A skilled nursing facility can bolster resident quality of life by focusing on its dining, a study from the LeadingAge LTSS Center @UMass Boston suggests.

That’s according to Natasha Bryant, senior research associate at the LTSS Center, who worked on a study that examined the impact of a person-centered care approach and household model on resident life in a nursing home.

“Where we really saw the benefits was in the dining area,” she explained. “So if someone didn’t want to make that level of investment of doing the entire nursing home, maybe in focusing on that dining area, they could see some improved interactions and quality of life.”

Focus on food?

Person-centered care (PCC) is focused on ensuring that resident needs and choices guide the daily life in a nursing home, according to a report from LeadingAge on the study. The “household model,” meanwhile, can be used to cluster a small number of resident rooms around a central dining room, kitchen and living room area.

The report said nursing homes that try to make nursing homes more person-centered will often use the household model for those purposes, with the physical layout designed to allow residents and staff members more time to interact. However there is little evidence on whether the household model and so-called culture change improve residents’ psychosocial well-being and cognitive functioning, and the LTSS study — which was funded by the Francis E. Parker Memorial Home in Piscataway, N.J., sought to examine this.

More than 100 residents, 180 aides, and 54 nurses at three nursing homes took part in the study. One of the homes, Parker at Monroe, featured the household model; Parker at River Road and Parker at McCarrick served as the controls. The observational study saw Rutgers University students observing residents during three time periods — baseline, 12 months and 18 months — for eight hours at five minute intervals.

The study found that the household model helped residents achieve greater psychosocial well-being, compared with residents in the control group, and helped the nursing home offer more comprehensive diagnosis and treatment of depressive symptoms, compared with the control nursing homes.

The results on cognitive decline, however, were mixed, and the study also did not find improvements in either active engagement or “affect,” the term used for the emotional presentation of residents as positive, negative or neutral, outside the dining area of the household environment.

Still, there was a notable difference in the way staff interacted with residents in the dining area, even when staff numbers didn’t noticeably differ, Bryant said.

“In terms of the number of staff, in terms of the staffing ratios, there wasn’t really a big difference in any of the nursing homes,” she observed.

Murky costs

Parker redesigned Parker at Monroe and implemented PCC, and comprehensive culture change usually involves a physical redesign, Bryant noted. It’s not clear how much this cost Parker, but given the thin margins and low reimbursement most SNFs have to face, it might be a factor in how much they could implement such a model.

“Given the growth and popularity of person-centered care and the household model, it is important to make sure that the benefits of culture change justify the costs associated with implementing this model throughout a nursing home,” the LTSS report said.

Still, renovations aren’t a requirement of establishing culture change, according to a statement emailed from Parker to SNN.

“The cost of cultural change is much more complex than simply building new construction,” the statement said. “Culture change really is focused on three dynamics: personal, organizational and physical transformation. Personal change must occur first because staff must learn the value and importance of person-directed-care and culture change, which may be new to many of them.”

For nursing homes considering implementing such a change without drastic renovations, Bryant had some suggestions.

“I think a key component is giving residents choices on their activities, when they eat, what they want to eat and when they want to bathe,” she said. “Then there should be an element of culture change on the staff and empowering staff members.”

Written by Maggie Flynn