Caspar, S., Davis, E., Berg, K., Slaughter, S. E., Keller, H., & Kellett, P. (2020). Stakeholder engagement in practice change: Enabling person-centred mealtime experiences in residential care homes. Canadian Journal on Aging, 40(2), 248–262. https://doi.org/10.1017/s0714980820000082
“The residents love choosing what they are going to drink for dinner and conversations increase as we give them choice.” – HCA
Mealtimes provide meaningful opportunities to study the effects of interventions aimed at increasing the provision of person-centred care (PCC) practices. Our aim was to create and implement a practice change initiative to improve PCC in residential care homes (RCHs), which emphasizes engagement of key stakeholders (e.g., care staff members, administrators, family members, and people with dementia). Researchers continue to find that care in RCHs tends to be more task-focused than person-centred, that individually tailored meaningful activities are not the norm, and that few possibilities for resident choice exist in daily care and activities.
Research in RCHs demonstrates that interventions aimed at increasing the provision of PCC that do not address contextual and system issues (e.g., deeply rooted care routines and regulatory standards that impede individuality, resident choice, and staff flexibility), most often fail. There is growing evidence demonstrating that the implementation of PCC in practice necessitates a multi-level, systems approach. Thus, it is reasonable to assert that promoting positive change in the residential care context requires more than education; it requires the engagement of key stakeholders who have the potential to facilitate change in the system as a whole.
Findings: Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment, social environment, relationship and person-centred scale, and overall environment scale. Our findings demonstrate that person-centred change initiatives at RCHs should incorporate individuals at all levels of care, and need to take into consideration the socio-structural components of the care environment.
“In 23 years I’ve never been involved in anything like this and it’s opened up my eyes a lot… now I want to learn more. I want to do more and that’s just amazing. It’s given me a new zest for my job.” – HCA