I enjoyed working with Cindy Heilman and Janelle Asai in my geriatric rotation this term, it validated my choice to work as an RD in geriatric nutrition as a career! I had several take-away thoughts that changed my perspective about dining;
My first was about empathy; Considering the barriers some of the elderly face regarding eating, such as visual impairments making food hard to identify, altered taste and smell due to medications, and swallowing difficulties from certain diseases, the challenges nursing home’s face with dining preferences does not seem to compare. Taking resident’s preferences and likes into consideration is the most important culture change that can occur in skilled nursing facilities.
It was refreshing to be introduced to Cindy Heilman, MS, NDTR and her Kind Dining® customer service and hospitality program. Having worked in nursing homes in the United Kingdom (UK) in the past, her Kind Dining® approach makes great sense to me. Listening to and serving our elders with kindness, respect and dignity in every dining experience should be standard everywhere, but sadly is usually neglected. Staff don’t have bad intentions regarding dining experiences, but usually just aren’t trained in applicable skills in their medical training or from their employers.
As a nursing assistant in the UK, I became keenly aware about honoring resident preferences and that different generations are used to different foods. A resident asked me for a banana and butter sandwich. I thought for a second that she might be joking, or perhaps wanted a banana and peanut butter sandwich. But she insisted, a banana inside buttered white bread. I made this for her, and she was so happy to have this item from her childhood again. Taking these preferences seriously can make all the difference for the resident, and hopefully will become a standard practice in nursing homes.
My second was about tasting the food; I discovered how the role of the RDN, NDTR, and CDM goes beyond clinical dietetics in this environment, and how tasting the food is a critical step to maintaining quality and satisfaction.
Observing mealtimes with Janelle, RD,LD was an “ah-ha” experience, as I saw how staff typically interacts with residents during mealtimes. We began in the kitchen, as Janelle often tasted the mechanically soft foods to be served. On one occasion she noticed what was supposed to be pureed stuffing was actually just pureed plain bread. We also observed residents eating, and many times, we, offered weighted utensils when tremors made it difficult for residents to put a fork to their mouth. You would think nursing staff would have thought of it first! Helping to solve the clinical nutrition challenges residents’ face is a huge contribution we make, however, I saw that being in the dining room and guiding the process, helped residents enjoy their food more.
My third was about training: No matter the type of dining service, changes to the atmosphere with staff training can greatly enhance the dining experience for residents.
Too often those serving resident’s meals have no actual food service experience. No matter if nurses, nursing assistants, or other healthcare staff is required to serve, training should be provided that focuses on customer satisfaction and not just serving a patient a meal. Food temperature and quality should be of the utmost importance regarding dining style or service method. Cold or unappetizing food can completely disregard all other well intentioned changes to food service enhancement.
Sometimes residents do need extra attention, and that is okay. Or sometimes medically ordered diets should be liberalized so residents can actually enjoy eating in their final years of life. The goal should be to create the most rewarding dining experience for residents as possible
All of these thoughts will be turned in action as step into my new career. I have learned through my geriatric experience the many aspects of dining for nursing home residents. By connecting with residents, and learning their preferences, needs, and experiences, eating can be a much more enjoyable and rewarding experience.
Thank you,
Andrea Cox
About the author: Andrea recently graduated from Oregon Health and Science University’s Dietetic Internship program in order to become a Registered Dietitian. She completed a geriatric rotation through her program with Higher Standards LLC and Asai Consulting LLC, where she was able to work in various nursing homes around the Portland area. She has previous experiences working as a healthcare assistant in nursing homes in the UK and would like to concentrate her future career as a dietitian within geriatric nutrition.