The Memory Unit OT

I’ve spent my fair share of time over the years developing Restorative Dining Programming for long-term care Residents. The nuances of each program have varied, working to meet the specific needs of the Residents on that unit at that given time, and integrating the available staff present to assist. But the core of these program has always remained the same.

Traditionally, a restorative dining program focuses on establishing a specific dining space for Residents who require greater levels of supervision and assist with eating.

Many of the Residents in these programs require supervision and/or cues for safe swallow strategies, modified diet textures, adaptive cups/utensils/dishware, and increased supports to execute self feeding skills. A single Resident may not require support in all of these areas, or they may require support in many of these areas.

The overall idea is to create an environment that implements external supports and strategies to promote independent eating, safe swallowing, and appropriate nutritional intake at all meals.

This blueprint will give you the foundational components of the program, that you can then tailor to meet the needs of your Residents and the Facilities that you work in.

Understand the Why Behind the Program.

This is an essential step in any program development process. Why does your facility need a restorative dining program? How many Residents require supervision or assistance with eating? How many Residents are on nutrition supplements because they’re not eating enough during meals? How many Residents are losing weight inappropriately? Are the staff able to make sure all Residents are supervised during all meals as needed? Are there Residents on the unit who are always eating in bed or their room because the traditional dining room is too busy or too stimulating?

The answers to these sorts of questions will both justify the need for the program and direct how the program develops and implements into the facility.

Identify the Residents who will be Included in the Program Prior to Developing other Components.

Knowing who will be integrated into this program will also direct how the program develops. The number of Residents you identify will determine both the size of the room needed and how many staff need to be present. You may need a space that includes tables of various heights and sizes to accommodate different styles of wheelchairs. If most of the identified Residents need increased time to finish a meal, then the Restorative Dining Room may need to be served before the traditional dining room and/or the floor.

Knowing who will be in the program will also give you an idea of how much equipment you’ll need, how much staff training will need to be provided, and the overall layout of the room so as to best accommodate everyone.

Create the Ideal Sensory Environment to Support Attention and Safety.

The room should be well lit. There should be ample space between tables to ensure staff can assist any Resident as needed. Ideally the room should be relatively quiet, far away from the noise of the kitchen or the traditional dining space. Calm music is a great addition. The tables should have minimal distractions; no center pieces, no excess items, no patterned tablecloths. Extra adaptive equipment should be kept in the room, as well as secondary meal options such as sandwiches, supplement shakes, or cereal. A mini fridge to have extra drinks on hand is a great addition.

It is likely that many of your Residents in this program will show better and more independent eating skills when the environment is not distracting or overstimulating. And that’s what you want to keep in mind when establishing the space.

Write the Manual.

I have found that keeping a small binder in the Restorative Dining Room makes the program feel less daunting to staff. A half inch, brightly colored binder that includes a short description of how the room should look (bright lights, minimal distractions, calm music), as well as an up-to-date list of diet textures and adaptive equipment is really all you need.

We’ve created simple laminated placemats in the past. Each mat is labeled with the Resident’s name, and includes a bulleted list of diet texture, adaptive equipment, and any recommended eating or swallow strategies.

Remember that things on the long-term units are frequently changing. This manual should be updated at least weekly, and information can be contributed by the dietary department, nursing, or therapy, depending on the flow and roles of your facility.

Integrate All Staff (if possible).

At the peak of one of the best Restorative Dining Programs I’ve been a part of, the facility implemented something called “all hands on deck”. Once the meal trays were plated, an announcement was called over the PA system: “all hands on deck”. That told all office staff, management, therapy staff, and any other designated team member that they were expected to be in the dining rooms to support the nursing team in getting the meal served.

The SLP I worked with at the time provided an in-service to all non-clinical staff about how to appropriately assist with eating, how to read meal tickets, and a basic breakdown of diet textures.

Because there was so much staff involvement and support, just about every Resident was in a community dining space, at their appropriate level.

This also allowed for a seamless transition of the Restorative Programming into the weekly summer cook-outs that the facility held every Wednesday in the summer.

Now, I realize this may not be realistic for every facility. But I want you to know that it is possible. If you truly feel that this level of support will improve the overall programming, your advocacy and call to action to management can have a much bigger impact than you may realize.

Introduce the Program for One Meal, Building up to Include all Three.

If you’re in a facility that’s never implemented Restorative Dining before (or it’s just been so long that most of the staff now don’t even remember what that looked like), it can be easier to start with just one meal first.

I find lunch is the best, because it’s in the middle of the day when you’ll likely have the most staff available to help.

Starting with just one meal a day can allow you to work out the kinks and fine tune things so that the transition to all three meals (which will incorporate a greater number of staff and a greater number of variables) will be much smoother.