1. Resident Directed Living Choice Dining Development STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION Resident Directed Living © Choice Dining Development STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION The Evolution of Culture Change Service Transformation Teaching - Aligning Experiences - Expectations – Resources – Outcomes Spring Conference Helena, MT March 17, 2011

2. Agenda Discussion of the role of dining for service change and culture liberation Program evolutions Contribution & collaboration with evolving community services 3/17/20112MHA Spring Conference

3. What are we providing? Dietary Food Services Nutrition Services Meal Service Dining Services 3/17/20113MHA Spring Conference

4. Must Rising Acuity Levels Mean Lower Dining Quality ? 3/17/20114 © MHA Spring Conference

5. “We did the best we could, with what we knew, And when we knew better, we did better. “ Maya Angelou 3/17/20115MHA Spring Conference

6. Environment & Constituencies Fiscal landscape transformation Emergence of non-traditional models Regulatory transition & interpretive inconsistency Deliberate seeking for “better” Competition Silver Tsunami Diversity of constituents and locations Expand servable constituencies 3/17/20116MHA Spring Conference

7. 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 3/17/20117MHA Spring Conference

8. Assumptions Thoughtful Culture & Service Change to Liberate Community Culture Envision the Future, Honor the Tradition Imposition of Dining Until the Dining Experience is Resident Directed, New Culture will not Take Deep Root What is Current Does Not Work As Well As It Can & Should 3/17/20118MHA Spring Conference

9. Resident Directed Living The 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. 3/17/20119MHA Spring Conference

10. Independent Living Residents Mandatory Dining Programs - # of Meals per month Limited Service Options A dining experience that does not foster Wellness Limited Choice & Control Daily schedule and events dictated by dining 3/17/201110MHA Spring Conference

11. Independent Living Residents Resident Choice Dining Flexible Service Options – Café/deli/bakery/grille – Traditional Dining – Bistro & Formal – Distinguished by Décor & Menu – Enhanced Take Out Increased Service Venues Wellness Enhanced design serve more residents and accommodate future resident mobility needs 3/17/201111MHA Spring Conference

12. Assisted Living Inflexible Service Options Serving Periods Limited Choice Adjust model with HCBS & service delivery 3/17/201112MHA Spring Conference

13. Assisted Living Flexible Service Options Traditional Dining Take Out Enhanced Venues Private Dining Capacity HCBS 3/17/201113MHA Spring Conference

14. Skilled Nursing Feeding Times Institutional Schedule Decreased Menu Options Food Service Schedule Dominator 3/17/201114MHA Spring Conference

15. Skilled Nursing RDL Dining Flexible Schedule Increased Menu Options with New Cooking Applications “country kitchen” Private Dining Capability 3/17/201115MHA Spring Conference

16. Staff Leftovers Inconsistent Quality Treated as a design afterthought 3/17/201116MHA Spring Conference

17. Staff Improved Selection Consistent Quality Enhanced Service Model – Café Dining with Minimal Wait Home Replacement Meals 3/17/201117MHA Spring Conference

18. Community Impact Adjusted Load and Distribution for Main Kitchen Enhanced Amenities to Create “Common Community” Destination Services 3/17/201118MHA Spring Conference

19. Experience Outcomes Community Connectivity Philosophy of Care Transparent Service – Available Throughout Campus Dining as the Common Service Denominator – Physical Design of Dining Service as Community Connector Well Defined and Measurable ROI 3/17/201119MHA Spring Conference

20. 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. 3/17/201120MHA Spring Conference

21. Comparison of Culture Pioneer Network Institution-Directed Culture Staff provide standard “treatments” based on clinical Institutional defined schedule and routines – resident comply Work is task oriented and staff rotates assignments – interchangeable residents Centralized decision making Hospital environment Structured activities There is a sense of isolation and loneliness Choice – Directed Culture Staff enters into a care giving relationship based upon individualized care & resident desire Residents and staff design the schedules Care is relationship-centered, consistent assignments Frontline decision making Environment reflects the comforts of home Spontaneous activities Sense of community and belonging 3/17/2011MHA Spring Conference Slide 21

22. Culture CULTURE OF CURECULTURE OF CARE LEADERSHIPHIERARCHIALSERVANT ENVIRONMENTOUTCOMERSIDENT FOCUSQUALITY OF CUREQUALITY OF LIFE PROCESSSTRUCTUREDSPONTANEOUS WORKMANSHIPCERTAINTYRISK MEASUREOBJECTIVESUBJECTIVE REGULATIONPROCESSENVIRONMENT PRIMARY SKILL/PERSONALITYSCIENCEART 3/17/201122