After years of pandemic-driven focus away from dietary departments, dining is back in the spotlight – and impacting operations.

Residents’ preference for in-room meals has created social and staffing challenges, while expectations for quality dining remain high, and this has resulted in some solutions that improve both clinical care and quality while reducing burdens for staff.

Creating a welcoming, social dining environment plays a vital role in residents’ overall quality of life and healing, said Jim White, chief culture officer for Ignite Medical Resorts. Encouraging residents to dine communally rather than alone in their rooms also allows staff to deliver a more controlled experience, while tray service adds complexity, increases staff burden and can negatively affect both morale and operational efficiency.

White spoke about how environmental design and dining business intelligence is influencing the future of facility operations during a webinar hosted by Skilled Nursing News. White was joined by Jason LeCroy, senior vice president of business development for Healthcare Services Group; and Matthew Trammell, COO at Journey Skilled Nursing.

The dining experience is also a key measure of facility quality, and unlike nursing care or therapy, food is universal – everyone is an expert in dining, and expectations run high. A renewed focus on dietary departments signals a broader rebalancing within the industry, after years of prioritizing clinical roles and departments during the pandemic.

“When people come into a facility, they’re not experts in rehab or nursing care or pharmacy, but everyone is an expert in food. They’ve experienced that their entire lives. They know what they like and it’s unique in every facility,” said LeCroy.

Overall, quality outcomes remain central to operational strategy, as reimbursement models tie payments to performance.

Panelists also discussed top priorities and areas needing improvement, referencing a survey conducted by SNN in August. The top areas for improvements among nursing homes were the resident dining experience, followed by staff satisfaction and retention, with 73% and 51% of respondents naming these as priorities, respectively.

Dining and staff experience are intertwined

Residents in a skilled nursing environment generally would prefer to eat in their rooms, White said; not the greatest social experience and a logistical headache for staff-strapped facilities.

“We really try to elevate the experience by giving people reasons to get out of their rooms and come to the dining room. It’s in the dining rooms that we actually can have some level of control over the experience … they get service at the table side, they get waited on. It also drives the psychosocial element when it comes to healing,” said White.

In-room tray service, meanwhile, makes operations more complicated and ties back to staff satisfaction and reimbursement, along with budget and survey performance, White added.

The dining experience is a “tentacle off the arm of quality,” LeCroy said, and is a huge part of resident experience talked about quite often with family members.

Cost per patient day for food can get tricky though, Trammell said, with larger operators having more purchasing power, better leverage through their vendors. Journey focuses on the basics when it comes to dining: good meals made with quality ingredients, served at the right temperature and on time.

Dietary focus is a sign of right-sizing

Renewed focus on dietary is a sign that the industry’s priorities are moving away from the immediate need for nursing and clinical resources during the pandemic. Dietary departments’ needs went from background noise to a “roar,” Trammell said.

“Ensure that they’re not second fiddle … nobody likes to be in the background when their jobs are just as hard. They’re under the same amount of pressure to perform, from an infection control standpoint or a dietary food service delivery standpoint,” Trammell said of Journey’s dietary department.

The industry is midway through a rebalancing of dietary departments as a whole – operators can’t lose sight of the big picture again, like they did coming out of the pandemic, Trammell noted.

The dining experience is tied to staff satisfaction, Trammell said, with dietary staff moving to fast food and other industry options during the pandemic. A dietary manager with a crisp schedule, morale boosting exercises for dietary staff is a tremendous help with staff retention and can help drive up survey success, he added.

Moreover, cooks, dietary aides and housekeepers could move into leadership positions, overseeing entire regions, depending on the size of the operator, LeCroy said.

Improvement around staff retention and satisfaction is wrapped up in programs aimed at ensuring a welcoming environment, programs that make staff feel appreciated, with different rewards linked to patient satisfaction as well, White said.

“Those two things are tied exceptionally close together, one clearly influences the other,” White said of staff satisfaction and retention, and resident satisfaction. “Take care of your people, and they’re going to take care of their guests. That thought process is very big among the leadership team.”

Quality measures always top of mind

Changes in reimbursement linked to quality scores has been a big focus for nursing home operators in the last year on top of improving dietary and staff retention, with many racing against the clock to improve scores from previous years. This is especially true with turnaround acquisitions, said Trammell.

“It does impact us in the market, so it is our top priority as we walk into this portfolio, and we can continue to acquire,” said Trammell.

About 90% of Journey’s facilities are within their first year of acquisition, he added.

Ignite’s hospitality model means patient satisfaction and experience are what drives operations, but added it would be foolish to ignore payer mix in revenue since it influences so many other aspects of the business.

While budgetary pressure is critical, it’s still important that effective and efficient care delivery is done in a way that won’t compromise on quality, noted LeCroy.

Reimbursement pressures may change how operators implement a budget and what will be done to make operations more efficient, but quality is the “stake in the ground” that LeCroy sees most consistently.

Respondents felt the same way, with 75% saying a focus on resident experience and satisfaction is the main macrotrend influencing their operations strategy, followed by 53% saying budgetary pressures tied to reimbursement trends and rising costs influenced their operations strategy.