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Culture change drives CHOICES

September 14, 2011
by Patricia Sheehan, Editor-in-Chief
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A revamped dining program empowers residents
Server amy laroche presents a tray of tempting delicacies to villa crest residents.
Photo by Rick Friedman
Server Amy Laroche presents a tray of tempting delicacies to Villa Crest residents.

Sarah McEvoy talks about the four daughters who showed up like clockwork every Monday around mealtime to visit their 98-year-old mother, a resident at Villa Crest Nursing and Retirement Center. “We didn't have a comfortable place to accommodate them,” says McEvoy, the high-spirited administrator of the nonprofit community for the past 14 years. The main dining room was nicely appointed with linen tablecloths and fresh flowers, but seating only accommodated 64 of the 155 residents and offered no space for guests.

Space was only one nagging issue related to the dining experience just two years ago. Residents chose from a four-item menu but had to make their lunch selections at the breakfast meal and their dinner selections at the lunch meal. The dining program featured a mass-produced, steam table approach to serving large numbers of residents in a short period of time. It lacked a fresh, made-to-order taste.

Residents entered the dining room promptly at noon and 5 p.m. and one server brought the meals out as quickly as possible. Beverages were pre-poured and passed once residents took their assigned seats. Although the starting table changed each day, the unfortunate residents who were served last waited up to 30 minutes to eat. Residents were limited to set mealtimes with little flexibility for late sleepers or early risers, daytime doctor appointments or afternoon beauty salon visits.

Residents who came to the center for short-term rehabilitation were restricted to room service because of the limited seating capacity and the fact that long-term residents sat in the same seats at each meal, leaving no space for new residents.

Still, “this is a really special place,” says McEvoy. “We have a beautiful blend of residents who are very independent and those who are very dependent. It's an integration that just works really well.”

Villa crest's team (from left to right-front to back): richard vachon, cook; janelle pizarro, waitress; steve wingate, cook; amy laroche, waitress; joe gifford, cook; cassie peterson, waitress; susan lievens, recreation director/hostess; kaitlyn mercier, waitress; paul silkman, diet aide; manny perry, food service supervisor; sheila letendre, diet aide, holly vanlaarhoven, recreation assistant/hostess; kathy o'hara, rd; seth sawyer, diet aide; alyssa sawyer, waitress; dan wheller, cook/waiter; tameson o'brien, recreation assistant.
Villa Crest's team (from left to right-front to back): Richard Vachon, cook; Janelle Pizarro, waitress; Steve Wingate, cook; Amy Laroche, waitress; Joe Gifford, cook; Cassie Peterson, waitress; Susan Lievens, recreation director/hostess; Kaitlyn Mercier, waitress; Paul Silkman, diet aide; Manny Perry, food service supervisor; Sheila Letendre, diet aide, Holly VanLaarHoven, recreation assistant/hostess; Kathy O'Hara, RD; Seth Sawyer, diet aide; Alyssa Sawyer, waitress; Dan Wheller, cook/waiter; Tameson O'Brien, recreation assistant.


Community management became convinced of the need for change after attending a culture change conference and touring several communities active in the movement. “Visiting those other centers showed us that there are different ways to make our center a home and make it more resident-centered. We returned thinking we can do so much more and do it so much better,” says McEvoy.


Since 1996, Long-Term Living has honored long-term care communities 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 Villa Crest Nursing and Retirement Center of Manchester, N.H. A trip by managers to a culture change conference followed by a tour of communities active in the culture change movement convinced the partners that change was imperative in their own community. They were exposed to dining options that met the need for resident choice, flexibility, socialization and satisfaction. A survey of community stakeholders led to the formation of CHOICES Restaurant in 2010. Specialized staff training taught servers how to blend hospitality with proper serving techniques. A new menu with a wide variety of meal choices, extended service hours and attentive staff resulted in a resident-centered approach to mealtimes. Other benefits included a place for families to visit and dine with loved ones, satisfied residents and improved resident weight outcomes.

Our congratulations to this year's winner for all the hard work, inspired ideas and commitment to making a positive change every day in every elder's life.

Not long after that, Manny Perry-the equally high-spirited food service supervisor and executive chef-said he wanted to do things differently at Villa Crest. “His approach is, ‘Let's give it a whirl and see what happens,’” McEvoy says, “whereas I'm more like, ‘Let's plan it down to every detail.’ We landed somewhere in the middle, which worked for us.”