1. 7 Proven Keys to Exceed Today’s Senior Dining Expectations
Presented by:
Donna M. Manring, DTR
Session Objectives:
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To develop an appreciation of the impact dining has on both quality of life and physical health.
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To raise awareness that each person attaches different meanings and customs to the dining
experience.
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To recognize the importance of the dining experience in the overall culture change of the home.
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To develop a basic understanding of the various dining styles.
House or a Home
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Home is very different from house. A house is a building. Home is a place that includes
organizational, social/interpersonal, operational, and physical dimensions.
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Home is psychological state and an expression of self, embedded within certain physical
environmental elements.
Where Does “Culture Change” Come In?
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Culture change represents change and innovation, a different way of looking at nursing home care
(from what we have come to expect when we go to a nursing home).
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In many ways culture change is the realization of the mandate of OBRA 87.
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This means that we have a right to expect – and demand – the benefits of culture change now.
Resident-Centered Dining
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“Resident-centered dining” is a popular phrase right now, but what does it mean?
Part of person-centered care
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The ultimate goal of person-centered care is to develop a system that honors and defends individual
preferences.
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All residents are to receive the opportunity and the necessary materials to thrive and grow.
Person-Centered Care & Dietary
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Residents deserve the chance to make decisions regarding their diet and mealtimes, including:
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Who they eat with:
If possible do not assign tables
Allow residents to sit with friends during meals
What Foods are Offered
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Offer a selective menu.
Consider liberalizing the menu.
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Do not underestimate the importance of presentation, paying special attention to making
mechanical soft and pureed foods more visually appealing.
Where Residents Eat
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Offer a homelike or restaurant-like atmosphere (usually preferred).
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Use plants, flowers, etc to bring “nature” inside, whenever possible.
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Provide a colorful and cheerful environment, with plenty of natural light.
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Play quiet, relaxing background music.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 1

2. When and How Often Residents Eat
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Provide the option of several “small meals” throughout the day.
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Think about using a snack cart.
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Consider room-service style dining or serving each meal for a few hours (e.g., breakfast available
7-9 am).
How are Residents Served
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Think about the different ways to serve—restaurant style, buffet style, family style, etc.
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Consider allowing residents to have the chance to prepare some of their own food.
CMS Interpretation
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The intent of the word “homelike” in this regulation is that the nursing home should provide an
environment as close to that of the environment of a private home as possible. This concept of
creating a home setting includes the elimination of institutional odors, and practices to the extent
possible.
Dining for Health and Happiness
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Meal times in nursing homes have the power to impact physical and emotional health, well being,
and quality of life.
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Meals are the single most consistently accessible, manageable, and effective health-promoting
activity that we can offer to residents.
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Nourishment and Comfort Meals
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For some, food can nourish the soul, provide links to family, provide comfort with emotions and
help create home.
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Using residents’ recipes, offering ethnic foods to residents and observing religious and cultural
customs related to dining can provide comfort to residents and serve to maintain each person’s
religious and social identity as well as create home.
Eating or Dining
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When we begin to think of the dining experience as more than just nutrition we take the first step
in reaching our dining goals.
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The dining experience cannot be a holiday every day, however by keeping the focus of dining as
a social experience you will find that outcomes will be less painless for your residents and your
staff.
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Ask Yourself These Questions
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What is the resident’s attitude on dining?
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What is the staff attitude on dining? Do the team members talk to the residents or discuss what is
going wrong on the floor?
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What is the atmosphere in the room?
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Do the residents interact with each other if able?
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 2

3. Ask Yourself These Questions
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What does the dining room smell like?
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How is the dining room décor? Is the room inviting?
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Do you call the garment protectors bibs?
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Are the residents greeted as patrons or consumers?
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Does the resident feel like they are being herded in, rushed to eat, and then herded out for the
next shift?
Discussion Time
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It is the entire teams responsibility to observe obvious displeasure by residents.
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Are you able to see conversations taking place and wow was that laughter in the dining room?
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Are tablemates getting along with each other?
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What may have been a good match originally may not always work out later.
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Do they have similar eating/feeding abilities? Personalities also influence outcome.
Fun in Dining Starts When Residents Enter the Dining Area
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Modern grocery stores vent from the bakery to the entrance of the store to entice your sense of
smell immediately upon entering the store.
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When selling your house you may be advised to bake cookies or have a pot of soup on the stove
to give that “home” feeling.
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Digestion begins with the sense of smell. Our saliva glands can be stimulated with smells.
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Let the nose be the guide when possible to the dining room.
Goals of an Enhanced Dining Program
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Customized dining program.
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Provide consistent quality.
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Environment that is a hot spot for socialization!
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Exceeds expectations.
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Meets nutritional needs.
Describe Your Dining Program
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Fun
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Personable
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Best quality consistently
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Highlight of the day
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Exceeds expectations
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Environment invites and encourages socialization
Dining into Dollars
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A pleasurable dining experience can contribute significantly to residents' overall sense of health,
happiness, and satisfaction with their surroundings.
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Create home-style ambience-and make residents feel like valued customers.
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In addition, you can market these types of dining service enhancements to attract new residents.
Factors That Influence Outcome
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Unappetizing food
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Lack of ethnic food
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Limited food choices
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Bad smells in the dining area
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Lack of staff sensitivity to needs
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Chaotic meal environment
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 3

4. Health Care Today
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Budget constraints
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Consistent standard of care
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Turnover in staff
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Training modules
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Dining Trends
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Mission & Vision Statement
The First Impression
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First impressions
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Stepping in the door
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First line of communication
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Greeting people
Lasting Impressions
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Ethic Transformation
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Personal ethics demonstrated in work and outside of work
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Leaders that demonstrate ethical behaviors and actions
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Team players responsible for ethical behaviors
Building On Ethics
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One system at a time
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One team player at a time
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One customer at a time
Administration/Leaders
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Transformational Leadership
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Walking the talk
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Building leaders at every level
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Core values
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Being a positive example
Team Dynamics
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Open Communication
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Communication is the glue that holds a team together
Effective Communication
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All contribute ideas
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Listen to each other
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Provide constructive feed back
Well Defined Goals
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Clear understanding of what and how you reach goals
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All team members contribute the same energy and commitment
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Trust that each member adds value to the team and goals
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 4

5. Commitment
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Define commitment
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Money
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Long hours
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Stress
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Contains unknown
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Pretend commitment
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Commitment requires TRUST
Trust is the Antidote
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Trust eliminates fear of the unknown
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Trust allows team members to be more willing to go through difficult situations
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Trust builds relationships and loyalty on teams
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Successful Team Strategies
Share
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Vision
Mission
Strategy
Accomplishments
Challenges
Challenges In Nutrition & Dining
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Poor attitudes.
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Turf wars.
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Lack of knowledge.
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IDC syndrome.
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Improper equipment.
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Lack of vision in dining.
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Budget concerns.
Feeder or Needing Assistance
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Think about the actual definition of a feeder.
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One suggestion that could be used instead is “residents who need assistance while eating.”
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As a team other ideas could be discussed.
National Nutrition Month
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Nutrition is not one size fits all
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Practice the same philosophy for our residents
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What works for some may not work for all
SEE YOUR DINING PROGRAM THROUGH THE EYES OF YOUR RESIDENTS
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Conduct an audit of current system
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Meal time delivery
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Location of team members
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Discussion on current systems
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Obstacles
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What is working well
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 5

6. Make Food Readily Available
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In addition to encouraging people to eat what they want, some facilities have helped maintain
residents’ weight and making eating more enjoyable by making food available to residents when
they want to eat instead of only at mealtimes.
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Breakfast rolls, bran muffins, yogurt, fruit, sandwiches, and other finger foods are available 24/7
from a food cart in a central area, and all staff, from nurses and nursing assistants to activities
staff and housekeepers, offer residents food throughout the day.
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Stop looking at what was a balanced meal and started giving people food that they want, when
they want it.
Take cues from the people we serve.
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Dining Room Assignments
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Consistent assignments and reducing staff rotation can eliminate many eating difficulties because
the staff really know the person—for example, that you’ve got to go slower when feeding Bill, that
John doesn’t like vegetables, that if you give Mary a little bit of sweets first she eats better.
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It’s not about one strategy, it’s about relationships.
Care Giving & Nutrition
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Today, caregivers are beginning to understand the need to be creative to ensure that nutritional
and quality-of-life needs are met.
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Caught in the Middle
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Nutrition care for the resident is both driven and hindered by the regulatory environment.
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On one hand, regulations speak of physician-prescribed therapeutic diets, and, on the other, they
speak of resident rights.
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Both regulations and ethics demand that facilities meet the nutritional needs of residents while
maintaining their dignity and quality of life.
Working Together to Meet Needs
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Work with physicians to plan feeding approaches to meet the individual’s needs and desires while
ensuring quality of care and heeding the regulations.
Time, Money and Budgets
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Serving meals that look and taste good does not have to break the budget.
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There are many simple changes and additions that can improve the look of foods.
Dining Room/Meal Times
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During the meal service, observe the dining room and/or resident’s room for the following:
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Comfortable sound levels
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Observe for institutional medication pass practices that interfere with the quality of the residents’
dining experience.
Dedicated Meal Service
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All non-urgent activities stop
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Enhances the focus on meal times for residents
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Increased assistance to residents by staff
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Allows staff to slow down and focus on meal times and what is truly important the “residents”
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Dedicated meal service both residents & staff benefit
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 6

7. Communication
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Communicate your dining vision to everyone including residents and families.
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Develop a team that includes all levels of management, departments, residents and family.
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Develop systems in communicating to keep care plans updated.
Dedicated Meal Outcomes
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Increased nutritional status
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Positive medical outcomes
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Happier & more relaxed residents
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Team members are able to focus on meals without interruptions
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Dedicated meal times is a win-win situation
Exceed Customer Expectations
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Buffet style dining.
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Extended hours of meal service.
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Offer additional side items beyond the menu.
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Comfort food.
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Snacks between meals.
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Traveling food/snack carts.
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Toaster in the dining room.
Buffet Style Dining
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Supervised dining program.
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Includes nursing, dietary and other departments.
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Offers a variety of food choices.
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Monitor food temperatures.
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Wonderful aroma of food.
Create A Quality Assurance Team
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Develop a team that includes residents, family and team members.
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Encourage participation to be on the team.
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Create a mission statement for the team that includes a vision.
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Enjoy food tasting for menu development.
What Do They Want
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Choice, choice, choice.
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Culture appropriate choices.
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Meals that taste great and exceed expectations. Watch menu cycles.
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To have a voice and be listened to.
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Human respect and dignity!
Empathy Meals
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Include team members involving a variety of physical and mental situations.
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Brain storm how physical and mental situations will reflect outcome.
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What can you do to improve outcome for these situations?
Aligned Culture of Caring
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“We all care” in every department.
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Develop a schedule of review for the dining progress.
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“Observe” meal rounds along with team and family interactions.
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While observing listen.
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Suggestion box in CLEAR site.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 7

8. Dietary Out of the Kitchen
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The people who were always on the serving line, always making up trays, now get into the dining
room and actually meet people
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Many homes have brought the kitchen staff out of the kitchen, with many stories of relationships
forming and staff members realizing things like, “Why would we serve that to Mary? She doesn’t
like it; never has.”
Team Tasters
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Team should include clients, team members and family.
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Taste testing should be for menu items and potentially new items for menu.
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Develop an evaluation sheet for taste records.
Kitchens and Dining Areas
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The revolution of culture change leads to big changes in dining, eliminating structured meal times
in favor of resident-directed choice of what and when they eat
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The dining room is open to the kitchen so residents can enjoy the sounds and smells of meal
preparation, stimulating good appetites
Culture Change
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The quality and quantity of food has greatly improved in long-term care facilities that embrace
culture change.
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At some communities, dietary aides collaborate with residents to order the type and amount of
food for their individual neighborhoods.
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This has led to greater food enjoyment for the residents and less food waste for providers.
HEALTHIER RESIDENTS
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Nutrition standards tend to improve in resident-centered, homelike environments.
Even when residents select the food they want, they tend to eat from all food groups and make
healthier choices.
Residents who previously struggled with maintaining healthy weights are gaining weight.
Providers are wasting less food and dining services can use leftovers to make snacks.
STAFF SATISFACTION
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Typically dining staff is removed from the residents, working behind closed doors assembling
food trays to be delivered to residents' rooms at a specific time.
Now, staff members are in the dining room interacting with residents.
Research indicates that staff members are developing relationships with residents and are more
in tune with their needs.
Resident Centered Attitudes
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All staff-including nursing, dining, housekeeping and management should participate in learning
circles to discuss vision and values leading to culture change and a person-centered delivery of
care.
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All staff members should be trained on sanitation and safe food handling classes.
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Staff should become a team working together versus individual departments working in isolation.
Staff satisfaction and productivity can increase dramatically..
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 8

9. Marketing Your Dining Program
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Welcome to ____. We are proud to offer one of the best dining programs around. Our quality,
variety, convenience and flexibility all help make your program dynamic. We strive to keep up
with the ever-changing trends in dining. We offer you traditional, American cuisine, ethnic dishes,
vegetarian and low-fat options - all without sacrificing quality.
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We guarantee that our entire dining staff is committed to making your dining experiences
enjoyable and satisfying. Recognizing that you made a choice to have ___ as your home, we
have planned many exciting special events, such as theme menus, picnics and holiday festivities
to help make your dining experiences fun and enjoyable.
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We look forward to serving you. (Sodexho)
Truth in Dining
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Liberalize diets as appropriate.
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Provide easy to understand diet orders.
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Improve dining environment continually.
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Reevaluate on a continual basis.
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Look to the future of dining.
Is Your Facility Ready For Survey
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Ask yourself if you have systems in place to protect your residents & your facility?
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What can you do to improve?
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There is not a better time to be in our field. Make the new guidelines work for you.
From Leadership to Implementation
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The best dietary ideas may never materialize unless leadership and management buy in and
endorse resident-centered food services.
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Leaders create the context and empower employees to do the right thing.
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Supplement with a positive attitude and lots of training and education and you will have exceeded
employee, resident and family expectations. And people will talk about that to others.
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EATING IS ONE OF LIFE’S GREATEST PLEASURES
Good food, good friends and socialization should be the goal for your dining program.

Donna M. Manring
Cheers to your successful award winning dining program.
Innovative Dining Solutions
608.225.0126
Page 9

10. 
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 10