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Food Service regs have changed for your Residents? Person-Centered Care at work! by Kathy Hughes, ADC Instructor - ActivityDirector.org

I was recently passed an interesting article from our instructor Kathy Hughes, ADC that I think we can all relate to. Nursing home food is often compared with hospital food and is rarely accused of being appetizing. However, the nationwide push to make care homes more person-centered has extended well beyond care and is now attempting changes in the dietary department. It may be hard for some to believe but prior to November 2016 family members weren’t allowed to bring outside food in. The value of sharing recognizable comfort food with a loved one in the throes of dementia could easily be recognized by the family, but couldn’t be executed until this all important CMS update in 2016 that was over 20 years in the making. According to the article:

The new and modified regulations explicitly state that menus at facilities participating in the Medicare and Medicaid programs must now reflect the religious, cultural, and ethnic needs of residents, be updated periodically, and undergo review by a dietician or nutrition professional (who, according to the new regulations, have higher certification requirements than in the previous iteration). Also, for the first time, nursing homes can officially grow their own food or buy it directly from local producers, and allow residents to eat food brought in by friends and family. Finally, meals and snacks can now be served whenever works best for the residents, not just at designated feeding times.

The changes these updates are making can be felt already in many homes, perhaps even yours. Rather than regular American staples day in and day out residents are now enjoying more ethnic foods being served right in their dining rooms. The ability to participate in
CSA (community supported agriculture) programs opens a whole new way to plan activities for your community as well, providing pathways for field trips, vegetable, fruit and herb education, harvesting and preparation, increased health education and the lists goes on and on. Better food isn’t just about better taste and nostalgia either. Nutrition is critical in determining how one’s life will unfold particularly at this leg of life. Fresh and accessible food, from a variety of trustworthy sources increase intake in general and nutritional levels greatly. The article discusses many advantages to these CMS updates, but its central point remains that the boost in mental well-being received by these residents is really what counts. The ability to feel autonomous and to be reminded of the good times in life go a long way in contributing to joy. A care home should not feel like a jail and access to a variety of food and lifestyle experiences is a basic freedom.

The updates are a huge step in the right direction however there is a stark difference between policy change and implementation. Positive effects are being felt as are the negative effects that variety can have on an ever decreasing dietary budget. The article references some worst cases scenario numbers that come in at less than $1 per meal. Think about that. Staffing issues also remain a concern that block many attempts above and beyond the norm of how things have always been. Even still, these changes are good changes and they were a long time coming. It allows residents to remain in contact with food, which is such a cornerstone of all of our lives and interactions therein. It is true progress and I for one was fascinated to read the article. I grew up in an Activity Department because my Mom was an Activity Director and I can remember the food vividly. I really hadn’t realized that food could be or was regulated in that way and that dietary had such restrictive guidelines and budgets (even though I should have because my Mom’s best friend Debbie was the Dietary Manager and she complained about it constantly!). I am glad to see these changes going into place and it gives me great hope about the type of facilities we are all pushing for together. The future is certainly brighter….and tastier.


Article Referenced:

Nursing home food is getting better. But the journey is far from over.
by Jillian D' Onfro

Nov. 27, 2017
Read the Article
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Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network.
Copyright © 2019 Activity Directors Network, LLC All rights reserved.

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Dehydration and the Elderly - Activity Planning During a Heat Wave by M. Celeste Chase, AC-BC, ACC, CDP

Dehydration and the Elderly

A widespread blanket of increasing rising temperatures is expanding across much of the country. . . . And of course, hot weather always increases the risk of dehydration.

Older aging populations are vulnerable to climate change-related health impacts for a number of reasons. The body’s normal aging process causes the body’s systems mechanisms, that are meant to protect us from dehydration, to work less efficiently as we age. The elderly population does not have the same internal thirst signals with age progression and consequently do not take action to reach the necessary liquid consumption.
NOTEElderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day.

Factors that put older adults at risk for dehydration include (includes but not limited to):
  • Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids.
  • Memory problems, which can cause older adults to forget to drink often, or forget to ask others for something to drink - even mild dehydration, can cause noticeable worsening in confusion or thinking skills.
  • Mobility problems associated with aging, such as muscle and bone loss, which can make it harder for older adults to get something to drink.
  • Older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure.
Dehydration can also be brought on by an acute illness. Older adults are also more likely to have a chronic health condition, such as diabetes, that requires medications for treatment. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated. Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure. Additionally, chronic mild dehydration may further exacerbate constipation problems.

Physical signs of dehydration may include:
  • high heart rate (usually over 100 beats per minute)
  • low systolic blood pressure
  • dry mouth and/or dry skin in the armpit
  • less frequent urination
  • dark-colored urine
  • delirium (new or worse-than-usual confusion)
  • sunken eyes
Caffeine and Dehydration
Coffee or Tea please!  We all know only too well how important it is for our seniors to enjoy a nice cup of coffee or tea while gathering in morning socials to shake off those morning cob webs and get ready for the day’s events.  Is there any other way to start the day?

Technically caffeine is considered a weak diuretic. By definition, a diuretic is a product that increases the body’s production of urine. Hence water, or any drink consumed in large volumes, is a diuretic.
  • It should be noted that urinating more does not inevitably lead to dehydration (excessive loss of body water).

Current studies suggest that caffeinated coffee or tea is not proven to be particularly dehydrating in people who drink them regularly. Caffeine, however, may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine for our senior population.

Feel free to offer decaffeinated drinks but if an older person particularly loves his/her morning cup of (caffeinated) coffee, there is no reason why they cannot partake unless it is physician ordered to avoid such liquids.
Help Them Stay Hydrated
Here are some reasonable approaches to help your seniors remain hydrated during current rising temperatures:
  • Identify continence issues that may make the older person reluctant to drink.
  • Consider a toileting schedule, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties.
  • Offer fluids in small amounts throughout the day; consider doing so on a schedule.
  • Ensuring the appeal of the beverages you offer – they will drink more if they enjoy it.
  • Determine if your senior prefers drinking through a straw.
  • Enlist interdisciplinary staff in your efforts.
  • Track in a journal how much the person is drinking; be sure to note when you try something new to improve fluid intake.
  • Offer more fluids when the senior is ill (seek nursing oversight).
Reducing Swallowing Problems By Making Liquids Thicker
While you focus on actions to prevent dehydration issues be mindful of anyone with a swallowing disorder, often experienced in the elderly.  Normal aging causes reduced muscle tone in the pharynx and esophagus and other changes that affect swallowing. Thickened drinks are normal drinks that have a thickener added to make them thicker. They are often recommended for people who can no longer swallow normal fluids safely, because normal drinks go into their lungs, causing coughing, choking or more serious risks such as chest infections and aspiration pneumonia (seek nursing oversight).
More Ways to Keep Seniors Cool in Hot Weather
  • Offer a cooling snack like popsicles (use cupcake liner to catch drips).
  • Place a cool washcloth on the back of the neck and a pan of cool water close by to periodically re-cool the towel.
  • Meals should be cold like chicken or pasta salad instead of heavy hot dishes like pot roast.
  • Encourage clothing that is lightweight and in light colored cotton so it’s easy to adjust to the temperature throughout the day by removing layers of clothing.
Calendar Programs
Older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F (38°C) to put them at risk for a heat-related illness. Be mindful of the temperatures when planning programs. Restrict your events to locations that offer cool environments. For outings; seek senior-friendly places that offer air conditioning (Restaurants, Shopping Mall or Stores, Public Library, Art Museums, Movie Theaters). Senior exercise programs may need to shortened in duration and restricted to easy and simple range of motion programs to prevent over- exhaustion. Don’t forget the hydrating liquids!
 
Stay Cool!      
Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org
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Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network.
Copyright © 2019 Activity Directors Network, LLC All rights reserved.

Our mailing address is:
2010 US HWY 190 W Ste 120 Livingston, Texas 77351

Creating In-Services for your Activity Department and the Facility - ActivityDirector.org

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Creating In-Services for your Activity Department and the Facility

by M. Celeste Chase AC-BC, ACC, CDP
ActivityDirector.org
Learning opportunities through in-services not only sends an intrinsic message that staff is highly valued but will also boost employment retention and job satisfaction. Appropriately supported, in-services have an added benefit of preventing job burnout for those in the demanding healthcare industry and that is a win-win for everyone!
Interpretive Guidelines Tag 679 – Identifies that “all staff” is accountable for assuring that meaningful activities are provided to ALL RESIDENTS regardless of resident limitations or lack of response.
To this end, all staff members must fully understand not only the therapeutic value of engagement as it relates to quality of life, but must possess appropriate skills, techniques and strategies to deliver meaningful activities. The Activity Director is the key individual to take the lead in this training through facility in-services.

A great place to find topics (“good bones”) for in-services can easily be found within the Interpretive Guidelines.

Let’s take a look at three up and coming guidelines from:
[Phase 3] - OBRA 87’ Interpretive Guidelines effective on: November 28, 2019

F940 §483.95 Training Requirements
Facilities must develop, implement and maintain an effective training program that is based on the Facility Assessment. Training must be completed for new staff, existing staff, contracted individuals and volunteers (consistent with their roles). The amount and type of training required should be reflective of the services and patient acuity identified in the Facility Assessment.

This guideline states that training topics must include, but are not limited to:
  • Communication
  • Resident’s Rights
  • QAPI - Quality Assurance & Performance Improvement
  • Infection Control
  • Compliance and Ethics
  • Behavioral Health
F941 Communication Training
Facilities must have mandatory training for direct care staff on effective communications. The importance of communication is emphasized, including communication across all shifts and information sharing between staff, residents and representatives. Direct care staff needs to understand their responsibilities for reporting change in condition and sharing information between team members for continuity in care provided that is based on individualized interventions.

F942 Resident’s Rights Training
Facilities must ensure that all staff membersnot just direct care staff – receive appropriate education on resident’s rights and be knowledgeable in the facility’s responsibilities in providing care for its residents.
Under F550 Resident’s Rights, residents have the right to be treated with dignity and respect, and all interventions with residents by staff must assist the residents in maintaining/enhancing their self-esteem and self-worth, show respect for each resident’s individuality and incorporate the resident’ goals, choices and preferences.
NOTE: This training requirement is likely to already exist in most facilities, but facilities that do not have this topic included in its staff education requirements will need to do so by the [Phase 3] deadline mentioned above.

You can easily see that OBRA 87’ Interpretive Guidelines makes training expectations abundantly clear and sets the bar for specific materials for learning opportunities. This will provide you with a strong arsenal of tools from which you can reference for new in-services to ensure that your facility complies with recommended standards. Be sure to compare these topics with your new staff member’s orientation training topics as well as your annual mandatory re-education plan.

For a successful in-service experience, develop a strategy that supports team synergy and mutual respect to get other staff members excited and willing to be committed to your program.

In-Service/ Foundation Plan:
Listed below are the preliminary steps to develop your in-service program. Each component is a building block to the next and will get you well on your way to creating a strong and successful in-service that will enlighten your fellow staff associates in a way in which they will better understand and respect the complex nature of the work you do as a professional Activity Director.

Component # 1 –Training Order
The order of presenting in-service training sessions can start with the most urgent to least urgent or oldest information to newest information, or build upon the initial session to the next. The ladder works well if the attendees need to understand certain things before assimilating more advanced materials.

Component # 2 - Ask How Your Attendees Learn Best
Another effective time saving strategy is to incorporate learning styles that are well suited to in-service attendees. As you most likely know, many of us attain information better when given specific ways to learn. Some people learn the quickest through reading, while others prefer visuals and hands-on experience. Understanding the learning styles of your audience will make your time more effective and productive thus, getting the most value for the time spent.

Component # 3 - Materials Distribution Before the In-Service
Consider distributing informative materials such as manuals, or short “cheat sheets” or step-by-step introductions relating to the topic scheduled for the in-service before training session begins. This is a great way to build up in-service anticipation and interest. Distribution prior to the in-service will also decrease the customary introduction time at the beginning of the in-service and help you jump right into the material to be presented.

Component # 4 - Create a Training Schedule
When in-service trainings are conducted during “on-duty” hours it is wise to set a predictable schedule. This allows attendees to plan for floor coverage and seek necessary supervisory approval in advanced. Be cognizant and adaptable to staff availability to ensure optimum participation. Mindful scheduling during on-duty hours to reduce staff “off the floor time” will also be looked upon favorably by your administration.


HINT: In-services held after regular work hours should also be respectfully scheduled so that it doesn't infringe upon the staff’s anticipated leisure time. Once again your consideration and sensitivity in this area will more likely create eager participation.

Component # 5 – Incorporate Session Breaks
It’s a given that long in-service training may not be permissible particularly when staff’s “off the floor” coverage proves to be challenging. That said, take a moment to break away even for s short bathroom visit. It may be all you need to keep your attendees focused and refreshed thus, moving the in-service in a positive direction throughout the session.

Component # 6 – Serve Light Refreshments
As a very common and familiar adage goes, If you feed them - they will come! Providing food at a business event can promote attendance and provide a welcoming atmosphere which in turn, will get your in-service off to a great start. Keep it simple – consider dietary restrictions. What you serve will depend on the time of day that you schedule your in-service. Morning events tend to focus on coffee, tea, fruits, pastries, etc. Afternoon events are more likely to be about soda, cookies, pretzels, etc. Bottled water is always appropriate no matter what time of the in-service and decaffeinated options should always be offered.

Creating and organizing interdisciplinary facility in-services for staff will set you apart from the rest and help you develop a reputation as a knowledgeable and credible professional in your field. Fellow staff members and associates will quickly recognize the complexity of your position and will readily get on board to ensure that every staff member provides “quality of life” opportunities for all the residents within your facility.


“Opportunities for learning - present an extraordinary prospect to expand our knowledge base and growth both in personal confidence and competency skills that ultimately will benefit the residents we serve.”



 Have a topic request or question for Celeste?
  Send them over to CelesteChase @ activitydirector.org



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Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. d820bd07-1237-4127-a86b-b91880553a13.png Copyright © 2019 Activity Directors Network, LLC All rights reserved.

Our mailing address is:
2010 US HWY 190 W Ste 120 Livingston, Texas 77351