Federal regulations are increasingly tying quality of memory care and outcomes to reimbursements. As part of this move, federal regulators are setting standards and issuing guidelines for everything from the use of antipsychotic medications to training for dementia caregivers. One example of this is the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which ties payments and reimbursements to improved outcomes—dementia care, reducing falls, infection prevention, skin integrity, discharge to the community and more—for residents at skilled-nursing facilities, long-term acute-care hospitals, inpatient rehabilitation facilities and home health agencies.
Given the large—and growing—number of people with dementia, the tremendous financial outlay for their care and the dollar figure of reimbursements at stake, there’s growing emphasis on memory care—and on the role nutrition plays in their well-being.
“Food and Nutrition Services can help improve care and quality outcomes to improve the bottom line,” says Gordon Food Service® Healthcare Segment Manager Dana Fillmore, RD. Three areas are key to improvements: adequate nutrition and hydration; effective interactions with Food and Nutrition Services staff; and not losing ground during transition-of-care at discharge.
“Adequate nutrition and hydration—especially for the elderly—are critical for well-being and preventing infection, risk of skin breakdown, falls and hospital readmissions due to weight loss,” Fillmore explains.
Here’s how to boost eating and drinking:
1. Learn food preferences. Survey patients/residents about their preferences—don’t go by what the family says. “Meet them where they are and give them the experience they want,” advises Samantha Thelen, Regional Director of Operations for Grand Rapids, Michigan-based Leisure Living Management. “Preferences change—often people go on to more hedonistic eating. Offer what gives them pleasure and the most calories.” Familiar food can help trigger memories, so ask about their favorite cultural foods as well.
2. Jumpstart the day. Encourage residents to participate in open breakfast—whatever they want,” Thelen advises. “After a big breakfast, they start the day happy and full.”
3. Mix things up. Offer choices—but just a couple of preferred options at a time.
4. Boost frequency. Serve small, frequent meals versus three large ones. Encourage snacking on high-calorie, nutrient-dense foods that are easy and quick to consume. Portable snacks—e.g., shelf-stable, prepackaged mini-muffins—appeal to those with short attention spans, those who can only manage small portions and those who wander while they eat. Install snack kiosks and employ food/beverage carts. Hold snacking happy hours. Stock common rooms with food and beverages available 24/7.
5. Make eating easier. Provide help to those who need it, especially in later stages of dementia. Provide consistency modified foods when indicated (pureed, mechanical soft, etc.) Serve handhelds that don’t require utensils.
6. Sweeten the meal. Adding sugar or another sweetener to the food, Thelen says, stimulates taste buds and increases intake. To promote dignity, use a sweet orange sauce or other juice-based sauce on foods. Be sure to monitor sugar for residents with diabetes.
7. Build a routine with a pleasant ambiance. Create a quiet, nurturing dining-room environment with soothing colors that doesn’t overstimulate and cause anxiety. Offer meals in this environment at the same time in the same way every day. People living with dementia, says Ruth Drew, Director of Family and Information Services for the Chicago-based Alzheimer’s Association, “aren’t good at handling new things.”
8. Seat strategically. Placement of residents within the dining room can affect outcomes. The human brain, Thelen explains, is made to copy. Humans compete and follow social norms, so foster social peer pressure that increases intake at the right stage of dementia. Also, seat appropriately. Square tables encourage focusing on tasks; round tables facilitate participation in both the meal and communication and are ideal for those who need social cues or modeling.
9. Preserve dignity, promote independence. Observe and ask—don’t assume, for example, someone needs a bib or help with eating. Provide the tools they need. And don’t rush diners—allow them time to focus, refocus and eat at their own pace. Remember, mealtimes are often the high point of their day.
10. Fortify when necessary. If someone isn’t getting enough to eat, try fortifying their favorite foods with extra nutrients. This way they can meet their needs by eating smaller amounts. If intake is still under goal, consider commercial supplements.
Train staff to be engaging and supportive at mealtime. A friendly, welcoming atmosphere, helpfulness and graciousness can alleviate frustration, and encourage interactions that increase intake versus escalating negative behaviors. Positive interactions can help control Behavioral/Psychological Symptoms of Dementia (BPSD) and the number of antipsychotic medications prescribed to treat them.
Join in. Encourage staff to dine or have coffee with residents instead of hovering around or walking away. “Meals are part of the activity experience,” Thelen says. “Sometimes staff can help spur conversation at the table.”
Communicate appropriately. Attention spans and the ability to process information vary at different stages of dementia. These Crisis Prevention Institute tips can improve mealtime interactions:
Track negative-behavior triggers. Determine what sets off agitation and aggression, which often stem from frustration.
Be consistent. Focus on the individual’s needs and be consistent in your interactions.
Nutrition support is essential for patients returning home or transitioning to another care setting. Share and work out comprehensive nutrition plans to reduce readmissions and maximize reimbursements.
These steps can help:
1. Coordinate. Work together to ensure that nutrition and meal planning are coordinated between hospital and post-acute care communities.
2. Educate. Teach caregivers at every touch point why proper nutrition/hydration are vital and which strategies encourage adequate intake. “Teach residents how to be as independent as possible,” Thelen says. Instruct them to eat small, frequent meals, to try to make healthy choices.” Remind them, she adds, that without consistent good meals, they’ll end up coming back here.
3. Facilitate. Include as part of discharge planning steps to ensure access to nonmedical services, such as a source for regular, well-balanced meals.
4. Investigate. Conduct follow-up visits to ensure proper nutrition and reduce risk of readmissions.
The bottom line? Quality outcomes are huge right now in terms of who gets paid and who doesn’t.
1. Garnishes. Sprinkle fresh herbs directly onto food to add flavor, nutrients and color. Sides of fresh-fruit purées add freshness to the plate.
2. Provide a pleasing palette. A mix of colorful food helps each item stand out while adding adds color and nutrients. Red plates stimulate appetites
3. Aroma. The smell of baked goods, freshly popped popcorn and hot, spiced cider perks up appetites.
Learn more about the CMS Focused Dementia Care Survey Tools, which include updated guidance under F309 for providing an appropriate dining environment and meeting food preferences.
Our free Cooking Up a Memory program offers approaches for early- to mid-stage and late-stage dementia.
Additional memory-care resources are availabe on Experience. Note: you’ll be redirected to the content after signing in.