Everyone wants to be catered to. Memory care residents don’t just want it – they need it.
For close to 30 years, Presbyterian SeniorCare Network in Oakmont, Pennsylvania, has been developing its person-centered care model.
In many regards, these person-centred practices reach their peak in memory care dining.
“Presbyterian SeniorCare Network lives a person-centered culture every single day,” says Carrie Chiusano, executive director of the Dementia Care Center of Excellence at PSCN. “Our team offers choice to everybody whether they’re living with dementia or they have no cognitive impairment at all. Specifically, our dining team takes on the task of meeting all of those special needs — that includes preparing the healthy diet options, and that includes creative finger foods and favorite recipes from years and years ago.”
For residents living with dementia, mealtime success depends on choice, patience and special accommodations. What Chiusano and the PSCN team has learned since the early 1990s, when it started its journey with the Woodside Place memory care community in Oakmont, is that a person-centered dining model in memory care must manifest itself in every aspect of the meal.
That means keeping the resident in mind with every dining decision — from the room size to its sounds and volumes, from the dishware color to the aroma of each meal. The company, which runs 40 communities throughout Pennsylvania, is among the organizations that encourages resident eating through the use of colored plates that contrast with the food, as an aid to dementia residents with eyesight challenges.
Presbyterian’s plate color of choice is lime green, followed by yellow, red and navy blue.
Throughout its journey, the Pennsylvania provider has worked to codify its methodology, producing a report in the 1990s called “Design for Dementia Care: A Retrospective Look at the Woodside Place Model,” and treating its offering as a hub for continual improvement. Chiusano recently shared the Presbyterian story on Transform, the new Senior Housing News podcast sponsored by PointClickCare.
Interview highlights with Chiusano are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts, SoundCloud or Google Play, and learn here how the operator from Oakmont delivers its person-centered promise to memory care residents — including its best practice around plating two meals.
On why person-centered dining is particularly important in memory care dining, moreso than other acuity levels:
Just because someone is living with dementia doesn’t mean they can’t continue to make their choices. We hear that all the time. “They have a diagnosis of dementia. How do you engage them?”
I have to tell you, our entire team does a fabulous job of engaging our residents, but specifically for our dining team, they include our residents in certain resident councils, in food committees, the lifestyle engagement gatherings, and they have always been known to plan the big events, like a sit-down Thanksgiving dinner or an Easter brunch.
My favorite things that have come from some of these gatherings are programs such as the breakfast club, with the residents’ favorite recipes. One of their favorites is special omelettes to order, or maybe a special recipe that includes an overnight french toast.
But the big deal about this is that the special events and the meals are planned by the residents, and they have their own family favorites from decades ago that have been added to this menu. Sometimes our residents will help prepare the meals, (but) if helping prepare a meal is not of interest, maybe a Montessori or life-skills approach is more appropriate. For example, setting the table, clearing the table, some of our folks will help make the coffee (or) clean up afterwards.
My favorite is that we have a little old lady who just loves greeting people as they come in. Honestly, it all depends on their interest and their level of functioning.
On the specific ways that Presbyterian SeniorCare Network builds its memory care dining program, and where operators should start if they want to emulate the approach:
I think we talked about what comes first in making sure that the residents have had the opportunity to be a part of the planning and the preparation. But once it comes down to meal time, coming into the dining room — when people think long-term care and dining, a lot of times they think about these big cafeteria-style dining rooms, or these big, extravagant dining areas where people come in with big fancy candles.
We’re not like that. It’s home. So we want a smaller, more intimate room to make for a more successful meal time. There are fewer interruptions. Less background noise. And more of a family feeling. It’s so important not to have the television playing, or the team members having conversations that don’t include the residents. If you want to play some music, it should be appropriate to the individuals who are dining. And again, just getting people enticed to enter the dining room, having those fresh aromas going is pretty important.
Once we have folks in the dining room, being that they’re living with dementia, we want to make sure that because their attention span is pretty short that we have something to keep them engaged until (meal time). And when we do have the meals, we want to make sure that we offer that choice again.
For example, so many people will ask us, “How in the world do you still offer choice to those individuals living with dementia, especially at meal time?” One of our most important Woodside standards (is that) whatever the meal choices are, we plate those choices and we show them to each person.
So often what happens is that if you ask a resident that is living with dementia, “Do you prefer chicken or lasagna?” most likely, the individual is going to answer, “lasagna.” However, if you flip that and say, “Do you prefer lasagna or chicken?” the individual is going to answer “chicken.”
What I’m saying is that typically what’s heard last is what the choice is. So what we do is we plate the food and we show. We show the chicken and right beside it we show the lasagna. And then we know what their choice is. We can see their eyes getting bigger. They’ll point to it. “Oh, that’s the one that I want.” And again, if neither one of those plates is something that the residents like, we go back to the kitchen and we get them what it is they do like.
Knowing the person is so very important. Sometimes if they don’t want either one of those, we go to the kitchen, because the refrigerator in each of the households have been stocked with what it is the residents who live in that household really like.
On why two is the magic number for plating food options:
We start with two. If they don’t like either one of those then we’ll go into the kitchen, and you have whatever it is they like. Chicken salad is a big seller here, so that’s the first thing that comes to my mind. But then we’ll plate two other things and show them, but never more than two at a time. We see our residents eating better if they’re eating what they like.
On getting to know resident preferences, to offer appealing foods and save money by reducing waste:
Initially when somebody first comes to us, it takes us a while to get to know them and get to know their preferences. But once we do, we find out that we’re not throwing food away anymore.
Interested in learning more about the future of evidence-based memory care dining? Click here to access Senior Housing News’ deep-dive report on the topic.