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CULTURE CHANGE IN DINING AND REGULATORY COMPLIANCEAsk
yourself WHY your facility may not have implemented CHANGES
FOR YOUR RESIDENTS TO MAKE DINING CHOICES? Did you
know there may be psychological HARM to your residents? HOW
can you reduce barriers from resistant staff? How can YOU
promote liberalized diets, resident rights, & self
determination &“All decisions default to the resident?” Are
you helping your facility prepare for survey by studying the
right of choice & regulations? Or has it just been too
DIFFICULT to change? Many will identify with concerns that
challenge this fictional nursing home, struggling with an
actual deficiency in F 151 (Resident Rights). STUDY & SHARE
the discussions & referenced quotes from pdf documents. Use
these in development of stronger resident-directed dining
systems. Many quoted references and applied concepts come
from timely Symposium Papers developed for CMS/Pioneer
Network: Creating Home II: Dining 2010
(www.pioneernetwork.net) in which I had the honor of
presenting. I participated on the ADA committee to develop
the new Standards of Practice for the Dietitian in
Extended Care Facilities (available in JADA in
April 2011.) The committee had to completely reword the
medical model of dietetics (heart healthy, live longer) as
practice standards of the LTC dietitian are so very
different (seeking quality of life as defined by resident.)
Continuing a watershed year, I was lead on 1st DMA Position
Paper, entitled the Role of the Certified Dietary Manager in
Resident-Directed Dining (April 2011.) I share research that
I found from Mayo Clinic for decision making & informed
choice/refusal. It will be referenced in new dining
practice standards from CMS/Pioneer Network Task Force
(out in fall 2011), partially taken from symposium papers,
application, & recommendations. So much information is
available. Are you prepared to help your IDT implement new
dining changes?Join me: Become an Advocate for Elder’s
Dining Rights in Nursing Homes! …
Those with loved ones in a nursing home understand the
important of this aspect of your loved one’s daily life. Would
you see your loved one in a state of hopelessness where almost
all decisions regarding dining were made for her? In the manual,
the dietitian Victoria laments about her former life as a
surveyor who surveyed with protocols for the right, safe, and
proper nutrition, not realizing the loss to resident rights and
choice. She thought she was making a difference in the lives of
many elderly just as I did when I surveyed and trained other
surveyors in my past surveyor life. This challenge of change to
recognize resident rights in dining with all decisions
defaulting to the resident (without the preemptive strike of
needing to be in regulatory compliance or safely protecting the
resident) is slowly being embraced by both surveyors and
providers alike. This is NOT new with YEARS of well documented
research promoting the need for this change.
Who-dietitians/managers/surveyors-really got quality of life
issues? The surveyor’s emphasis was definitely to identify and
prevent the potential of physical decline or harm from
inadequate nutrition. During my surveying, I don’t recall a
concept of psychological harm from NOT allowing a resident to
have daily dining decision making and to make informed choices
with a right of refusal in dining. Understanding this type of
new harm and how it can be prevented by supporting resident
rights of choice is the intent of regulation. The
questions are: Who has the right to make decisions? What are
facility responsibilities when choices are made?
I invite you to help make the difference for your
resident, in a supportive “home- like” environment: The
right to decide if she wants to have any dietary restriction or
ordered diet at all, including the right of informed choice to
refuse dietary restrictions that might put her at choking risk.
The right to arise when she wants and eat or not eat breakfast.
The right to stay up late and snack throughout the day. The
right to decide if she wants to partake of any foods brought in
by visitors or staff as she would have in her own home. The
right to greater variety and flexibility in mealtime offerings
just as she would have in her own home. May your nursing home
residents benefit from your advocacy on their behalf! As a
member of the Baby Boomer generation, be forewarned, we are
definitely going to BOOM in our demands and knowledge of our
dining rights! Thank you for your understanding as this author
humbly tries to present insights of fictional characters mixed
with references and regulations (not easy!)
This manual is finished and awaiting CEU approval from ADA
and DMA. Watch for an order button to buy on PayPal by mid March.
Read Early Reviews:
This is your best yet! I wanted to stop, take
notes, make lists, and put everything in it to good
practice. Thank you. Timely in providing the necessary
information needed by practitioners to understand the
intricacies of the changes in the approach, mind-set and
process used by nursing home operators and surveyors to
provide self-determination and freedom to chose the care
received by the new generation of elders.
--Digna
Cassens, MHA, RD
We finally have a definitive, well-written manual on the
process to convert our homes to resident-centered,
resident-directed nutritional care! Linda's manual truly
incorporates the Culture Change principles. It focuses on
the resident's rights and our professional obligation to
insure the care our residents deserve, with extensive
references for further information
--Ruth Rauscher MA, RD, CSG, LMNT
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