1. Massachusetts Culture Change Coalition Dining Culture

2. Culture Change The only thing that should change when someone moves into a nursing home is their address

3. Culture Change It is a journey, not a destination – Residents, Family & Staff Goals OBRA supports Culture Change – 483.15 - Quality of Life

4. Culture Change By identifying and implementing the Resident’s wants and needs you will meet OBRA Regulations “each facility provide care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident…”

5. Culture Change - Massachusetts Conferences in Massachusetts – 2006 Consistent Assignment 2010 Dining Experience – Benefits to Residents – Benefits to Staff and Facility – DPH

6. Culture Change – Consistent Assignment Considerations: – Waking and sleeping – Meals – Food Preference – Daily Routine – Bathing frequency, time & method – ADLs – Activities

7. Culture Change Defining Dining …It’s About Me Pioneer Network.org Creating Home in the Nursing Home II -- A National Symposium on Culture Change and the Food and Dining Requirements 2010

8. Culture Change - Nutrition CMS Interpretation: Culture Change Input and Questions Survey and Certification Group: S&C-07-07 S&C -08-09 and S&C-09-39 – Time between meals – Food brought in from other sources

9. Culture Change - Nutrition S&C-07-07 F-Tag 368 and 370 – These are regulatory questions sent from culture change groups and the CMS answers – Questions 1, 2, 11 & 15 relate to food

10. Culture Change - Nutrition S&C -08-09 and S&C-09-39 – 09-39 clarifies 08-09 F-Tag 371 and 242 – Food Procurement and Self Determination and Participation

11. Culture Change - Nutrition DPH & regulations OBRA 1987 – Survey process – Participates in MCCC and conferences – May require waiver of some regulations – Contact DPH with questions – Refer to references

12. Culture Change - Nutrition Dietitians - Nutrition Educators Residents & families: – Assessing and care planning – Increase nutrition education opportunities Identify risks vs. benefits of choices – Have the right to make bad decisions dignity/rights

13. Culture Change - Nutrition Dietitians – as Nutrition Educators – Liberalize diet Ask preferences Monitor for changes Re-evaluate with resident Document

14. Culture Change - Nutrition Dietitians - Nutrition Educators Staff – Clinical – DON, CNAs, Therapies – Dietary/Nutrition – Increase communication among all areas

15. Culture Change - Nutrition Goal is to reduce incidence of Weight loss Pressure sores Supplement use Dehydration

16. Culture Change - Dining Experience How to achieve goal : Choice in foods Choice with meal times Consistent assignment

17. Culture Change- Dining Experience Resident Rights’ Week- October 2010 – Massachusetts programs’ activities Cooking contests Luncheons DPH speakers Dining Scarves Arc-ct.org – Dining with friends video

18. Culture Change – Dining Experience Mass facilities that are a work in progress: St Camillus in Whitinsville- Bill Graves Loomis House – Lori Todd Holy Trinity in Worcester – Diane Buckley

19. Culture Change- Dining Experience National resources for Culture Change: Eden Alternative Pioneer Network Consumer Voice (NCCNHR) Picker Institute Advancing Excellence Campaign

20. Culture Change – Dining Experience Culture Change in Massachusetts Mass Advocates for Nursing Home Reform- MANHR: 800-988-4450 Mass Senior Care: 617-558-0202 Mass Aging Services: 617-244-2999 Long Term Care Ombudsman: 617-727-7750

21. Culture Change – Dining Experience Welcome to the table. Bon appétit Elizabeth M. Bradley, MEd, RD/LDN Long Term Care Ombudsman Program