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Slide Notes
Dining Services Focused on Culture Change “Creating Home within the Nursing Home”
Centers for Medicare & Medicaid Services (CMS) Process of Implementation, promoting Culture Change, with the goal of “Creating Home within the Nursing Homes“ assures quality health care for Medicare Beneficiaries through accountability and public disclosure".
Quality Care directly relates to Quality of Life…
1 Based on a 2010 survey 40 percent of the 16,500 long term care facilities failed to meet the bases of 42 CFR. This Webinar will focus on the opportunity for Dining (Food) Service Operations to perform within the intended regulation, understand and interpret intent.
This webinar may be used as a training tool for Dining Service Managers who want to perform higher in the (QIS), or who have failed to meet or implement CMS guidelines relating to Enhanced Dining Protocols.
Centers for Medicare & Medicaid Services (CMS) Process of Implementation, promoting Culture Change, with the goal of “Creating Home within the Nursing Homes“ assures quality health care for Medicare Beneficiaries through accountability and public disclosure".
Quality Care directly relates to Quality of Life…
1 Based on a 2010 survey 40 percent of the 16,500 long term care facilities failed to meet the bases of 42 CFR. This Webinar will focus on the opportunity for Dining (Food) Service Operations to perform within the intended regulation, understand and interpret intent.
This webinar may be used as a training tool for Dining Service Managers who want to perform higher in the (QIS), or who have failed to meet or implement CMS guidelines relating to Enhanced Dining Protocols.
Dining Services Focused on Culture Change “Creating Home within the Nursing Home”
Published on Nov 19, 2015
Culture change has been the movement that has transformed institutions, professions and practices which have influenced and improved the 'quality of care', resulting in 'Improved Quality of Life’ for Centers for Medicare and Medicaid Services (CMS) Participants. The transformation of ‘facility’ into a ‘home’,’ a ‘resident’ into a ‘person’,’ and a ‘schedule’ into a “choice” as stated in "The Pioneer Network Dining Standards Practice".
MORE DECKS TO EXPLORE
PRESENTATION OUTLINE
Culture Change
“Creating Home within the Nursing Home”
Dining Services Focused on Culture Change “Creating Home within the Nursing Home”
Centers for Medicare & Medicaid Services (CMS) Process of Implementation, promoting Culture Change, with the goal of “Creating Home within the Nursing Homes“ assures quality health care for Medicare Beneficiaries through accountability and public disclosure".
Quality Care directly relates to Quality of Life…
1 Based on a 2010 survey 40 percent of the 16,500 long term care facilities failed to meet the bases of 42 CFR. This Webinar will focus on the opportunity for Dining (Food) Service Operations to perform within the intended regulation, understand and interpret intent.
This webinar may be used as a training tool for Dining Service Managers who want to perform higher in the (QIS), or who have failed to meet or implement CMS guidelines relating to Enhanced Dining Protocols.
Centers for Medicare & Medicaid Services (CMS) Process of Implementation, promoting Culture Change, with the goal of “Creating Home within the Nursing Homes“ assures quality health care for Medicare Beneficiaries through accountability and public disclosure".
Quality Care directly relates to Quality of Life…
1 Based on a 2010 survey 40 percent of the 16,500 long term care facilities failed to meet the bases of 42 CFR. This Webinar will focus on the opportunity for Dining (Food) Service Operations to perform within the intended regulation, understand and interpret intent.
This webinar may be used as a training tool for Dining Service Managers who want to perform higher in the (QIS), or who have failed to meet or implement CMS guidelines relating to Enhanced Dining Protocols.
Photo by virtual_tourguide
CEU
download post test to access certificate
This Webinar will offers 1.5 CEU Corexcel’s Accreditation,
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel. Participants who successfully complete this activity may request a certificate with 1.5 Continuing Education Units (CEUs).
Click the link at the end of the session to go to "Post Test" to access Electronic Certificate.
(Electronic Certificate download is $9.50 additional)
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel. Participants who successfully complete this activity may request a certificate with 1.5 Continuing Education Units (CEUs).
Click the link at the end of the session to go to "Post Test" to access Electronic Certificate.
(Electronic Certificate download is $9.50 additional)
What Are Dining Practice Standards
*Identify “Best Practice” for Nutrition
*Know Resources
*How to Implement at the Facility Level
Three (3) Part Series
Creating Home in the Nursing Home-No Longer A Movement
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Culture change has been the movement that has transformed institutions, professions and practices which have influenced and improved the 'quality of care', resulting in 'Improved Quality of Life’.
The transformation of ‘facility’ into a ‘home’,’ a ‘resident’ into a ‘person’,’ and a ‘schedule’ into a “choice” as stated in "The Pioneer Network Dining Standards Practice".
Creating Home in the Nursing Home-No Longer A Movement
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Culture change has been the movement that has transformed institutions, professions and practices which have influenced and improved the 'quality of care', resulting in 'Improved Quality of Life’.
The transformation of ‘facility’ into a ‘home’,’ a ‘resident’ into a ‘person’,’ and a ‘schedule’ into a “choice” as stated in "The Pioneer Network Dining Standards Practice".
Regulation Purpose...
Returning control to elders” (Older Americans)
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Culture change has been defined by the Pioneer Network as “a transformation anchored in values and beliefs that returned control to elders” (Older Americans) and those who work closest with them.
The Transformation has taken place in most every aspect of healthcare; environmental, clinical, life safety, and residents rights.
The future long term care...
Robinson and Gallagher have stated that the future long term care “…customer, savvy and well educated, will re-formulate long term care by demanding fine dining, and concierge services, and healthy fast foods from a food court with ‘brand’ named franchises open 24 hours per day”
(Robinson and Gallagher, 2008)
Part 1 Introduction
History of Movement
Culture change has been defined by the Pioneer Network as “a transformation anchored in values and beliefs that returned control to elders” (Older Americans) and those who work closest with them.
The Transformation has taken place in most every aspect of healthcare; environmental, clinical, life safety, and residents rights.
The future long term care...
Robinson and Gallagher have stated that the future long term care “…customer, savvy and well educated, will re-formulate long term care by demanding fine dining, and concierge services, and healthy fast foods from a food court with ‘brand’ named franchises open 24 hours per day”
(Robinson and Gallagher, 2008)
Culture Change Movement” 1994
Objective- Hospitals, Nursing Homes Leadership Deliver Systems...
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Develop Model Policies/Procedures
Liberalization of Diets, Focus on Altered Consistencies, Real Foods, Choice, New Negative Outcomes
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Develop Training Protocols
Up-To-Date Process, Initial Orientation, Ongoing Training...
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Part 1 Introduction
History of Movement
Several Organizations have advanced quality of care issues, and have been branded as part of “The Culture Change Movement” since 1994 a transforming of ‘residents rights’, offering 'dignity in a place they can call home".
There are several Culture change models, but most notably Pioneer Network has made the most strides in advancing the transformation of ‘Dining Standards Practice’ in healthcare (environmental, clinical, life safety, and residents rights) but more specifically in Nursing and or Long Term Care.
Provide Corrective Actions/Protocols
Re-Thinking how we should approach Meal/Dining/ Dining Choices
Photo by virtual_tourguide
National Stakeholder Workgroup
- American Association for Long Term Care Nursing (AALTCN)
- American Association of Nurse Assessment Coordination (AANAC)
- American Dietetic Association (ADA)
- American Medical Directors Association (AMDA)
- American Occupational Therapy Association (AOTA)
- American Society of Consultant Pharmacists (ASCP)
- American Speech‐Language‐Hearing Association (ASHA)
- Dietary Managers Association (DMA)
- Gerontological Advanced Practice Nurses Association (GAPNA)
- Hartford Institute for Geriatric Nursing (HIGN)
- National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC)
- National Gerontological Nursing Association (NGNA)
Culture Change Is Now The Standard
Part 1 Introduction
History of Movement
The Culture Change Movements started as a result of strategy of practitioners, working together in order to modify existing regulations, such that they would better support new models of aging in long term care.
Called "A National Stakeholder Workgroup", developed guidelines of "best practice" for individualization in long term care living to provide regulatory overview, interpretive protocol, investigative guidance, as well as prepare related education materials to facilitate implementation.
Part 1 Introduction
History of Movement
The Culture Change Movements started as a result of strategy of practitioners, working together in order to modify existing regulations, such that they would better support new models of aging in long term care.
Called "A National Stakeholder Workgroup", developed guidelines of "best practice" for individualization in long term care living to provide regulatory overview, interpretive protocol, investigative guidance, as well as prepare related education materials to facilitate implementation.
Establish nationally agreed upon new standards of practice supporting individualized care
list of organizations that support & agree to standard...
Part 1 Introduction
History of Movement
Organizations Agreeing to the New Dining Practice Standards
• American Association for Long Term Care Nursing (AALTCN)
• American Association of Nurse Assessment Coordination (AANAC)
• American Dietetic Association (ADA)
• American Medical Directors Association (AMDA)
• American Occupational Therapy Association (AOTA)
• American Society of Consultant Pharmacists (ASCP)
• American Speech‐Language‐Hearing Association (ASHA)
• Dietary Managers Association (DMA)
• Gerontological Advanced Practice Nurses Association (GAPNA)
• Hartford Institute for Geriatric Nursing (HIGN)
• National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC)
• National Gerontological Nursing Association (NGNA)
History of Movement
Organizations Agreeing to the New Dining Practice Standards
• American Association for Long Term Care Nursing (AALTCN)
• American Association of Nurse Assessment Coordination (AANAC)
• American Dietetic Association (ADA)
• American Medical Directors Association (AMDA)
• American Occupational Therapy Association (AOTA)
• American Society of Consultant Pharmacists (ASCP)
• American Speech‐Language‐Hearing Association (ASHA)
• Dietary Managers Association (DMA)
• Gerontological Advanced Practice Nurses Association (GAPNA)
• Hartford Institute for Geriatric Nursing (HIGN)
• National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC)
• National Gerontological Nursing Association (NGNA)
Photo by ITU Pictures
"National Stakeholder Workgroup"
"best practice" for individualization in long term care..."
The Culture Change Movements started as a result of strategy of practitioners, working together in order to modify existing regulations,
such that they would better support new models of aging in long term care.
Called "A National Stakeholder Workgroup",
developed guidelines of "best practice" for individualization in long term care living to provide regulatory overview, interpretive protocol, investigative guidance, as well as prepare related education materials to facilitate implementation.
such that they would better support new models of aging in long term care.
Called "A National Stakeholder Workgroup",
developed guidelines of "best practice" for individualization in long term care living to provide regulatory overview, interpretive protocol, investigative guidance, as well as prepare related education materials to facilitate implementation.
Photo by Michele Ficara Manganelli
Early Efforts...
Eden Alternative (1994) reduction negitive outcomes
Early Efforts that started the movement...
A 2007 article “What is Culture Change and Why an aging Nations cares” states “Culture change is not just about nursing homes—it’s about a society that’s lost its way. In a discussion about her “ethical will” taped in 2001
The Eden Alternative
Eden Alternative- was one of the first 1994 to institute what are called neighborhoods, areas in a home that serve small groups of up to 15 residents with their own living and dining rooms and consistent staffing.
The evaluation of the Providence program showed an 11% reduction in routine medication utilization, a 40% reduction in the use of medication for bowel management, a 100% reduction in antianxiety medications, a 100% reduction in antipsychotic medications, a 100% reduction in sedative hypnotics, a 50% increase in resident activity levels, and a more than 100 % increase in social interaction
A 2007 article “What is Culture Change and Why an aging Nations cares” states “Culture change is not just about nursing homes—it’s about a society that’s lost its way. In a discussion about her “ethical will” taped in 2001
The Eden Alternative
Eden Alternative- was one of the first 1994 to institute what are called neighborhoods, areas in a home that serve small groups of up to 15 residents with their own living and dining rooms and consistent staffing.
The evaluation of the Providence program showed an 11% reduction in routine medication utilization, a 40% reduction in the use of medication for bowel management, a 100% reduction in antianxiety medications, a 100% reduction in antipsychotic medications, a 100% reduction in sedative hypnotics, a 50% increase in resident activity levels, and a more than 100 % increase in social interaction
Moving Forward
Accountable Care Organizations- Hospitals & Nursing Homes working together...
Moving Forward
Accountable Care Organization (ACO) are the next phase in the culture change movement that will shape standards of care, with the aim of preventing re-admission and additional cost in Medicaid and Medicare services.
Remember CMS goal is to improve quality of live, by improving quality of care...
Accountable Care Organization (ACO) are the next phase in the culture change movement that will shape standards of care, with the aim of preventing re-admission and additional cost in Medicaid and Medicare services.
Remember CMS goal is to improve quality of live, by improving quality of care...
Baby Boomers Shaping Healthcare
So culture change is not just about Nursing Homes anymore,
but every facet of our society healthcare systems, more specifically, "our health, quality of life, and the quality of care and those that administer any facet of it".
Health care is the second-fastest growing sector of the U.S. economy, but nursing is the largest occupation within the industry, with more than 2.4 million jobs and the highest projected growth{2}.
The culture change movement is also about how doctors, hospitals, families and care givers perceive and treat an aging society.
but every facet of our society healthcare systems, more specifically, "our health, quality of life, and the quality of care and those that administer any facet of it".
Health care is the second-fastest growing sector of the U.S. economy, but nursing is the largest occupation within the industry, with more than 2.4 million jobs and the highest projected growth{2}.
The culture change movement is also about how doctors, hospitals, families and care givers perceive and treat an aging society.
Older adults want a home that will help them stay healthy
"at least as healthy as possible, as they age..."
Bill Thomas, the physician who created The Eden Alternative, “has long predicted the demise of the nursing home for having failed to pay attention to customer needs and preferences.
What older people are looking for {America Has a Major Misconception On Aging} "is not the right healthcare provider but the right housing environment".
Older adults want a home that will help them stay healthy, or at least as healthy as possible, as they age”.
What older people are looking for {America Has a Major Misconception On Aging} "is not the right healthcare provider but the right housing environment".
Older adults want a home that will help them stay healthy, or at least as healthy as possible, as they age”.
Photo by UNKIEPAUL / Paul Johnston
Implementation of Dining Services Focused Changing Dining Standards,
Goal of Presentation
Focusing on The importance of Implementation of Dining Services Focused on Culture Change Dining Standards,
“Creating Home within the Nursing Home” and other Healthcare settings.
Culture Change (also known as person-centered care or resident-directed care) transforms the critical care medical model to one's that nurtures the human spirit, as well as meeting therapeutic needs in food service.
Focusing on The importance of Implementation of Dining Services Focused on Culture Change Dining Standards,
“Creating Home within the Nursing Home” and other Healthcare settings.
Culture Change (also known as person-centered care or resident-directed care) transforms the critical care medical model to one's that nurtures the human spirit, as well as meeting therapeutic needs in food service.
Photo by City of Marietta, GA
Recaping History
-
Culture Change Is Now The Standard
Culture change has been the movement that has transformed institutions, professions and practices which have influenced and improved the 'quality of care'
Advancement of the 1987 'Nursing Home Reform Act'
Started back in 1994, The Eden Alternative- was one of the first to institute what are called neighborhoods, areas in a home that serve small groups of up to 15 residents with their own living and dining rooms and consistent staffing.
Two Parts:
Creating Home I (2008)
Environmental Changes- transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home.
Creating Home II (2010)
“Negative Outcome of Restrictive Diets (clinical markers), Shifting from “Traditional Professional Control” to support of Self-Directed Living...
Culture change has been the movement that has transformed institutions, professions and practices which have influenced and improved the 'quality of care'
Advancement of the 1987 'Nursing Home Reform Act'
Started back in 1994, The Eden Alternative- was one of the first to institute what are called neighborhoods, areas in a home that serve small groups of up to 15 residents with their own living and dining rooms and consistent staffing.
Two Parts:
Creating Home I (2008)
Environmental Changes- transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home.
Creating Home II (2010)
“Negative Outcome of Restrictive Diets (clinical markers), Shifting from “Traditional Professional Control” to support of Self-Directed Living...
Creating Home I
.
Creating Home I- Healthcare Dining Service: "Environment Promotes Resident’s Quality of Life”
Part 2 of (3) Part Series Creating Home in the Nursing Home
No Longer A Movement- Culture Change Is Now The Standard...
April 2008
a day, long-term care innovators, regulators, researchers, architects, advocates and public officials came together in an unprecedented discourse to highlight environmental innovations and to discuss regulatory challenges associated with transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home.
Part 2 of (3) Part Series Creating Home in the Nursing Home
No Longer A Movement- Culture Change Is Now The Standard...
April 2008
a day, long-term care innovators, regulators, researchers, architects, advocates and public officials came together in an unprecedented discourse to highlight environmental innovations and to discuss regulatory challenges associated with transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home.
Home
Creating Home I- Environmental Changes
This is not just about how to make a "Nursing Home" a home, but why it is important to not let it be a institution...
(CMS) The Centers for Medicare and Medicaid Services and Pioneer Network hosted a historic symposium on the impact of “Innovative Environmental Design on creating home and community for nursing home residents. There are several resources on this Symposium, but he most complete is Pre-symposium Background Paper, 2008 Creating Home in the Nursing Home:
This is not just about how to make a "Nursing Home" a home, but why it is important to not let it be a institution...
(CMS) The Centers for Medicare and Medicaid Services and Pioneer Network hosted a historic symposium on the impact of “Innovative Environmental Design on creating home and community for nursing home residents. There are several resources on this Symposium, but he most complete is Pre-symposium Background Paper, 2008 Creating Home in the Nursing Home:
Untitled Slide
How Do You Make It Home
Often when a resident says “I want to go home” they are not necessarily referring to the house they came from, but rather to a state of being that was comfortable, ordered, and fundamentally orienting.
Make It Theirs...
Since the passage of the Nursing Home Reform Act of OBRA ’87, providing care “in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life” has been required by Quality of Life at 42 CFR §483.15, Tag F240- not to mention an entire section dedicated to quality of life.
* right to Dignity at 42 CFR §483.15(a)
* the right to self-determination- Tag F241,
* Safe, Comfortable 483.15(b), Tag F242,
* Homelike environment at 42 CFR §483.15(h), Tag F252
* right to Privacy at 42 CFR §483.10 (e)
* Resident Rights section 42 CFR §483.15
Often when a resident says “I want to go home” they are not necessarily referring to the house they came from, but rather to a state of being that was comfortable, ordered, and fundamentally orienting.
Make It Theirs...
Since the passage of the Nursing Home Reform Act of OBRA ’87, providing care “in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life” has been required by Quality of Life at 42 CFR §483.15, Tag F240- not to mention an entire section dedicated to quality of life.
* right to Dignity at 42 CFR §483.15(a)
* the right to self-determination- Tag F241,
* Safe, Comfortable 483.15(b), Tag F242,
* Homelike environment at 42 CFR §483.15(h), Tag F252
* right to Privacy at 42 CFR §483.10 (e)
* Resident Rights section 42 CFR §483.15
Choice...
Creating Home I
creates an enviorment where customers are empowered to make choices...
Creating Home I is not just comfort measures, quality of life issues like being able to bring your own furniture from home, but also issues and services that represents a residents life-long-choices, while also be ‘life-affirming, satisfying, humane, and
Meaningful (Carmen S. Bowman)
It is important to note “CMS guidance serves as expectations for facility providers: NOT to RESTRICT residence RIGHTS. While each facility must comply with all regulatory requirements; regulatory requirements cannot be used to restrict residents' rights to make choices.
creates an enviorment where customers are empowered to make choices...
Creating Home I is not just comfort measures, quality of life issues like being able to bring your own furniture from home, but also issues and services that represents a residents life-long-choices, while also be ‘life-affirming, satisfying, humane, and
Meaningful (Carmen S. Bowman)
It is important to note “CMS guidance serves as expectations for facility providers: NOT to RESTRICT residence RIGHTS. While each facility must comply with all regulatory requirements; regulatory requirements cannot be used to restrict residents' rights to make choices.
.
Importance of the Physical Environment
"There are many ways of framing the concept of environment - the social environment, the total environment, the atmosphere or milieu - but we are limiting our use of the term to the physical environment of the building and what is in it in terms of furniture and decor, equipment, lighting, flooring, the layout, and use of spaces". (Carmen S. Bowman- Pre-symposium Background Paper )
"There are many ways of framing the concept of environment - the social environment, the total environment, the atmosphere or milieu - but we are limiting our use of the term to the physical environment of the building and what is in it in terms of furniture and decor, equipment, lighting, flooring, the layout, and use of spaces". (Carmen S. Bowman- Pre-symposium Background Paper )
.
Quality of Life
The quality of life experienced by anyone is related to that person’s sense of well being, level of satisfaction with life, and feeling of self-worth and self-esteem. (Dr. Schwarz, assistant professor of Environmental Design at the University of Missouri-Columbia)
For nursing home residents this includes a basic sense of satisfaction with oneself, the environment, the care received, the accomplishment of desired goals, and control over one’s life... (Improving the Quality of Care in Nursing Homes)
The quality of life experienced by anyone is related to that person’s sense of well being, level of satisfaction with life, and feeling of self-worth and self-esteem. (Dr. Schwarz, assistant professor of Environmental Design at the University of Missouri-Columbia)
For nursing home residents this includes a basic sense of satisfaction with oneself, the environment, the care received, the accomplishment of desired goals, and control over one’s life... (Improving the Quality of Care in Nursing Homes)
Self-Directed Care
shift from "provider, professional directed care
Creating Home I
Change The Model...
The shift from "provider, professional directed care to self-directed care".
Under the basic view, nursing home design is simply based on the wrong model - the medical model".
Residents/customers MUST make the choices of what make it "Their Home".
Cutler and Kane go on to point out that CMS requirements include honoring resident choices (Self-determination and participation at 42 CFR §483.15 (b), Tag F242), accommodating the environment to meet individual needs and preferences (Accommodations of Need at 42 CFR §483.15 (e), Tag F246), and helping each resident to obtain their highest practicable quality of life (Quality of Life at 42 CFR §483.15, Tag F240). (Cutler and Kane, 2006).
The National Work-group:
GOAL STATEMENT: "Establish nationally agreed upon new standards of practice supporting individualized care and self‐directed living versus traditional diagnosis‐focused treatment".
Change The Model...
The shift from "provider, professional directed care to self-directed care".
Under the basic view, nursing home design is simply based on the wrong model - the medical model".
Residents/customers MUST make the choices of what make it "Their Home".
Cutler and Kane go on to point out that CMS requirements include honoring resident choices (Self-determination and participation at 42 CFR §483.15 (b), Tag F242), accommodating the environment to meet individual needs and preferences (Accommodations of Need at 42 CFR §483.15 (e), Tag F246), and helping each resident to obtain their highest practicable quality of life (Quality of Life at 42 CFR §483.15, Tag F240). (Cutler and Kane, 2006).
The National Work-group:
GOAL STATEMENT: "Establish nationally agreed upon new standards of practice supporting individualized care and self‐directed living versus traditional diagnosis‐focused treatment".
Creating Home I I
“Negative Outcome of Restrictive Diets (clinical markers)
Creating Home I I
Avoiding “Negative Outcome of Restrictive Diets (clinical markers), Shifting from “Traditional Professional Control” to support of Self-Directed Living...
Goal of Presentation
Focusing on The importance of Implementation of Dining Services Focused on Culture Change Dining Standards...
Avoiding “Negative Outcome of Restrictive Diets (clinical markers), Shifting from “Traditional Professional Control” to support of Self-Directed Living...
Goal of Presentation
Focusing on The importance of Implementation of Dining Services Focused on Culture Change Dining Standards...
Enhancing the dining experience...
Self-Directed Living -- residents chose..
Creating Home II
Focus On “Negative Outcome of Restrictive Diets” --
Therapeutic diets are often ordered for residents of long-term care facilities.
A therapeutic diet is defined as a diet intended to treat a disease or help manage a medical condition...
Enhancing the dining experience improve the likely hood your customers will eat more...
Shift from “Traditional Professional Control” to support of Self-Directed Living -- residents chose what they want to eat rather than being put on a regimented diet or selection...
Focus On “Negative Outcome of Restrictive Diets” --
Therapeutic diets are often ordered for residents of long-term care facilities.
A therapeutic diet is defined as a diet intended to treat a disease or help manage a medical condition...
Enhancing the dining experience improve the likely hood your customers will eat more...
Shift from “Traditional Professional Control” to support of Self-Directed Living -- residents chose what they want to eat rather than being put on a regimented diet or selection...
Photo by Elvert Barnes
Self-Directed Living
Re-Thinking how we should approach Meals
D. Remsburg “Advancing Excellence in long term care...
"These programs were well-intended but contributed to Weight loss…"
(negative outcomes...)
*Very little benefit of highly restricted diets of older individuals in long term care.
*Resulted in “Unintended Results” because residents were not eating-
Tag 325 Nutrition
* Malnutrition
* Dehydration
* Poor customer satisfaction
Re-Thinking how we should approach Meal/Dining/ Dining Choices...
"These programs were well-intended but contributed to Weight loss…"
(negative outcomes...)
*Very little benefit of highly restricted diets of older individuals in long term care.
*Resulted in “Unintended Results” because residents were not eating-
Tag 325 Nutrition
* Malnutrition
* Dehydration
* Poor customer satisfaction
Re-Thinking how we should approach Meal/Dining/ Dining Choices...
Re-Thinking Meal/Dining
- Diet Liberalization
- Alternated consistencies
- Tub Feeding
- Real Foods First
- Honoring Resident Choice
- Shifting “Traditional Professional Control
- New Negative Outcomes
Culture Change II
Avoiding “Negative Outcome of Restrictive Diets (clinical markers)
Re-Thinking the approach to meal time & dining experience
Re-Thinking how we should approach Meal/Dining/ Dining Choices
1 Diet Liberalization
2 Alternated consistencies
3 Tub Feeding
4 Real Foods First
5 Honoring Resident Choice
6 Shifting “Traditional Professional Control” to support self-Directed Living
7 New Negative Outcomes
-Unintended Harm
-Actual Harm
-Severity Level 4
-Severity Level 3
Avoiding “Negative Outcome of Restrictive Diets (clinical markers)
Re-Thinking the approach to meal time & dining experience
Re-Thinking how we should approach Meal/Dining/ Dining Choices
1 Diet Liberalization
2 Alternated consistencies
3 Tub Feeding
4 Real Foods First
5 Honoring Resident Choice
6 Shifting “Traditional Professional Control” to support self-Directed Living
7 New Negative Outcomes
-Unintended Harm
-Actual Harm
-Severity Level 4
-Severity Level 3
Re-Thinking how we should approach Meal/Dining
Individual support of Self Directed Living
Culture Change II
Re-Thinking how we should approach Meal/Dining/ Dining Choices
Traditional Professional Control to
Individual support of Self Directed Living
* We serve as partners, consultants, educators’
professionals
* We develop new approaches, programs that reflects the view that the elderly are able to make
choices about dining
* We Develop care plans from the problem approach
Re-Thinking how we should approach Meal/Dining/ Dining Choices
Traditional Professional Control to
Individual support of Self Directed Living
* We serve as partners, consultants, educators’
professionals
* We develop new approaches, programs that reflects the view that the elderly are able to make
choices about dining
* We Develop care plans from the problem approach
Unpalatable Diet
weight lossand under nutrition and a spiral of negative health
Creating Home II
Re-Thinking Diet
-- An unacceptable or unpalatable diet can lead to
poor food and fluid intake, resulting in weight loss
and under nutrition and a spiral of negative health
effects
-- Collaboration between resident, facility and
practitioner to identify alternatives to restrictive
diets when resident declines medically relevant
dietary restrictions.
-- Restrictive Diets restrict residents rights and healthy choices
Qualified Dietitian ensures diet that promotes choice and healthier eating
Re-Thinking Diet
-- An unacceptable or unpalatable diet can lead to
poor food and fluid intake, resulting in weight loss
and under nutrition and a spiral of negative health
effects
-- Collaboration between resident, facility and
practitioner to identify alternatives to restrictive
diets when resident declines medically relevant
dietary restrictions.
-- Restrictive Diets restrict residents rights and healthy choices
Qualified Dietitian ensures diet that promotes choice and healthier eating
Alternated Consistencies
Swallowing abnormalities do not necessarily require modified diet
Alternated Consistencies
-- Swallowing abnormalities do not necessarily require modified diet and fluid texture modifications (AMDA)
-- The RD needs to collaborate with the SLP
and/other health professionals to ensure
that the older adult receives appropriate modified texture diets (AND)
-- Holistic approach is necessary to determine
course of action. No one intervention consistently prevents aspiration and no test consistently predicts who will get aspiration
pneumonia. (CMS
Photo by toyfoto
Look beyond symptoms
Enteral nutrition may not be appropriate for terminally ill older adults
Creating Home II
Re-Thinking approach to Meals/Dining
-- Tube feeding may be clinically appropriate in certain instances but should not be an automatic step when other feeding strategies have failed (AMDA)
-- Enteral nutrition may not be appropriate for terminally ill older adults with advance disease states, such as terminal dementia. (AND)
-- Look beyond symptoms to
determine plan of care (CMS)
Re-Thinking approach to Meals/Dining
-- Tube feeding may be clinically appropriate in certain instances but should not be an automatic step when other feeding strategies have failed (AMDA)
-- Enteral nutrition may not be appropriate for terminally ill older adults with advance disease states, such as terminal dementia. (AND)
-- Look beyond symptoms to
determine plan of care (CMS)
Photo by Alin S Living with Autism
Real Foods First
Improving nutritional status with wholesome food
Creating Home II
Re-Thinking approach to Meals/Dining
Real Foods First
-- Provide foods of a consistency and texture that allow comfortable chewing and swallowing (AMDA)
-- Food service goal should be meals that are natural and independent as possible making choices from a wide
range of menu items with input from residents, families and staff.(AND)
-- Improving nutritional status with wholesome food is preferable to nutritional supplements (CMS)
Re-Thinking approach to Meals/Dining
Real Foods First
-- Provide foods of a consistency and texture that allow comfortable chewing and swallowing (AMDA)
-- Food service goal should be meals that are natural and independent as possible making choices from a wide
range of menu items with input from residents, families and staff.(AND)
-- Improving nutritional status with wholesome food is preferable to nutritional supplements (CMS)
Photo by tripu
A therapeutic diet is a diet- treat a disease or help medical condition
Avoiding “Negative Outcome of Restrictive Diets
Photo by symphony of love
Identify Proper Balance
"allowing for personal choices is the essence of good medicine"
Creating Home II
Re-Thinking approach to Meals/Dining
Honoring Resident Choice
-- Identify proper balance between medications, modifications and restrictions and allowing for personal choices is the essence of good medicine approach. (AMDA)
-- Involve individuals about food and dining choices such as food selections, dining locations, meal times. (AND)
-- There are regulatory requirements to ensuring that resident exercises rights and able to make choices ex. F242, F280
Re-Thinking approach to Meals/Dining
Honoring Resident Choice
-- Identify proper balance between medications, modifications and restrictions and allowing for personal choices is the essence of good medicine approach. (AMDA)
-- Involve individuals about food and dining choices such as food selections, dining locations, meal times. (AND)
-- There are regulatory requirements to ensuring that resident exercises rights and able to make choices ex. F242, F280
Shifting “Traditional Professional Control”
to support self-Directed Living
Creating Home II
Re-Thinking approach to Meals/Dining
Shifting “Traditional Professional Control” to support self-Directed Living
-- Traditional Professional Control to Individual support of Self Directed Living
-- We are partners, consultants, educators’
professionals
-- Develop new approaches that reflects the view that the elderly are able to make choices about dining
-- Develop care plans from the problem approach to the choice or preference approach.
Re-Thinking approach to Meals/Dining
Shifting “Traditional Professional Control” to support self-Directed Living
-- Traditional Professional Control to Individual support of Self Directed Living
-- We are partners, consultants, educators’
professionals
-- Develop new approaches that reflects the view that the elderly are able to make choices about dining
-- Develop care plans from the problem approach to the choice or preference approach.
New Negative Outcomes
.
Creating Home II
Re-Thinking approach to Meals/Dining
New Negative Outcomes
F325 Nutrition
--Severity Level 4 Immediate Jeopardy e.g. Mechanically altered diets provided against
the resident’s expressed wishes resulting in significant and unplanned weight loss.
--Severity Level 3– Actual Harm- weight loss due to lack of assessment of risk vs benefit of restriction or down grading diet and food consistency or accommodate preferences in accepting related risks.
Re-Thinking approach to Meals/Dining
New Negative Outcomes
F325 Nutrition
--Severity Level 4 Immediate Jeopardy e.g. Mechanically altered diets provided against
the resident’s expressed wishes resulting in significant and unplanned weight loss.
--Severity Level 3– Actual Harm- weight loss due to lack of assessment of risk vs benefit of restriction or down grading diet and food consistency or accommodate preferences in accepting related risks.
New Dining Standards
Culture Change is about changing the culture of serving seniors, empowering them to make choices... improve the quality of their lives...
-- The New Dining Standards a different mind set that would take a lot of imagination, creativity and ability to think “outside the box”
* Change in food service administration and
application of New Dining Standards, as well as know how to apply.
* Change in our role as professionals.
* Educate yourselves.
* In the end, it will improve the quality of life for our seniors!
-- The New Dining Standards a different mind set that would take a lot of imagination, creativity and ability to think “outside the box”
* Change in food service administration and
application of New Dining Standards, as well as know how to apply.
* Change in our role as professionals.
* Educate yourselves.
* In the end, it will improve the quality of life for our seniors!
CEU's
(Electronic Certificate is $9.50 additional)
The 1 CEU, 1.5 Contact Hours through Corexcel
(Electronic Certificate is $9.50 additional)
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel.
Participants who successfully complete this activity may request a certificate with 1 Continuing Education Units (CEUs), offering 1.5 contact hours.
You must follow the link to "Instruction page, take post test to receive Electronic Certificate.
(Electronic Certificate is $9.50 additional)
If you desire a Certificate of Participation (no ceu's ) email us...
(Electronic Certificate is $9.50 additional)
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel.
Participants who successfully complete this activity may request a certificate with 1 Continuing Education Units (CEUs), offering 1.5 contact hours.
You must follow the link to "Instruction page, take post test to receive Electronic Certificate.
(Electronic Certificate is $9.50 additional)
If you desire a Certificate of Participation (no ceu's ) email us...
Additional Information on topic...
.
References & Credits:
For more information:
This Webinar offers 1 CEU, 1.5 Contact Hours through Corexcel. (Electronic Certificate are $9.50 additional)
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel. Participants who successfully complete this activity may request a certificate with 1 Continuing Education Units (CEUs), offering 1.5 contact hours.
Corexcel is an Accredited Provider of the International Association for Continuing Education and Training (IACET).
Resources
- Artifacts of Culture Change Tool- Carmen S. Bowman, MHS, ACC, Edu-Catering http://www.artifactsofculturechange.org/Data/Documents/artifacts.pdf
- How Boomers Shaping Healthcare- https://www.healthdesign.org/sites/default/files/news/How%20Boomers%20Will%...
- Practical Strategies to Transform Nursing Home Environments: https://www.pioneernetwork.net/Data/Documents/Practical_Strategies_to_Trans...
- The Environmental Side of the Culture Change Movement- Carmen S. Bowman, MHS, ACC, Edu-Catering https: //www.pioneernetwork.net/Data/Documents/Creating-Home-Bkgrnd-Paper.pdf
Pub. 100-07 State Operation Provider Certification- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/download...
Full Teaching, Links, additional references can be found on my LinkedIn Blog:
https://www.linkedin.com/pulse/article/culture-change-longer-movement-now-s...
For more information:
This Webinar offers 1 CEU, 1.5 Contact Hours through Corexcel. (Electronic Certificate are $9.50 additional)
This educational activity is being offered through a joint providership agreement between Frontline of Food Safety, AudioEducator and Corexcel. Participants who successfully complete this activity may request a certificate with 1 Continuing Education Units (CEUs), offering 1.5 contact hours.
Corexcel is an Accredited Provider of the International Association for Continuing Education and Training (IACET).
Resources
- Artifacts of Culture Change Tool- Carmen S. Bowman, MHS, ACC, Edu-Catering http://www.artifactsofculturechange.org/Data/Documents/artifacts.pdf
- How Boomers Shaping Healthcare- https://www.healthdesign.org/sites/default/files/news/How%20Boomers%20Will%...
- Practical Strategies to Transform Nursing Home Environments: https://www.pioneernetwork.net/Data/Documents/Practical_Strategies_to_Trans...
- The Environmental Side of the Culture Change Movement- Carmen S. Bowman, MHS, ACC, Edu-Catering https: //www.pioneernetwork.net/Data/Documents/Creating-Home-Bkgrnd-Paper.pdf
Pub. 100-07 State Operation Provider Certification- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/download...
Full Teaching, Links, additional references can be found on my LinkedIn Blog:
https://www.linkedin.com/pulse/article/culture-change-longer-movement-now-s...
.
The Presenter
Larry Bowe has successfully supervised over 5+ years of consecutive “Deficiency Free Surveys Operations” over half of his (LTC) career 16 years are Long Term Care deficiency free; he has a total of 36 years of Food Service management.
-Serves on Advisory Board of Delaware State University Hotel, Hospitality Management Program. Currently developing a
training curriculum for "Serving Seniors, Dining Service Aides, Cook Supervisor in Healthcare .
-Over the past 11 years Larry Bowe has developing training tools, program as a Principle Consultant, HACCP Navigator LLC (dbs FrontLineofFoodSafety.com) with a focus on developing Frontline Food Service Staff.
-Larry notes while most healthcare training programs focus on certification, & training managers; -HACCP Navigator places it focus on materials, mythology and technology to equip, focus on healthcare Frontline food service works to deliver safe food service.
HACCP Navigator is designed to develop "Critical Thought, Mastery, among food service operations, management teams,
Frontline Workers. This work is specific to Long Term Care, Healthcare, and or retail food service operations.
Larry Bowe has successfully supervised over 5+ years of consecutive “Deficiency Free Surveys Operations” over half of his (LTC) career 16 years are Long Term Care deficiency free; he has a total of 36 years of Food Service management.
-Serves on Advisory Board of Delaware State University Hotel, Hospitality Management Program. Currently developing a
training curriculum for "Serving Seniors, Dining Service Aides, Cook Supervisor in Healthcare .
-Over the past 11 years Larry Bowe has developing training tools, program as a Principle Consultant, HACCP Navigator LLC (dbs FrontLineofFoodSafety.com) with a focus on developing Frontline Food Service Staff.
-Larry notes while most healthcare training programs focus on certification, & training managers; -HACCP Navigator places it focus on materials, mythology and technology to equip, focus on healthcare Frontline food service works to deliver safe food service.
HACCP Navigator is designed to develop "Critical Thought, Mastery, among food service operations, management teams,
Frontline Workers. This work is specific to Long Term Care, Healthcare, and or retail food service operations.
Real Foods First
Re-Thinking how we should approach Meal/Dining/ Dining Choices
Photo by ONETERRY. AKA TERRY KEARNEY
Enhanced Dining Choice
Re-Thinking how we should approach Meal/Dining/ Dining Choices
Photo by virtual_tourguide
