Dining Culture Change: Balancing Resident Choice with Resident Care

Although residents have a choice not to follow their diet or not to eat, that does not absolve us from our legal and moral responsibilities to do everything possible to assist the resident in maintaining or improving his/her health.

It is not enough to simply offer choices, we must offer good choices, and help the residents to choose wisely. To put it another way, do not offer bad choices; do not offer items that a resident cannot have on his/her diet.

Have you even been in a restaurant, decided what you wanted to eat, only to be told by the server that it was not available and you could not have it? How did it make you feel? How do you think a resident feels if you offer her something and when she states she would like it, you tell her she cannot have it?

For example, if you have a written selective menu, only include on the menu the items that the resident can have on his/her diet. Yes, this means a different menu for each diet (therapeutic and texture modified) that you offer. Yes, this is a great deal of work if you do not have a computerized menu system that will print them automatically. But it will increase customer satisfaction.

If you have a spoken selective menu, only offer the items the resident can have. Yes, this means work through either educating staff or different menus, or both, but it will increase customer satisfaction because it will decrease the conflict that arises when a resident is told they should not eat something.

Sometimes residents will see what other residents are eating and want it. That is when we are really between the rock of resident rights and the hard place of regulatory compliance! And there is no one best way to handle it. It depends upon the situation and the resident.

If the resident routinely does not want to follow the diet, or does not want to eat, we assess to determine why, we develop plans to address the situation, we implement the plans, we evaluate to see if they were successful, and we develop and implement new plans as necessary. We involve the resident, we involve the physician and the other members of the care team, we involve the family as appropriate, and we educate, educate, educate. And we document everything we do, because if it is not documented, it did not happen.

There is no doubt that it can be a tough balancing act, but we have to follow regulations as well as honor resident rights.