| Diving into Dining with Sparkling Innovations | https://www.providermagazine.com/Articles/Pages/Diving-into-Dining-with-Sparkling-Innovations.aspx | Diving into Dining with Sparkling Innovations | <p>Like so many aspects of everyday life, dining will take on new dimensions post-pandemic. To ensure that residents stay safe and can again enjoy the social aspects of dining, nursing homes, assisted living communities, and other long term care settings are embracing creative ideas, thinking in fresh new ways, breaking some norms, and making meals a source of health, fun, and celebration.</p><h2>Creating Dining Options</h2><p>During the pandemic, many communities devised creative ways to make dining fun for residents. Some took mobile margarita or mimosa carts (often nonalcoholic) around to rooms, while some had restaurant-style dessert carts with an array of tempting sweets. <br></p><p>Some places had live chef demonstrations where residents could enjoy the fresh food they watched being prepared. <br></p><p><img src="/Articles/PublishingImages/2021/0721/Dining_LauriWright.jpg" alt="Lauri Wright, PhD" class="ms-rtePosition-1" style="margin:5px;width:145px;height:186px;" />“When you’re shut in your room, time gets away from you, and people sometimes forget to eat,” says Lauri Wright, PhD, RDN, LD, national spokesperson for the Academy of Nutrition and Dietetics. “It’s useful to have more touchpoints and opportunities to eat and intake fluids,” she says. Staff have gotten creative in this regard.<br></p><p>For instance, afternoon snacks have taken on a new dimension. Some communities celebrated special events such as National Peanut Butter Day or National Pretzel Month with themed treats. “During the summer, we brought in a snow cone truck,” says Ashley Langley, LBSW, director of social services at Hearthstone Nursing and Rehabilitation in Round Rock, Texas. “We took a few residents at a time out to get snow cones, and we brought in treats for those we couldn’t take outside. It was lots of fun, and everyone loved it.”<br></p><p>Especially where such innovations became popular with residents, they can be continued in some capacity even as the pandemic winds down and buildings open up. For example, in many buildings, activities staff got involved with helping residents to eat.<br></p><p>“For example, our activity team will have late morning activities, such as baking cinnamon rolls, to stimulate appetite,” says Phyllis Famularo, DCN, RD, CSG, LDN, CDP, CADDCT, senior manager of nutrition services for Sodexo. “Having food cooked right on the unit triggers hunger. This is one of the biggest things we can do.”</p><h2>Safety and Socialization</h2><p>Dining is back, Wright says. “Slowly we are starting to do small group meals with sparser seating in the dining rooms,” she says. “We also are finding some of those vacant spaces, such as sunrooms, to bring people together in a social but safe way.”<br></p><p>In locations and climates where outside dining is viable, it has become an increasingly popular option. “This can be challenging for residents with memory issues or dementia, but you can monitor people in small groups for a barbeque or picnic,” says Famularo.<br></p><p><img src="/Articles/PublishingImages/2021/0721/Dining_GregHunteman.jpg" alt="Greg Hunteman" class="ms-rtePosition-2" style="margin:5px;width:145px;height:181px;" />Greg Hunteman, AIA, president of Pi Architects in Austin, Texas, agrees. “There will be a lot more opportunities for external dining, including the use of covered patios and enclosed sun porches,” he says. “Inside, there will be a need for cutting-edge air filtration. Ensuring safe, controlled air circulation in buildings will be essential.”<br></p><p>However, he says, residents shouldn’t feel claustrophobic in indoor dining spaces. There should be windows and lots of natural light. At the same time, it will be important to have indoor areas that open onto patios, courtyards, balconies, and decks that enable access to fresh air and sunshine.<br></p><p>Hunteman says color can impact appetite, so splashes of reds and yellows will help trigger hunger as well as create bright, cheerful dining spaces. Ultimately, he suggests, facilities will offer multiple and more varied dining venues—from bistros and coffee shops to takeout windows, food trucks, and pop-up cafes.</p><h2>Innovations in Fun</h2><p><img src="/Articles/PublishingImages/2021/0721/Dining_AshleyLangley.jpg" alt="Ashley Langley" class="ms-rtePosition-1" style="margin:5px;width:145px;height:181px;" />As more residents and staff are vaccinated, watch for the return (or the start) of happy hours. “We enjoy going home or out with friends for a glass of wine and a little conversation,” Langley says. </p><p>“Residents should be able to do that, too. We limit the amount of alcohol, but residents can have a drink and a snack, and we play music that they grew up with. It has a great impact on mental well-being and mood,” she says. <br></p><p>At least for the time being, gone are the plates of cookies and bowls of fruit in dining halls and common areas. To maximize safety and sanitation, expect to see more prepackaged snacks, including healthy items such as dried fruit and cheese. Shared condiments and items such as cream and sugar likely will be replaced by individual servings in sealed packaging. <br></p><p>The farm-to-table concept has become popular in the dining world, and it is making its way into senior living as well, says Hunteman. “Onsite gardens and orchards are huge. People like to eat fresh foods that are grown in their own backyard and that they have had a hand in producing.”</p><h2>Opening Doors Is Not Enough</h2><p>As much as isolation was problematic during the pandemic, the truth is that many people got used to eating in their rooms and are hesitant to come out again. As Famularo says, “Some residents need enticement to get out of their rooms. Things like a happy hour with snacks or someone playing the piano during meals can be helpful.” She suggests that when nursing and other staff are engaged, they can help get residents out and enable them to embrace new routines. <br></p><p>It is important to realize why residents may prefer to stay in their rooms, providers say. After all, they’ve been told for a year that it was necessary to keep them safe. Now managers are telling them it’s safe to come out. This may be confusing for some.<br></p><p><img src="/Articles/PublishingImages/2021/0721/Nutrition_PhyllisFamularo.jpg" alt="Phyllis Famularo" class="ms-rtePosition-2" style="margin:5px;width:145px;height:181px;" />At the same time, Famularo observes, “Many residents are really enjoying going back to group dining; some never really did like it. We need to realize that our outgoing, social residents were impacted the most by having to eat in their rooms.”<br></p><p>Sherry Perry, a long-time nursing home and home care certified nurse assistant, says, “Some residents don’t want to come out because they’re scared. A lot of them know that they got the vaccination, but they don’t necessarily understand it means that they can safely be more social. This needs to be explained to them.” <br></p><p>“Start slow,” she says. “Bring them out a little at a time. Be encouraging and supportive.” <br></p><p>Although many residents may see their room as their safe zone, the warm weather and sunshine could be enticing. “We always see a big change in residents when the seasons change. When the sun is shining and it’s pretty outside, residents are happier to go and sit outside, dig in the garden, and make sure the bird feeders are filled,” Perry says. “If we can get them out now, we can help readjust them to spending time outside of their rooms.”<br></p><p>Of course, if people want to eat in their rooms, that is their right. However, says Wright, “we can make it more homey, with a separate space designated for eating, fewer distractions (turn off the TV), and provide soft music.”<br></p><p>With some residents staying in their rooms to eat, it can be helpful to position small portable ovens in different areas throughout the facility to bake cookies and stimulate appetites with tempting aromas, she says.<br></p><h2>Eating Assistance Through Devices</h2><p>Dining is particularly challenging for residents who have trouble feeding themselves. Assistive devices may help, says Famularo. “The best thing we can do as a team is to identify those who are just beginning to need help and address the issue before they start losing weight.” Devices such as weighted utensils and plates and bowls with lips that making scooping food easier can enable some residents to feed themselves in spite of physical disabilities or limitations, she says.<br></p><p>Anne Royer, president of The Meal Lifter and a family member of a resident in an assisted living community, says that such assistive devices not only can help residents feed themselves but also can help give them dignity.<br></p><p>“My mother-in-law was a lovely, elegant woman who always took pride in her appearance. We had dinner with her after she moved into assisted living, and because of her Parkinson’s tremors, she was spilling food on herself. She didn’t want to wear her meal, and she was embarrassed,” Royer says. “Once we made it easier for her to get food from the plate to her mouth, she was much happier and able to enjoy her meals. She gained back some of the weight she had lost.”<br></p><p>There are many “wonderful assistive devices available,” Royer notes. “It is useful to discuss them with staff and families and try to identify who might benefit from which ones. Then it is essential to train people on their use.”<br></p><p>During the pandemic when family members and volunteers were unable to come into the buildings, teams had to be more creative. Devices helped in some cases. However, Famularo stresses, “What works best is when we have all hands on deck—housekeeping, administrative, and other staff—all trained to help feed residents.”</p><h2>Putting Back the Fun in Food</h2><p><img src="/Articles/PublishingImages/2021/0721/Dining_MargaretRoche.jpg" class="ms-rtePosition-1" alt="Margaret Roche, MS" style="margin:5px;width:145px;height:181px;" />“We need to bring back the celebration of food and the joy food can bring in these settings,” says Margaret Roche, MS, RD, CDCES, CSG, FAND, founder of Illinois-based Roche Dietitians. “People will bounce back and fairly quickly if we focus on these things and get them engaged again in eating. <br></p><p>“When we bring back joy—the parties and the celebrations—we create an opportunity to connect with others on a human level, and with that comes the added benefit of improved nutrition,” she says. <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em><br></p> | To ensure that residents stay safe and can again enjoy the social aspects of dining, long term care settings are embracing creative ideas, thinking in fresh new ways, breaking some norms, and making meals a source of health, fun, and celebration. | 2021-07-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/0721/0721_Dining.jpg" style="BORDER:0px solid;" /> | Quality | Cover Feature | Joanne Kaldy | 48 | 7 |
| Nutrition Takes Center Stage Post-Pandemic | https://www.providermagazine.com/Articles/Pages/Nutrition-Takes-Center-Stage-Post-Pandemic.aspx | Nutrition Takes Center Stage Post-Pandemic | <p>Good nutrition in older adults can be challenging in the best of circumstances. Add a year-long pandemic and months of isolation to common age-related changes in taste, smell, and appetite; oral health problems; impaired mobility and dementia; and weight loss and malnutrition are among the top concerns in nursing homes, assisted living, and other long term care settings moving into the post-COVID world.</p><h2>From Isolation to Identification</h2><p>“One of the biggest issues we experienced during the pandemic that presented a nutritional challenge was that family members weren’t able to come in. Not only had they brought in food their loved one enjoyed and shared mealtimes, they also could help recognize and report subtle signs or issues about the resident’s eating habits or intake,” says Lauri Wright, PhD, RDN, LD, national spokesperson for the Academy of Nutrition and Dietetics. <br></p><p><img src="/Articles/PublishingImages/2021/0721/Dining_LauriWright.jpg" alt="Lauri Wright" class="ms-rtePosition-2" style="margin:5px;width:145px;height:181px;" />As a result, problems sometimes weren’t recognized until the person was already losing strength and/or weight. “Once someone starts to lose weight, it can start a downward spiral that causes a number of problems. Malnutrition is a killer,” Wright says. <br></p><p>As facilities open up, staff should be on the lookout for residents who might have special nutritional needs. </p><p>“We need to watch for residents who are still self-isolating and don’t want to do much, especially those who have experienced weight loss,” says Ashley Langley, LBSW, director of social services at Caraday Healthcare’s Hearthstone Nursing and Rehabilitation in Round Rock, Texas. “These individuals may just need a little extra encouragement and support, or they may need to be assessed for depression or other issues,” says Langley.</p><h2>Observation Roles Critical</h2><p>Supervised activities also will give staff an opportunity to observe patients for mobility, balance, gait, and strength problems. “As things open up, we will have more chances to identify mobility impairments before they result in falls or other problems,” says Arif Hussain, DO, a physiatrist in the Chicago area. <br></p><p>“We need to make sure all staff who interact with residents know what signs and red flags to watch for.”<br>Of course, everyone who interacts with residents is positioned to identify diet- or intake-related warning signals. For instance, Sherry Perry, chair of the board of the National Association of Health Care Assistants and a long-time certified nurse assistant, suggests watching for the following:<br></p><ul><li>Residents spilling food on themselves when they eat.</li><li>Individuals who aren’t eating or seem disinterested in their food.</li><li>Coughing, eyes watering, or nose running when someone eats or drinks.</li><li>Signs of oral/dental pain, such as bleeding gums, bad breath, wincing or crying when they eat, holding their mouth or face, or saying it hurts when they chew.<br></li></ul><h2>Nutrition and Rehab</h2><p>“Nutrition is an important part of rehab, building strength, and even wound care. This is always on our minds, and we are always asking about patients’ intake,” says Hussain. As with anything else, he says, “this requires a team approach. It starts with educating the patients and their families about the impact of nutrition on overall health, strength, and healing. These messages need to be repeated and emphasized by every team member.<br></p><p><img src="/Articles/PublishingImages/2021/0721/Nutrition_ArifHussain.jpg" alt="Arif Hussain" class="ms-rtePosition-1" style="margin:5px;width:145px;height:181px;" />“We need to assess patients on admission and regularly thereafter for their ability to self-feed. We need to make sure they get any assistance they need before they lose weight or experience muscle weakening,” he says.<br></p><p>It is important to assess why someone isn’t eating, Hussain says, and this can start with a conversation. “We need to ask patients why they’re not eating. Sometimes it’s simply because they don’t like the food they’re getting. In this case, we can work with the dietary staff to make sure they get the kinds of food they like. Diet needs to be very patient-centric.”<br></p><p>Phyllis Famularo, DCN, RD, CSG, LDN, CDP, CADDCT, senior manager of nutrition services for Sodexo, agrees. “Residents eat better when they have a choice and a say in what foods they have. We almost had a riot when we took hot dogs off the menu,” she says. “We need to track choice and preferences over time and make the foods they want.”</p><h2>Are Tortilla Chips Taboo?</h2><p>Dietary restrictions are common for people with various illnesses and conditions. However, there has been a movement in recent years to liberalize diets for elders in long term care. <br></p><p>“It’s the right thing to do from the standpoint of dignity and quality of life,” Wright says. Getting some calories and nutrition into residents, especially those who aren’t eating and are losing weight, is a top priority. If that means giving a person with diabetes a dish of ice cream or someone with high blood pressure a bag of chips, it may be a viable compromise, she says.<br></p><p>“When our residents are eating better and taking in more calories, we can better manage their underlying conditions while we enhance their quality of life,” Wright says. <br></p><p>The key is moderation, Famularo says. “We have found that, for example, most people with diabetes are happy just to have a small piece of cake or pie. We also have lighter desserts because we don’t want to overload anyone with a lot of sugar.” </p><p>Read more for an in-depth discussion on <a href="/Issues/2021/July/Pages/Walking-the-Tightrope-Between-Risk-and-Autonomy.aspx" target="_blank" title="Walking the Tightrope Between Risk and Autonomy">balancing risk and choice.</a></p><h2>Some Old Ideas Still Apply</h2><p><img src="/Articles/PublishingImages/2021/0721/Nutrition_PhyllisFamularo.jpg" alt="Phyllis Famularo" class="ms-rtePosition-2" style="margin:5px;width:145px;height:181px;" />There are tried and true guidelines and ideas regarding nutrition that continue to have merit moving forward. For instance, Famularo notes, “We have some meal service and nutrition guidelines we developed at the beginning of the pandemic. We’ve been looking at them to see what works and if we need to revise them. The only thing we really had to change was that we can’t put out a tray of cookies or cheese and crackers. We can’t serve family-style meals.”<br></p><p>Back in 2005, the American Dietetic Association (ADA) reported that under-nutrition affected anywhere from 23 to 85 percent of nursing home residents. This problem, ADA said, was associated with poor outcomes and the risk for increased mortality. At the time, it was determined that many residents with some evidence of malnutrition were on restricted diets.<br></p><p>In 2011, the Pioneer Network released New Dining Standards to address the importance of individualized diets that accommodate both choice and quality of care, issues that continue to be of concern in the post-pandemic world of 2021.<br></p><p>According to Diane Hall, NHA, RD, LDN, president and chief executive officer of BSN Solutions, “We should not only address dining standards but also consider how CMS [Centers for Medicare and Medicaid Services] regulations and USDA Dietary Guidelines fit in the post-pandemic world because they are so closely bound together.”<br></p><p>All of the standards support individualized regular diets from the start that offer a variety of healthy foods and beverages, along with providing opportunities for choice and independence, she says.<br></p><p>Moving forward, suggests Hall, providers should continue to honor meal and snack choices and provide pleasant and diverse dining experiences. “Now is the time to establish effective strategies to promote adequate hydration and nutrition,” she says. “We need to go back to the basics by conducting surveys and audits that include staff, families, and residents.”<br></p><p>At the same time, Wright adds, “It’s critical that we’re screening and rescreening nutritional status. We have tools and assessments for those at risk. We need to be gathering information and devising care plans for anyone who has a drop in intake.”</p><h2>Everyone’s On Board</h2><p>Margaret Roche, MS, RD, CDCES, CSG, FAND, founder of Illinois-based Roche Dietitians, has connected with many dietary practitioners during the pandemic. “In the beginning, there was a focus on emergency foods and menus—ways to keep people fed and satisfied when there were shortages or delays in food deliveries,” she says. The vast majority of people she spoke with said they were concerned about residents’ nutritional status. <br></p><p>“Weights are a crucial indicator of nutritional status, and we have systems in place to address this,” Roche says. However, she stresses that monitoring nutrition requires involvement by more than just the dietitian. <br></p><p>“We need to take every opportunity to bring our teams together and ensure that food has nutritional power behind it. We need to double-down on our focus on nutrition, not only at mealtime but during residents’ engagement and socialization as well.”</p><h2>Dietitians Take the Lead</h2><p>While nutrition is a team effort, there is no doubt that dietitians have been on the front line during the pandemic. Roche notes that their experiences during the past year can be used to help inform dietary and nutrition policies, procedures, and processes moving forward.<br></p><p>Leadership is key to good dietary practices, Roche says. “No matter how we feed people, we need dietitians involved with dining leaders, and we need to understand and practice what good leaders do in a crisis.” Part of this involves flexibility.<br></p><p><img src="/Articles/PublishingImages/2021/0721/Dining_MargaretRoche.jpg" alt="Margaret Roche" class="ms-rtePosition-1" style="margin:5px;width:145px;height:181px;" />For instance, she says, “We need to be prepared for different types of emergencies—how we can ensure we have adequate food on hand and what we’ll do if we don’t have a fully functioning kitchen staff. We need to have emergency menus and adequate stocks of food.”<br></p><p>Dietitians and dining leaders are trained to be agile in a pinch, Roche says. “We can adapt operationally. We can think about opportunities to promote nutrition, whether that means giving out finger sandwiches instead of cookies at an event or serving smoothies instead of fruit punch. We have the players and systems in place to do this.”</p><h2>From Mundane to Wonderful</h2><p>As facilities open up, families may again be able to play a key role in helping to ensure loved ones get adequate nutrition and hydration. However, New York-based physician, medical director, and founder of Patient Pattern Steven Buslovich, MD, CMD, MSHCPM, cautions about the risks of bringing unvaccinated visitors into the facility.<br></p><p>“Visitation comes with a price tag. You have to weigh the risks and benefits,” he says. “Unvaccinated families can drop off food and treats for a loved one, and we can encourage not-for-profit organizations such as schools to bring in pre-prepared meals. These are great ways to connect residents with the outside world and provide them with food they love while keeping them safe.”<br></p><p><img src="/Articles/PublishingImages/2021/0721/Nutrition_StevenBuslovich.jpg" alt="Steven Buslovich" class="ms-rtePosition-2" style="margin:5px;width:145px;height:181px;" />Getting residents to eat can be challenging, even in the best of times. As Buslovich notes, “A lot of residents have lost their sense of smell and taste, especially those with dementia. However, they retain interest in texture, and presentation can make a difference.” He says anything that can be done to give residents something different and more fun than what they’re used to can go a long way. <br></p><p>“Like all of us, they don’t want the same thing all the time or to be forced to eat things they don’t like,” he says. “We need to take the time to identify residents, such as those with worsening frailty, who are at greatest risk for malnutrition and address it promptly. At the same time, we need to ensure an individualized, person-centered approach to nutrition and hydration for all of our residents.” </p><p>Read More: <a href="/Articles/Pages/Medications-and-Nutrition-The-Good,-the-Bad,-and-the-Bad-Taste.aspx" target="_blank">Medications and Nutrition</a>.<br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Add a year-long pandemic and months of isolation to common age-related changes in taste and appetite, and weight loss and malnutrition are among the top concerns in nursing and assisted living communities. | 2021-07-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/0721/0721_Nutrition.jpg" style="BORDER:0px solid;" /> | Quality;Management | Cover Feature | Joanne Kaldy | 48 | 7 |