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24-hour dining feeds culture change

September 1, 2009
by Maureen Hrehocik, Editor
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Rolling Fields Conneautville, Pennsylvania

Since 1996, Long-Term Living has been honoring long-term care facilities that are proactive with programs that go “above and beyond” routine care for their residents with our prestigious OPTIMA Award. It is conferred by a jury of your long-term care peers from submitted entries. This year's winner is Rolling Fields, a nursing and independent living facility in Conneautville, Pennsylvania. A snowstorm was the impetus to change the facility's culture forever by instituting 24-hour dining. As the owners say, the change affected every aspect of the 181-bed facility in northwestern Pennsylvania. “We knew we had to just jump off the cliff and do it,” says co-owner Kim Moody. What resulted is truly an amazing transformation that revolves around resident choice and a dissolution of regimen. The change has improved morale among staff, residents, and their families, as well as improved the health and physical and mental well-being for residents.

Our congratulations to this year's winner for all the hard work, inspired ideas, and commitment to make a positive change every day in every elder's life. Information on entering next year's OPTIMA Award competition will be in the February 2010 issue.

For Kim Moody, passing out a breakfast tray was an epiphany that changed every facet of the nursing home she owns with her sister, Cindy Godfrey, and her mother, Marlene Braham, who is now retired. It was a snowy morning in Conneautville, Pennsylvania, a rural town in the northwestern part of the state. The staff at Rolling Fields, a 181-bed nursing and independent living facility, had a hard time getting to work because of the weather. The breakfast trays were ready, but there weren't enough employees to deliver them, so a call went out to management to help.

Cindy Godfrey, elder Julia Garnet, and Kim Moody enjoy fine restaurant-style dining in Rolling Fields dining room

Photo credit: Aaron Praetzel

Cindy Godfrey, elder Julia Garnet, and Kim Moody enjoy fine restaurant-style dining in Rolling Fields dining room

“I remember going into one elder's room with a tray,” Moody, who at the time was administrator, recalls. “She was sound asleep, mouth wide open, and snoring. I thought, ‘This is crazy! I can't wake her up to eat.’ It was an amazing revelation to me. Everything we did was revolving around meals. The answer was to get rid of our tray delivery service and offer 24-hour dining.”

As Moody says, since that decision, “our whole world has changed.” The project has gone much further than food. It has transformed the Rolling Fields' culture change journey. Everything that is done now at Rolling Fields is based on elder choice and creating a feeling of home. “All regimen is gone,” Moody says.
(Top) Dining room before renovations; (bottom) dining room after renovations

Photos by Aaron Praetzel

(Top) Dining room before renovations; (bottom) dining room after renovations

The journey begins

The sisters say they had no idea at the outset of this major change, all that it would entail. “It touched absolutely every aspect of living,” Godfrey says. The first thing they did was ask for volunteers to start discussing the idea of 24-hour dining. Thirty employees signed up. On August 17, 2007, the group “jumped off the cliff” as Moody describes it. “There was no easy way. We just had to jump in and try our best.” The two-hour weekly meetings to get the project under way were dubbed “JUMP” meetings. They decided on using one of the “streets” in the home as a pilot project for two months. In October 2007, another street “jumped” and the entire house jumped in December 2008.

One of the largest changes was not with food or delivery. It was with reframing people's jobs. “We no longer had what we called LPNs, or housekeepers, hospitality assistants, or CNAs. Everyone is now a caregiver or certified caregiver and is expected to do whatever the elders need done, whether that is to order food, help them with dining, keep their living area clean, help them choose a paint color for their room. Everyone is empowered.” These caregivers are the backbone of the program's success. Fifteen to 20 caregivers are assigned to a street in a 24-hour period. Once the pilot project was successfully completed, the rollout continued to the other five streets with 30 elders each.

Moody and Godfrey consulted several area chefs to help them transform Rolling Field's institutional kitchen into a restaurant kitchen. “They helped us determine what equipment we needed, what equipment we currently had that we did not need, and what the best way would be to set up the kitchen,” Godfrey says. The kitchen had to be reconfigured from an institutional kitchen to a restaurant-style kitchen. Certain appliances, like a charbroiler, are being leased. The pantries in the home were changed to include coffee, cereal, juice, and other snack items for the elders whenever they'd like to partake. New servingware was ordered and over-the-bed table linens are used for a more “room service” feel for those elders who choose to eat in their room. A POS system was specifically designed by Micros and was installed for ordering food.