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California Coalition for Culture Change
Issue: 32 September 2, 2009
Greetings! 
This week's issue features some of the responses from the "Culture Change" poll that was taken a few weeks ago by some of you. Thank you again for your time, and for sharing your experience with HMC.
RD News

My Involvement in Culture Change Practices as an HMC Dietitian:

It seems we have many exceptional dietitians at HMC using their expertise to help facilities implement culture change practices in dining or food services. Read on for inspiration: 
Anita M: None yet, hope to make small changes in near future. Both facilities have DSS positions vacant......just struggling to stay a float on day to day activities for now.
 
Lauren H: I think the biggest change is having the dining rooms look more like a formal dining room as opposed to cafeteria style. Also, having menus available so residents can request items.
 
Lolita F:  From my observation they have formal dinners during special occasions, breakfast meals prepared like when they go out to eat in restaurants. Food Service Director/Dietary Supervisors go to residents room to ask and obtain food preferences, or if they have any concerns about the food. Consultant RD comes in to speak to resident if requested by resident/resident's family.
 
Annie F: One facility implemented a restaurant-style dining program about a year ago. Another facility is in the process of remodeling their facility to have more home-like features (hardwood-type floors in the residents' rooms & carpeting throughout the facility). Yet another facility plans to implement a semi-select menu to allow residents to have more of a choice in their meal selections.
 
Stephanie H: Meal service by table, resident choice meals, summer BBQ's.
 
Susan M: The DSS is in the process of implementing restaurant style dining.
 
Susanna M: Pets on wards, no non-emergency overhead paging, snack stations, personal shoppers (social services dept),
Best of all, these look great... HMC should get a pattern, sew, and sell them: bibs designed to look like shirts (reversable masculine/feminine)
 
Tony N: Large Catholic population with many retired clergy residents that are served in the facility. Meat and meatless options (Fish)are served every Friday secondary to many Catholics not eating meat on Fridays even pre-post Lent.
 
Deborah N: At one facility a server takes each table's order and then comes back to the kitchen to prepare each plate. (This is an assisted living facility) The Alzheimers unit does not have this option. Another facility is a very small facility (approx. 80) many with psychological issues so the DSS goes around and asks each resident what they want for the next day and then that is what is sent out. We still have a lot of work on implementing this into a restaurant setting.
RD Tip
Culture Change Practices Implemented by HMC RDs:
 
Judy M: Oversight in the dining areas, quality assurance for meal appeal, taste, temperatures, assisted in the overall set up of the program a couple of years ago.

Anita M: Hope to have involvement in cultural change in near future.

Lauren H: Honoring food preferences to tailor what residents are used to eating at home. I would really like to have 'snack stations' implemented so residents can make their own choices.

Lolita F: As mentioned above, in some cases in the clinical aspect of it if there have been some significant changes noted during assessing nutritional status of residents , I talk to residents/family as well and explain ithe mportance of nutrition with regards to the health and well-being of the resident. Always put in consideration to honor their requests considering restrictions as well.

Annie F: I have not been involved in the remodeling process at one facility, however I helped the staff at another facility assure that their restaurant dining program maintained compliance with therapeutic diets and temperature regulations. I plan to help with the roll-out of the new menu system at yet another facility and would like to implement a breakfast buffet there as well.

Stephanie H: One facility desires to do meal service within each of the dining rooms to provide direct interaction between resident and the meal. I have worked with the administrator to brain storm ideas for execution of this goal.

Susan M: This facility already has a full time RD. As an assisting consulting RD, the DSS has been asking for my feedback and opinions as she is making this transition. The RD, DSS, and Administrator have also asked me to observe their enhanced dining program as well so that they could have an outsider's perspective. They are always appreciative of any feedback both positive or constructive. I love that that the Administrator there is both supportive and vocally proud about his dietary department!

Susan M: In-servicing on homelike dining and advocating  for change.

Tony N: Some residents do not like fish and choose not to eat meat on Friday as well. As an RD I need to find protein alternatives to make sure each resident meets their needs. Whether it be in the form of supplementation or foods based on the residents preferences.

Deborah N: Currently, I have very limited involvement in this aspect but anticipate this to change. 

Dear Dietitians;
HMC has arranged for five of our dietitians to participate in the Coalition for Culture Change Collaboratives this year. I am proud of each of them as well as the rest of our exceptional HMC dietitians. Thank you for your commitment to excellence as a registered dietitian representing HMC.

Lee Tincher, MS, RD
President
HM Composite, Inc.