Statement on Dental Care in Nursing Homes Issued. Journal of the American U.S. Department of Health, Education, and Welfare, Public Health Service, Waldman, H. Barry, D.D.S., M.P.H., Dentistry for the Nursing Home Patient, Waldman, H. Barry, D.D.S., M.P.H., Dentists Provide Nursing Home Care, Waldman, H. Barry, D.D.S., M.P.H., The Nursing Home Patient; a Challenge for Waldman, H. Barry, D.D.S., M.P.H., The Problems of Nursing Home Dental Care, Washington Dental Service, Dental Care for Residents of Nursing Homes: A Demonstration Program Administered by a State Dental Service Corporation under Community Health Services Project Grant No. CH 51-3,A-63 and B-64 from the U.S. Public Health Service, April 1, 1963-March 31, 1965, May 1965. Case prepared by: Charles J. Donnelly, DDS Chief, Research Grants Units CASE STUDY DIETARY SERVICES IN A NURSING HOME Background Information: The Tiller County Nursing Home is a county-owned, 60-bed facility offering skilled nursing care to the medically indigent of the county. The Board of Commissioners of Roads and Revenues, acting through the Tiller County Physician (a part-time county employee), administers this institution. An assistant administrator with a business background is responsible for the day-to-day operations of the institution. Six months ago, Mr. Jack Frost was employed to supervise the dietary service of the home. Although he had previously served for ten years as a mess sergeant with the U. S. Army, his experience was limited to troop messes and did not include hospital food service experience. The assistant administrator, Mr. Johnson, has been favorably impressed with Mr. Frost's ability to motivate the food service employees and to organize his service into a smooth operation. He has, however, questioned the nutritional adequacy of Mr. Frost's menus, and the Director of Nurses has questioned the accuracy and acceptability of the therapeutic diets. Mr. Frost made no pretense of competence in these areas when he was employed, and indicated that he would welcome all the assistance he could get in menu planning for both the regular and special diets. However, except for a single visit from the State Health Department's dietary consultant two years ago, no guidance from a professional dietitian has ever been utilized by this home. Problem: Mr. Johnson is anxious for the Tiller County Nursing Home to qualify for certification as an extended care facility under the government health insurance program for the aged. He has learned that one of the Conditions of Participation in this program requires supervision or regularly scheduled consultation from a professional dietitian or a dietary consultant. Approach to Problem: He has discussed with Dr. Adams, the administrator of the home, and the Board of Commissioners the need for dietary consultation and has requested an increase in the dietary service operating budget to pay for this service. Approval has been given, as the Board feels that necessary funds must be provided to pay for services required for certification of the home as an extended care facility. The Director of Food Service at the Medical Center, Miss Verna Cox, has helped him get information on qualifications of a professional dietitian and on current salary schedules paid by the center. She has emphasized the need for higher rates for professional personnel employed on a part-time or consultant basis. Usually such personnel are not eligible for all of the fringe benefits--holiday, vacation, and sick leave of full-time employees. She has suggested appropriate hourly and daily rates that he should be prepared to offer a dietary consultant. -2 Mrs. Miss Cox has now given Mr. Johnson the name of Mrs. Jean Olson. Olson has a baccalaureate degree from the State University where she majored in Foods and Nutrition. She has family responsibilities but has worked parttime at the Medical Center when there was a vacancy for a dietitian. Now the Medical Center's vacancy is filled and Mrs. Olson is not working so may be interested in part-time or consultant services to the home. Mr. Johnson is planning to interview her. He wants very much to initiate a sound plan for a continuing consultant service, and hopes to accomplish this without jeopardizing the status and security of Mr. Frost. Questions: What are the requirements in the Conditions of Participation in the health insurance program (Medicare) to assure that the dietary service will be directed by a qualified person? 2. Where present supervision of dietary services does not meet these requirements, what course of action might be taken? 3. If a dietary consultant is to be introduced to an ongoing program, 4. What are appropriate responsibilities of a dietary consultant on the staff of an extended care facility? 5. What might a dietary consultant look at in evaluating the present dietary services of the home? 6. What are the resources for locating dietary consultants, and on what basis other than full-time are they available? CASE STUDY DIETARY SERVICES IN A NURSING HOME Possible Solutions to Problems and Discussion: 1. 2. 3. What are the requirements in the Conditions of Participation in the health insurance program (Medicare) to assure that the dietary service will be directed by a qualified individual? a. A person designated by the administrator is responsible for the 1) A professional dietitian meets The American Dietetic Association's qualification standards. 2) Other persons with suitable training are graduates of Where present supervision of dietary services does not meet these a. A professional dietitian or other person with suitable training as defined above must be employed to serve as a supervisor or as a consultant on a regular basis. If a dietary consultant is introduced to an ongoing program, how might this be done without jeopardizing the present situation? a. b. In this case, Mr. Johnson did some preliminary planning. He Mr. Johnson planned to interview Mrs. Olson privately at first. He wished to explore with her what she thought her contribution could be. He recognized she would have to observe and get acquainted with the staff, the facilities, and the patients so far as diagnoses and/or disabilities and food preferences are concerned before priorities for her service could be established. -2 4. C. d. He planned to introduce her to members of the staff and to arrange for her to meet with them separately to discuss problems and needs. He planned to outline with assistance from Mrs. Olson and Mr. Frost, the duties and responsibilities of each so that lines of authority and working relationships would be clear. What are appropriate responsibilities of a dietary consultant on the staff of an extended care facility? a. b. C. d. e. Participation in conferences with the administrator and other supervisors of patient services in setting patient care policies and procedures as they relate to dietary services. Recommendations concerning the quantity, quality, and variety of food purchased. Participation in the orientation and training of food-service Recommendations concerning adequacy and hygiene of dietary staff. f. Interpretation and guidance in carrying out physicians orders for therapeutic diets. Routine evaluation and assistance in menu planning. g. h. Guidance in preparation of food. 5. i. Provision of information and assistance in establishing corrective measures in safe and sanitary practices. What might a prospective dietary consultant look at in evaluating the present dietary services of the home? a. Assessment of quality of the food; how well is it accepted by b. Facilities: Adequacy, orderliness and cleanliness of dining room, kitchen, equipment. C. Supplies: Are refrigeration and storage adequate? Is there at least a one-week supply of staple foods and a two-day supply of perishable foods? |