Dining Room Programs: How to feel the fear… and do it anyway!

Dining club, dining program, supervised dining… these initiatives go by many names, but it might surprise you to learn what a POWERFUL effect they could have in your facility!

Take a minute and think about your own eating habits.  Now, I’m not talking about what kind of food you eat, how often you snack, or whatever diet you’re currently attempting to adhere to – I’m referring to where you eat, how you eat, and who you eat with. 

On the whole, people tend to eat with one or more people.  Eating is a very social activity.  In fact, the University of Oxford published research in 2017 showing: the more often people eat with others, the more likely they are to feel happy and satisfied with their lives. 

Now, apply this thinking… to where you work.

Take a moment and consider the patients you’re currently working with – where are they eating their meals?  Are they alone?  Are they eating in their wheelchairs, or their beds?  Now, I want you to consider their intake – is it good?  Are their nutritional needs being met?  Are they losing weight?  Lastly, consider their dietary needs – do they have dysphagia?  Can they feed themselves?  Now consider the answers you gave to those questions – dare any red flags being raised to you?

In a traditional long term care facility or nursing home, there is usually a centrally located main dining room, and then other smaller day rooms on the individual units that are utilized for mealtimes.  It is common practice to have the more independent residents eat meals in the main dining room (if they choose) and then have the residents who require much more assistance with mealtime eat either in their rooms or in the smaller day rooms on the unit. 

Is this the same for inpatient rehabilitation?  In-patient rehab is usually more focused on a return to independence, or the previous level of function. Yet, dining outside of their room can be a major blind spot for therapy and nursing staff. Perhaps this may be because it isn’t always clear ‘whose role’ it should be!

Let me ask you some questions…

  • Is there a dining room program facilitated at your facility?
  • Are you overwhelmed at the idea of starting such a program? 
  • Are your patients losing out, for want of a program like this??

If any of the above are true… Fear not!  We’re going to discuss some top tips as to how to get a dining room program initiated at your facility.

How will it look?

First and foremost, think about what you want your dining room to look like. This means, how you want the tables arranged, and what patients would you like participating in the program.  It is often beneficial to break up the dining room into three sections – speech treatment area, direct supervision area, and independent/social dining area. 

Designating tables into these sections, assists staff members with knowing who needs the most amount of supervision or assistance.  For example, if a patient is assigned to the independent/social dining area, the staff members who are distributing meals know those individuals are able to set themselves up, and do not have any dysphagia diet restrictions or strategies. 

How will we communicate about it?

Next, consider how you want to communicate to other staff members who is currently participating in the dining room program.  A good suggestion is to put out a daily list of which patients eat where.  Some items to include on that list are: name of the patient (remember – do NOT use room numbers as identifiers in place of patient names!), dysphagia diet level (if applicable), dysphagia strategies (alternate liquids and solids, etc.), any type of adaptive equipment, and any type of feeding assistance they may require.  Ensure that all staff involved with mealtimes receive a copy of that list or know where to find a copy.  Providing a list to the dietary staff is also important. They should know where to distribute meal trays, and so there is not any delay in someone getting their meal. 

How can we involve the whole team?

Lastly, be sure to conduct thorough education of all departments regarding the dining room program.  It’s very important to highlight the ‘why’ behind implementation of a new program.  Change can be tough for people to adapt to. Highlighting the benefits of a new program will assist with staff compliance, and ‘buy in’.  It is also important to empower staff to make altered diets appealing for the patients.  Referring to something as “baby food” or “mush” is not going to make the patient feel good about their meals. 

Check out the ‘Say This, Not That!’ Cheat sheets here to make communicating about altered diets easier for everyone!

Dining room programs are a true team effort, and the responsibility cannot solely fall on one department’s shoulders.  At the end of the day, this is being done to benefit the patient, not to make anyone’s job harder! Remembering how much we care for our patients can be the raison d’etre for many working in in-patient facilities!

So let’s say you’re having difficulty getting your new dining room program off the ground – what can you do?  Well, be sure to highlight the benefits of a dining room program, which we are about to get in to!

Improved patient safety. 

By having patients that have dysphagia (swallowing difficulty) closely supervised while eating, it can ensure increased use of compensatory swallowing strategies and quicker identification of new swallowing problems.  Also, do people usually eat their meals of the day while laying down in bed?  More often than not, NO THEY DO NOT!  Being upright in a wheelchair or standard chair can assist with the good positioning needed for safe and effective eating. 

Improved intake.

Some patients need cues and encouragement to persist with their meals. That type of encouragement cannot be effectively provided if the patient is eating alone in their room.  It also gives a more accurate picture of a patient’s meal intake.  Some of our patient will “accidentally” throw portions (or all) of their meals away or give their meals away to visiting family or to their roommates.  Having those patients eat meals in the dining room with supervision gives us a more accurate picture of how much, or little, they’re eating.

Improved socialization. 

‘Say This, not That’

As mentioned in the beginning of this article, people who eat meals surrounded by other people have an increase in life satisfaction.  Most social activities are built around food – dinners out, happy hours, brunches, etc.  Take a moment and think about yourself – do you eat alone if given the option, or do you choose to eat with a group of people and socialize?  Now, it is nice to occasionally eat alone but on the whole we are all very social creatures who enjoy the company of others.  It gives our patients the chance to interact with other people in a natural setting and have an organic non prompted conversation.

What if you have trouble getting patients to buy into your dining room program?  Be sure to highlight the items that were just listed, but also be sure to stress that it is a part of their rehabilitation program.  Also emphasize the importance of trying to establish and maintain a more “normal” routine while being in rehab.  It is easy for someone to fall into a bad habit of eating in bed and not keeping a schedule when they are not at home in their normal environment.  Ultimately, we cannot force sometime to participate in a dining room program… but we can make a pretty appealing case as to why they should!

As mentioned throughout, a dining room program is a true interdisciplinary team effort.  All people involved in patient care need to be on board and need to keep in mind that programs such as one like this is ultimately going to improve patient outcomes.  Wouldn’t you like the option to eat with other people who know what you are currently experiencing and socialize a little?  Remember, if it is something you would like to have offered to you, please be sure to offer it to your patients.  Food tastes much better when shared with others (metaphorically speaking, of course!). 

Want to learn more about dysphagia, and the social and ethical implications of management? You will love ‘Life With Dysphagia: Knocking Down Social and Ethical Barriers‘, a 0.3 ASHA/0.3 AOTA CEU, self-paced seminar that will take you through the lesser known conundrums of dysphagia, and arm you with the tools to manage it. Come see why this course is an SLP/OT favorite!

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