Originally published in AJDC April/May 2013 Vol 2 No 2
The introduction of ‘help-yourself’ finger food and a person-centred dining approach has proved a successful addition to daily life at three Scalabrini Village aged care facilities in Sydney and Griffith which support people with dementia. Rocco Andreacchio and Lauren Kingsbury explain how residents, care staff and families have benefited from the changes
Scalabrini Village introduced a finger food menu in 2012 to help many of our residents with dementia who find it difficult to stay seated long enough to eat an entire meal, often walking around and forgetting to return to the table to finish their meal.
Residents were not losing weight, but we believed it could become a problem if people were unable to eat a complete meal and were also moving around a lot and burning up energy.
We decided to think creatively and come up with different ways to cater for these residents’ nutritional needs. After discussing the issue with Scalabrini’s Bexley manager Jenny Graham and clinical staff, we approached dietician Frances Cloughley who
suggested offering finger food. She helped us design a menu of high-calorie snacks and small portions of food that could be eaten while people were walking around. The finger food menu is only for those residents with cognitive impairment, including those with dementia, and is available in addition to our standard menu.
We put a well-illuminated glass-fronted fridge near the dining room in each of the three facilities’ dementia-specific units. The fridge is stocked 24-hours a day with a wide variety of snacks and finger food, including finger-sized leek and vegetable frittata, ham and cheese croissants, sandwiches, chicken wings, cold meat platters, muffins and sliced fruit and cheese. The illuminated fridge door attracts attention and stimulates the residents to eat.
Since we started offering the finger food menu the residents have maintained their weight, with one or two showing slight gains. Other benefits from the changes are that less physical assistance is needed from care staff to help people eat or remind them that it is time for a meal. Residents’ sleeping patterns have also improved as they are more content overnight and are not walking around looking for extra sustenance.
Being able to see and choose food has also encouraged independence and social interaction and given residents a greater sense of achievement, creating a more harmonious environment for all.
Improving the dining experience
With input from the other managers we also came up with, and introduced, the following ideas to improve the dining experience for people with dementia in our residences:
- We stopped serving three-course meals on trays and now serve only one course at a time, on smaller plates. We find this is less daunting for the person and it also reduces confusion caused by having to choose from a variety of utensils and glassware.
- When a resident chooses to eat a meal at the dining table, staff sit with them to prompt and help them to eat, rather than standing beside them and directing them. This approach is more encouraging and less invasive.
- Staff wear aprons and the tables are set for lunch and dinner with placemats or tablecloths, linen napkins, china crockery and flowers to create a more home-like environment that’s familiar and respectful to the generation we are caring for.
- We are trialling the use of spill-proof plastic sports drink bottles to encourage independent
Implementing the changes
Staff and residents have welcomed the changes. Initially some relatives were a little unsure about the idea of their family member eating finger food whilst walking around, because many are from the Italian community where substantial meals eaten at the dinner table are seen as an important part of family life. However, since the introduction of finger food we have seen positive changes in residents’ interactions with family and friends. The conversations are more personal and free-flowing, as the focus is not on meal times and weight management. Relatives are encouraged to join their family member when they are having snacks and to eat meals with them.
Initially we over-catered and there was an increase in food wastage, but we have now adjusted the amount and portion sizes to suit residents’ needs.
Advice for other facilities
- Use the dining experience to enhance enjoyment of food – work with colours, fragrances, seating arrangements. Encourage and trial whatever initiatives the team can
- Reconnect memories to food and talk to residents about recipes or reminisce about Sunday roasts. If people are happiest enjoying a cup of tea and a piece of fruit cake with a friend, ensure the friend recreates this experience each time they
- Add a scoop of ice-cream in a milkshake, fresh strawberry jam on warm scones or biscuits (broken in half) on the tea cup This approach is more effective than a gloved hand placing a biscuit on the table.
- Explain the reasons for the changes to staff and relatives – that traditional nursing focuses on maximum calorie intake at every mealtime, whereas finger
food offers options 24 hours a day to make it easier for residents to eat. ■
Scalabrini Village offers culturally-specific care to members of the Italian community and other cultural groups at its residences in Sydney and Griffith. At the time of writing, Rocco Andreacchio was Scalabrini Village Procurement/Food Services Manager. Lauren Kingsbury was Scalabrini Village’s Griffith Manager. For more information visit: www.scalabrini.com.au