Tag F741 Non-pharmacological Approaches – Food Preferences: Exploring each person’s Personal Biography of Nutrition including Birthday Wishes

CMS Tag 741 includes a long list of examples of individualized, non-pharmacological approaches to help meet behavioral health needs. We will be reviewing all of them. We are still looking at the first one which raises food preferences first:

• Ensuring adequate hydration and nutrition (e.g., enhancing taste and presentation of food, addressing food preferences to improve appetite and reduce the need for medications intended to stimulate appetite); exercise; and pain relief;

A highlight of my career was being invited to facilitate Creating Home II: A National Symposium on Culture change and the Food and Dining Requirements co-sponsored by CMS and the Pioneer Network which resulted in a task force I also facilitated that developed the New Dining Practice Standards (2011). Because these Standards are so helpful to all professionals, I highly recommend downloading them from www.pioneernetwork.net and making copies for your whole leadership team. In a sentence, they help professionals help people eat what they really want to eat.

A small research study in a nursing home discovered that each person has their very own Individual Biography of Nutrition (Hoffmann, AT. Quality of Life, Food Choice and Meal Patterns – Field Report of a Practitioner. Ann, Nutr Metab 2008; 52 (suppl 1): 20?24).

For those of you in certified nursing homes, this is basically required. It is here in Tag 741 for behavioral health as well as other food and nutrition regulations. Does food help your behavioral health? Mine too. It is very apropos that CMS listed food preference first, I think.

Regulations for assisted living, memory care, hospice, home health all typically have some requirement concerning a person’s preferences, choices, individuality, etc. so this list will serve anyone wherever they live.

It’s really all about preferences. Basically, ask what a person’s preferences are for everything as knowing and honoring preferences prevents problems! Whereas not knowing and not honoring preferences creates problems. Perhaps this is why preferences are references 232 times in the federal CMS regulations! Perhaps this is also why CMS regulations now reference “the resident’s goals” 53 times. Hopefully you and your team know this. Even if you cannot meet a preference right now, you have to find out and move in the direction of meeting it. There are options. A person may have their own money, may prefer to purchase certain things and may need to spend their money in some cases. Families sometimes want to be helpful, bring preferred items, need gift ideas for all of the many rotating gift-giving opportunities during the year. Sometimes a fund raiser, or gift drive for Christmas, or a call asks you what is needed by people who love there. Be ready.  And then of course there is the home’s budget. Depending on what it is, depending on each situation, depending on the person consider the options.

Consider this the start of a list that could be considered your or anyone’s …

Personal Biography of Nutrition

Breakfast:

Lunch:

Supper:

Snack routine:

Where to dine:

Dining ambiance (music, quiet, people to talk to, etc.):

Foods disliked/allergies/sensitivities/intolerances:

Foods that do not work/make you sick/textures not tolerated:

Foods that prevent sleeping:

Foods that cause a spike in sugars:

Comfort foods (bring a sense of security/comfort even when just thinking about them):

Favorite foods:

Ethnic foods:

Foods enjoyed preparing:

Preferred healthy choices:

Preferred foods that are available here:

Preferred foods unavailable here and plans for obtaining:

Preferred laxative medications or natural foods:

Preferred supplements artificial or natural:

Preferences for portion sizes:

Goals for nutrition:

Goals for weight:

Daily pleasure (food/drink preference needed every day, ensures it happens):

Simple pleasure (food/drink preferred name brand, flavor, etc.):

Birthday foods and celebration preferences:

I realize whoever is reading this has varying degrees of authority when it comes to honoring food preferences, but I want to encourage you to please share this with your whole team. The better you all get at asking and learning preferences, the closer you will also get – as a team who cares about each individual – to fulfilling the preferences you now know.

If you haven’t yet moved over from institutional birthday practices, that is something else you could pursue. Not everyone wants a group birthday party. In normal life outside of institutional life, we don’t get together with everyone we know who has a birthday in the same month. Although all involved in community living have become accustomed to group birthday parties. Smushing all individuals’ birthdays into one party is an example of group think. Group think is institutional. We think things have to take place in a group to be more efficient. Efficiency then, sadly, replaces individuality. There are more regulations about serving the individual than the group, however.

And be aware of the next institutional practice, which is to do something more individual but still the same- generic – for everyone. Everyone gets the balloon, the personal cake and sung to, if they accept. Still institutional. Still generic. Still not individual. Have fun finding out what each person prefers for their birthday and work as a team to make it happen. You, let’s say, the activity/community life coordinator/team do not have to be the only ones unless of course you are able. Make it a community-wide thing. Ask for help, for volunteers, it can change institutional culture when you trade in an institutional practice for an individualized practice. Watch everyone get excited to discover and make happen individual wishes for individuals’ birthdays.

This has been considered a culture change practice for many years, beginning on the Artifacts of Culture Change in 2006 and carried over to Artifacts 2.0 in 2021:

Artifact #12. The home celebrates residents’ individual birthdays rather than, or in addition to, celebrating resident birthdays in a group each month. Each resident’s wishes for how to celebrate his/her birthday, on their birthday, are discovered and honored(https://www.pioneernetwork.org/artifacts-culture-change/).

If you lived where you work, would you appreciate being asked about your Personal Biography of Nutrition as well as your personal wishes for your birthday? We all would. What a privilege we have to do this for others.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement/community life, regulatory compliance and culture change consultant.  She is a co-developer of the Artifacts of Culture Change original/2.0 Nursing Home and first-ever Assisted Living version. She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. At www.edu-catering.com join The Be Encouraged Blog, Become a Leader of Normal Life with the eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC and share with your team the eBook Individualizing Medication Administration using Regulations. At the Edu-Catering YouTube channel