Double your dining space at no added cost.

Many nursing home administrators are perplexed by the need to serve too many residents in too little dining room space. At Ashbrook Nursing Home in Scotch Plains, New Jersey, we discovered how to double the number of diners without adding to the cost.

Ashbrook provides long-term skilled and intermediary care services to 120 patients. However, the main dining room can comfortably provide seating for only 68 persons. For years, this meant many residents were required to dine in their rooms or in the hallways, both less than ideal alternatives. We were well aware of the disadvantages of having residents scattered throughout the facility at mealtime:

1. Labor intensive food distribution to

multiple locations.

2. Logistical difficulties for nurse-managers

and the dietitian trying to

observe and supervise meal service

and consumption.

3. Delays in serving meals to multiple

locations resulting in unacceptable

changes in food temperatures.

4. Extra housekeeping work caused

by food spills throughout the building.

5. Reduced quality of life for residents

who eat in rooms or hallways.

Two dining room seatings had never been seriously considered. After all, it was hard enough to schedule staff meal breaks around one resident seating. How could we do it around two? When a new Director of Nurses suggested two seatings per meal, one for each 60-bed unit, we decide to try it. What, at first glance, appeared to be twice the work provided to be both labor-saving and quality enhancing.

Key members of the nursing and dietary staff, the administrator and several residents visited a nursing home using this system. A Food Service Supervisor familiar with the two seatings per meal system was retained as a consultant. She developed a step-by-step guide for dietary to follow. One labor-saving strategy was to tape the diet cards for residents dents at the second seating directly onto the table top. The first seating group, consisting of the higher functioning residents, dines with tablecloths on each table. For the higher functioning group, diet cards are displayed in a holder at every seat. After the meal, the tables are bussed (dishes, flatware and glassware are placed into racks that go directly into the dishwashing machine). when the tablecloth is removed, the diet card for the second seating is revealed. Paper placemats are then used for the second seating. There is a one-hour time period between servings; for example, lunch is at 11:30 a.m. for the first group and 12:30 p.m. for the second.

Each department identified key elements for a successful transformation to the new system. The Nursing Department decided to group residents on the units based upon level of functioning. The nurses placed all of the more independent residents on one unit and those who needed the most care on the second unit. This move greatly simplified staff scheduling. The plan was to have all of the residents from a particular unit dine at one time and have all the staff for that unit assist and supervise the process.

The Dietary Department had to alter work routines and assignments for dietary staff. They developed a system for rapid bussing of tables and setting up the next serving. On the plus side, the eliminating of tray service to the units cut out the task of setting up tray trucks. Both Nursing and Dietary had to adjust times for employee meals and breaks to avoid conflict with patients' meals. Also, dietary staggered working hours to accommodate changes in times of food preparation and meal service.

Careful planning, attention to timing, and teamwork are key elements for success. At all seatings, the entree and side dishes are served restaurant style from a steam table. Dietary staff serve the meal while nursing personnel assist in feeding residents as necessary.

On the whole, two seatings per meal has proven to be a great success. For nursing it has been easier to accurately monitor and record each patient's meal intake because all patients are in one area. For dietary, concentrating patients in one area facilitates faster service and cleanup. For higher functioning patients, it has created a more congenial atmosphere for dining. Space now exists for families to join patients in the dining room for meals if they wish to do so.

The single biggest problem was that long-term residents had become accustomed to a leisurely meal service. Several patients balked about the requirement to be in the dining room on time at the start of each meal. Until the dietary staff gained proficiency in bussing of tables, residents complained about being rushed through a meal at the first seating.

Within two months, though, everyone had adjusted well to the new system of two feedings per meal.

Daniel J. Moles, RN, is Administrator, and Victoria Mount is Director of Nursing, at the Asbrook Nursing Home in Scotch Plains, NJ.