Bon Appetit! The Joy of Dining in Long-Term Care By Jitka Zgola, OT(C), and Gilbert Bordillon, BEH

1. Introduction
   
   
   • Imagine Losing It
     
   • Overview
     
   • Can It Be Done?  Beware of Red herrings!
     
   • Money
     
   • Time
     
   • Staffing
     
   • Regulations
     
   • Reimbursement Levels
     
   • A Vision for Implementation
     
     
2. The Dining Experience
   
   
   • Menu Choices
     
   • Introducing the Meal
     
   • Pre-meal Activities
     
   • Environmental Cues
     
   • Transitioning from Other Activities
     
   • Arriving at the Dining Room
     
   • Waiting to Be Served
     
   • Serving Meals
     
   • Tray Service
     
   • Course-by-Course Service from a Steam Table
     
   • Trolley Service
     
   • Family-Style Service
     
   • Combination Service
     
   • Social Interaction During a Meal
     
   • Grouping for Social Interaction
     
   • Staff’s Facilitating Social Interaction
     
   • Ending a Meal
     
   • After a Meal
     
   • Hospitality and Service
     
   • Welcoming
     
   • Knowledge
     
   • Atmosphere
     
     
3. The Dining Environment
   
   
   • Place
     
   • Space
     
   • Accessibility
     
   • Privacy
     
   • Traffic Flow
     
   • Lighting
     
   • Sounds
     
   • Movement
     
   • Air Quality
     
   • Temperature
     
   • Aroma
     
   • Décor
     
     
4. The Food We Serve
   
   
   • Mealtimes
     
   • Selecting Ingredients
     
   • Characteristics of Food
     
   • Taste
     
   • Nutrition and Taste
     
   • Importance of Color
     
   • Importance of Smell
     
   • Texture and Consistency
     
   • Nutritional Value
     
   • Healthful Vegetables and Natural Food Alternatives
     
   • Cooking Methods and Times
     
   • Food Supplements
     
   • Food Supplies
     
   • Canned Foods
     
   • Frozen Foods
     
   • Provisioning
     
     
5. Preserving Autonomy in Feeding
   
   
   • Perspective on the Individual — Information Gathering
     
   • Historical Information
     
   • Current Preferences
     
   • Observation of Current Functioning
     
   • Assessing Functional Abilities—Finding the Reason
     
   • Person’s Priorities
     
   • Person’s Abilities
     
   • Demands of the Activity
     
   • Circumstances
     
   • Recommendations and Plan — The Problem-Solving Approach
     
   • Sharing Information
     
     
6. Program Planning for Mealtimes
   
   
   • What is Restorative Dining?
     
   • Phases of Restorative Dining
     
   • Objectives
     
   • Team Building and Support
     
   • Pan-Departmental Programming
     
   • Dining Programs
     
   • Individual Programs
     
   • Group Programs
     
   • Sensory Stimulation Programs
     
   • Unitwide Programs
     
     
7. Finger Foods
   
   
   • What is Finger Food?
     
   • Principles of Finger Food
     
   • Morsel Size
     
   • Consistency
     
   • Safety
     
   • Texture
     
   • Cleanliness in Handling
     
   • Nutritional Balance
     
   • Variety, Taste, and Aroma
     
   • Presentation
     
   • Kinds of Finger Food
     
   • Logistics of Developing and Maintaining a Finger Food Line
     
   • A Basic Finger Food Menu
     
   • Food for Thought in Developing Your Own Finger Food Menu
     
   • Introducing the New Line of Foods
     
   • Servicev
     
   • A Valuable Resource
     
     
8. Supportive and Assistive Dining Techniques
   
   
   • Good Helping Techniques
     
   • Before Helping
     
   • Graded Helping
     
   • Dining “With,” Never “For”
     
   • Positioning
     
   • General Guidelines for Positioning
     
   • Wheelchair Seating
     
   • Positioning for Feeding in Bed
     
   • A Seating Program
     
   • Adapted Equipment and Techniques
     
   • Use of Assistive Devices
     
   • A Problem-Solving Process for Dining—The Seven “Ws”
     
   • General Principles of Choosing and Presenting Assistive Devices
     
   • Feeding
     
   • Residents Are Not “Feeders”
     
   • Principles of Feeding
     
     
9. Staff Training and Motivation
   
   
   • Responsive Training
     
   • In-House Training Team
     
   • This Training Is for Everyone
     
   • Special Training for the Dining Enhancement Team
     
   • Features of the Training Session
     
   • Environment of a Training Session
     
   • Timing of the Sessions
     
   • Focus and Length of Time
     
   • Respect for the Principles of Positive Social Interaction and Adult Learning
     
   • A Tradition of Learning
     
     
10. Outline of the Bon Appetit! Training Program
    
    
    • Supervisor’s Introduction
      
    • Aims of the Session
      
    • Teaching Materials
      
    • Props and Equipment
      
    • Trainer Preparation
      
    • Session Content
      
    • Process
      
    • Personal Resolutions to Change or Learn
      
    • Feedback to Dining Enhancement Committee
      
    • Session 1:  Introducing the Program
      
    • Aims of the Session
      
    • Teaching Materials
      
    • Props and Equipment
      
    • Trainer Preparation
      
    • Session Content
      
    • Process
      
    • Personal Resolutions to Change or Learn
      
    • Feedback to Dining Enhancement Committee
      
    • Assignment
      
    • Session 2: Effects of Dementia—Understanding the Impact of Cognitive Impairment
      
    • Session 3:  Relationships and Communication at Mealtime
      
    • Session 4:  Assessment and Information Gathering
      
    • Session 5:  Enhancing the Dining Experience
      
    • Session 6:  Helping Techniques
      
    • Session 7:  Feeding Techniques—The Final Session
      
    • Special Session for Dining Enhancement Team Members or “Action Team”
      Handouts
      
      
11. Making It Work
    
    
    • A Clear Vision and Mission Statement
      
    • A Step-by-Step Action Plan
      
    • What Is an Action Plan?
      
    • Benefits of an Action Plan
      
    • Clear Lines of Communication
      
    • Enrollment of All Staff, Management, and Affiliates
      
    • Follow-Up and Feedback
      
      
12. Bon Appetit! Recipes
    

Glossary of Cooking Terms
References
Appendix A: Environmental Assessment Form
Appendix B: Individual Resident Dining Review and Plan
Appendix C: Focus Group Guide and Record
Appendix D: Dining Enhancement Team Report