MEMBERS PRESENT: Sophia Bunch, Lisa Drury, Laurie Gyscek (via telephone), Beth Hercher, Laurie Loughlin, Liz Pearson, Virginia Vollmer, Carol Wesson, Linda Williams, Sarah Yates

Laurie L. convened the meeting at 11:00 a.m.

The first part of the conference revolved around dining changes being implemented at participating facilities. In many surveys, food issues rank highest in factors determining resident satisfaction. Kort Nygard sent information that homes with restaurant-style menus report no increase in raw food costs because there is 50% waste in traditional “one size fits all” meals and near 0% waste when residents eat what they want; residents also eat more and experience less weight loss.

Carol reported that Tennessee Health Management (THM) facilities vary in the styles of dining that they offer which can include buffet, restaurant, set-up menu and a la carte items which can be ordered in advance. They have to follow doctors’ dietary orders, but many physicians are switching their patients back to regular diets as they tend to eat better on those than on the special diets. Some have even left standing orders for alcohol to be served for special occasions.

Virginia shared that at Alexian Brothers, slips are passed out to the residents prior to each meal so they can check their choices, which the aides then bring to the kitchen. Residents whose cognitive impairment makes it impossible for them to understand the choices are served a customary meal.

Linda declared that at Ivy Crest the staff members eat with the residents, rotating tables so they can all get to know each other. Every other week a resident’s name is drawn, and that resident gets to plan the lunch and dinner menus plus an activity for that Friday.

Sarah stated that at Tennessee State Veterans Home (TSVH) in Murfreesboro they have a buffet 3 times a week and that breakfast waffles are made right in the units so that the residents can experience the wonderful smells. Sophia added that they try to accommodate late risers and requests for special items at meals. If the kitchen does not have the ingredients for an item on hand, the resident is promised that they will obtain said ingredients and serve the item the next day. They have weekly weight meetings, and families are encouraged to bring in home-cooked meals.

Virginia, who is a volunteer, asked if the other homes with members present used volunteers as servers in the dining room as is done at Alexian Brothers because “in our society, food is love, and that is one way to make the residents feel cared about”. She informed the group that in some other states, volunteers are trained as feeding assistants because this constitutes good interaction, and that speech therapy programs have some good videos that demonstrate and explain about the swallowing process.

Carol responded that at THM, volunteers assist at meals by filling glasses, etc., but that they are not allowed to feed the residents. They primarily help out with activities. Sophia answered that at TSVH volunteers mainly help organize and orchestrate parties and outings. Linda told the group that a volunteer at Ivy Crest leads a weekly devotion and takes individual time with each of the residents, which they really appreciate.

Laurie announced that at the 5th Eden Alternative International Conference in June (see Item #5 in the “Mark Your Calendar” section below for more details) Kort Nygard and Melanie Adair will be co-presenting 2 sessions on ageism and institutionalization, one with Dr. Bill Thomas and one with Joe Adair.

Virginia opined that, because nurses and social workers are acutely aware of both the emotional and physical well-being of their residents and the regulations that govern their care, they are in an excellent position to point out to the powers that be that the Centers for Medicare and Medicaid Services (CMS) has recently been making a lot of references to long-term care culture change, and to impress upon them that adopting culture change practices will ultimately have a positive effect on the bottom line.

QSource officers Beth (Memphis) and Laurie G. (Nashville) detailed the progress of 3 projects in their Achieving Excellence Campaign. The use of physical restraints is down from 13% to 4.5%, with some participating facilities at 0. Pressure ulcers have also declined. They have administered the Patient Safety Culture Survey that has been used in hospitals for 2 years to staff at some of the nursing homes, and this revealed that lack of adequate communication is the #1 perceived threat to resident safety. These surveys are anonymous by employment category and provide a good tool for facilities to see where the breakdowns are occurring.

Re updates from facilities, Sophia revealed that the Certified Nursing Assistants (CNAs) at TSVH have a lot of passion for their work and freely come up with ideas and suggestions. Virginia interjected that Alexian Brothers is also empowering its direct care staff and that by serving on committees, they have more say. Carol was happy to report that the THM leadership is seriously embracing culture change and attending various trainings and meetings. They are implementing consistent assignment and have eliminated nurses’ stations where possible. Linda leads learning circles during staff meetings at Ivy Crest. After the recent snowstorm, they took the residents on a drive to see the ice in the trees. They have bought a scanner to make videos of the residents on their birthdays. And, in a continuous celebration of holidays, the residents have made Valentine boxes to put outside their doors and have constructed Mardi Gras floats by wrapping tissue paper around shoe boxes and decorating them.

Kort recommends a new book by Al Power entitled Dementia Beyond Drugs: Changing the Culture of Care published by Health Professions Press as an excellent analysis of polypharmacy and the effects of off-label use of antipsychotics.

Laurie L. adjourned the meeting at 12:20 p.m.


Mark Your Calendar:

  1. TEF BOARD OF DIRECTORS MEETING – Thursday, 03/04/20, 7:00 p.m.
  2. TEAC MEMBERSHIP MEETING – Thursday, 04/01/20, 11:00 a.m. – 1:30 p.m., in Nashville; see “TEAC MEMBERSHIP MEETING SCHEDULE 2010” for details.
  3. TEF BOARD OF DIRECTORS MEETING – Thursday, 05/06/20, at 7:00 p.m.
  4. TEAC VIDEOCONFERENCE – Thursday, 06/03/20, 11:00 A.M. – 1:00 P.M.
  5. 5th EDEN ALTERNATIVE INTERNATIONAL CONFERENCE – Sunday 06/13 – Tuesday, 06/15/20 at the Westin Tabor Center, Denver, Colorado
  6. TEF BOARD OF DIRECTORS MEETING – Thursday, 07/01/20, 7:00 p.m.
  7. TEAC MEMBERSHIP MEETING – Thursday, 08/05/20, 11:00 A.M. – 1:30 P.M.
  8. TEF BOARD OF DIRECTORS MEETING – Thursday, 09/02/20, 7:00 p.m.
  9. TEAC VIDEOCONFERENCE – Thursday, 10/07/20, 11:00 a.m. – 1:00 p.m.
  10. TEF BOARD OF DIRECTORS MEETING – Thursday, 11/04/20, 7:00 p.m.
  11. TEAC MEMBERSHIP MEETING – Thursday, 12/02/20, 11:00 a.m. – 1:30 p.m.

Submitted by Laurie Loughlin