Get 'cart'-ed away: a program that brings the dining room to your residents. (Food Service).

MEALTIME IS MUCH MORE THAN THE simple intake of food. It is an integral part of our residents' daily lives. That is why the vision of dining-services programs in long term care facilities is to provide optimum nutritional care in an environment that encourages friendship and respect. Dietary professionals need to look for systems that not only foster independence by offering choice, but also increase service. One way to achieve these goals is to use a system that uses mobile carts to deliver dining-room choice and service to residents without their having to be in the dining room.

Rolling out of the dining room

Residents are given menus to fill out in advance. These menus are used as a guide for stocking the carts. A breakfast cart, for example, would be stocked to offer hot and cold cereals, fresh fruits, fresh-baked pastries, and an array of hot items such as French toast, waffles, eggs, bacon, and sausage. Dietary staff members bring the carts to the residents' rooms and remote dining areas. Nursing staff members assist the dietary staff with serving each resident's selected menu. If a resident decides to change his or her choice, substitutions are easily made at the point of service.

A breakfast cart services approximately 80 residents without interruption for restocking. At Mount Carmel in Milwaukee, we use five carts to serve breakfast to our 457 residents and it takes about 1 hour and 10 minutes. Our previous trayline service took almost twice as much time to serve the same meal.

Training needed for the caregiving and dietary staffs was minimal. Our dietitian and I held a 20-minute inservice for the nurses and CNAs on the units and a 30-minute inservice for the dietary staff. These sessions explained how the program works, how the carts are set up, and how to serve the residents, During the first week, we followed the carts to provide additional staff training as needed.

Residents' choices and consumption are logged per established procedures; those who may be routinely making poor choices are referred to the nutritional support staff. While this type of program may be new to the industry, it is compliant with all our state and federal codes. Mount Carmel has been through three annual surveys since this program was instituted and has received positive reactions from state surveyors.

The carts have had a tremendous impact on the residents as well. For mildly to moderately impaired residents, the increased ability to make choices gives them greater independence. Severely impaired residents can make choices and substitutions with the help of their caregivers. Family satisfaction and perception of dining services is increased as well. Family members' involvement in the residents lives and care is increased because the family can assist the resident with making his or her selections.

Add variety to your carts

This program can be adapted to offer other meals, desserts, and snacks. Desserts are very important to our residents and an excellent tool in our pursuit of quality-of-life improvements. This makes the dessert cart a popular variation of the cart program. The use of a dessert cart not only changes the appearance of desserts, but also allows you to provide more variety. While a greater selection of regular desserts is important, an increased selection of desserts for therapeutic and mechanically altered diets is equally important. One caveat: This cart requires some additional training for the dietary services staff.

A snack cart is yet another use of this program. The snacks offered can vary from building to building, depending on your residents' requests. Some common snack-cart offerings are freshly made cookies, assorted fruits, assorted sandwiches, puddings, cupcakes, assorted crackers, and a full selection of beverages. Many dietary departments struggle not only with providing a variety of late-evening snacks for residents, but also with the logistics of distributing the snacks. Because it focuses on the dietary and nursing staffs working as a team, this program successfully addresses both of these issues.

Benefits abound

In addition to increasing quality of life, this program has measurable outcomes. After implementation at Mount Carmel, unavoidable weight loss was reduced by 2.3 percent, commercial-supplement use decreased by 5.6 percent, and average intake rose by 17 percent. Interviews with our residents conducted before and after implementation of this program showed a 15 percent increase in satisfaction. The last measurable outcome is cost. These programs should not increase the raw food or labor costs at the average facility. However, some facilities may see costs increase, as it may be necessary to change product selections to increase customer satisfaction.

As a consultant, I hear the same common theme at every facility: Residents want service, variety, and choice. But we must realize that future residents may have different needs and wants from those of current residents. This cart program is designed so that it can evolve to meet those changing needs.

Richard Daehn is director of Dietary Services for Mount Carmel In Milwaukee, and director of Benedictine Health System Nutritional Centers of Excellence, Cambridge, Minn.