Dining Assistant Programs in Nursing …
Manual
Dining Assistant Programs in Nursing Homes: Guidelines for Implementation
Contents
Chapter One ................................................................................................................ 1 Chapter Two................................................................................................................ 3
Federal Regulations............................................................................................... 4 State Regulations................................................................................................... 5 Compliance with State Surveys ............................................................................. 6 Chapter Three ............................................................................................................. 7 Models of a Dining Assistant Program................................................................... 9 Resident and Facility Assessment ....................................................................... 11 Chapter Four ............................................................................................................. 17 Immediate Program Goals ................................................................................... 18 Long-Term Program Goals .................................................................................. 22 Measuring Goal Progress .................................................................................... 25 Chapter Five .............................................................................................................. 27 Targeting Recruits................................................................................................ 28 Chapter Six................................................................................................................ 33 Available Training Manuals.................................................................................. 34 Training Enhancements ....................................................................................... 36 Chapter Seven .......................................................................................................... 41 Identifying Residents Appropriate for the Program.............................................. 42 When to Implement the Program ......................................................................... 44 How to Monitor Dining Assistant Care Quality..................................................... 45 Chapter Eight ............................................................................................................ 49 Appendix ................................................................................................................... 51 Appendix A Dining Assistant Program Worksheets ......................................... 53 Appendix B Federal Register Notice ................................................................ 55 Appendix C State Contacts .............................................................................. 57 Appendix D CMS-Issued Guidance for State Surveyors.................................. 59 Appendix E Dining Assistant Observation Tool and Scoring Rules ................. 61
Contents i Dining Assistant Program
Chapter One
Introduction
What nursing home administrator or director of nursing has not cringed at the sight of half-eaten trays returned from the dining room, untouched supplements dumped in the trash, and monthly logs showing unintentional weight loss? Food and issues around dining are usually the top complaint in every nursing home satisfaction survey. A Dining Assistant (DA) program that could address and mitigate just a portion of these issues with a minimal investment of nursing home resources deserves consideration.
DA programs are flexible ? they can involve only one or two residents or only several staff, and be implemented on only one unit or one shift. They can involve community volunteers or paid workers, or in-house non-nursing staff looking for opportunities to advance to direct care work. They can be scaled up or back depending on the needs of the residents and resources of the nursing home (NH). If the decision is made to train non-nursing staff, the DA program can be the nursing home's first step toward culture change.
While the Centers for Medicare & Medicaid Services (CMS) and the majority of states now allow the use of dining assistants in long-term care facilities, relatively few nursing homes have implemented their own programs. We believe this is due to the limited resources currently available to educate decision-makers on designing and implementing dining assistant programs and insufficient understanding of the advantages to the resident and the NH overall of a Dining Assistant Program.
Several stakeholder organizations--e.g., the American Health Care Association (AHCA), the American Dietetic Association (ADA), and the Colorado Department of Public Health and Environment-- have developed and published training manuals. These training manuals are discussed in Chapter 6 and provide staff developers with complete lesson plans that prepare trainees to safely and effectively assist residents during mealtimes. They do not, however, address the decision-making process that nursing home management face as they attempt to determine whether or not a DA Program is appropriate for their NH.
Chapter One 1 Dining Assistant Program
Dining Assistant Programs in Nursing Homes: Guidelines for Implementation is a manual intended to guide management staff through a step-by-step process of assessment, goal identification, program design, implementation, and planning for program sustainability. It includes specific guidance to assist management with:
Assessing their NH in terms of their strengths and weaknesses around dining quality;
Determining if a DA program is an appropriate addition to current programming;
Designing a DA program that meets the residents' needs using the NH's resources; and
Successfully implementing a DA program that improves residents' quality of care, residents' and families' satisfaction around dining, and encourages and promotes staff involvement and advancement.
In addition to program descriptions and guidance throughout the chapters of the manual, we provide DA Program Implementation Worksheets (see Appendix A), designed to be copied from the manual and used by nursing home staff developers and others to assess and plan DA programs.
Developed by Abt Associates and Vanderbilt University with funding and input from CMS and the Agency for Healthcare Research and Quality (AHRQ), the manual is the culmination of three years of research that involved an inventory of state programs in all 50 states, site visits to DA programs in several states to observe the programs and interview staff, and implementation of pilot programs in two sites in two states. The research team consists of experienced long-term care nurses, nationally- known nutrition experts and a gerontologist, along with CMS and AHRQ staff.
The manual is further enhanced by the invaluable contributions of nursing home staff developers who have implemented DA Programs in their NHs. They generously shared with us lessons learned from their experience with the program, recommended viable options for recruitment and retention, and offered suggestions on how to implement an optimal program. Additional contributions to this manual come from other stakeholder groups such as long-term care affiliate organizations (e.g., AHCA; American Association of Homes and Services for the Aging (AAHSA)) and the ADA.
It is our hope that this manual will encourage nursing home management to consider whether a DA Program could benefit their NH, as well as provide a valuable resource for developing and instituting a successful program.
Chapter One 2 Dining Assistant Program
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