Setting higher standards at mealtimes will help your senior living community reach these goals faster
Meeting the AHCA/NCAL Challenge in the Dining Room
by Cindy Heilman, MS, DTR
Last October I presented "How to Meet the Demanding Dining Needs of Boomers
" at the AHCA/NCAL 63rd Annual Conference in Tampa. Of course The Quality Initiative
was on everyone's mind throughout the conference and I immediately started considering how Higher Standards, LLC could help senior living communities meet these ambitious, but important, goals through Kind Dining® Training
As you know, The Quality Initiative sets specific, measurable goals for continuous improvement in quality of care in skilled nursing centers and assisted living communities. AHCA/NCAL members are encouraged to reach defined, concrete goals over the next three years, in four core areas.
Successful leaders agree the place to start a quality shift is in the dining room. In In Pursuit of the Sunbeam
, LaVerne Norton and Steve Shields observe, "We often start [system change] in dietary because it allows for incremental shifts in resident service that often lead to highly visible and positive results and creates those 'a-ha' moments that energize teams and the process of change." Industry expert Vivian Tellis-Nayak, Phd, says in Hospitality for Boomers
, "Higher satisfaction with the dining experience wins over residents and family members. They in turn are more likely to recommend a community." Instruction in service basics, geared toward strengthening knowledge, confidence and communication skills, can quickly and fundamentally impact the collective psyche of the entire community.
Mealtime offers an opportunity not just to serve, but to connect. When a server takes the time and knows how to skillfully communicate, personal connections are made and satisfaction soars for both residents and staff. Offering superb service at mealtime can quickly move the organization forward to meet the requirements for more person-centered care. The lessons learned in the dining room can then be applied in housekeeping, reception, nursing, and all areas of the community.
1. Safely Reduce Hospital Readmissions
According to AHCA/NCAL, improving communication between care providers and residents, consistent staffing, and engaging providers at all points throughout the spectrum of care are three ways to meet the goal of safely reducing hospital readmissions. These elements of high quality care create an environment where staff are familiar with "what is usual" for each resident. When something changes, staff is more able to spot the problem early, before hospitalization is required.
Because improving communications between all stakeholders is a core component of Kind Dining® Training, communities who have implemented the curriculum have found AHCA/NCAL is on target with this recommendation. Kathy O'Hara, a Registered Dietitian at Villa Crest Nursing Retirement Center
in Manchester, New Hampshire recently shared, "We've always had low rates of significant weight loss, but [since implementing Kind Dining®] we have no unexpected
weight losses." She observes, "Staff has gotten to know residents much better and have even learned peoples' dining preferences, departments are cooperating like never before, and we are all focusing on meeting the residents' needs."
2. Improve Staff Stability
The Quality Initiative recognizes "empowering staff at all levels to participate in problem solving and quality improvement ensures solutions are based in first-hand knowledge of the systems and challenges that impact day to day care. There is significant research showing that satisfied and happy staff contributes to greater quality of life of the residents in our communities and provide greater quality of care."
Higher Standards, LLC has found well-trained, respected workers who feel satisfaction and a sense of ownership in their job remain engaged. Employees who truly enjoy their job, feel valued, and feel connected to the entire organization are more loyal, stay longer, and help recruit other high-quality workers. Kind Dining® Instructors regularly report employees like the positive feedback they receive when they start using their new skills. As staff continues to polish their skills, a positive loop develops resulting in greater satisfaction among residents and staff alike.
3. Increase Customer Satisfaction
As AHCA/NCAL points out, "Just like any other business, skilled nursing care centers and assisted living communities must ensure that the customer is king. Research shows that facilities with the highest rates of satisfaction perform better in other organizational indicators including staff stability, staff retention, survey results, census and cash flow."
Because mealtimes are so important to residents
, if they enjoy eating in your community, they are more satisfied overall with living there. Conversely, the less they enjoy eating in your community, the less satisfied they are overall. Research shows this holds true for all levels of senior housing: skilled nursing, assisted living, and independent living.
When describing what leads to mealtime satisfaction, residents see three things as important:
Server courtesy and attitude during service
The social skills of their servers
No one is born with this knowledge. Therefore, staff training is crucial to transforming your community's dining experience. However, time and again, Kind Dining® Training has proven these key skills and attitudes can be taught and inspired at every level of staffing. From nurses deciding to pour coffee
to new trainees encouraging their teammates to excel
, our experience shows small steps in dining service make a big difference community-wide.
4. Safely Reduce the Off-Label Use of Antipsychotics
As AHCA/NCAL points out, how care is delivered to residents with dementia can reduce the need for behavior modification through drugs. Consistency in staffing, schedules, and processes combined with a resident-centered, positive atmosphere, can help prevent the frustrations that lead to challenging resident behaviors and give staff non-pharmacologic approaches for addressing residents' behavioral expressions when they do occur.
Since providing a great dining experience strongly enhances the health and well-being of residents, and because mealtimes are so important to residents, the benefits gained in the dining room—better nutrition, social connections, and activity—have a tendency to carry on throughout the day. Done right, dining "sets the stage" for an optimal resident experience.
Now is the Time
Meeting The Quality Initiative goals isn't just about learning to set down plates politely, but research and experience show customer service is one of the most important tools available to meet the health and quality of life goals communities hold dear. Setting higher standards in the dining room is also one of the best ways to improve your community's reputation, marketability, and profitability. Forward-thinking senior care organizations are making profound changes in their dining rooms to meet The Quality Initiative goals, new nursing home survey processes, industry-mandated initiatives, and their own internal missions. As the long-term care profession moves increasingly toward person-centered care, the time is right for providers to advocate for best practices in serving meals that enhance the experience of residents and the entire organization.
Download The Quality Initiative one sheet for skilled nursing here.
Download The Quality Initiative one sheet for assisted living here.
Setting a Higher Standard in Bethesda's Dining Rooms
Muriel Van Oordt demonstrates how initiating higher standards starts with hands-on research
"My goal was to move beyond the traditional nursing home model of meal service, which is targeted as simply nourishing the body, to set the stage for a dining experience that also nourishes the souls of those who are served and those providing the service," said Muriel Van Oordt
, Vice President and Senior Administrator at Bethesda Dilworth
in St. Louis, Missouri.
Muriel decided to enhance Bethesda's dining experience while a fellow of the 2011 LeadingAge
Leadership Academy. After 30 years in healthcare and a long history with Bethesda, Muriel had some insights into how to tackle the dining project. She started with hands-on research to determine her project's focus. She dined at each Bethesda facility to assess service, food, and table settings. She also visited with management, staff members, and residents to learn what mattered most from each perspective.
"I found out that some of the things [residents] missed the most were candlelight dinners and being able to eat outside," Muriel said. "From that point, we decided to use hospitality as our model."
Muriel assembled a team comprised of herself and Bethesda long-term care dining directors Shelly Carley, RD, LD, Mary Knowles, CDM, and Amy Van Oordt, RD, LD, (Muriel's daughter), plus other key staff, to develop a plan that would improve the entire dining experience. The team decided to focus on three areas: hospitality training, employee appearance, and table setting. Then, they researched hospitality training options. Kind Dining®, a program developed by Cindy Heilman, MS, DTR, was chosen for staff training.
"One of the things Cindy observed was high levels of anxiety among seniors when they moved into a new community and were seated with people they didn't know." Muriel said. "The interdisciplinary program she created recognizes the importance of a meal and how we can all make it an enjoyable, relaxing experience for our seniors."
According to Amy Van Oordt, RD, LD, and Director of Dining Services at Bethesda Meadow, Kind Dining® Training has been very well received:
"The employees almost always come into the class with doubts that they should be there, especially those employees from departments other than Dining Services. Once the class gets started they all really seem to enjoy the class and usually all are participating. We have received very positive feedback from every person who attends the class. There are always a few staff members who stop and thank us for teaching the class and express how much they learned. We will continue promoting positive customer service through implementation of Kind Dining®."
Meanwhile, the core team worked to update uniforms and upgrade place settings.
"When you're coming back from being at a hospital, small touches, like crisp ironed linens and fresh flowers, are aspects of the dining experience our patients really seem to appreciate," Muriel said.
The ultimate goal for the Bethesda team, Muriel explained, is to "improve the dining experience across Bethesda's long-term care communities, and for changes to continue to evolve."
Their successes thus far
are an example of why raising service standards in senior living begins with careful assessment. When leaders like Muriel are prepared to act and take an honest look at current procedures, the steps required to increase resident satisfaction and quality of life become clear.
Do you aspire to build a stronger organization that exceeds resident expectations? Follow Muriel's lead: share a meal with residents at your senior living community today.
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