Strategies to Improve Dining Satisfaction Using the PELI

Person-centered dining practices place residents at the center of all dining activities. This approach is based on an active partnership among residents, staff members and administrators to assure that resident needs and preferences take priority in shaping the community’s dining experience. The goal is to offer choices that genuinely reflect resident preferences to the fullest extent possible.

Research shows that residents’ perceptions of food choice are correlated with their satisfaction with care.^[1] When residents feel their preferences are taken into account, they are more likely to eat well and experience the social and psychological uplifts that come with dining: enjoying the simple pleasures of a good meal and the chance to relax and connect with others. Of course, familiar foods also add comfort and meaning to holiday and milestone celebrations.

When preferences are overlooked, residents may leave food uneaten, possibly leading to malnutrition and weight loss as well as diminished satisfaction. We all appreciate when our food preferences are considered, and older adults living in residential settings are no different. 

This tip sheet introduces strategies to cultivate person-centered dining practices by opening up communication to learn about resident preferences, offering staff development regarding new approaches to dining, and focusing energy on sustaining improvements.

Communication: The Key to Learning about and Honoring Food Preferences 

Communication practices to help your community develop a person-centered approach to dining include:

• Idea 1: Use a tool such as the Preferences for Everyday Living Inventory (PELI) to gather systematic information about residents’ food preferences.
  • Incorporate the six PELI food preference questions into the move-in process. Staff will gain vital information needed on Day 1 and throughout the resident’s stay in the community.
  • Assure that residents have many opportunities to discuss their food preferences – during formal interviews, care-planning meetings, and informal conversations with care team members. For example, dining, nursing, social work, housekeeping, chaplaincy, and direct care staff can find occasions to open up conversations about dining preferences with residents. 

• Idea 2: Establish a monthly food committee, or add a discussion about food to the resident council agenda, so that residents, staff and administrators have a forum to share their thoughts about current dining practices and opportunities for improvement.  
  • Encourage residents and care team members from multiple departments to attend food committee meetings so that dining concerns and preferences can be communicated openly and directly among community members. Depending on the size of your community, consider asking each neighborhood to nominate a representative to serve on the food committee. This individual can bring ideas to meetings and then report back to the neighborhood. 
  • Engage the food committee to better understand residents’ regional preferences. This is especially important for communities using a corporate menu that spans a wide geographic area. For example, people who grew up in certain regions prefer coleslaw made with mayonnaise and others do not.
  • Be transparent. Food committees provide a good opportunity to explain why some items are served regularly and others are not. Regulations can be explained and then ask the food committee to brainstorm ideas that would meet regulatory mandates, yet offer residents choices they prefer.
  • Some care communities may want to consider incorporating discussions about food preferences into family council and caregiver support meetings. Participants can share ideas about the types of food and serving approaches that work best with loved ones. 

• Idea 3: Create opportunities to introduce new items into the community menu. Options include:
  • Ask residents to bring in favorite recipes that the chef can review and incorporate into regular or holiday meals. For example, ask residents to suggest generational or cultural foods that give them comfort or that they enjoy with their families. 
  • Depending on the community, bring in outside vendors to talk with residents about particular types of food, how they are prepared and the costs. For example, invite a butcher to give a talk about the different cuts of meat and their costs. 
  • Host a taste testing or food fair where residents can sample new items or compare three different ways of preparing the same dish, such as chili. Ask them to vote on their favorite, post the results and incorporate the top dish into regular, seasonal or holiday menus. 
  • Involve all relevant departments, particularly dining and activities, in planning and launching these initiatives. This helps staff understand how food impacts all areas of residents’ lives. 
  • Seek anonymous feedback with each new food option. Consider a short questionnaire with questions such as “Would you like to see this item on our menu in the future?” 

Culture: How to Cultivate Person-Centered Dining

Practical approaches to building a person-centered dining culture include:

• Encourage staff participation and input in creating a community vision for person-centered dining. 
  • Ask staff to think about their own food preferences and how important choice is in fostering autonomy. This may help staff develop empathy to encourage resident-direction. 
  • Create opportunities for staff and residents to talk about their food preferences, favorite recipes and memories of food from childhood or holidays. For example, schedule monthly meals where staff and residents dine together and have informal conversations about food and other topics.  
  • Enlist staff from key departments to observe person-centered dining in action. Visit communities that successfully provide person-centered dining, or organize live video-chats with these communities and encourage staff to ask questions. 
  • Use inclusive communication strategies, such as Learning Circles, to ensure that all staff members have an opportunity to provide input into dining change initiatives.  

• Ask residents about dining experiences outside of the community, such as eating in restaurants or at the home of family or friends. It’s best to inquire about these events right after they occur to help residents recall preferred elements. 
  • Specifically ask residents what types of food they ate, how the meal was served and what aspects of the environment they enjoyed, such as lighting or music.
  • Start with no- or low-cost changes, such as serving meals family style or playing preferred music during meals.   

• Provide education on dining regulations, which require communities to consider both residents’ needs and preferences in all dining processes.  
  • Use New Dining Practice Standards published by the Pioneer Network and endorsed by the Centers for Medicare and Medicaid Services (CMS) as a guide for training and discussion. The document describes policies and implementation strategies to enhance resident dining.
  • Practice navigating how to handle food preferences that may involve some risk to the resident. Introduce the Honoring Preferences When the Choice Involves Risktraining video, tip sheet and toolkit. Together these resources offer a framework to help care teams work through dining preferences with residents and families. The goal is to develop dining plans that respect health standards while also meeting resident preferences.

Sustainability: Practices to Maintain Person-Centered Dining

Practices that can help your community keep or build on a person-centered dining initiative include: 

• Make an ongoing commitment to a vision for person-centered dining in the community.  
• Understand that turning a new concept into reality takes time and patience. Some staff may need continued encouragement to shift from a task-oriented to a resident-directed approach. Both staff and residents need time to observe, and understand, how new person-centered practices improve dining satisfaction for everyone involved. 
• Begin with low-cost, high-impact changes, such as offering open dining hours during breakfast. This practice would offer residents more choice in dining time, and allow flexibility in their morning wakeup time and routine. Once staff see the benefits of person-centered dining, they will believe changes are doable! 
• Celebrate successes! Make certain to acknowledge person-centered dining initiatives that go well. Thank both staff and residents who participated in these initiatives. 
• Try to schedule consistent staff during mealtimes. Consistent staff will become familiar with residents’ food preferences. Their knowledge can be helpful when a resident struggles to express a preference, or when the care team needs to help residents address preferences that involve risk. 

Resources

• Flexible Dining Services Tip Sheet by Pioneer Network
• Pathways to Transforming Dining by Pioneer Network
• Honoring Preferences when the Choice Involves Risk by Preference Based Living
• New Dining Practice Standards by Pioneer Network and endorsed by CMS