It’s cold and snowy outside. It’s lunchtime, and I just ate a bowl of homemade lentil soup accompanied by a hunk of fresh bread and a glass of iced tea. It was yummy and chocked full of vitamins, minerals, and fiber. How much? Don’t know, don’t care . . . but then I have that luxury when it comes to my personal food intake!
It pains me to think that the pleasure of a bowl of hot soup and bread my not be an option for me when I’m in the nursing home due to individual interpretation of F363 Menu Planning (individualized) and F366 Substitutes (equal nutritional value).
One of my clients wanted to transition from a select menu to a rotating substitute menu of a daily soup and sandwich plus chips – per resident request. Sounds like a typical Zoup! or Panera pick-2 menu item. So what’s the big deal? It is a big deal in the long-term care arena of regulatory requirements.
My immediate response from years of conditioning was, NO you cannot due that! a) The State requires a substitute of equal nutrition value, b) Illinois surveyors prefer regulatory compliance as a substitute of a hot food for hot food and cold for cold, and c) it may not please all the residents.
Now of course the only person centered consideration was c) it many not please all the residents, but as a consultant I have to consider the other two as well.
The Dining Services Manager, Menu Planner, and I debated the idea through email and finally talked via conference call on New Year’s Eve to discuss how to move forward with the resident request and regulatory compliance.
Our final plan was to comply with the resident’s preferences and offer a substitute of soup, sandwich, and chips at each meal, in addition a few ‘hot’ items were made available for individuals not wanting a sandwich. We also evaluated each meal to ensure the substitutes were as nutritious as the planned menu. When they were not the menu was adjusted, such as adding potato salad to replace the chips.
Another key part of the plan was to ensure this was what the residents wanted. Preferences were documented in the Resident Council Meeting minutes and the RD conducted a resident satisfaction survey. There were mixed reviews, but overall residents were satisfied with the choices.
The final test for success was making it through survey. I believed we had the documentation we needed to show the survey team this was a resident preference, not a facility preference. As predicted the survey team identified the soup and sandwich option as an issue. They talked to residents, they talked to staff, and they reviewed documentation. In the end the surveyors did not cite the facility for substitutes.*
The key to success with person-centered care is to identify what the resident’s want/prefer and identify regulatory compliant methods to make it happen. This must be tied up with a ribbon of documentation supporting policy, procedure, and resident preference.
*Endnote: In my practice I have witnessed multiple facilities attempt to reduce the cost of meals by substituting a lunchmeat sandwich – a couple slices of a poor quality lunchmeat on two slices of white bread. The lunchmeat didn’t come close to meeting nutritional requirements. The type of sandwich was repetitive (cheese or peanut butter) and there were no hot alternatives. So I understand the surveyor’s reluctance, at first glance, to embrace the facility’s substitute menu. Our goal was to make it a true choice and preference of the residents that met basic nutritional requirements.