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Dining as a Catalyst Liberating Care & Navigating
Change
Rhythms of Daily LivingRhythms of Daily Living©
A Service of Choice
Aligning Experiences – Expectations – Resources – Outcomes
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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Must Rising Acuity Levels Mean Lower Dining Quality ?
©©
Independent Living Assisted Living Memory Enhanced Skilled Nursing
Nutrition Quality Food Quality Service Quality Life Quality
November 7. 2005 AAHSA - Quality Through Community
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Bridging The Quality GapServe 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
November 7. 2005 AAHSA - Quality Through Community
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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?
November 7. 2005 AAHSA - Quality Through Community
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Rhythms of Daily LivingRhythms of Daily LivingThe 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.
November 7. 2005 AAHSA - Quality Through Community
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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.
November 7. 2005 AAHSA - Quality Through Community
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STAGES of RDL1. 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.
November 7. 2005 AAHSA - Quality Through Community
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Stages of RDL3. 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.
November 7. 2005 AAHSA - Quality Through Community
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Stages of RDL5. Schedule Choice I[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.
November 7. 2005 AAHSA - Quality Through Community
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Assessment Points for RDL ImplementationStages 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
November 7. 2005 AAHSA - Quality Through Community
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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
November 7. 2005 AAHSA - Quality Through Community
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The ROI Of A Dining ExperienceBuilding “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
November 7. 2005 AAHSA - Quality Through Community
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Contact Information
Dan Look 3605 Sandy Plains Road Suite 240-269 Marietta, GA 30066
[email protected] www.dm-resources.com 770-565-4006
November 7. 2005 AAHSA - Quality Through Community
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"For every complex, difficult problem,There is a simple solution.And, it is probably wrong!"
H.L. Mencken