended nursing home dining practices that focus on resident choice and limiting the use of restricted diets. Continue reading “CMS Supports New Dining Practice Standards”