1. Rhythms of Daily Living Dining as a Catalyst Liberating Care & Navigating Change Rhythms of Daily Living © A Service of Choice Aligning Experiences – Expectations – Resources – Outcomes

2. November 7. 2005 AAHSA - Quality Through Community 2 Session Objectives  Present  Concept of Dining as Catalyst  Key Factors for Transition  Discuss  Transition Experience  Integration of Key Factors  Tradition & Transition  Provide  Process for Transition  Outcome  Create Documented Process for Community Program Transition

3. November 7. 2005 AAHSA - Quality Through Community 3 Assumptions  Envision the Future, Honor the Tradition  Imposition of Dining  Until the Experience Dining is Resident Centered, a New Culture will not Take Deep Root  What is Current Does Not Work As Well As It Can & Should

4. November 7. 2005 AAHSA - Quality Through Community 4 Presentation Points  Review Changing Factors of Environment & Constituencies  Review Demographics  Define Assumptions  Introduce Choice Dining Concept & Implementation Process  Discuss Culture of Service, Leadership, Choice  Identified Measurable Indicators

5. November 7. 2005 AAHSA - Quality Through Community 5 Changing Demographics  More Couples  More Choice & Selection  More Control  More Flexibility  Experience Consumers  More Knowledgeable of CCRC Living  Healthier – Wellness Important  Seamless Experience  Broader Constituencies

6. November 7. 2005 AAHSA - Quality Through Community 6 Assumptions  Imposition of Dining  Transition is for All Levels of Living  Choice is a Key for Quality of Living/Work  Operational Evolution Enabling Culture Transformation  Requires Servant Leadership

7. November 7. 2005 AAHSA - Quality Through Community 7 Must Rising Acuity Levels Mean Lower Dining Quality ? ©

8. November 7. 2005 AAHSA - Quality Through Community 8 Bridging The Quality Gap Serve The Resident, Not The System  The System – Individual Preparation, Bulk Service  Prepare Individual Menu Items For Storage  Place On A Tray For Transport To Feeding Area  Transport and Leave In Cart  Distribute and Unwrap At Scheduled Meal Time  The Alternative – Bulk Preparation, Individual Service  Prepare Menu Items In Bulk  Transport To Dining Room Servery  Plate Individually and Serve Upon Request

9. November 7. 2005 AAHSA - Quality Through Community 9 How Do You Individualize Care?  What Are Community Strategic Objectives?  What Is The Vision for Community Dining Experience?  What Is History of “Transformation” Projects?  What Are Constituency Most Important Experiences?

10. November 7. 2005 AAHSA - Quality Through Community 10 Rhythms of Daily Living The core of RDL is the opportunity to exercise choice – residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination. RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.

11. November 7. 2005 AAHSA - Quality Through Community 11 Choice Is The Way We Live “Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.” Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.

12. November 7. 2005 AAHSA - Quality Through Community 12 STAGES of RDL 1. Readiness GAP Analysis  Establish clear understanding among all constituents (residents, staff and administration) as to the program impact on 6 principle areas. 2. Culinary Capacity  Establish a servery on the resident floor where all meals can be finished, plated and served.

13. November 7. 2005 AAHSA - Quality Through Community 13 Stages of RDL 3. Individualized Service – Establish a service program without the tray system. Meals are plated in the servery when the resident is in the dining room. Choice is based on pre-ordered menu items, however time of service is not flexible. 4. Point of Service Menu Choice –Establish the opportunity for the resident to choose alternate items during meal service.

14. November 7. 2005 AAHSA - Quality Through Community 14 Stages of RDL 5. Schedule Choice I[1][1]  Establish the opportunity for residents who are self-sufficient and independent to dine at a time of their choosing, within established service times. 6. Schedule Choice II  Establish the opportunity for residents who require assistance with dining but are able to determine when they would like to dine to do so within established service times. 7. Venue Choice (If Appropriate)  Establish the opportunity for residents to choose alternate places to dine.

15. November 7. 2005 AAHSA - Quality Through Community 15 Assessment Points for RDL Implementation Stages are defined against the requirements of:  Administration: fiscal, management and leadership considerations  Regulatory: compliance criteria (grouped by clinical and operational considerations)  Systems: software programs, forms, policy & procedures, protocols  Personnel: staffing requirements, training, HR. The impact on each care disciplines is identified by department  PP&E: Property, Plant & Equipment necessary to perform the tasks and functions  Community: Communications, Resident & Family education; community collaboration

16. November 7. 2005 AAHSA - Quality Through Community 16 What Are Your Experiences? Obstacles  Structure of ordering  Staff resistance to change  Inadequate staffing  Training of staff to new tasks  Management of change (fair process)  Need to educate the staff in the process of change  Clear explanations of the reasons/outcomes of changes  How changes will impact staff security and knowledge of job tasks and resident served

17. November 7. 2005 AAHSA - Quality Through Community 17 The ROI Of A Dining Experience Building “Experience Equity” Dining establishes the daily quality of life for all members of a senior living community. The culture defined by the dining experience resonates with and dictates that of the entire community. The dignity and joy of making self-determined choices are at the core of any good dining experience. BAD DINING EXPERIENCE GOOD DINING EXPERIENCE High Staff Turn-Over/Contract Labor = High Costs & Poor Morale/Service High Staff Retention = Lower Labor Costs High Food Waste/Use of Supplements = High Food Cost Low Food Waste/Elimination of Supplements = Lower Food Costs Low Appetite/Unanticipated Weight Loss = High Care Costs Healthy Appetite = Lower Care Costs Poor Image = Higher Marketing Costs and Lower Income Great Dining Program = Lower Conversion Costs & Higher Occupancy

18. November 7. 2005 AAHSA - Quality Through Community 18 Contact Information  Dan Look  3605 Sandy Plains Road  Suite 240-269  Marietta, GA 30066  dcl@dm-resources.com dcl@dm-resources.com  www.dm-resources.com www.dm-resources.com  770-565-4006

19. November 7. 2005 AAHSA - Quality Through Community 19 "For every complex, difficult problem, There is a simple solution. And, it is probably wrong!" H.L. Mencken