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Creating Home in the Nursing Home II

A National Symposium on Culture Change and the Food and Dining Requirements

The Deep-Seated Issue of Choice:
Based on her work as a culture change pioneer both as a dietitian and administrator of one of the first nursing homes in the Household Model, Linda Bump will challenge us to think about what is possible, what makes new ideas difficult, and how to effect the deep organizational change needed so that a person's right to choice in their own home is honored. Difficult questions such as, "Who wins the care plan?" and "Who are we to decide for people what is best for them?"will be addressed through the lens of the OBRA mandate to honor the resident's right to self-determination as well as the right to refuse treatment.

Presenter: Linda Bump, MPH, RD, LNHA, CD, Culture Change Consultant and Trainer


The Role of the Physician Order:
Hear from a physician who has been at the forefront of providing self-directed care, how liberalized diets and personalized medication pass can not only work but also enhance clinical outcomes. Questions will be tackled such as how do we monitor clinical outcomes? What is the role of the physician order? What should happen when a person chooses not to follow a physician's order? From a clinical perspective, what is the physicians', nurses' and facility's obligation to the person?

Presenter: Matthew Wayne, MD, CMD, Medical Director University Hospital Health System Senior Services, Geriatric Services Southwest General Hospital, University Hospital Foley ElderHealth Center, Legacy Health Care and Provider Services


Outcomes of Choice in Dining:
Positive outcomes related to choices in dining documented in several studies, including her own on buffet style dining, will be shared from the perspective of a nurse researcher who will also address nursing challenges in implementing change to meet both the nutritional needs and dining preferences of residents.

Presenter: Robin Remsburg, PhD, RN, GCNS, BC, FAAN, Director School of Nursing and
Associate Dean College of Health and Human Services George Mason University



The Food Code:
The federal regulations refer to the Food Code which is written by the Food and Drug Administration, an agency of the US Department of Health and Human Services, as a standard of practice and many state regulations require it be followed. A representative from the FDA will describe how the code gets written and revised.

Presenter: Glenda Lewis, MSPH, FDA Office of Food Safety


The CDC Infection Control Guidelines:
Infection control is an important element of the food and dining experience in nursing homes. Federal regulations refer specifically to the Centers for Disease Control (CDC) guidelines for infection control. A representative from the CDC, an agency of US Department of Health and Human Services, will explain the development and revision of the guidelines.

Presenters: Glenda Lewis, MSPH and Nimalie Stone, MD, CDC


Survey Interpretation of the Regulations:
As self-directed care becomes more common, CMS is striving to keep up with regulations, guidance and survey procedures. Survey issues to be addressed include: the requirement for menus versus resident choice; facility responsibility for food safety and honoring resident choice for 'visitor' foods, potlucks, and food in personal refrigerators; the 14/16 hour rule; and compliance with the new guidance for self-determination, dignity and homelike environment. Lastly, the story of the California Person Centered Dining Pilot Project's collaboration between the state survey agency, the CMS regional office and the California Culture Change Coalition will be told and results discussed.

Presenter: Linda Handy, MS, RD, Consultant, Retired Specialty/Trainer Surveyor CDPH



Paid Feeding Assistants – Six Years Later:
Research regarding the outcomes of utilizing paid feeding assistants has been conducted by Abt Associates under contract with CMS and the Agency for Health Research and Quality (AHRQ). Findings will be shared and lessons learned discussed.

Presenters: Rosanna Bertrand, PhD, Abt Associates Inc.
Sandra Simmons, PhD, Vanderbilt University, Center for Quality Aging



The Role of the Pharmacist:
Pharmacists become involved with non-time-specific medication passes, food and drug interactions, appetite stimulants and nutrition supplements. Balancing pharmacy practices with self-directed living will be addressed in the context of liberalized dining.

Presenter: Denise Hyde, Pharm.D., RP, Community Builder Eden Alternative Inc.

Meet the Presenters
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