By making meals and the dining experience the primary focus behind creating ‘home’, it forces everything else to change”
Dining in the Meadowlark Hills households is not just about nutrients and calories: Heaping measures of choice, creativity, familiar home-life activities, interactions as equals with persons of all ages and positions, meaningful relationships and enduring friendships – these also are essential ingredients in every household recipe.
Here, “a home cooked meal is everything a nursing home isn’t.” says Willie Novotny, CEO for the continuing care retirement community in Manhattan, Kansas. Family members who work alongside elders and staff to cook and cleanup in the household kitchens and the frequent presence of children in the dining room support Novotny’s claim. Some residents’ family members seemingly eat as many dinners at Meadowlark as they do in their own homes. Barriers dissolve as staff, elders and family members collaborate in the kitchen.
“It’s when the 20-year old CNA starts getting cooking lessons from an 85-year old elder … that’s the natural way for things to be in life,” explains Novotny. Almost anyone, including the very frail, can participate in these most normal of all home activities, even if only to drink coffee and watch others chop vegetables, set the table or wash dishes. Staff members who feel “put on the spot” when asked to lead traditional activities they know little about will readily help coordinate residents in the familiar activities of meal preparation.
Meadowlark’s journey to households began in the kitchen with a focus on breakfast, setting the tone for the rest of the day and the entire change process. “We established early on that it had to be a made-to-order breakfast for each person,” says Novotny. That, in turn, allows residents to awaken when they like, which leads to individualized times for administering medications, taking baths and serving lunch and dinner. It also requires staff on all shifts to train in food service and other basic household functions. It’s not uncommon, for instance, to find staff on the night shift making pancakes and sandwiches for a resident at 2 or 3 a.m., especially in households for people with advanced dementia.
It’s proven just as efficient, Novotny explains, for one staff person to cook for one or a few individuals at a time throughout the day, as it is for all staff to participate in mass-producing meals served to the entire household at a set time.
Still, offering individualized dining in all seven Meadowlark households was no piece of cake. Full, commercial-grade kitchens compliant with local fire codes were easily designed into the two households built from the ground up. But in the five households created by renovating the existing T-shaped nursing home building, full kitchens were not feasible due to financial and space limitations.
Instead, designers creatively used the space they had – working closely with regulators while establishing small “activities kitchens” from nooks found in each household that formerly were used for a variety of functions in the old nursing home (a spa, a storage area, a congregate dining room, for example). These spaces are now furnished with a microwave, conventional oven, dishwasher, sink, a refrigerator for food stock and another for residents’ items.
Stovetop cooking in these areas is prevented by regulations, so meat, pancakes and other items are placed on cookie sheets and cooked in ovens or grilled outdoors, weather permitting. Only the main entrees for lunch and dinner are still carted in from a central kitchen, with portions placed in the refrigerator for dining throughout the day. All else, including the entire breakfast, is made on demand within the households from residents’ favorite food items stocked in the fridge and cabinets for easy access.
Everything in our culture revolves around food. “By making meals and the dining experience the primary focus behind creating ‘home’, it forces everything else to change,” concludes Novotny.
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