1. RDS IMPACT ON PERSON CENTERED DINING FOR SENIORS

2. 13.8% of the population 1 in 8 people is a senior Fastest growing group, by the year 2030 they will be 19% of population (>72 million) Average life expectancy is 79 years Only 3.6% live in institutions 72% voted in presidential election >age 50 control 77% of all financial assets & 50% of all credit cards(average annual income $105,000.00)

4. Culture Change Person directed care, practices Short term Rehab Liberalization of therapeutic diet restrictions Move from hospital model to hospitality model Decentralized dining options / choices Personal choice with full backing of CMS Sustainability

5. Culture change" is the name given to the national movement for the transformation of older adult services, based on person- directed values and practices where the voices of elders & those working with them are considered & respected. Core person- directed values are choice, dignity, respect, self-determination & purposeful living. All Decisions Default to the Person

6. Often starts in the kitchen as this leads to significant improvements in the quality of life for elders. Food is a powerful symbol of love,nurturing & needs to be served in ways that appeal to people; it has to be attractive & desirable. We need to bring the concept of home as much as possible to the dining experience.

7. Flexible meal times Available snacks, beverages 24 hours a day Menu choices Pleasant environment Flexible seating Input into menu design Pleasant dining environment

8. Short-term rehab involves therapy for individuals recovering from a surgery, illness or accident. These programs help residents achieve their maximum functional capacity to return to their homes & community in the shortest time possible. These residents are demanding improved & flexible dining choices.

9. Pioneer Networks New Dining Practice Standards (August 2011) established nationally agreed upon new standards of practice supporting individualized care & self-directed living versus traditional diagnosis-focused treatment. CMS regulations support this new standard of practice & individual choice as seen in F325, F281, F242 & memo dated March 1,2013.

10. More homelike atmosphere More dining/food choices Staff empowerment Real food vs. supplements Flexibility of schedules Less institutional environment

11. The younger seniors want green, organic/natural foods & local sourcing practices. They want to eat healthy but not restrictive diets. More emphasis on allergies e.g. gluten-free options. Vegetarian options.

13. Food/Dining choices are a great place to start.

14. We are the ones who can educate & train staff (dietary, nursing, activities), residents, & families on healthful eating & various nutrition therapies. We are also the ones who can give equal support & energy to assisting residents in following their own course of action & what is reasonable & realistic for them.

15. We need to embrace the switch to more food choices & flexibility in dining & not insist on restrictive diets without resident input. A major concern among the elderly is weight loss which often is the result of restrictive diets & dislike of food being served. As health care professionals we need to be assisting & educating the resident to make appropriate food choices within their abilities & not insisting that they change their eating habits at their age. Eating should be a positive & healthful event.

16. Pioneer Networks New Dining Practice Standards support ANDs position on individualizing the elders diet. Evidence based research supports that therapeutic diets are detrimental at worst, neutral at best for the elderly. It is time to let go http://www.pioneernetwork.net/Data/ Documents/NewDiningPracticeStandar ds.pdf http://www.pioneernetwork.net/Data/ Documents/NewDiningPracticeStandar ds.pdf http://surveyortraining.cms.hhs.gov/p ubs/VideoInformation.aspx?cid=1101

17. ADAs Position Papers also support & provide evidence that therapeutic diets may not be helping our residents. Liberalization of the Diet Prescription Improves Quality of Life for Older Adults In Long Term Care, 2005 Individualized Nutrition Approaches for Older Adults in Health Care Communities, 2010

18. Want to know what to eat, not what they cannot eat How to shop for & prepare healthy food How to read nutrition labels Straight, simple answers to the mass of nutrition misinformation they see everywhere We need to put our aprons back on & start cooking

19. RDs need to be able to translate nutritional science into food choices. Research confirms that taste wins out over nutrition when it comes to our food choices.

20. Take baby steps: Review & evaluate how you are currently serving meals Can the dining room be made more homelike? Can snacks be made available at any time? Talk to your residents & see what they want Revamp your menu Staff training Work with physicians to limit therapeutic diets Educate residents & families about changes Promote & embrace informed choice

21. Start slow & remember that change is not a threat but an opportunity.

22. Nancy Ferrone,MS,RD,LDN Dietary Consulting Inc. nferronerd@verizon.net