TMC Excellence in Action: April 2022

A T.E.A.M. Approach to Combatting Declines

Restrictions related to the COVID-19 pandemic have created a dilemma for long-term care (LTC) facilities: How best do you protect the vulnerable elderly residents from the rapidly spreading virus, and the risks involved with resident isolation? LTC sites were aware that limiting the residents’ connections to the world around them would inevitably lead to an increase in depression and in feelings of anxiety, frustration, and irritability, and for many long-term residents the mental toll of social isolation has led to declines in physical health as well. Some of the most common resulting behaviors include withdrawal from care – such as refusing to eat and take medications – and reluctance to engage in self-care tasks and social activities, which can lead to weight loss, generalized weakness, falls, and more.

Our team in Natchez, MS – consisting of SLP Keedra, PTA Jamie, and COTA/L Kristie – has been proactive in their efforts to combat weight loss and ADL decline by advocating with facility leadership to resume communal dining with their residents. After the initial Covid outbreak, they quickly realized that isolation, change in routine/environment, and changes in taste and smell were going to significantly impact their residents. As soon as their administrator gave approval, they began identifying residents who were at increased risk for weight loss and who needed increased assistance with feeding and brought them to the dining room for their meals while remaining mindful of social distancing. They began this effort toward the end of 2020, and as a result, except for a slight change in December 2021 due to a COVID outbreak, they have not noted a weight loss trend throughout the duration of the pandemic.

As COVID restrictions have begun to lessen, our team has advocated for the entire facility to resume communal dining, as it has proven to improve feeding and socialization and to decrease weight loss. Our therapy team has collaborated with Administration and the facility Director of Nursing (DON) to get the ball rolling again. As a part of this most recent collaboration, the Rehab Team has provided screens for each resident to ensure that they each have a functional mode of transportation – such as a wheelchair, geri-chair, walker etc. They have also assessed and determined the level of feeding assistance for each resident, proper table placement with appropriate compatibility, and physical table placement in the dining room. In addition, they have offered suggestions to help the serving process run smoothly – including having extra condiments, napkins, utensils available to serve the residents without interrupting the kitchen staff.

As they have moved toward the transition back to communal dining, they realized that the current nursing home staff now consists of very few staff members who have been working in long-term care when communal dining took place, as their site has large population of Agency nurses with limited long-term care experience. As staffing shortages have been on the rise, our Team had assumed an “all hands on-deck” approach, assisting at meals to the point that the staff relied heavily on the assistance from the therapy department and their input regarding feeding and the dining experience. One concern they noted was regarding table placement and identification of residents by staff who may not be familiar with the dining room or the residents themselves.

The administrator suggested placing acrylic boxes with the residents’ photos at each table, to assist with seating for residents and staff. The Rehab Team utilized this idea as an opportunity for group activities and created beautiful spring centerpieces to help the residents recognize their table in the dining room. They also created a door design with large colorful tissue paper flowers that our PTA student, Hailey, used as a photo backdrop to take pictures for the seating assignments at each table. The residents, as well as nursing students who are on a rotation at the facility, participated in creating the “coffee filter flowers” in the arrangements. Caregiver education and training were also provided for implementation of safe swallow precautions when therapy is not present or in the building. All the components of the arrangements and communal dining program are a result of our entire team working together to create a positive experience for the residents we serve. Our team plans to update the table arrangements for each season and holiday, to keep the dining room a festive, fun location, and to maintain the program. In Natchez, MS, we know that having a T.E.A.M. approach to address each resident’s needs makes all the difference in their world, and that Together, Everyone Achieves More!