Caption: Minoru dining room at mealtime.
In our long term care homes, mealtimes are critical to quality of life for residents. They create time for connection and interaction, and are often a highlight of the day.
"Good care provided at mealtimes is essential to the dining experience, which can not only affect food intake, but also overall health and well-being," says Nicky Dhugga, Manager of Minoru Residence. As we strive for a culture that is always learning and looking to improve care for our residents, the Team-Based Quality Improvement Team (TBQI) at Minoru decided to take a closer look at their dining practices to see if they could be improved.
“Person-centred care is considered best practice and has been the philosophy of care at Minoru for a number of years," says Nicky. “But in a recent assessment of our dining process, staff reported that they didn't feel they were adequately equipped with the knowledge, skills, and support to make meal time the best it could be for residents."
The team did some further investigation — conducting resident assessment tests, as well as interviews with staff, leaders and resident and family advisors. The results indicated:
Meal times were “chaotic" and “non-resident focused"
Staff felt rushed in serving and feeding residents
The dining process and area were loud and disorganized
The dining process was confusing and difficult for casual staff
Armed with this information, a working group came together including the manager, resident care coordinator, care aides, TBQI representatives, union stewards and catering staff (Sodexo) to see how this feedback could inform an improved dining process. The purpose? To create a streamlined process that avoided overcrowding in the dining area and provides care aides and nurses more time to spend feeding and interacting with residents. The ultimate goal? To create a more relaxed, home-like, and social experience for residents and families at meal times.
The group decided to pilot a new dining approach on the second floor to address the concerns raised by staff, residents, and families, implementing a number of improvements including: include:
Moving the dining cart to the kitchen, instead of the hallway, to minimize crowding.
Using dietary aides to assist with serving and feeding meals, so care aides could spend more time interacting with residents.
A seating plan that encourages residents to form a regular meal group. The seating plan was also allowed residents with similar dietary needs to sit together.
Care aides taking on mentor roles with dietary aides, to help them with facial recognition of residents in order to provide a more person-centered approach.
Extending meal times by 20 minutes to allow for more social interaction.
Due to COVID-19, the team has also separated the tables in the dining area to accommodate physical distancing requirements and relocated the serving cart to provide more distance between staff serving the meals and the residents.
“The feedback we've received so far about the pilot has been very encouraging," said Peter Togado, Clinical Operations Supervisor at Minoru. “By employing dietary aids in the meal service, we've freed up care aides so they can spend more time with residents from the beginning of their meal to the very end."
Care aides are also enjoying the revised meal processes. Derek Yung says that “we have more time to spend with residents and it's created more team work and collaboration with kitchen staff." Marianne Bernal agrees, saying that “care aides and nurses are able to be more resident focused" thanks to the changes made, “giving more quality time to each resident to help make their mealtimes an enjoyable experience."
Phase two of the dining transformation at Minoru is a Team Grant research project looking at the CHOICE principle—connecting, honouring, offering support, supporting identity, creating opportunities, and enjoyment—and seeing how these can be adapted within the Minoru care setting during meal times.
“Our goal of the study is to engage with stakeholders to examine factors that influence mealtime care and identify priority needs," says Lilian Hung, clinical nurse specialist for Vancouver Coastal Health and lead investigator for the research project. “We hope our research will uncover useful and practical outcomes that will help us improve quality of care in real time, improve staff practice, and contribute to building capacity in conducting patient-oriented research." We look forward to sharing these results with you in the future.