Massachusetts Culture Change Coalition

Dining Culture

Culture Change

The only thing that should change when someone moves

into a nursing home is their address

Culture Change

It is a journey, not a destination– Residents, Family & Staff

Goals OBRA supports Culture Change

– 483.15 - Quality of Life

Culture Change

By identifying and implementing the Resident’s wants and needs you will

meet OBRA Regulations

“each facility provide care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident…”

Culture Change - Massachusetts

Conferences in Massachusetts –2006 Consistent Assignment2010 Dining Experience

– Benefits to Residents– Benefits to Staff and Facility– DPH

Culture Change – Consistent Assignment

Considerations:– Waking and sleeping– Meals– Food Preference– Daily Routine– Bathing frequency, time & method– ADLs– Activities

Culture Change Defining Dining …It’s About Me

Pioneer Network.org

Creating Home in the Nursing Home II -- A National Symposium on Culture Change and the Food and Dining Requirements 2010

Culture Change - Nutrition

CMS Interpretation: Culture Change Input and Questions Survey and Certification Group:

S&C-07-07 S&C -08-09 and S&C-09-39– Time between meals – Food brought in from other sources

Culture Change - Nutrition

S&C-07-07 F-Tag 368 and 370

– These are regulatory questions sent from culture change groups and the CMS answers

– Questions 1, 2, 11 & 15 relate to food

Culture Change - Nutrition

S&C -08-09 and S&C-09-39– 09-39 clarifies 08-09

F-Tag 371 and 242– Food Procurement and Self Determination and

Participation

Culture Change - Nutrition

DPH & regulations OBRA 1987

– Survey process– Participates in MCCC and conferences– May require waiver of some regulations– Contact DPH with questions– Refer to references

Culture Change - Nutrition

Dietitians - Nutrition Educators Residents & families:

– Assessing and care planning– Increase nutrition education opportunities

Identify risks vs. benefits of choices

– Have the right to make bad decisionsdignity/rights

Culture Change - Nutrition

Dietitians – as Nutrition Educators– Liberalize diet

Ask preferencesMonitor for changesRe-evaluate with residentDocument

Culture Change - Nutrition

Dietitians - Nutrition Educators Staff

– Clinical – DON, CNAs, Therapies– Dietary/Nutrition – Increase communication among all areas

Culture Change - Nutrition

Goal is to reduce incidence of

Weight loss Pressure sores Supplement use Dehydration

Culture Change - Dining Experience

How to achieve goal :

Choice in foods Choice with meal times Consistent assignment

Culture Change- Dining Experience

Resident Rights’ Week- October 2010– Massachusetts programs’ activities

Cooking contestsLuncheonsDPH speakersDining ScarvesArc-ct.org – Dining with friends video

Culture Change – Dining Experience

Mass facilities that are a work in progress:

St Camillus in Whitinsville- Bill Graves Loomis House – Lori Todd Holy Trinity in Worcester – Diane Buckley

Culture Change- Dining Experience

National resources for Culture Change: Eden Alternative Pioneer Network Consumer Voice (NCCNHR) Picker Institute Advancing Excellence Campaign

Culture Change – Dining Experience

Culture Change in Massachusetts

Mass Advocates for Nursing Home Reform- MANHR: 800-988-4450

Mass Senior Care: 617-558-0202

Mass Aging Services: 617-244-2999

Long Term Care Ombudsman: 617-727-7750

Culture Change – Dining Experience

Welcome to the table. Bon appétit

Elizabeth M. Bradley, MEd, RD/LDN

Long Term Care Ombudsman Program