A

s a result of the expansion of community services and growth in assisted living facilities, today’s long-term care resident is older, sicker, and physically frailer. Most residents need a great deal of assistance with their meal service, and a fair number of them need their food and fluid consistencies altered due to dysphagia or other chewing or swallowing disorders. As healthcare providers, we must ensure that every individual’s food is nutritious and presented in a safe and dignified manner.

The facility’s wine and cheese socials give residents a time to relax, socialize with friends and staff, and enjoy music.

       At the Hebrew Home for the Aged at Riverdale (Riverdale, NY), a nonprofit long-term care facility, we strive for a dining experience that is nutritious as well as creative and fun. During therapeutic events, we noticed that whenever refreshments or meals were part of the event, residents consumed greater amounts of food. We attribute this to 2 key elements. First is the change in atmosphere during the event. Many of the events are held in spaces other than the neighborhood dining rooms. Consequently, the change in atmosphere and the routine appears to facilitate a change in appetite, usually positive. Second, residents respond favorably to the party-like ambiance of the event. As a result of this observation, we created special programs that would combine good nutrition and foster socialization. Our goals were to:
• Promote self esteem among residents and staff
• Encourage staff participation
• Provide good nutrition and encourage adequate hydration for our residents
• Ensure our residents maintain a healthy weight
• Be easy and fun
• Foster socialization.

Getting Started

       We met with other members of the interdisciplinary care team to introduce the concept and to gain their support. Each staff member contributed his or her expertise to help solve a variety of challenges. Not only were we faced with overcoming cognitive challenges, we also had to overcome physical limitations and, more specifically, chewing or swallowing impairments. We also needed to address and reduce unintended weight loss.
       We began the process by looking at each unique neighborhood. Programs were designed to meet the residents’ needs. For example, in our special care neighborhoods where residents are at risk for weight loss and dehydration, we created “Shakes, Rattle, and Roll.” The focus of this program is to allow supplement distribution to be a more fun, party-like event. Real milkshakes were prepared in the kitchen in a variety of flavors (including vanilla, chocolate, strawberry, peanut butter, and coffee) and brought to the neighborhoods. The therapeutic activities department decorated the activity space to resemble an ice cream parlor where they played lively music. All staff members were invited to participate in the event with the residents and were offered a milkshake. Everyone sang, danced, and enjoyed the shakes—some even asked for seconds. We made sure that thickened shakes were available in the neighborhoods that needed them so that everyone could participate in the event.

Catering to Each Resident

       In our facility, a special program identifies residents who require thickened liquids. Residents who are on thickened liquids have a single blue dot on their ID bracelets, and those who cannot have anything by mouth have a double blue dot. These residents’ names appear on a master dysphagia list, which identifies food and fluid consistencies safest for these residents and is available in every neighborhood. The goal is 100% participation, and we work collaboratively to liberalize diets to enhance the quality of life for our residents. The physicians are very supportive and participate in the process.

Open seating and live violin music are 2 of the ways in which the facility enhances ambience for residents.

       After program implementation, we noticed a dramatic decrease in unintended weight loss during our weekly weight reviews. We also noted the staff’s positive reaction to being invited and included in the event. It became a time that residents and staff knew they would have fun.
       Our wine and cheese socials have also proven to be very successful. These are held in our skilled nursing and enriched residential neighborhoods. Residents are offered a choice of white, red, or rose wine accompanied by a variety of cheese and crackers. We hold this type of event in the late afternoon before the evening meal. The residents enjoy this time to relax, socialize with friends and staff, and listen to the soothing music. The physicians help us determine the appropriateness of residents’ participation, taking into account their medications and diagnosis. Wine is offered with the hopes of stimulating the resident’s appetite for the evening meal. For some residents, this activity is a new experience, and for others, it is a lifestyle continuum. Staff is always on hand to provide assistance.

Enjoying the Great Outdoors

       In our “Great Outdoor Programs,” residents enjoy scheduled barbecues, impromptu outdoor lunches, which may be as simple as finger sandwiches, and nature walks along the scenic Hudson River. Dining al fresco provides residents an opportunity to enjoy the outdoors, savor the enticing aromas from the grill, listen to enjoyable music, and socialize with their peers and caregivers while enjoying their meals. We invite the staff and volunteers who assist with the program to enjoy the outdoor cuisine as well.
       Residents are also offered a fine dining experience in our River Café, an on-campus restaurant. Using a little creativity, a restaurant-like environment can be created in almost any space. This is a good example of how a change in atmosphere has a positive effect on an individual’s appetite. The residents in each neighborhood are invited to dine in a manner that varies from their normal routine. The menu from our last program highlighted Italian cuisine and consisted of Stracciatella soup, ravioli with asparagus, garlic bread, cheesecake, and, of course, a glass of Chianti. The table setting included special china with an Italian motif, red-checkered cloths and napkins, and glass wine goblets. Open seating and a strolling violinist enhanced the ambience.
       These types of programs foster good nutrition, socialization, and peer-staff relationships and enhance quality of life. When developing programs, recruit the support of all departments, volunteers, families, and friends and—of course—have fun while you are doing it.