Dining Culture Change: Culture Change in Long-term Care

In the past, nursing homes have had a facility-directed culture. Management decided what was to happen and when. It was important that schedules were followed. This was good from an efficiency standpoint, but not so good if you, as a resident, did not like the schedule imposed upon you. Or you did not like to eat what was served to you.

Residents were not necessarily viewed as individual people. Often they were viewed just as people to do things to, like feed, bath, clothe. Sometimes, too, because they needed care, they were treated as infants or children. Staff knew best what the resident needed!

Later, many facilities started a resident-centered culture. Events in the facility were to center around the resident. Some good came of this. The environment become more attractive, meal service more pleasant, menu selection made more options available. But resident-centered care does not go quite far enough.

Resident-directed care is the goal for long-term care to create a real culture change. With resident-directed care, each resident has the right to direct his or her own life within the facility. This means that each resident has the right to choose when to get up, when to go to bed, when to eat, what to eat, whether or not to follow physician’s orders, etc.

Think of the huge shift in attitude that this requires in staff! The goal now is not to take care of residents, but to help them take care of themselves. The type and amount of care varies with each individual resident. And it is the resident directing what assistance he/she wants. It is no longer acceptable to treat residents as children. It is necessary to view them and treat them as equal adults.

A good place to start with this level of culture change is with behaviors. Terminology is one behavior. Instead of calling someone a “feeder,” indicate that this is someone who needs to be fed. Instead of calling someone a “pureed,” indicate that this is someone who requires a pureed diet. Rather than “bringing” residents to the dining room, “escort” them to the dining room. This helps staff to view residents as individual people with their own needs, thoughts, and feelings.

Other behaviors include simple courtesy. Call the resident by name, make eye contact, engage him or her in conversation, and talk with him or her rather than with co-workers. Treat each resident with respect and dignity.

Depending upon your employees, you may have to define what treating someone with respect and dignity means. Remember, they come from their own home culture. In their home, it might be normal to yell or shout at other family members.

Open meal times, buffets, selective menus, dessert and salad carts, resident-selected menus are all great ways to offer residents more choice. But new systems like these alone will not change the dining culture. How the employees of a facility, especially management, views and treats the residents is what will create the greatest culture change.

And even the golden rule does not go far enough. It is not about how you want to be treated, but how each individual resident wants to be treated.