Food Service & Nutrition - Volume 1 No.2 - 12


dining, true choice is exemplified in point
of service choice...
Develop approaches to dining that reflect
a view of elders as capable of making
choices and deciding what, when, and with
whom to dine as a mental wellness activity
because it "exercises" the decision-making
circuitry of the brain, enhances pleasure
and strengthens memory encoding and
retrieval (Food for Thought paper for CHII).
The majority of nursing home residents
are able to reliably answer questions about
their satisfaction with the food service,
regardless of cognitive status, and the presence of complaints is related to poor meal
intake and depressive symptoms (112).
There needs to be a new "red flag" or
"assumption" for both surveyors & providers that tray line or set/limited meals are
now viewed as an obvious contradiction
of choice, and if this lack of choice leads
to failure to thrive it would be considered
harm during the survey process (CHII recommendation). - page 41
We do not assume that just because a
resident may not be able to make decisions
in some parts of their life, they cannot
make choices related to their dining preferences. Education, good observational skills,
strong advocacy and consistent relationships with caregivers enables a person with
impaired decision-making capacity to make
choices. - page 42
We all need to shift to agreeing that
care givers will offer to do what is clinically best for a person, and if the person
refuses, that's okay. Along with liability
comes responsibility to the person we're
serving - if an elder decides to not eat
what is clinically best, we work with them
but never force them - caring for someone
doesn't mean you have to make the choices
for them (CHII recommendation). - page 45
Shifting meal service delivery from
"back of the house" to a much more
interactive experience for the resident,
and providing meal service directly in
front of clients is research-supported.
This often requires a significant culture
shift from pre-determined meal delivery
(tray or servery), to one that embraces
self-determined living. What does selfdetermination actually mean? The dictionary describes it as "the power of

12

Shifting meal service
delivery from "back of the
house" to a much more
interactive experience
for the resident, and
providing meal service
directly in front of clients
is research-supported.
making free choices unconstrained by
external agencies." Another way to say
it is this; it's not the staff's job to decide
on behalf of a resident but instead it is
our job to communicate options and allow
the opportunity for residents to speak for
themselves first on a daily basis.
Let's examine your workplace's meal
services. Does it truly support residents
to say if and how much they want to eat
and drink? Is there the ability to ask for
less or more food at point-of-service? Or
is there a heavy reliance on preference
lists, staff are making assumptions on
behalf of the resident, and they just
assume because they know the residents? Is a resident getting orange juice
every day until someone changes the
juice list? Is there the mindset that if
a resident can't verbally communicate
quickly or well, it will take much time
and it's just not feasible? Are other communication styles promoted and honoured? Is it a "hospitality" culture or
a "clinical" culture at your workplace?
Yes, our menus need to meet provincial
licensing standards and Canada's Food
Guide, but what a resident chooses is
their fundamental right and must be
honoured and respected. If a resident
nutritional status decreases due to poor
choices, then a care team meeting can
occur but meal time dining studies provide evidence that "enabling residents to
choose what they want to eat at mealtime
does not result in negative nutritional
outcomes but enabling choice can actually

CA N A D I A N S O C I E T Y O F N U T R I T I O N M A N AG E M E N T

increase nutritional intake and increase
resident family and caregiver satisfaction
(133, 134)" - page 48
Excuses can be many from staff who are
stuck in the old way of doing things and it
is the Food Manager's role to challenge this
old-school thinking, and inspire all staff.
Dr. William Thomas, founder of the Eden
Alternative - a leading agency in culture
change in residential care - states "that
it is a fundamental right of a resident to
self-determine." So, ask yourself honestly
if this is really showing up in your dining
room? It might be time to change.
Having the right equipment is critical
to be able to allow the staff to do the job
well. Moving away from tray service, or
pre-plate servery style, to a flexible service works best if you have the right tools.
Small neighborhood kitchens are becoming
popular dining venues that allow for easy
close communication directly with the client. Table-side service with mobile carts is
another effective option that is working
well in many different size dining rooms.
For example, a beverage cart service with a
variety of choices (similar to how it is done
on an airplane); a cereal cart with a variety
of bulk cold cereals and a kettle crock pot
of hot cereal (consider how many cereal
choices are in your cupboard at home); a
dessert cart with choices of fresh fruit,
pudding and cake; hot food cart (such as
SuzyQ carts) to put the entrée items are
all ways to bring items to the residents to
allow them the autonomy and dignity to
choose for themselves, depending on their
appetite which can change day-to-day,
meal-to-meal.
Another entertaining way to get residents involved is using a Cooking Action
Station where cooking is demonstrated
and served directly in-front of the residents. It can be fun for residents who
then see and smell the food being prepared, and feel involved in the process.
How about a weekly breakfast club with
cooking done by staff or volunteers?
But be aware: not all equipment is equal
and there can be a danger in paying too little for cheap equipment that breaks down
and difficult to get service for. Sometimes
the initial investment is worth it in the
long run of 10-15 years that the equipment



Table of Contents for the Digital Edition of Food Service & Nutrition - Volume 1 No.2

President’s Message
Malnutrition: Becoming Food Aware
Food Service Systems Management
Clinical Nutrition Competency
CSNM Corporate Member Profile
Ask an Expert
Advertiser Index
Management Notebook
Industry & CSNM News
Continuing Education Quizzes
Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - cover1
Food Service & Nutrition - Volume 1 No.2 - cover2
Food Service & Nutrition - Volume 1 No.2 - 3
Food Service & Nutrition - Volume 1 No.2 - President’s Message
Food Service & Nutrition - Volume 1 No.2 - Malnutrition: Becoming Food Aware
Food Service & Nutrition - Volume 1 No.2 - 6
Food Service & Nutrition - Volume 1 No.2 - 7
Food Service & Nutrition - Volume 1 No.2 - 8
Food Service & Nutrition - Volume 1 No.2 - 9
Food Service & Nutrition - Volume 1 No.2 - Food Service Systems Management
Food Service & Nutrition - Volume 1 No.2 - 11
Food Service & Nutrition - Volume 1 No.2 - 12
Food Service & Nutrition - Volume 1 No.2 - 13
Food Service & Nutrition - Volume 1 No.2 - Clinical Nutrition Competency
Food Service & Nutrition - Volume 1 No.2 - 15
Food Service & Nutrition - Volume 1 No.2 - 16
Food Service & Nutrition - Volume 1 No.2 - CSNM Corporate Member Profile
Food Service & Nutrition - Volume 1 No.2 - 18
Food Service & Nutrition - Volume 1 No.2 - Ask an Expert
Food Service & Nutrition - Volume 1 No.2 - Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - Management Notebook
Food Service & Nutrition - Volume 1 No.2 - 22
Food Service & Nutrition - Volume 1 No.2 - Industry & CSNM News
Food Service & Nutrition - Volume 1 No.2 - 24
Food Service & Nutrition - Volume 1 No.2 - 25
Food Service & Nutrition - Volume 1 No.2 - Continuing Education Quizzes
Food Service & Nutrition - Volume 1 No.2 - Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - cover4
Food Service & Nutrition - Volume 1 No.2 - outserts1
Food Service & Nutrition - Volume 1 No.2 - outserts2
Food Service & Nutrition - Volume 1 No.2 - outserts3
Food Service & Nutrition - Volume 1 No.2 - outserts4
http://www.nxtbook.com/naylor/CSNQ/CSNQ0418
http://www.nxtbook.com/naylor/CSNQ/CSNQ0318
http://www.nxtbook.com/naylor/CSNQ/CSNQ0218
http://www.nxtbook.com/naylor/CSNQ/CSNQ0118
http://www.nxtbook.com/naylor/CSNQ/CSNQ0417
http://www.nxtbook.com/naylor/CSNQ/CSNQ0317
http://www.nxtbook.com/naylor/CSNQ/CSNQ0217
http://www.nxtbook.com/naylor/CSNQ/CSNQ0117
http://www.nxtbook.com/naylor/CSNQ/CSNQ0416
http://www.nxtbook.com/naylor/CSNQ/CSNQ0316
http://www.nxtbook.com/naylor/CSNQ/CSNQ0216
http://www.nxtbookMEDIA.com