Food Sensitivity and Feeding in Long Term Care Facility

There are many special considerations when it comes to feeding residents within a long term care facility.  These residents were once able to feed themselves and have now lost that ability, yet another piece of their independence has been taken away.

Meal time for residents can be the highlight of their day, if a caretaker does not take the time or the consideration while feeding a resident, this joy to their day to day life can be diminished. 

There are many reasons for a resident to need feeding; they can include Arthritis of joints that determines if a resident can hold utensils or glasses.  If a resident has Multiple Sclerosis, a resident often needs to be fed due to the lack of limb control.  Parkinson’s residents need to be fed a great deal of the time due to their tremors, they do not have the function to get the utensil from their plate to their mouth with all the food maintained on it. Stroke patients often have one side of their body paralyzed; this can lead to the necessity to be fed.  Mentally challenged patients may not have the capacity or ability to feed themselves. 

During my career I have been able to observe meal time at many different long term care facilities.  I often find myself asking the below questions.  These questions are a great starting point from nutrition and food service management point to the nursing and nursing aid staff when working together on menu planning, food items and diet therapy.  Meal time observation should always be a part of the nutrition and food service manager when working in a long term care facility. This time allows you to interact with residents, nursing and observe how your product is being received.

• Why is the resident being fed?
• Where are they being fed? Why?
• Can the resident speak? – If yes, can they communicate with staff Re: food preferences?
• Is there any anger or reassessment taken out on caregiver?
• How much time does it take for resident to be fed?
• How much of the meal did the resident intake?
• How do the resident and the caregiver interact? –how was the caregiver positioned?
• Rate the experience of the resident: pleasant, neutral, unpleasant?
• Other things that may have affected the feeding experience, e.g. was the resident wearing a bib? – was there special utensils, so the resident could feed with supervision? The level of independence that the resident was given? Any distractions for either the caregiver or the resident during feeding time?

From my observations of feeding times at long term care facilities I have drawn some general conclusions and suggestions for any facility to adapt.

• Everyone seems to have their own style when feeding a resident. Some take time and have compassion.  This including interacting with the resident and having small chats with them. This often resulted in better eating habits of the residents.
• Control for the residents is a big factor.  The more control you can give to someone the better they will receive helps.  This means that if they can hold a special utensil and feed them with supervision; this resulted in better eating habits and a well received meal time experience.
• Time is always a concern when feeding multiple residents with small amount of staff. Although this is a time management issue, quality of life always has to be considered and every resident should get the same amount of attention.
• Feeding in a patient room vs. feeding in a communal area.  Preconceived notions of feeding in a communal area are often case, because feeding time is such a social time for people.  However, I have also observed that nursing and nursing aids tend to be more distracted in dining settings and chatting amongst themselves, where as if residents are fed in their rooms they get more attention and have a better feeding experience.

Overall, the main suggestion I have for people that feed residents or are responsible for people that feed residents would be to sit back and take a couple extra minutes to feed these residents. An extra 5 minutes might make a huge difference in that resident’s day and quality of life. 

The most significant learning experience from observing the feeding experience was to learn how by feeding a resident with care you could have a direct affect on the residents improved quality of life.  This was an incredibly rewarding realization and made the importance of the issue very clear and worth working towards.