Dining Culture Change: Dining Times Options

Offering choices is a good way to enhance culture change. At home, we have choices on what to eat and when. We also have choices on when to get up in the morning. (Well, most of us at least have choices on weekends!) When we retire, however, our options will open up greatly. And the same choices we will have then are what we should be offering our residents now.

Some facilities have implemented the 5-Meal a Day Program. This is also called Everyday is a Holiday and Resident Choice Meal Plan. In essence, it allows residents to rise when they want. The meal pattern follows. Times are approximate and depend upon the facility.
7:00 – 9:30 a.m., optional continental breakfast served on the units
10:30 – 11:30 a.m., brunch served in the dining room(s)
1:30 – 2:00 p.m., heavy snack served on the units
4:00 – 5:00 p.m., dinner served in the dining rooms(s)
7:00 – 7:30 p.m., night cap snack (mini-meal) served on the units

With this system, there really are two large meals (brunch and dinner) and two heavy snacks. The continental breakfast is optional for those residents who like to rise early and have something light to hold them over until brunch.

Facilities that have had success with this plan report a quieter morning environment, a more even workload for staff, more variety with meals, positive clinical outcomes, and positive financial outcomes. In some facilities, this works great and residents and employees really enjoy it.

It has not worked in other facilities, however. From my experience it seems that a major stumbling block is the concept that a continental breakfast is light. It means a slice of toast and a glass of juice or a muffin and coffee. Oftentimes too much is offered and residents choose several or all of the options: cereal, toast, fruit, juice, coffee, etc. In reality, they have had a full breakfast. When it is time for brunch, residents do not want breakfast items—they already had breakfast in their minds. They want lunch.

The concept that a continental breakfast is light and optional also appears to be difficult for the employees as well. This may be why residents have difficulty with it. Residents will always take cues from staff. (This goes back to why behaviors and attitudes of staff are so important to culture change!)

In many facilities, this program has evolved into open meal times. Rather than breakfast being served at 7:00, breakfast is available from 7:00 to 9:30 (for example). This allows those residents who want to sleep in to do so. Or, a hot breakfast is available from 7:00 to 8:00 and a continental breakfast is available from 8:00 to 10:00 (again, the times are just examples). This allows the resident to choose which is more important to him or her—a hot breakfast or sleeping later.

It also avoids citations for F368 which states that no more than 14 hours may elapse between the evening meal and breakfast the next day, unless there is a substantial evening snack, then 16 hours may elapse. For example, if dinner is served at 5:00 p.m., and breakfast is offered and available at 7:00 a.m., then F368 is being met. It is resident choice if the resident wishes to eat at 7:00.

In addition to offering open dining times for breakfast, it is possible to do this for lunch and dinner as well. This is very similar to what retirement centers do routinely. Residents can eat anytime during the posted dining room hours. This requires very careful planning of employee schedules and very close cooperation between dining and nursing services, but it does happen!