The RPN/LPN Leader in LTC: Facing the Challenges and Realizing the Opportunities/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Sep 15, 2022
Effective Date: Sep 15, 2022
The RPN/LPN Nurse Leader in Long-Term Care
RPNs/LPNs working in long term care (LTC) love their profession, despite the many challenges and hardships they encounter, and there certainly has been a myriad of challenges during the COVID-19 pandemic. Their profound concern for the well-being of the residents is driven by their deeply held values and a desire to provide the highest quality of care possible. This translates into a passion for, and commitment to, the residents who live in the Home.
RPNs/LPNs represent the largest category of nurses working in LTC (approximately 70%) and the majority of these RPNs/LPNs work directly on the care units. As their education and scope of practice has continued to expand and be recognized, the role of the RPN/LPN has grown and evolved in LTC. RPNs/LPNs are responsible for increasingly complex activities, including leading teams, supervising PSWs*, critical decision-making, dealing with families, and collaborating with others.
Examples of Roles of the RPN/LPN Nurse Leader in LTC
• monitor and supervise care provided by PSWs
• collaborate with the interdisciplinary care team
• communicate with staff, residents, families, as well as other members of the care team
• problem-solving and decision-making
• respects, values, and empowers others
• build trusting team relationships
• manage conflict
• mentors and coaches’ others
• offers emotional support to others
• conduct resident assessments (formal and ongoing)
• identify resident risk indicators
• complete documentation
• work with resident and family to develop care plans – set goals, interventions, time frames
• administers medications and treatments
• transcribe medical orders
• maintain unit medication management process
• ensure resident and staff safety
The job position of the RPN/LPN working on the care units may be referred to as “clinical leader,” “team leader,” “nurse supervisor,” or “charge nurse” etc., and these titles are familiar to most people who work in LTC. These titles are often used interchangeably, resulting in ambiguity in the responsibilities and accountabilities encompassing this role. This vagueness causes confusion for staff, residents, families, and even for the RPN/LPN Nurse Leader his/herself. In this article the term “RPN/LPN Nurse Leader” refers to both the leadership aspect of this role, as well as the clinical, knowledge-based skills and competencies essential to achieving quality resident care.
The Impact of Effective RPN/LPN Nurse Leadership
The RPN/LPN Nurse Leader is in a unique position of being able to influence not only the quality of care being provided to the residents, but also positively impacting PSW job satisfaction. Research reports that effective nurse leadership directly impacts resident outcomes and staff satisfaction (McGilton et al., 2016a). When /LPN Nurse Leaders stand strong and uphold their personal and Home’s values, they garner respect from everyone, but in particular from the front-line staff. PSWs quickly recognize they share many of the same values of their RPN/LPN Nurse Leader, and as a result, they are inspired to follow their leader. The result is a work environment where staff are truly committed to providing quality resident care. As RPN/LPN Nurse Leaders effectively lead and support the direct care staff, they are not only impacting quality of care, but they are also respecting, valuing, encouraging, and empowering the care team. As the saying goes, “happy staff means happy residents.” PSWs who are “happy” experience more joy at work, provide better care, and are less likely to leave their jobs. This has even more relevance as a high turn-over of PSWs can result in poor resident outcomes such as increased infections, pressure ulcers, increased falls, and resident behavioural issues. RPNs/LPNs who inspire their staff contribute immensely to positive resident outcomes and less PSW turnover. This fosters their personal sense of achievement and “of making a difference” - in other words, they achieve a sense of self-actualization.
Challenges Facing the RPN/LPN Nurse Leader in LTC
Up until 2020 and the COVID pandemic, much of this article would be focused on leadership development or clinical strategies, in an effort to enhance the role and practice of the RPN/LPN Nurse Leader. But the pandemic has now placed such a heavy burden on all staff working in LTC, that this challenge has taken priority. For the RPN/LPN Nurse Leader the stress and added workload has been demoralizing. Many RPNs /LPNs are now considering leaving LTC, with some even leaving nursing altogether. Others who stay are feeling frustrated, exhausted, and under-valued, although even with all the added pressures they have endured, they carry on. This raises real concern for RPNs/LPNs personal health and well-being. Strategies to help address this can be found in a previous article, “Protecting Nurse Well-being in the Face of Burnout and Moral Distress” Sept. 29, 2021 (located on CPS website/resources).
In the context of this article, given the discussion about the positive impact RPN/LPN Nurse Leaders have on quality resident care and PSW job satisfaction, this is of critical concern. Some of the challenges faced by RPN/LPN Nurse Leaders include:
1. Given the ongoing challenges that COVID has created, the RPN/LPN Nurse Leader may become so absorbed in meeting new and ever-changing requirements, they may unintentionally lose focus on their staff needs. They may not recognize the PSWs’ frustrations and fears, seek their input less often, or not listen and really “hear” their staffs’ concerns.
2. Staff shortages have required the RPN/LPN Nurse Leader to step in and help other nurse leaders, especially new nurses, or agency staff, who are not familiar with the residents and/or policies. This may include assisting when there is a change in a resident’s health status or completing work left by the previous shift. RPNs/LPNs are also filling gaps when they are short PSWs, spending more time helping with direct resident care. This increased workload affects the RPNs/LPNs ability to connect with, and support, the care staff, often leaving them frustrated in their abilities to do their job well.
3. There may be a lack of support from senior nurse managers, given they are being pulled away to deal with other COVID related demands. This limits their availability to connect with the RPN/LPN Nurse Leaders on the units, and to hear their issues and concerns.
4. Role clarity and scope of practice for RNs and RPNs/LPNs has not been well understood and still is open to misinterpretation. Nurses have had difficulty differentiating between the scope of practice of the RN and RPN/LPN leading to tension, confusion, and ambiguity as to their roles, responsibilities, and functions. It is not uncommon in LTC to hear that the RN and RPN/LPN role is the same. Although there is significant overlap and many of the tasks and functions are similar, this does not always take into consideration the complexity of knowledge, judgement, and critical thinking required of nurses to support clinical decision making. This has become even more of an issue during the pandemic. Due to the shortage of RNs working in long term care, it is more challenging for the RPN/LPN to find an RN to collaborate and consult when necessary. RPNs/LPNs may inadvertently step outside of their scope of practice and assume additional responsibilities in an effort to meet the needs of the resident.
5. There has been limited availability, or requests for, professional development. When feeling overwhelmed and exhausted this is very understandable. However, further learning and education empowers the RPN/LPN and can increase their confidence and work performance. The RPN/LPN is more likely to be motivated and loyal to their organization that invests in them and supports their development. One example of this in Ontario is the RPN-RN bridging program, with reimbursement of tuition fees and other financial support. Participants must agree to work in long term care post-education for a designated time – a fantastic opportunity, as well as recruitment and retention strategy.
6. Fair compensation has also been a challenge. In Ontario when the MOHLTC announced a $3.00 hour wage for PSWs, the RPNs supported this initiative, as they understood more than anyone the challenges PSWs have faced in the past prior to COVID, and now continue to confront during the pandemic. However, no additional financial support has been offered to the RPN Nurse Leaders, or others, in long term care. This has fostered a tense work environment at times, as RPN do not feel recognized for the contribution they have made, and continue to make, to ensuring quality care. The $3.00 an hour raise was a PSW recruitment and retention strategy, and yes, we need more PSWs in LTC. However, RPNs/LPNs feel they have been treated with a lack of respect and dignity, and it has given them one more reason to re-consider their future in LTC, especially given the growing workload, stress, and responsibilities they are facing.
7. COVID-19 has highlighted the significant shortcomings in our health system, and in particular LTC. Nurses have been calling for reform in LTC for many years due to the struggles they have encountered in the optimum delivery of person-centered care and quality of life for residents. Increased funding is a high priority; for more LTC care staff, more full-time positions, and adequate staffing levels, are essential. As governments move ahead with plans to significantly improve long term care, RPNs/LPNs working in the sector need their voices heard, as they are experts.
Realizing the Opportunities
The list of challenges facing RPNs/LPNs working in LTC are substantial, but there is reason for optimism. Never before has there been so much attention focused on LTC … by the government, media, families, other groups, and associations. Governments are committed to making significant improvements to ensure the safety and quality of life for residents and to improve the work environment for staff.
While the disproportionate number of resident deaths, and countless hours of overtime to the point of exhaustion, has taken a profound emotional and physical toll, there is hope. Staff, residents, and families are accepting the new realities, and making adjustments. Public sentiment has shifted in support of change in long-term care. These changes signal a new era, a period of hope and renewal – a just reward for all who have served their residents so courageously through the pandemic. RPNs/LPNs need to seize this opportunity! This is the time to renew your passion for LTC. Dig down deep and find your inner strength, courage, and commitment to the residents. Consider this …
“Hearing patients reflect on their families, their grandchildren, their lives—and often being with them in their final moments—offers a professional and personal significance that keeps many long-term care nurses right where they are.” - Wolters Kluwer Health May 05, 2015
About the Author
Darlene Legree is the Co-Owner of Silver Meridian. For over 20 years, Silver Meridian has helped LTC managers, and nurse leaders hone their leadership skills. As they empower and energize others, they have become recognized as Inspired Leaders in the provision of care. Go to the Silver Meridian for more details, including the Fall intake for the Online DOC/ADOC Leadership Certificate Program (Accredited).
*PSW – personal support worker, may also be referred to as a personal care attendant/aide
Redefining Your Dining Experience with Kind Dining/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Sep 01, 2022
Effective Date: Sep 1, 2022
Have you ever noticed how some people step into a room and the room immediately brightens? Have you ever wondered why that is? Have you ever thought about how that works? It is the presence of kindness the person carries with them and it doesn’t come naturally to everyone, at least not at first. It is a skill that you can teach or learn. After practice, it does come naturally without even thinking about it. Every person on your food serving team, including each employee that lifts a food tray or even carries a glass of water, in every senior living community, needs to learn this skill. Not only does it transform your mealtimes, but it overflows to brighten your community every day, all day. Kindness becomes a way of life that improves the life of the giver and the receiver.
Kindness is infectious. When a kindness is extended, even the small act of retrieving a book dropped to the floor by an elderly person who can’t get down to pick it up. The person receiving the kindness is relieved and thankful. The person giving the kindness probably doesn’t even realize what a huge gift they gave. It is so simple to pick up a book off the floor, but not so easy for everyone. This is an example of small ways that kindness slips into a person’s habit and becomes a way of life. Kindness enhances everyone touched by it, the giver and the receiver.
The small kindness of casual conversation or asking an open-ended question when serving a meal to an older adult can wash away a feeling of loneliness. It conveys the sense that you care about them. It’s a selfless act of compassion and empathy.
This is just what some residents long for after losing so many friends, leaving them with a feeling of isolation during the pandemic. To reverse the epidemic of loneliness, we need to create communities where residents know they belong. And the easiest, cost effective and most rewarding place to begin to create communities of belonging is through the dining experience, delivered with intentional kindness. Chasing loneliness away increases a person’s immunity, lessening the chance of illness moving in and taking over. Studies claim it lowers blood pressure, lifts depression, and helps to relieve aches and pains. Small acts of kindness show phenomenal results in a person’s physical and mental resilience. Again, that works for the giver and the receiver.
One of the most vital changes that can happen in your senior living community (and it doesn’t cost a cent) is adding this learned skill to your staff’s training and weekly discussions. When you introduce the subject, give everyone a minute to recall a kindness done for them. Many stories of small encounters that they may not have realized were truly acts of kindness. Have you ever stretched on tiptoes to reach the top shelf at the food market when a complete stranger just plucked the item you wanted and handed it to you? I have. Many times and was thankful for this small act of kindness. Lead your staff into becoming aware of what kindness is, what results come out of it, and how it will affect them personally as giver and receiver.
Kindness generates kindness. When one person is touched by a kind deed, it will open them to do a kindness for someone else. Kindness dissolves walls of anger and resentment some people carry with them to hold people at bay. Change that begrudging attitude in your community to employees who love to come to work every day. Encourage them to develop and use intentional kindness toward everyone. It only takes 5 seconds to allow this skill into your thought. Then kindness practiced will come naturally and enhance your way of living. When you have an atmosphere of kindness abounding in your community, your employees won’t need those walls they have built within. When you are discussing kindness with your team of food servers remember to remind them that kindness is to be shared with each other. It’s what makes a team great! And it benefits the giver and the receiver!
About the Author
Cindy Heilman MSFN, NDTR,FAND, Owner of Kind Dining® and creator of Kind Dining® training series, founded her company in 2006, as a coaching and training company to create affordable training tools exclusively to serve older adults in the senior care marketplace. Her company, Kind Dining training, is one of a kind. It’s a 9-module online and on-demand training series that delivers consistent training in a flexible format. Each module varies in length depending on the topic, and it takes 8 hours to complete all 9 sessions. It offers immediate skill building to develop staff professional, interpersonal, and technical skills to close service gaps, raise quality standards, resident satisfaction, and staff retention across departments, beginning with dining service. Throughout the series, students are taught to respect residents and their home environment as they perform their work. At the same time, they learn foundational principles of kindness, civility, empathy, and our unique brand of hospitality, communication, food safety, and serving skills and they benefit from the improved atmosphere of teamwork and communication. The Kind Dining training series has been approved by the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics USA, for 11 continuing education credits, including 1 for Ethics for Registered Dietitians, Dietetic Technicians, and Certified Dietary Managers. To see a full list of modules, and to contact Cindy directly, visit www.kinddining.com.
4 Smoothie Recipes to Bust Out of Blender Boredom/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Aug 03, 2022
Effective Date: Aug 3, 2022
Whether you’re rushing off to work or looking to refuel after the gym, smoothies can be a healthy, grab-and-go option. Well-made smoothies are a delicious way to help get the fruits (and veggies!) you know you need, complete with an extra boost of vitamins and minerals to give you energy to conquer your day.
But it can be difficult to find the right flavour combination (and too easy to turn your smoothie into a high-calorie, high-sugar dessert). And even if you are the most tried and true fan of smoothies, you can find yourself a bit bored of the same old smoothie, with the same few fruits, day after day.
We’re here to help bust you of out blender boredom with unexpected ingredients like mint, ginger, cinnamon, and more that add new, delicious, and healthy flavours to your smoothie list. Grab your blender and try these four Aramark chef-created smoothie recipes to make at home!
1. It’s Easy Going Green
This is sure to be your new go-to drink. In addition to the power-packed kale and spinach, it has almond milk, zingy ginger, and earthy and colorful turmeric, which is gaining popularity for its anti-inflammatory properties. Ground turmeric can be found in the spice aisle of most grocery stores.
2. Berries and Spice and Everything Nice
You don’t often see cranberries in smoothie recipes, but we think that’s about to change! Here, vitamin C- and fibre-packed cranberries get added to sweet strawberries and blended with ginger and cinnamon for a little spiciness.
3. It’s Peanut Butter Berry Time
We took the classic combo of bananas and peanut butter to the next level. This smoothie has it all – fresh fruit, extra protein, and it’s dairy-free. The chia seeds add fibre and healthy omega-3 fatty acids.
4. Tropical Fruit Meets Cool Mint
This tangy smoothie is perfect for a hot day. The fresh mint adds a cooling taste, while the pineapple and apple sweeten it up. The vanilla yogurt adds creaminess.
When it comes to smoothies, don’t be afraid to mix things up! Get creative and play around with different ingredients to find the perfect recipe that fits you.
Understanding the What and How of IDDSI/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Jul 20, 2022
Effective Date: Jul 20, 2022
Dysphagia is defined as difficulty swallowing and affects a multitude of people worldwide. The modification of food texture and fluid thickness has become the cornerstone of dysphagia management around the world.
Food textures can have many different names and be defined in a variety of ways depending on where you live in the world. Even right here in Canada, there are a variety of names and definitions for the same textures. For example, a minced diet could also be referred to as soft, mashed, ground, or chopped. These multiple names can be very confusing for everyone but also present a great risk for the individual with dysphagia, possibly leading to aspiration and choking. The solution to this was the formation of The International Dysphagia Diet Standardisation Initiative (IDDSI) founded in 2013 by a diverse group of professionals from around the world. Their goal was to develop new global standardized terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia.
IDDSI is a framework that consists of a continuum of 8 levels from 0-7. Each level is identified with numbers, text labels and colour codes. Food textures are shown as a downward pointing triangle starting with Level 7 (Regular) in which no texture modification is required and progressing toward Liquidized (level 3) where the most texture modification is required. Fluid Consistencies are represented by an upward pointing triangle starting at Level 0 (Thin) and progressively getting thicker through levels 1 (slightly thick), level 2 (Mildly thick), level 3 (Moderately thick) and Level 4 (Extremely Thick). You will notice that Liquidized food texture and Moderately Thick liquids are on the same level (3). Likewise for Pureed and Extremely Thick both being level 4. This is because they take on the same characteristics.
The foods in each level of the framework have their own detailed descriptions, characteristics, physiological rationale for the level and specific easy and practical testing methods to decide if the food meets that specific IDDSI level. Audit sheets have also been developed to assist when testing recipes to determine if it meets a specific IDDSI level.
The implementation of the IDDSI journey can feel a little daunting; however, it is possible (and fun) so long as you have actionable “bite-sized” steps to follow. The first step to the implementation process is appointing an IDDSI champion who will act as the spearhead for this initiative. This individual will start by learning about the importance of IDDSI for resident safety as well as the framework and testing methods. Once they feel comfortable, they will share the importance (and create a general awareness) of IDDSI throughout the home to all departments as well as residents and family members. The next step would be to set up your home’s IDDSI implementation team. This team will be led by the IDDSI champion. This would be a multidisciplinary team and include all departments affected by IDDSI. This should include a mixture of both management and front-line staff involved in resident care or feeding. This team would be responsible for reviewing current policies and practices related to resident eating and to determine the implementation tasks that need to be completed along with an implementation timeline. This team would also determine the team members who will be responsible for specific tasks and identify possible challenges that could be encountered.
Although IDDSI is not mandatory, having one national and international language to talk about dysphagia and texture modified foods is considered best practice. More and more organizations are implementing IDDSI. Manufactures are also embracing IDDSI. They have started to map their existing products to determine how their product fits into the IDDSI framework. They have also been developing and/or reformulating current texture modified products/fluids to meet the IDDSI framework. Labels of texture modified products have started to appear with either dual labelling or full transitions to the IDDSI terminology.
Members of Complete Purchasing Services are encouraged to visit the eCPS members portal to find valuable information on IDDSI which includes many articles, webinars; as well as an IDDSI Implementation Guide and Planner.
You can also visit www.IDDSI.org to find detailed information on descriptors of each IDDSI level. There’s an IDDSI YouTube channel with food- and fluid-testing videos, as well as recorded webinars on IDDSI updates and experiences of implementing IDDSI in various healthcare settings. The IDDSI site also offers publications, including research articles and reports, FAQs, and many printable consumer handouts. This information also can be accessed via the free IDDSI app (available for iOS and Android devices) and by following IDDSI on Twitter @iddsi_org. If you are considering implementing IDDSI in your facility, the IDDSI.org website also has an implementation guide which can help.
Use of the IDDSI Framework
The IDDSI Framework and Descriptors are licensed under the CreativeCommons. By Attribution Share Alike 4.0 License https://creativecommons.org/licenses/by-sa/4.0/legalcode. Attribution is requested as follows: (c) The International Dysphagia Diet Standardisation Initiative 2019 @http://iddsi.org/resources/framework/. Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death. http://iddsi.org/framework.
About the author, Heather Stukalo
Heather joined Complete Purchasing Services in 2016 as a Registered Dietitian with the Menu & Culinary Support Team. Heather has extensive knowledge in menu planning and the International Dysphagia Diet Standardization Initiative (IDDSI), having lead the CPS Menu Development team's integration of the new framework, and is a member of OSNAC (Ontario Seniors Nutrition and Advocacy Committee) and FNAT (Food and Nutrition Advisory Team. Prior to working with Complete Purchasing Services, Heather worked in LTC for 26 years in both corporate and clinical roles. She has also worked as a Home Care Dietitian for 5 years.
Make the Most of Summer’s Finest Fruits and Vegetables/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Jul 07, 2022
Effective Date: Jul 7, 2022
The summer season comes with many joys. But one stands out from the rest: gardens and farmer’s markets bursting with crisp vegetables and juicy fruits in their prime. From sweet corn, green beans, and summertime squash to stone fruits, heirloom tomatoes, blackberries, and more, the abundance of fresh produce this season makes it easier to eat our way to better health and all the nutrients will help you feel energized and ready to take on the day.
Here’s the scoop on how to choose, store and use your colourful summer’s bounty:
Nothing says summer quite like sweet corn. Sweet corn straight from the cob is high in fibre, packed with antioxidants and is downright delicious. Sweet corn will stay fresh for about five days if stored properly in the refrigerator, and it can be grilled, boiled, or even microwaved. Aramark Chef Scott Zahren loves sweet corn tossed with a small amount of light mayonnaise, lime juice, smoked paprika and cayenne pepper for a quick and easy version of Elotes or Mexican Street Corn. We’re a fan of adding it to our lunch grain bowls, too!
Crunchy cucumbers can help us hydrate and stay, as the saying goes, cool as a cucumber. Plus, cucumbers couldn’t be easier to eat! They are best eaten raw and can be enjoyed with or without the peel, making prep a breeze. For a simple, no-fuss dish Aramark Chef Scott Zahren recommends a fresh cucumber salad made with cucumbers, onion, fresh dill, a dash of sugar, salt, and pepper and a splash of cider vinegar. In the mood for something creamy? Take on Tzatziki, he says. This yogurt-based sauce, traditionally used in Greek-style meals like Gyros, utilizes fresh cucumber, onion, and garlic. You can even sub in Greek yogurt for regular for some added protein.
Peaches have more than 20 micro and macronutrients, including fibre, vitamins, A, C, E, and potassium. They also contain the antioxidant beta-carotene. While they are delicious with no preparation, sometimes peaches bruise. Fortunately, there are plenty of ways to use up those not so pretty ones. Try Aramark Chef Bill Allen’s Fired Up Peaches, a zesty hot sauce that you can use to add a bit of bang to your burger. To make it, put peeled peaches and tomatoes, chilis, salt, sugar, and a little water in a saucepan, bring it to a boil and reduce. Cook it until the peaches are soft, and then cool the mixture for a bit and puree. Store it in the refrigerator or enjoy immediately! Other peach options include drying slices for a nutritious, chewy snack or grilling with cinnamon or nutmeg for a tasty, healthy dessert.
Tomatoes have plenty of nutrients, including vitamins A and C and the antioxidant lycopene. And, with so many varieties to choose from, it’s easy to include tomatoes in lots of dishes. Just remember to store your tomatoes stem end up on the counter to prevent bruising and to keep them tasty. The cold temperature in the fridge weakens the flavour and prevents tomatoes from fully ripening. Aramark Chef Scott Zahren is a fan of using tomatoes in Israeli Salad. He combines Israeli couscous, fresh tomato, cucumber, herbs, and a vinaigrette dressing. The wonderful thing about this dish is that it’s so versatile! Try parsley, mint, or chives for the herbs. For additional nutrients throw in bell peppers and spinach. You can even swap out the couscous for another grain, like quinoa.
Don’t know how to select a watermelon? Look for a firm, symmetrical melon that doesn’t have bruises, cuts, or dents. Lift the watermelon and select one that is heavy for its size with a creamy yellow spot on the underside from where it sat on the ground. Watermelon is tasty and easy to enjoy sliced, but there are plenty of other ways to eat it, too. While we love a good watermelon feta or cotija salad, we’re also big fans of Aramark Chef Bill Allen’s savory Watermelon Prosciutto Salad. Mix cubed watermelon, arugula or other greens, a small amount of thinly sliced prosciutto and parmesan cheese, and olive oil and balsamic vinegar for his Italy-inspired dish. Another option is to make watermelon ice cubes. Watermelon is 92% water, so you can cut it into cubes and freeze it on wax paper. Then, use the cubes for added colour and flavour in lemonade and iced tea!
Note: Since everyone’s health history and nutritional needs are so different, please make sure that you talk with a registered dietitian to get advice about the diet and exercise plan that’s right for your residents.
Understanding Resident Mental Health Challenges in Long Term Care/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Jun 22, 2022
Effective Date: Jun 22, 2022
For many residents, admission to Long Term Care (LTC) is either preceded by poorly managed mental health, or the admission itself may trigger a decline in mental health. It is imperative to determine the resident’s mental health perspective, from the time of admission and moving forward, each subsequent day. Just imagine experiencing all the losses that newly admitted residents are confronted with, without having anyone to talk to about it. Experiencing loss is an expectation as one ages, but the benefit of talking about it and having others share in the grieving experience is so important and can significantly change the quality of life for the resident.
The rate of diagnosis of depression for residents living in LTC is 44%. (Canadian Institute for Health Information, 2010, 2015) It is believed that this number is low! We know that in the general community people who are depressed are stigmatized. This stigma is even more prevalent in the elderly, so the resident does not tell anyone that they have a low mood. Staff see it, but this is often after some time has passed. The resident may not participate in activities provided in the Home, there may be a lack of social interaction with others, as well as a growing isolation away from others.
For Homes who follow a Recovery Philosophy of Care, a partnership that focuses on the individual’s strengths and values, will allow the resident to truly be their best selves and to feel supported in their daily lives.
Admission to Long-Term Care
People who have lost the ability to function independently in the community are admitted to LTC for assistance in activities of daily living (ADLs) and Instrumental Activities of Daily Living (IADLs). Changes in ability to function in the community may be related to a medical acute crisis causing delirium, advancing dementia, loss of caregiver in the home and/or poorly managed mental illness, including depression and anxiety. A history of drug and alcohol abuse may also contribute to the admission, given that as one ages the ability for the body to manage excessive drugs or alcohol diminishes.
Little is known about the difference between grieving (complicated or typical) and depression. The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition. (American Psychiatric Association. 2017. Diagnostic and Statistical Manual of Mental Disorders. 5th edition)
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)
5. Fatigue or loss of energy nearly every day
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Persistent Complex Bereavement Disorder
The diagnosis of Complicated Grief is now Persistent Complex Bereavement Disorder. It is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who experience an unusually disabling or prolonged response to bereavement.
Persistent complex bereavement disorder causes sufferers to feel extreme yearning for a deceased loved one, usually over a prolonged period. Feelings of longing are often accompanied by destructive thoughts and behaviors, as well as general impairment in resuming normal life. (American Psychiatric Association. 2017. Diagnostic and Statistical Manual of Mental Disorders. 5th edition)
Use of the Social Readjustment Scale can help the staff determine if someone is grieving for all the loss they have had in the past year, along with any changes that are stressful. A score of 300 increases the risk of the person having a mood disorder to 80%. Some common losses/changes newly admitted residents experience are: death of a spouse; marital separation (frequently only one of the married couple is admitted to LTC); personal injury or illness; retirement; change in financial state; change in living conditions; change in residence; change in recreation; change in social activities; change in sleeping habits and change in eating habits. A loss of a care giver in the home or a change in medical condition (diagnosis of dementia, progression of life limiting illness such as COPD or Heart Failure) can cause all these other changes to occur for the person being admitted to LTC.
Understandably admission to LTC is a busy time for the staff, resident, and family. There is a period of adjustment. One step that can ease the burden on the resident is to support them in their grieving. Grieving is a natural way for people to allow emotions of shame, guilt, sadness, and anger to be present and managed. One way of supporting the person is to open the conversation by asking, “What have you left when you moved to LTC? How do you feel about everything that is happening? Have you had some control over how things have gone for you recently?” To grieve one needs to express how things are feeling for them. This may be the first time anyone has had this type of conversation with the person. Holding an unconditional positive regard for them allows for a supportive and respectful environment. It can go a long way in helping with the adjustment to living in LTC.
These conversations rarely happen when one is admitted to long term care. Not being able to grieve can lead to Persistent Complex Bereavement Disorder which may result in depression and a loss of hope. The presentation of grieving a loss, or many losses, is significantly different than depression. A simple discussion with the person about what they have lost can often spark a smile or laugh as they remember how things were. In depression there is apathy (do not care about anything, unmotivated), anhedonia (lack of pleasure in anything) and in the older person we see anxiety as a primary expression of depression.
Depression signals a problem in the neurotransmitters in the brain, especially serotonin and dopamine. Antidepressants will generally be effective in treating Major Depressive Disorder (MDD). Antidepressants will not change the mood for someone who is not depressed but are instead grieving. There is also evidence that Antidepressants can account for significant medical concerns and are not effective for those who have been diagnosed with depression and dementia. This may be because the diagnosis of MDD is not accurate in this population. Perhaps they are grieving their many losses. It is interesting that this group finds supportive counselling, including Cognitive Behavioural Therapy, helpful in improving mood, quality of life and ability to perform ADLs. (Orgeta, V., Leung, P., del-Pino-Casada, R., Qazi, A., Orrell, M., et al (2022). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systemic Reviews).
Dementia and Depression
Many people admitted to LTC have either early cognitive impairment or a diagnosis of dementia. Staff are challenged to get a thorough history of the persons health when they are admitted and even more difficult to determine the resident’s mental health history. Families are not always aware of a diagnosis of depression, and up until this time have allowed the person to manage their own health, with their primary care provider. As challenging as it seems, a good mental health assessment should be completed.
There may be some information about the resident’s medications, and on admission a thorough medication review is completed. Frequently residents are on a very low dose of an antipsychotic or antidepressant, often prescribed to help with sleep, not to treat a mental illness. Many of these medications are sedating. (Health Quality Ontario. (2015) Looking for Balance) If the reason for these medications is insomnia, a sleep assessment needs to be completed to determine why the resident is having trouble sleeping. There may be an underlying physical or mental health concern that has not yet been discovered and diagnosed.
We have discussed the scenario for most people admitted to LTC. They have their families and supports with them and sometimes even have a say in their care if they have not been deemed incapable. But what about the other people - those admitted through hospital or from home because they are no longer functioning independently? They come with no one. No supports, or perhaps a family member who is present at admission and only visits periodically. These residents are often described as having a “difficult personality”. They present as mean and angry all the time, and if things are going well in the common area, they will disrupt the calm with outbursts and maladaptive behaviour.
Often, there is a belief by staff and other residents that these residents behave this way on purpose and families, when they are present, say that they have been this way their whole lives.
Maladaptive behaviours are often a symptom of a Personality Disorder. People who have trended a certain way in their personality will often, because of stresses and losses, follow that personality to an extreme. When the behaviour affects their social and occupational functioning, it becomes a disorder. Examples are Narcissistic Personality Disorder, Borderline Personality Disorder and Obsessive Compulsive Disorder.
Personality Disorders begin with trauma and/or neglect in childhood. During childhood the immature brain tries to make sense of the abuse/neglect from someone who should be caring and nurturing them. Core beliefs are changed in these individuals. The core beliefs of someone with a personality disorder are:
1. The world is a dangerous place
2. No one loves me
3. I am unlovable
Of course, the person does not have access to these core beliefs and their behaviour is subconsciously driven. Because of the trauma the amygdala (fight or flight center of the brain) is left in the “on” position, citing danger to the person subconsciously when things are good, when things are neutral and when things are bad. There is a sense that because the person survived the trauma in childhood, they are more comfortable when things are bad. Often in good times they will sabotage the environment affecting those closest to them. This then causes a break in the relationship. Another aspect of the person with a personality disorder is that they are always the victim. Because the behaviour is driven subconsciously, they have a difficult time taking responsibility for the behaviour, and when addressing the maladaptive behaviour, we often hear, “you made me do it”.
Personality Disorders are described in the Psychiatric world as Axis II, preceded by Axis I diagnoses such as Major Depressive Disorder, Schizophrenia, Bipolar Disorder. There is no medication to manage Personality Disorder. In LTC what works is a consistent, assertive approach by all staff. This approach must be gentle, kind, and supportive, and when staff realize that childhood trauma is the cause of the personality disorder, they find it much easier to be supportive. Unfortunately, very little attention is given to the person with a Personality Disorder. We rarely see a diagnosis, and often the person has never had any mental health care. What they do have is many broken relationships, and in LTC they have burned all their bridges and are left with little to no family support.
The mental health of residents admitted to and living in LTC is impacted significantly by mental illnesses such as Depression and Personality Disorders (with a history of trauma). Many residents have also experienced losses over a short period of time and have not been assisted in grieving these losses. Instead, they have been moved away from a familiar, personal environment to a congregate LTC setting with many other older people. When left unsupported many residents may feel hopeless and depressed. A Recovery Philosophy of Care can support these residents by respecting the individual and encouraging them to share their story in all its beauty, hope, and sometimes yes, with despair.
About the Author
Franzis Henke, Nurse Practitioner.
As a Silver Meridian Associate, Franzis provides extensive expertise in Palliative Care, working with the dying and their families, Geriatrics, and Geriatric and Adult Mental Health. She is also a Mental Health Specialist and is the co-facilitator of RecoveryCare Mental Health Program. https://silvermeridian.com/resident_focus/mental-health-recoverycare/
Silver Meridian is pleased to present a new program, developed and presented by Franzis, “New Approaches to Palliative Care in LTC: Embracing the Opportunities” starting in early July. Details for this 10 hour accredited CEU certificate program are available at https://silvermeridian.com/new-approaches-to-palliative-care-in-ltc/
For details on all Silver Meridian programs visit https://silvermeridian.com
Palliative Care in Long Term Care: Re-thinking the Purpose and Approach/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: May 19, 2022
Effective Date: May 19, 2022
Care for the dying has been an important and expanding function in Long Term Care (LTC). Over the past 10 years the typical length of stay has been shortened to approximately 18 months and the stay usually ends in death (Canadian Institute for Health Information, 2015). Many care centers have been supportive of a person-centered, palliative approach to care, but unfortunately, others have not made this adjustment.
Palliative Care, death and dying have been practiced, experienced, and accomplished in Long Term Care (LTC) for as long as these institutions have existed. However, until the first death from COVID 19 occurred and subsequent deaths, very few of the general population had any sense of what LTC looks like and how it is for the residents living there, and the staff working there. As residents and staff continued to contract and die from COVID 19 the lens on LTC, especially by the media, was adjusted and the government ultimately held accountable. Statistically LTC residents accounted for 3 % of the COVID cases and 43% of all deaths by COVID in Canada (Canadian Institute for Health Information (CIHI), and National Institute on Ageing; COVID 19’s Impact on Long-Term Care, December 9, 2021). This truth has led to changes in The Long -Term Care Act that include a need for adoption of a Palliative Care Philosophy in LTC. (Ontario’s Regulatory Registry. Fixing Long-Term Care Act, 2021; Phase I Regulations).
The Long-Term Care Act is now asking for the following to be adopted into LTC during Phase I. “Requiring that integration of a palliative care philosophy include a holistic and comprehensive assessment of a resident’s needs and when needed, improvements to a resident’s quality of life, symptom management, psychosocial supports and end of life care, always subject to a resident’s consent.” (Ontario’s Regulatory Registry. Fixing Long-Term Care Act, 2021; Phase I Regulations).
So, what does it mean to incorporate a Palliative Philosophy of Care? From Bill 37 (Part II) the elements that must be included are:
1. Quality of Life Improvement
2. Symptom management
3. Psychosocial support
4. End of life care
Let’s step back for a moment to pre COVID. In 2019 people were moving into LTC for various reasons. Most could no longer function independently at home, even with some support. This may have been for medical reasons, such as final stages of a life limiting illness (Dementia, COPD, Heart Failure, Cancer…), a serious and poorly managed mental illness leading to an inability of the person to care for themselves, or the loss of a primary caregiver (often a spouse) due to death. The Social Readjustment Scale is a helpful tool that indicates all the losses many people experience prior to and on admission to LTC.
So why are people coming to live in LTC.? For physical care of course, and potentially for some improvement in function now that they have support, and the little talked about, but yes, to die. The first two items are always talked about as encouragement to come and live in LTC and in an attempt to persuade the person to leave their home and all that they know from a social perspective. Rarely is the person told that their dying time will probably come while they are living in LTC and that this will be their last home of this life.
So now the expectation is that discussion about the Palliative Philosophy of care is completed prior to admission to LTC. Wow! How is that discussion going to go when we live in this death phobic society where death happens to us, but really against our will. Many say, “we are born to die” and yet we see the struggle to even discuss what our death may look like and how we would like it to go. When we do talk about our death at all, it is way in the future, or we ask to prolong it and get “more time” for as long as possible.
Let’s briefly discuss this concept of “more time”. Stephen Jenkinson discusses this in his writing in Die Wise: A Manifesto for Sanity and Soul, 2015. People who are dying will ask for medical treatment to get “more time”. What they mean by this is more life or longer life, but what often happens is that dying is prolonged. The quality of life is not what people were hoping for and yet when treatment is offered, they grab the chance to have more time, not knowing what this will look like. With a Palliative Approach to care, we must be honest in our discussions with people. If they are asking for “more time” or being offered treatments which may give them this time, we need to paint the picture of what this “more time” may look like. Most are surprised that the treatment, at best will prolong their death, not improve, or increase the time of their living.
The requirement to now discuss Palliative Care prior to admission is really a requirement to discuss life in LTC and death during the stay. Re-thinking a palliative approach is so important for people so they to have a say in their last days of this life. Using a Palliative Approach to care means that conversations about how the person may die (disease projection) are discussed with the person along with any treatment options, quality of life and symptom management, and who their people are, including Substitute Decision Maker (SDM). They may come into LTC with an Advance Care Plan already in place and this would need to be revisited. Often no discussions about their dying time have happened and now it is up to the LTC staff to have this frank and difficult discussion perhaps for the first time.
Included in the new LTC Act is the need for consent to give care following a Palliative Approach to care. This has long been a concern for some working in the LTC sector, as people are often admitted to LTC because they are deemed incapable to live independently. This includes difficulty completing Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs) independently. Persons admitted to LTC often come with a broad diagnosis of Dementia and families, caregivers and staff often believe that this diagnosis predetermines that the person can no longer make decisions or give consent for any treatment or care. This belief is false. It makes great sense to always include the person coming to LTC in all discussions so that they have the opportunity to give consent.
The easiest way to talk about someone’s dying time is to respect their input. And listen. These difficult conversations need not be so difficult. Ask the person why they have come to live in LTC. They will tell you about of all the changes and losses in their lives. And here there can be hope! By living in LTC they are able to talk about their dying time coming, without it being minimized or brushed aside. They will see co-residents complete their dying here, and with an open discussion about this life ending soon, people can enjoy their lives without the doom of the unspeakable and not talked about event of their last days here.
Staff in LTC have such difficulty in having these discussions with people and yet these discussions should come so naturally, especially if people know that they are approaching the end of this life. And that is the key - people do not know that their dying time is coming soon. Instead, what is discussed is that the reason they have come to LTC is because they are no longer able to manage their life and health independently, and they need a higher level of care. Families may, on some level, know that this is what is happening and still it is rarely discussed. Maybe if we don’t talk about it, it will not happen. Still, we will all die and come to this time in our lives.
We discussed the shorter length of stay in LTC from compared to the past. Most people who enter LTC will die there so length of stay is mostly a measurement of time from admission until the time the person dies. LTC staff members, thus, see a lot of dying. So why the discomfort in talking about it? We would expect that most staff have seen people go “kicking and screaming” to their death. But most have also seen what would be called a “good death” with pain well managed, and family supporting, sometimes in vigil with, their loved one until death. Most of the discomfort in talking about dying must then come from the not so pleasant view of dying. As well, when the dying person does want to discuss their imminent death (which they instinctively know is coming soon) they get told statements such as “don’t talk like that, you have years to live” or “don’t worry, you will get better.” Yet we must question why we would worry about dying when we all know that all of us will die?
Of the 4 elements that need to be included in the palliative philosophy of care, one of the most difficult requirements may be quality of life. Quality of life is a subjective experience, so how do we even measure that? This question should be asked of the resident. But is it? For many people entering LTC making decisions is not left to them. Caregivers and family members make these decisions because “the person is not capable.” That is why they are coming to LTC. And yet the language is very clear that we must have the resident’s consent for decisions. Capability is not a black and white status. It fluctuates and where people may no longer be capable to look after their own finances, for example, they can decide if they want a certain treatment or another, whether they want to proceed with their dying in LTC or whether they want to have treatment (if possible) in another setting. To ask these questions of a resident, they must first know that they are coming close to their dying time.
Having that frank and honest conversation with someone can be a synergistic time for all involved. How freeing it is to talk about your own dying, when you know you are doing it, with someone who is comfortable talking about it. I have been with so many people who are dying and there are common themes which can make these discussions much easier to have. First of all, look to the psychology world where Erikson says that people progress through stages in their life, and which way they go can greatly influence quality of life and death. For the population living in LTC we will look at 2 Stages. Age 40-65 years old is covered by Generativity versus Stagnation. Age 65-death we look at Integrity versus Despair. So. if we do not encourage conversations about what coming to LTC means we will often see stagnation and despair. When speaking to many staff working in LTC, what they see is older people, with many losses recently in their lives, brought to LTC by family and left there without having a sense of what changed in their lives to bring them here. The Palliative Philosophy brings an honesty to the conversation. Yes, you will probably die here, but how can that life look before death. Is there an opportunity for Generativity and Integrity? Probably not if the person being admitted is not involved in the conversations. It is important for staff to have the person being admitted present and giving their consent to all care offered. No matter their capability, they should be present and included always in these conversations. (Erik Erikson’s Stages of Psychosocial Development. (Kendra Cherry, July 18, 2021).
What we have also seen is that at the end, just before death (weeks to days), people struggle to leave their legacy. Legacy leaving is interesting, but what we see is an attempt, often very late, to show one’s true self or self actualize (as Maslow would put it). How one shows their true self would mean another article, however in simple terms it means showing who you are from a strengths and values perspective, being free now of all defense mechanisms and maladaptive behaviours. We often, throughout our lives put up walls and wear different faces, our perception being that we will be more pleasing to others if we act the way we think they want us to. This does us and others a disservice, and at the end of our lives we try desperately to come clear of this.
We also see such mystery around our dying time. Again, do we ever talk about this to our resident’s. Do they know that near their death they will probably see their dead (loved ones who have already died) and that they will find great comfort in this? Most of us, who have worked in LTC have seen these mysteries. What a great opening to relate these stories to move to a discussion about your resident’s dying time. We need to find out what quality of life means to them, and it goes beyond symptom management. It is so much about leaving a legacy of who they are for those they are leaving in their dying.
In summary, we are regulated now to provide a Palliative Philosophy of Care to all residents in LTC. As noted, consent for this care must be given by the resident. Let us proceed with the honest conversations, which, yes, are sad in that we will all die and leave this life as we have known it, but what a glorious time this dying time can be if we just open up to its importance as the last significant act we will do in this life.
About the author, Franzis Henke, Nurse Practitioner.
As a Silver Meridian Associate, Franzis provides extensive expertise in Palliative Care, working with the dying and their families, Geriatrics, and Geriatric and Adult Mental Health. Silver Meridian is pleased to present a new program, developed and presented by Franzis, “New Approaches to Palliative Care in LTC: Embracing the Opportunities” starting in early July. Details for this 10 hour accredited CEU certificate program are available at https://silvermeridian.com/new-approaches-to-palliative-care-in-ltc/
For details on all Silver Meridian programs visit https://silvermeridian.com
Posted Date: May 11, 2022
Effective Date: May 11, 2022
The concept of “liberalized diets” has been around for some time within senior living but it is receiving increased attention as more is being understood about the role diet can play on quality of life and seniors health. This approach is also now being published in reference guides such as the Dietitians of Canada document, Menu Planning in Long Term Care (2020) - an influential guide for planning your menus in Canada. If you have not done so already, now is the time to start evaluating if this approach would work in your home.
What exactly are liberalized diets? Simply, a liberalized diet is one that is a non-restrictive or non-therapeutic diet. In practice, this means that residents who have diabetes for example, are not given a separate “diabetic diet” and instead receive the regular diet. Based on this simple definition, liberalized diets can often be misunderstood to mean that the residents’ health is not important, when in fact this is not at all the case. Instead, the adoption of liberalized diets represents a shift in priorities for the older adult. Whereas a younger person with diabetes living in their own home may have a goal of maintaining good blood sugars; that same individual 30 years in the future and now living in a care setting, may have the primary goal of enjoying life and maintaining their body weight. It is not that blood sugar control for the older adult does not matter, it is just that it does not matter as much as it once did. Quality of life is now paramount and weight loss and malnutrition are a greater risk to their health than elevated blood sugars. Indeed, this exact approach is also endorsed by Diabetes Canada, which states, “In older long term care residents, regular diets may be used instead of ‘diabetic diets’ or nutritional formulas.” This shift in priorities for older adults is what drives homes to liberalize their diets but doing it right is just as important as doing it at all.
Many people may question the safety of adopting a liberalized diet approach. Clinical staff, family members and the residents themselves may be concerned about what a change to the resident’s diet will do to their health. These concerns could be addressed by promoting the change through a presentation to staff and a separate one to residents and family. There are numerous organizations that have endorsed this approach, especially in long-term care. The Pioneer Network, the American Dietetic Association as well as the Dietitians of Canada Menu Planning in Long Term Care (2020) document, all have especially useful information about this approach and why it should be considered. These could be used to build the case for moving toward liberalized diets in your home.
Most importantly for adopting liberalized diets however is ensuring that the regular diet will continue to meet the residents’ needs, even if they have diabetes. The diabetic diet cannot simply be eliminated, and all residents moved to the regular diet without some adjustments to the base regular diet. For those in long-term care with diabetes, the type of carbohydrate is not as important as the timing and consistency of amounts received. Having a “regular” piece of cake with dinner is ok, so long as the amount of carbohydrates at each meal and is consistent from day to day. Not surprisingly, this approach is called “consistent carbohydrates” and is recommended for those with diabetes in care settings. In addition to consistent carbohydrates, evenly distributed protein between meals is shown to be effective at reducing unintentional weight loss in older adults and should be considered on all long-term care menus. Both approaches require menu management software with nutrition analysis to ensure your carbohydrates are consistent and proteins evenly distributed, day to day.
Finally, if you choose to adopt liberalized diets and eliminate some of your therapeutic diets, there will still be exceptions to the regular menu for some residents. This is where the clinical staff will need to develop individual meal plans or changes to the standard menu, as they do today. This process will not change; however, the default menu for new residents will be the regular menu until there is reason to change it, instead of the other way around.
With an increasing emphasis on resident quality of life in seniors' homes, liberalized diets are no longer an innovative trend and are now something worth considering for all homes.
Why “Now” is Not the Best Time to Quit!/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Apr 27, 2022
Effective Date: Apr 27, 2022
For anyone working in long term care, the pandemic has become the primary talking point and focus of attention in almost every conversation. The pressures and demands on staff have resulted in unprecedented levels of absenteeism, turnover and staffing shortages. If people were considering retirement or a career change, for many this has been seen as the ideal time to move on.
While such decisions may seem prudent in the heat of the moment, pausing to reflect may prove to be the wiser choice. In the face of many challenging realities, there are compelling reasons to step back and reconsider a decision to quit working in long term care. This period of change and uncertainty is providing “golden opportunities” to grow and excel, for those who embrace the challenges.
When there is a shortage of magic wands to deal with major disruptions, with insight, some people are able to embrace golden opportunities, and make their own “magic.” We want to share some examples of these golden opportunities.
While not everyone may be able to incorporate every opportunity listed here to make magic in their personal workplace experience, there are enough opportunities to ensure that every employee can find a way to embrace the challenge, and realize more positive realities for themselves.
Opportunities Abound. The bad news is, many people are quitting. The good news for you – many people are quitting! With this much turnover, your chances of advancing are dramatically improved – where you are working now. You have automatically moved up the ladder, whether it is in terms of seniority, experience or workplace knowledge. Your skills are probably more in demand now than they have ever been. A golden opportunity to move to a new position or role you have been wanting.
Which leads to…
Leverage to Negotiate. You are now in a better position to discuss these personal “upgrades,” whether it is a change of role, responsibilities, an increase pay, or perhaps requesting more coaching, training or education to upgrade your skills. Don’t be shy about talking to your manager about what you want – it not only reflects your personal motivation, but reinforces your commitment to your work.
From The Pot Into the Fire? Yes, you are dealing with significant challenges in your long term care role today. But, you do know what you are up against. Do you really know what another place is going to be like? When you talk to other employers, are you really getting the full picture? Over the years we have witnessed people who have left for the “greener pastures” (such as increased compensation), only to return because the picture looked much different, once they were on the inside. Step back, look around at what you have, and consider the positives of your current workplace.
Friends and Acquaintances. Never minimize the importance of the relationships you have in your current workplace. It has taken time to develop your workplace relationships, those connections built on mutual trust and respect. Do you really want to start over somewhere new? Think about it – when you enter a new workplace, you have to seek out and work on developing new and strong relationships, among people who don’t need you for that – they already have their own relationships in place before you arrived!
And while we are talking about relationships…
Your Mentor or Advocate. If there is someone in your workplace that values you and supports you in your role, then you already have a built-in relationship that works in your favour. Leave now, and go somewhere else? Maybe for a while the person who hired you will be in your corner, but the pressure will be on you to prove yourself quickly. You have had an extended period of time to foster the relationship with your current mentor or supervisor. These troubled times are a great time to cement that relationship even further, by letting them know how committed you are to your work, and to your Home.
Your Reputation. If you are known as someone who works hard, gets things done, works well with others, is an effective leader…whatever…remember that you are known for those qualities where you work now. If you decide to leave to work elsewhere, you might tell people you have these qualities, but without the benefit of time and experience, they won’t have a reason to believe you. You have earned your reputation – don’t waste it.
Self-Reflection and Insight. So, you are considering leaving your job because (fill in the blank). Before making such a decision, take a long, hard, and honest look at why you are considering such a move. Make a list of all the reasons. Then, when you are done, beside every item on your list, write down what you have done to address each of these reasons for leaving. Have you shared your concern with your peers, your supervisor or someone who might be able to support you? Have you honestly dealt with the person who is the reason you want to leave? In other words, by reflecting on what you have done, and what you haven’t done, it might provide you with some insight as to what you should do before making the decision to leave. Remember the earlier Pot and the Fire example. Maybe there are some things you can do now, and avoid a bigger “scorching” somewhere else!
Now That I’m Hired – I Quit! How many times have we seen the newly hired employee who maybe completes their orientation, and then quits within a matter of days? So frustrating for the Home, and so disrespectful of the residents. We know, you didn’t know it was going to be this hard! But before you jump ship, think about this: 1) Why did you start down this long term care path, and if was to make a difference in the lives of residents, then that IS what the job is all about. So don’t give up on your dream; and (2) if it was easy, everybody could do it! It’s not easy work, but the joy and sense of accomplishment you will feel as you gain experience and confidence, and realize the impact you are having on your residents, will make it all so worthwhile.
If you took this job because you needed a job, and are not passionate about making a difference in the lives of residents, then please quit – now! You are getting in the way of people who care.
Because You Are You. The thought of people leaving the long term care sector reminds us of one of the many stories about Steve Jobs. As the young founder of Apple, Jobs was trying to lure the top-level Pepsi CEO, John Scully, to manage the company. When Scully turned Steve’s offer down, Jobs leaned in close to Scully and said, “You want to sell sugar water for the rest of your life, or do you want to come with me and change the world?”
Jobs challenged Scully to reflect on how he wanted to be seen and remembered. These are challenging times for everyone working in long term care. What you do every day, is about changing the world – the world of the residents you serve. As a human being, your beliefs about who you are as a person are measured not by what you say you stand for, but by how you respond in the face of such challenges. We all need to ask ourselves, “When I reflect back on my life, what do I want to see in my rear-view mirror?”
We believe that because of where you are today, having gone through what you have experienced over the past two years, who you are as a person is not in question. The question now is, are you up to what we hope and anticipate is the final stage of this most horrific challenge of our collective lives?
Hopefully, we have shared some insights that will inspire you to seize one or more of these golden opportunities, to help you make it over the top, and realize new successes in your career, and in your personal life.
You deserve it.
Your residents are worth it.
You can do it!
About the Co-Authors
Darlene Legree has over 35 years of diverse experience in long term care, from direct care provider, registered nurse, to management and staff education positions. With additional education in Nursing Informatics, MDS and Adult Education, and receiving her Gerontology Certification from the CNA, Darlene provides training and consulting in clinical, documentation, leadership and organizational practices. Darlene sits on the executive of Gerontological Nursing Association of Ontario – Central East Chapter and is the co-owner of Silver Meridian.
Ron Martyn (BSc Recreation, MSc Gerontology) has served as a Recreation Director and Administrator in long term care, and as a Retirement Home Owner. For over 20 years as the Co-Owner of Silver Meridian, Ron and the team have helped LTC managers hone their leadership skills, by empowering and energizing people, and becoming recognized as Inspired Leaders in the provision of care (English only). Go to Silver Meridian (https://silvermeridian.com) for more details.
Ingredients for a Healthier Tomorrow in Senior Living/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Mar 25, 2022
Effective Date: Mar 25, 2022
This year’s month of March 2022 marks Dietitians of Canada’s 40th anniversary for Nutrition Month, which is an event shared and promoted by Dietitians across the country. Complete Purchasing Services (CPS) is happy to share this year's theme “Ingredients for a Healthier Tomorrow”, with a focus on senior living and long-term care. Under this theme, a popular topic is a use of “Sustainable Healthy Diets”, which is described by the World Health Organization as healthy diets with minimal impact on the environment. We believe there are 3 areas where seniors homes can have an impact on health and sustainability:
1. Sustainable food sourcing
2. Reducing food waste
3. Use more plant-based foods
The goal of this article is to encourage you to question what changes you can make for a healthier tomorrow.
Sustainable Food Sourcing
Sourcing food ingredients that have less impact on the planet is becoming more important as the world evolves. The awareness of climate change is increasing, and the way we run our food operations will affect future generations. One way you can make a change is by sourcing responsibly in your establishment, which involves choosing suppliers that are local, or have sustainable production methods. This can include local produce, or food products with certifications like Energy Star, Green Seal, Fairtrade, and more.
At CPS we are committed to sourcing our food products responsibly, that are made or grown locally across Canada, including Indigenous suppliers. We source humanely raised proteins and are the first food service provider to have a membership with The National Farm Animal Care (NFACC). We also have a partnership with MSC (Marine Stewardship Council) and certifications to have responsibly sourced wild-caught seafood products. For other food categories, we partner with suppliers who have a variety of certifications such as Fairtrade, Organic, Rainforest Alliance, and many more.
Reducing Food Waste
A major barrier to reaching sustainable goals is the significant amount of food wasted in Canada, which according to WRW Canada is estimated to be 58% of all food produced. Amongst senior homes, some contributing factors can include the food demonstration plates (show plates), or lack of implementation of waste prevention practices.
There are several solutions you can implement in your home to minimize food waste. One major tip involves training staff to minimize food waste by monitoring portion sizes, taking inventory, and following best practices for food storage. Leftover food should be recorded to track areas of over production, and inventory should be rotated properly using the first in first out rule (FIFO) to avoid spoilage. Kitchen staff can also be trained in how to cook with food parts often discarded in recipes like broccoli stems for example. Dining rooms can use tablet software such as CPS’s ShowPlates app, to show residents appealing menu images, instead of food plates that get discarded. Finally, your home can minimize food waste by taking resident preferences into account by gathering feedback on menus. Each of these steps can help minimize your home’s food waste impact.
Use More Plant-Based Foods
Our third point for a healthier tomorrow is to include more plant-based foods on your menu. They are full of nutrients, colorful (pleasing to the eye), cost-effective, and can often be sourced locally. They are also useful in targeting nutritional goals recommended in the Dietitians of Canada Long Term Care Meal Planning Guide such as 100g of protein and 30g of fibre daily. These nutrients play a large role in preventing common risk factors in the elderly like malnutrition and constipation. One ingredient to start including in your recipes is beans! They are packed with protein, iron, and fibre, and can be utilized across many recipe categories. Here are some ideas:
Starter: make soups and salads heartier and more colorful by adding beans
Entree: use lentils to replace ground beef in recipes like meatloaf or shepherd's pie
Dessert: try black bean brownies or chickpea blondies
Snack: try new hummus flavours to impress your residents like roasted garlic or fresh herbs
There are many topics to address under the umbrella of sustainability but starting with just one can already bring you towards a healthier tomorrow. Reviewing your supplier list, tracking food waste more closely, or even adding a Meatless Monday to the calendar are a few of the many ways to begin.
At CPS the health of the clients we serve is important to our team and we always strive to make sustainable menus that meet Canada’s Food Guide. We also have vegetarian menus, offering more plant-based options to residents, which you can use in your home. If you would like more information about our menus or food products, please visit ecps.ca.
Happy Nutrition Month!
Monica Chackal, RD
Bilingual Registered Dietitian
Complete Purchasing Services
Keep Calm and Keep Disinfecting!/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Mar 16, 2022
Effective Date: Mar 16, 2022
Make your visitors feel safe when it counts the most.
After two years of trying to keep COVID-19 under control, pandemic fatigue is becoming a real problem. News of another variant makes the return to normal life seem that much further off, which can make it difficult to stay motivated to keep up with the seemingly constant changes. Louise Taillon, Sani Marc’s Director of Training, has been helping clients clean for both health and appearance for more than 30 years. In ‘Your questions in good hands’, Louise answers some important questions about how to stay the course in the fight against COVID-19.
What do new COVID-19 variants mean for building owners?
As new variants emerge you have to keep being vigilant in your efforts to maintain a clean and healthy environment. Even before COVID-19, disinfecting has always been essential for breaking the chain of infection and preventing the spread of germs that make people sick. This includes influenza, noroviruses and E. coli, all of which can be transmitted by hands and high touch surfaces. According to a 2020 report published by Deloitte, 62% of hospitality customers consider cleaning surfaces between interactions as essential to customer safety. 73% of property management employees want to see cleaning taking place throughout the day in order to feel safe, and 83% of retail customers say their perception of a store’s hygiene practices greatly influences their decision to shop there. During this time when people are fearful of entering facilities and interacting with others in close quarters, businesses must adopt new methods of cleaning.
Why is the added vigilance important?
It reassures clients, building users and employees that your building is safe, and it goes a long way towards building consumer confidence. Pandemic fatigue is real, but people still want to feel safe and they welcome any efforts made to protect them from contracting the virus.
What can be done to keep staff and visitors motivated to fight COVID-19?
Let your staff know that by taking extra care in disinfecting and allowing themselves to be seen doing so, they are becoming part of a much bigger solution. Their efforts will not only reflect well on them as employees, they are helping to protect themselves as well as their families, and they are contributing to the clients’ reasons to believe in the company and its values. On a more practical level, encourage good hand hygiene by providing disinfecting wipes and hand sanitizer and keeping restrooms well stocked with hand soap. Use infographic posters to demonstrate proper handwashing technique. Taking steps like these shows that your organization makes customer and staff health and safety a top priority.
What should we disinfect first?
Disinfect what matters. 80% of germs are spread by hands and viruses can live on hands for five minutes. Identify hand touch points (high touch points) and create a schedule to disinfect them several times during a day. There’s no need to disinfect all surfaces several times a day; only surfaces that are touched by multiple people.
When is the best time to disinfect?
Disinfect touch points during the day when building users are present. This helps to create a sense of security, that the building is safe. Clients and visitors who see this are more likely to return.
What is the most important thing to remember when disinfecting?
Respect the contact time or dwell time of the product you are using and make sure your surfaces stay wet with the disinfecting solution for the amount of time indicated on the label. For information about products, tools and turnkey solutions you need to help with COVID-19, visit https://www.sanimarc.com/disinfectant-product/.
Five Tips to Protect Your Property During Winter Months/wps/portal/eCPS/root/public/Resources/Resources/!ut/p/z0/04_Sj9Q1NDE2MTUwMTc11Y_Qj8pLLMtMTyzJzM9LzAHyI6PM4s0dHV09HA0Mfd39HF0NAo1dwtxdPMMMDNzM9HOjHBUBqmk2TQ!!/
Posted Date: Mar 02, 2022
Effective Date: Mar 2, 2022
One of the smartest things you can do as a business owner or property manager is to implement a winter disaster preparedness plan which will allow for you to be prepared for issues that might arise. The colder months not only bring plummeting temperatures but also ice, heavy winds, freezing rain, blizzards and snow that can wreak havoc on your business and your bottom line if you aren't prepared.
Winter storms can create a higher risk of car accidents, hypothermia, frostbite, carbon monoxide poisoning, and can knock out heat, power, and communication services. Know your area's risk for winter storms and pay attention to weather reports and warnings of freezing weather and winter storms. Sign up for your community's warning system or visit The Emergency Alert System (EAS) for emergency alerts, so you can stay on top of any potential threats related to winter weather conditions.
With the potential threats that the colder months can bring, businesses need to take every step possible to winterize commercial facilities including:
1. Avoiding Frozen Pipes and Plumbing Issues: Take steps to avoid frozen pipes by checking exposed exterior pipes for signs of cracks and openings that can lead to water leakage and freezing. Seal any cracks that are identified. Keep interior temperatures at a minimum of 55 degrees at all times during the colder months.
2. Checking and Inspecting Building Insulation: Have an expert come in to check your HVAC systems to see if interior or exterior insulation needs to be replaced. Routinely replace all building air filters. Old or inadequate insulation and filters can lead to higher energy costs.
3. Inspecting Roof Space and Clearing Debris: Clear your building's roof space of leaves and debris that can cause blockage of gutters. Doing this will allow melting snow to properly drain away from the building. Clearing debris can prevent ice dams and heavy snow from buildup on your roof which will prevent excessive loads on the roof and can cause unwanted structural damage.
4. Routinely Checking Property During Cold Periods: Check your commercial spaces regularly, at least once per week during the coldest months and winter storms, to identify a potential issue before it becomes a problem.
5. Partnering with a Restoration Professional: Develop a partnership with a professional restoration company that offers emergency planning services, so you are prepared if the worst happens despite all of the preparation. A trusted restoration company can help you create an emergency response plan in the event of winter weather related emergencies.
About FIRST ONSITE
FIRST ONSITE is Canada’s leader in disaster restoration for commercial properties focused on prevention, preparedness, response, mitigation and recovery. Locally-based and backed by extensive national resources, they can be first to arrive and first to make a difference when (or before) you need it most. Their unmatched speed, scope, and scale combined with and excellent team of professionals committed to excellence, service, and doing the right thing, ensures they can help your business whenever their services are needed...no matter what!
The RPN/LPN Leader in LTC: Facing the Challenges and Realizing the Opportunities
RPNs/LPNs working in long term care (LTC) love their profession, despite the many challenges and hardships they encounter. Their profound concern for the well-being of the residents is driven by their deeply held values and a desire to provide the highest quality of care possible. This translates into a passion for, and commitment to, the residents who live in the Home.
Redefining Your Dining Experience with Kind Dining
From the moment we rise each morning to the end of our day, we interact with people. Ordering a beverage at a café, buying groceries from a cashier, having and order delivered from a server. These simple connections with one another can have a positive, or even negative, impact on our mood and influence how with interact with each other. Cindy Heilman, creator of Kind Dining® training series, shares the benefits of redefining the dining experience with kindness, specifically in senior living.
4 Smoothie Recipes to Bust Out of Blender Boredom
Whether you’re rushing off to work or looking to refuel after the gym, smoothies can be a healthy, grab-and-go option. Well-made smoothies are a delicious way to help get the fruits (and veggies!) you know you need, complete with an extra boost of vitamins and minerals to give you the energy to conquer your day. Read on for some delicious smoothie ideas.
Understanding the What and How of IDDSI
Food textures can have many different names and be defined in a variety of ways depending on where you live in the world. Even right here in Canada, there are a variety of names and definitions for the same textures. Click on the article to understand the framework for texture modified foods as defined by IDDSI and the resources available to help you get started.
Make the Most of Summer’s Finest Fruits and Vegetables
The summer season comes with many joys. But one stands out from the rest: gardens and farmer’s markets bursting with crisp vegetables and juicy fruits in their prime. From sweet corn, green beans, and summertime squash to stone fruits, heirloom tomatoes, blackberries, and more, the abundance of fresh produce this season makes it easier to eat our way to better health and all the nutrients will help you feel energized and ready to take on the day. Click on the article for menu inspirations.
Understanding Resident Mental Health Challenges in Long Term Care
The mental health of residents admitted to and living in LTC is impacted significantly by mental illnesses such as Depression and Personality Disorders (with a history of trauma). Many residents have ...
Palliative Care in Long Term Care: Re-thinking the Purpose and Approach
Care for end of life has been an important and expanding function in Long Term Care. Since the beginning of the pandemic over two years ago, there have been changes in the Long Term Care Act that include a need for the adoption of a Palliative Care Philosophy. Franzis Henke, Nurse Practitioner, and Silver Meridian associate discusses these changes and what it means to incorporate a Palliative Philosophy of Care. Click to read the full article.
The concept of “liberalized diets” has been around for some time within senior living but it is receiving increased attention as more is being understood about the role diet can play on quality of life and seniors health. This approach is also now being published in reference guides such as the Dietitians of Canada document, Menu Planning in Long Term Care (2020) - an influential guide for planning your menus in Canada. If you have not done so already, now is the time to start evaluating if this approach would work in your home.
Why “Now” is Not the Best Time to Quit!
For anyone working in long term care, the pandemic has become the primary talking point and focus of attention in almost every conversation. In the face of many challenging realities, there are compelling reasons to step back and reconsider a decision to quit working in long term care. However, his period of change and uncertainty is providing “golden opportunities” to grow and excel, for those who embrace the challenges.
Ingredients for a Healthier Tomorrow in Senior Living
This year’s month of March 2022 marks Dietitians of Canada’s 40th anniversary for Nutrition Month, which is an event shared and promoted by Dietitians across the country. Complete Purchasing Services (CPS) is happy to share this year's theme “Ingredients for a Healthier Tomorrow”, with a focus on senior living and long-term care.
Keep Calm and Keep Disinfecting!
After two years of working to keep COVID-19 under control, trying to keep up with the seemingly constant changes can be confusing. To help maintain a clean and healthy environment that is safe for guests and residents Louise Taillon, Sani Marc’s Director of Training, answers some important questions about how to stay the course in the fight against COVID-19.
Five Tips to Protect Your Property During Winter Months
We’re not out of Winter just yet and with the cold, snowy weather conditions that the final weeks before Spring can bring it is important that businesses implement precautions to winterize commercial facilities. FIRST ONSITE highlights 5 key steps you need to be aware of to protect your property during winter months.