Excellence in Action- Thinking Outside of the Box for COVID-19-Related Weight Loss!

As residents of our Natchez, MS facility began to be released from the COVID-19 unit, it quickly became clear that recovery would entail a great deal more than a negative test.  Poor appetite and hydration, weight loss, weakness, and increased confusion were the product of weeks of decreased taste and smell, poor eating habits, and the devastating change in routine that isolation and illness produced.  In addition, our therapists noticed that patients were also losing weight as a result of social isolation and quarantine.

Members of our therapy team, Keedra, SLP, Jamiee, PTA, and Kristie, COTA, soon realized how this would affect the functional outcomes of all disciplines and stepped into action. As a team, they continued to do anything possible to help our residents.

They began by observing and addressing each of the resident’s behaviors during meals. Initially, they sat with residents in their individual patient rooms, encouraging intake while determining the patient’s remaining abilities, prior levels of function, and individual goals and needs, using skills obtained through their Dementia Capable Care training, provided by TMC. 

With COVID-19 impacting not only a high number of residents, but also facility staffing numbers, they realized that individual in-room feeding interventions would prove to be challenging.  The DON at their facility gave permission for high-risk residents to return to the dining room with appropriate social distancing, allowing therapy to assist those most impacted with meals. Then, based on patients’ individual needs, abilities, and goals, numerous person-centered approaches were taken and tailored to the residents’ needs.  These interventions included:

• One-on-one assistance with setup and feeding in the dining room for activities such as opening cartons, cutting meat, self-feeding, etc., as well as offering the structure and mindset of eating at the table as opposed to alone in the room.
• Smaller portions of high-nutrient meals/snacks were provided several times a day, as opposed to three large meals per day.  This was implemented due to the high levels of fatigue that patients recovering from COVID experience, which impacts their ability to tolerate larger meals.  This would also be helpful for individuals with Dementia, as their abilities to attend to meals may be an additional contributing factor to decreased intake. 
• Removing food from Styrofoam boxes so it looked homemade as opposed to take-out.  We know that the dining experience is more than just eating.  Making the food appear more palatable can be very helpful in improving intake.
• Moving food to an actual plate or individual bowls, making it more appetizing and less overwhelming, in regard to portion size.
• Keedra, SLP, found out the patients’ favorite outside foods, and she purchased them and brought them in to encourage intake.
• Therapy implemented fun activities such as making smoothies as a group activity, to give to residents.
• Therapists assisted the Activities Department with making and distributing milkshakes to residents to increase caloric intake.
• Therapy assisted Nursing and Dietary in distributing high-calorie snacks and offering hydration to facility residents, as well as checking water pitchers and assuring that they were within patients’ reach and visual field.
• Our SLP collaborated with the Dietician, Dietary Department, and Nursing Staff with recommendations of diet changes and strategies to increase appetite.

The identified residents continue coming to the dining room for our therapy team to assist them, and the positive difference is noticeable! With our therapists’ out-of-the- (Styrofoam!) box thinking and collaboration with other departments and disciplines, these residents are slowly returning to their prior levels of function and are enjoying a more positive dining experience and a better quality of life!

In Natchez, MS, we are ALL IN for improving the lives of our residents who are not only recovering from the effects of the active COVID-19 disease, but also those whose lives were impacted by the effects of social isolation and quarantine. 

Great job, Team!