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Redefining Dementia
resources and helpful life experiences, the podcast will look to connect with the audience to provide helpful and meaningful takeaways.
Redefining Dementia
Creating Meaningful Dining Experiences in Dementia Care
On this episode, we are joined by Registered Dietitian and President of SuzyQ Menu Concepts, Suzanne Quiring. Suzanne shares her passion & experience on “how” meal service can be done as resident focused as possible, and the culture change that is needed to do so. Listeners will gain tips on providing a harmonious dining environment, and caregivers will learn to navigate the challenges of dietary care - turning a routine activity into a peaceful experience that supports both physical health and cognitive well-being.
Suzanne's insights extend into the heart of healthcare communities, where her SuzyQ Cart System is revolutionizing the dining experiences for residents. She shares how this revolutionary movement is reshaping meal service through increased resident & staff interaction and the power of offering choice.
Please see the following links to resources Suzanne shares in this episode:
Pioneer Network
The Eden Alternative
Butterfly Model of Care
Pineapple Academy
Research Institute of Aging (RIA)
RIA Choice+ Program
Dietitians of Canada
Academy of Nutrition and Dietetics
Suzanne's LinkedIn
About our Hosts:
https://www.personcentreduniverse.com/about/
All right. So welcome Suzanne. We're so excited to have you today on redefining dementia. Thanks for joining us.
Speaker 2:Thank you for having me. I'm excited to share with you.
Speaker 1:We were excited to hear from you, and so our first question really centers around you know, from your perspective, what are the most important factors that you focus on when it comes to good nutritional care for individuals who are living with dementia.
Speaker 2:Right, that's a really good question and it's a complicated one because there's so many factors to look at, but I think what a good lens to look through is with folks with dementia is trying to keep things simple because it can be stimulus overload during the meal time and it can be a noisy experience that sort of thing.
Speaker 2:So I think one of the first things I look for is reducing the distractions when people have dementia. So is the TV off? Is there just like? Is the is music off, like? Sometimes the radio can be on and that can be really distracting and sometimes there's noise from plates and cutlery and that sort of thing. So really kind of looking at noise would be one of my first things before the meal starts.
Speaker 2:The second thing is setting that person up for success. So that means you know if they wear glasses, do the other glasses on, do they have their hearing aid and are they comfortable where they're sitting, and kind of making sure that that person is like in a good space to be able to have meal. And then we kind of look at overall meal management. Sometimes with folks with dementia they have a better time understanding what maybe a fork and knife in a spoon is for. And when dementia progresses more and more, sometimes you know they'll just get rid of all the calorie and just use our fingers. So I think sometimes looking at your place setting and making sure that it's simplified is really helpful. So sometimes just putting a spoon and not having the fork in the knife.
Speaker 2:Sometimes, you know, understanding what a knife is used for can be hard for people.
Speaker 2:So again, maybe cut up their meal ahead of time and so that they don't have to worry about using a knife. So that's sort of the meal management thing. And then if someone with dementia is very PC meaning they're up and down and up and down and moving then you go with that. You don't say you have to sit still. Maybe it's eating on the run, so putting food in their hand and while they maybe pace, maybe smaller, more frequent meals, rather than a set breakfast, lunch, supper meal, maybe you're going to be doing, you know, six mini meals through the day, or maybe they're more hungry at supper time and so you're going to get the calories and the protein in during that meal versus in the morning. So it really depends on where, what level of dementia they have and where they're at. But you're really looking at the whole person and looking at that meal time and saying how can I best set this person up for success, not based on my schedule, my needs, but what that person needs at the time.
Speaker 3:I love that. Yeah, it's so. It's like meeting them where they are to right.
Speaker 1:Really encouraging that intuition, allowing it to be intuitive as opposed to kind of prescriptive. Yeah, I love that.
Speaker 2:There's different you know, every person with dementia manages meals differently. So I'm thinking of a whole bunch of different folks I've worked with, and I'm thinking of one person who just literally would do you know, walk around and around and every time they came around for a loop.
Speaker 2:We'd put another piece of food in their hand and they would just pace with it and walk with it, and that worked for them. Trying to get that person to sit down at a spot impossible, like it is just not going to happen, and that's okay. There's no rule that says you need to eat like this. So we have to become much more flexible with what our expectation is with people with you know the half dementia and again meeting them where they're at.
Speaker 3:So I think you kind of started or partially definitely answered this, but just thinking about, like, say, someone who's recently, like you know, received a diagnosis, and just kind of learning how to navigate kind of the new normal of you know, learning about about dementia and their diagnosis, can you explain and this is a large question because, as you say, everyone's a little bit different but could you explain to your listeners maybe some of the changes that they may see or encounter kind of early on, if at all, like relating to meal time and nutrition, as like after, you know, soon after receiving a dementia?
Speaker 2:Yeah, it is a big question because it's so individualized depending on the person, but as a registered dietician, what are the things that I'm looking for when I'm working with folks? I think my primary focus tends to be just getting the protein and the calories in. However, that being done as easily as possible, weight loss and malnutrition tend to be our number one issues. It's not weight gain and we're not on diets. This is the time that we liberalize the diets big time. If that person loves ice cream, they might be getting ice cream for breakfast. All our rules that we have in our life when it comes down to food all of that goes out the window and everything's up for discussion.
Speaker 2:Really, we're trying to maximize how to get the calories and protein in Might be looking at really calorie-dense meals maybe drinking calories is way more effective than actually eating them. Maybe making a really high calorie, high protein milkshake or pudding or ice cream or any of those ideas on how to get the calories, Because what we're trying to prevent actually is the weight loss, but also skin breakdown. That tends to be a big one. What skin breakdown means is that when your skin becomes really fragile because of malnutrition, you have the risk of getting a thing called a pressure injury or pressure sore. When that happens, that can be very, very difficult to get ahead of. What we want to do is not even go there. When pressure injuries happen, then you end up going into wound care and it can go dangerously fast if we're not on top of it.
Speaker 2:Calories, protein, slow-frequent meals, one, maybe one food at a time, providing it to them rather than giving them a whole bunch of meals and overloading the senses of here's your soup and sandwich and dessert and your drink, and you might have to slow down in one thing at a time. Just sort of see how they're managing what overall, what it's called is just meal time management. You're looking at the person and seeing how they are doing. If they're not recognizing food, if they're not understanding how to use cutlery, if they're not sitting down, if there are lots of going on, that's going to really distract them from eating.
Speaker 3:Well, I'm thinking you gave so many practical examples at the beginning when you were talking about how to set them up for success, and I'm thinking about how that might translate as well to situations where they're in restaurants or gatherings over the holidays and stuff. I think you've already answered my question, which is some practical advice for those situations. I think probably what you say the answer is that it's like educating others. Probably is a big one there, right. It's like to introduce what the needs are of the individual.
Speaker 2:Yeah, if you think about a restaurant setting, that can probably be one of the toughest scenarios to put someone with dementia into, because it's very regimented. You're going to sit here, there's probably a lot of noise going on and you have to wait and wait for your food and everything comes at once. I just would think that would be so overwhelming for someone with dementia. I would recommend to caregivers that maybe a restaurant's not the place that you go. Maybe you do take out and you go to a park and you go to a park bench or a place where it's safe for them maybe to get up and wander around and you walk with them with the food. But yeah, really think about how regimented and noisy a restaurant is and why that doesn't work well often with dementia.
Speaker 3:I think that's a really good alternative solution for sure. I think what oftentimes comes as you know, I'm sure, from with individuals who are living with some type of dementia and say the family unit or the support units, is that food is just often and food experiences are so emotionally grounded too. Yes, and that's when you were saying absolutely, you're right, it's, a restaurant is probably one of the toughest environments, but, however, then there's a, you know, kind of a double-edged sword of like. But then the impact of maybe, if they were someone who went to diner every Saturday morning as part of their like, that's part of their story, you know, then you're navigating like losses too of those those types of rituals.
Speaker 3:So I love you know the suggestions that you made of different, different twists on those kinds of experiences.
Speaker 2:Yeah, well, we we love through food. Often we care through food.
Speaker 2:It's a very social experience. It's an intimate experience that we usually have with other people. When we get together, it's usually food is involved, right, so we can still do that. But I think it's really invaluable for caregivers to think, okay, I can still feed this person, love them, sit with them, visit with them through food, but is my environment too hard for them to manage that? So maybe we need to shift. If we're talking about person-centered care, you have to put the lens on as to how that person is doing. Not well, this is what we're doing. That doesn't always work. So, you know, let's we can still love through food and care through food and dine with food and socialize and everything, but maybe how it's all done is quite different.
Speaker 1:Yeah, absolutely so true, and I'm one of those people I love through food. I'm very proudly loved to cook for other people, share meals with other people, and so do you have any suggestions on how you can adapt those approaches so that you can still include individuals living with dementia in that meal prep experience and also the eating experience? And I know you touched on the eating side, but really around that prep, yeah exactly.
Speaker 2:Well, if we look at the whole meal from start to finish, eating is only part of it, right. So if you even break it down into like four or five parts, well, the preparation can the person with dementia, can they still maybe, peel a carrot? Can they shut corn? Can they break beans? Can they, you know, is there things that they can still do safely and effectively? You know they might not be, you know cooking over the stove and understand that part, but there's other stuff in prep that you can easily do. Can you stir this? Can you? You know, involving them.
Speaker 2:And I highly encourage even folks that are in dementia care communities that the staff do that with folks, that if they're in their own homes, yes, you can get them involved. Because, like, even I'm just thinking, like, for a lot of our folks with dementia, being a homemaker was their primary role in life. You know, they raised the family, they stayed home and they cooked and they cleaned and that was, that was their job in life. And then all of a sudden you take that away from them. That can be devastating. So let's not take opportunities away from them. Let's still give them every opportunity to be involved, but let's shift so that we can still do it in the same way.
Speaker 2:So, prepping the food, even when you're asking them, when you're plating the food, you can still give people the opportunity to say what they want and how much. So you can say, you know, would you like apple juice or orange juice? You can show them, and people with dementia might understand the colors and better than the words. So using visuals is really helpful and it is a fundamental right for people to self-determine. So what that means is is that no one can take that right away from me. I need to still be able to have the opportunity to say if I want something, in how much, and even with folks with dementia.
Speaker 2:So I find sometimes people just make assumptions too much for people. But people can still see, laugh, hear, cry, have all those emotions. We still need to tap into that. So to giving them that right. So that's our pre-meal, and then during the meal which we've talked about, and then post-meal, you know helping with the cleanup, bringing your dishes to the kilter or to the sink. You know, give them a broom. I bet you they would know how to still. You know still sweep, wiping down tables. Yes, you might have to wipe the table after them and, you know, disinfect it afterwards, but they can still go through that action of wiping tables. So there's lots of little things that we do in the meal hour that folks with dementia can still do. Maybe we just adopted a little bit more.
Speaker 3:Wow, your answers are so person-centered, they're just speaking to my heart. I guess I have a question and then a request of you. So one question that I would have is this is kind of a two-part. So do you have any favorite like practical resources, like books or handbooks or actual physical resources that you know you love and you always go to, that we might want? And then, as a part two, this is my request is because a lot of I mean you have a large body of work. Obviously you're very, very prominent leader in this field in our country and in Canada, and I think our listeners would probably love to hear the story of the Susie Q Sure.
Speaker 1:Yeah, just because it's a wonderful story.
Speaker 3:But anyway, whichever way you want to tackle those, yeah.
Speaker 2:So I'll tackle the first one about the best resources. So, as a registered dietician, we always lean into best practice. So everything that is research-based or evidence-based, that is the foundations of what we do. And so what is my foundation? Where do I go to to really make sure that I'm doing the best care as possible? So there's a handful of resources that I really like. So the first one that comes to mind is the Pioneer Network. The Pioneer Network is a culture change organization, so there's a lot of really, really good resources on their website. It's pioneernetworknet, and there's a whole section about dining, and so there's tip sheets, there's resources for family caregivers, everything, and they actually came up with the dining practice standards and in there it's a two-year document. It took two years to write this document. It's all research-based and there's some. It's just really helpful to kind of go okay, is liberal diet the best way? What do I do with?
Speaker 2:my diabetic dad and you know, can you still have dessert? See, can, by the way. So there's lots of really, really good stuff in the Pioneer Network. The Eat An Alternative is another culture change organization I lean into. There's the Butterfly Model of Care, there's the Pineapple Academy, which has lots of good resources, and then, when that's come out in the last year or two, which is Canadian-based, is the Research Institute of Aging, so RIA, and they have a program called Choice Plus and that is all about dining. So I actually you can sign up for Instagram. They have a Choice Plus Instagram page and so they put little videos and little ideas together for caregivers and staff to kind of really think through with that. And there's some dining room checklist, there's a meal time checklist there on the Research Institute of Aging. And then we have, of course, dieticians in Canada, the Academy of Nutrition and Dietetics, but that's kind of getting really clinical. You don't want to go there. Those are the resources.
Speaker 2:And then the CZQ story is that I was a director of food service and clinical dietician at a care community and we did meal service the way everybody tends to do meal service, which is either pre-plating in the back of the kitchen or institutional trace and I thought there's got to be a better way to do this. And my aha moment came to me when I was on a flight and the airline service came down with a juice cart and asked me what I would like to drink. And I thought, oh my gosh, if we can ask people 30,000 feet in the sky what they would like to drink and give them some choice, we have to do this in our dining rooms in communities. And so, instead of we were pre-poring everything, we pre-pored juice, we pre-pored cereal, we pre-pored dessert, we pre-pored or pre-cut, pre-organized meals and sort of red sheets with people's name, because one day they said they liked orange juice and they get orange juice every day until someone changes the sheet. And I thought, no, let's switch it up, let's do it how they do it on the airlines when we're in the sky. So I got my stuff to start like just going around with a juice cart with bulk of juice clear containers so that folks with dementia can see the colors of the juice and what.
Speaker 2:Lauren B Holdry found that people actually chose different things different days. So I like apple juice, but I also like cranberry juice. Sometimes I just want water. Why are we pre-poring everything, and so it's kind of started there with a juice cart and then we got a dessert cart going, had some different choices of dessert and if someone wants two desserts, give them two desserts. If they even put an aerosol can of whipped cream on the dessert cart and decorated in front of them bringing the show to them, because the dining experience is more than just calories on a plate.
Speaker 2:it is a whole experience. It's our place of connection. It's where we really see people and hear people all together. So we started to have a lot of fun with these little juice carts and dessert carts and that sort of thing, and then my cook wanted to come out with the food because everybody else was out in the dining room.
Speaker 2:The cook was in the back of the kitchen still and she said I want to come out, but there really was nothing out there that would allow for bringing hot meals into it, and usually you have these big stationary steam tables and I thought, well, let's just make something for you. Then there was nothing in the industry, nothing like this, and so my husband's an engineer, so I was telling him my challenge and so together we sort of drew up this very compact mobile cart and I got it made and it literally transformed our dining room, because now the cook was out actually interacting with the residents, seeing them, hearing them and then plating their meal exactly what they wanted. So if a resident just wanted mashed potatoes, they can have just mashed potatoes. We don't need to plate the meat and the vegetable and and just because, from a licensing point of view, we have to provide a menu that meets licensing standards and the Candice Food Guide and that sort of thing. But what a person chooses to have is their rights, so why are you serving food that they don't want?
Speaker 2:And so it literally transformed this entire dining experience, and then there was an opportunity to write an article about this in the journal a gerontology nursing that my administrator asked me to write and so I wrote it. And then I started to get phone calls at work from other dieticians and organizations saying can you teach me what you did and how to read how do I do it? So now fast forward 20 years. It's been around for 20 years. Now they're in over a thousand healthcare communities across Canada and the US and, yeah, it's just really fun seeing homes shipped from pre-plate predetermined to more of a self-determined mobile system.
Speaker 2:And this was a huge solution during COVID, when dining rooms got closed overnight, all they did was just literally move, you know, down hallways and all codes and stuff like that, rather than take out containers. So it was a huge solution If there was any silver lining of.
Speaker 2:COVID, we learned that. But, yeah, that's the kind of the Susie Q, so they're made in Canada For Canadian folks, they're made in Winnipeg and they are, yeah, used all across the country. Well, and it's such a brilliant concept and idea, and so thank you for sharing the story.
Speaker 1:Suzanne, I didn't realize I didn't know the narrative behind it, if you will. And I just wanted to say you know I think it's such a great solution, not only both for the residents, like in in in COVID. I think it's such a great solution not only both for the residents, like in implementing those person-centered practices, but also for the staff, because then you're allowing and encouraging them to be part of again that meal experience. So thank you?
Speaker 2:Yes, well, one of my, one of my favorite stories and I'll try and say it without getting choked up, but it does choke me up almost every time I share it. So we'll see how I do this. I'm not sure if you're aware of that, but I had a cook named Linda who came in through the back receiving door and left through the back receiving door and did her shift like that for, you know, 20 years. And then when we shifted to do a mobile meal service with the Susie Q, you know she wasn't really happy at the beginning because it was changed and changes hard. Even if it's for something better, change is still hard. So I think that's why she was very resistant and very verbal with me about why she didn't want to change. But I said you know what, we're going to try this and we'll work through it and we'll keep talking and that sort of thing.
Speaker 2:Well, at the beginning she was very nervous because she had never really interacted with residents before. Like I said, she came in through the back receiving door, left through the back receiving door and just read lists. So Linda starts going out and serving our folks with dementia and she's very nervous at first, but then she kind of got right into it and started having really a lot of fun. So here's my story Linda is in on her day off and sits with one of our residents who's palliative and passes away, and it's Linda's hand that that resident is holding.
Speaker 3:That's so amazing yeah.
Speaker 1:Yeah.
Speaker 2:And so see, I can't get through without talking about it, but it really is just so like. That's what this is about is really seeing the person and giving them the dignity and respect that they deserve. And if we can do that through food and we're giving them choice and that connection, the person-centered connection, relationship-centered focus, that's what dining really is at the end of the day. It's not just the calories and protein.
Speaker 3:Yeah, yeah, thank you for sharing that story and we cry all the time, so don't worry, we have a really good company. I just was thinking the whole time when you were telling the story of the Sisi and Kukart, like, of course, I'm sure that there are lots and lots of you probably have 20 years in so much data to show efficiencies and cost savings and all of those things equality, improvements in the meal, the actual menu and things like that but really like a catalyst for change is what it was. Right, yeah, how different is Linda and all the Lindas like feeling about their purpose from an older model where it's more institutional and all departments don't interface with, you know, the residents in the same way. So, yeah, yeah.
Speaker 2:I think that you're amazing and segue with that. If I had. Advice for communities or staff is actually to have a learning circle to an and have an enhanced dining team where you come together as a multidisciplinary group and kind of pass the talking stick or the conch shell and you talk about what is frustrating you about the dining experience. What, on a scale of one to 10, what would you give it? Is it a one or is it a 10? And if it's not a 10, why isn't it a 10? What is it that needs to change? And so when you're putting the problem in the center of the room not because some people can get really defensive and gather back up about change, but what you're talking about you're using the lens of person-centered care and relationship-centered care. And how can we do this really well in the dining room, which tends to be the hub of the community and all hands on deck? And so talking about it as a learning circle allows for the culture change often to happen, which is the tough piece.
Speaker 3:Yeah, sure is. Worth it so worth it and worth the investment to put that, to make the changes and to get there. But it is very hard.
Speaker 1:Yeah, and it's one of those things we often so. We have a colleague who is in famous for saying when residents in long-term care talk about two things what they ate today and what they did today, they don't talk about the other stuff. And so, to your point, it's really important for us to get it right and to have the voices of our whether it's residents or the people who we're caring for in communities heard so that we can provide them that quality, person-centered care. That's just, it's brilliant. Thank you, suzanne. Yeah, you're welcome.
Speaker 3:Oh my gosh, I feel like we need. We could probably have you back again. As I said, we'll spin off Epidodes for this podcast. So I think, gosh, I think that you've probably answered most of the practical questions. I think I would just have one more, maybe the last kind of practical, and we have one question that we ask everyone who does our podcast. So Ashley's saving that one for the last, but I guess I would just maybe like, can you maybe just spend a couple of minutes just touching on hydration and-. Yeah, because that's a big one, I know, and especially for family members or people who are caring for loved ones at home in the community, that can be something that maybe gets overlooked a little early on.
Speaker 2:Yeah, yeah, absolutely yeah. Hydration is a big thing that we look at as dieticians. When someone is dehydrated, they then have issues with constipation, skin can break down more easily. You can get your neary tract infections. So preventing those things from happening is really helpful. And so it can be as simple as do.
Speaker 2:They have a water bottle nearby, so it's just sort of the sip and go thing Constantly. I know that myself. I have a water bottle and I know if I have a water by me I'm gonna sip it more frequently than if I did sit down and okay, now I'm going to drink. I think the second would be is it fluids that they want? So are you asking what they would like to drink and not always assuming? So that's again, the self-determination piece is really helpful.
Speaker 2:Remember, there's fluids in lots of different things, so it's not just water. It can be soup, it can be milkshakes, it can be ice cream, like all those things do bring down into fluids, but there's also the calories and protein and some of those foods as well. So just kind of, how often? I mean, if you're helping them use the washroom then and you're there and their urine is quite dark, then you know right away that they're not drinking enough. So I call it the P test, but it really is truly the way that we find out. If we're hydrated enough before urine isn't bright yellow, then that's an easy sign to figure out. So, and how often are they going to use the washroom? If they're only using the washroom two or three times a day, then maybe they need a little bit more fluid. So those are just some very practical ideas. How about?
Speaker 3:it Really helpful. Thank you, because I think we who Ashley and I both and yourself like kind of grew up and spent careers in healthcare formalized settings, but even us in like so many times in long-term care, you know, nine times at a time. If somebody all of a sudden is acutely experiencing, you know, it seems like they woke up and they had dementia, it's like nine times at a time it can be attributed to a UTI or some other time. So people at home who maybe aren't as experienced caregivers like that's really practical advice for helping to identify possible causes for changes that they may be seeing.
Speaker 1:Thank you, yeah, thank you. And so our very last question, Suzanne how would you like to redefine the journey someone's going through or living with dementia through that personalized meal experience and meal management?
Speaker 2:How would I change it? Well, I would love to see. First of all, my goal in my life actually is to have all residential care communities off pre-determined service. I think the first one. That is what jazzes me up and gets me excited every day to go to work.
Speaker 2:I wanna see communities get away from deciding for people what they're gonna eat and drink Just because it's on a sheet Like let's get rid of the sheets, burn the sheets, get rid of them, and let's start talking to people and interacting and remembering why the whole eating experiences is so critical on many, many levels. And if we learned anything during COVID and the isolation that that caused, now we don't have those restrictions, now that we've gotten into the other side of it. But we have seen from that experience how critically it bring it is to be together. And so that would be my first one for communities that are healthcare communities. I don't like using the word facility, by the way, because we don't live in facilities, we live in a home, and so being a healthcare community or a home is the language we should be using.
Speaker 2:And then I think, for folks that are at home with a loved one with dementia, I first wanna say it's hard, like it's hard and we see you and we hear you and we walk alongside you. It's a tough journey. Don't get caregiver burnout. You're struggling, you've gotta reach out and get help. But also, again at the beginning of the podcast, just talking about the whole meal time experience and maybe altering how you look at it in the lens that you're looking at it and it might need to shift to work for that person better. So, whether it means small, frequent meals, pacing, simplify the meal, allowing them to still participate with meal make pre and post meal activities All that sort of stuff is an engaging thing. It's a brain activity as well. So don't do everything for that person. Still allow them to be part of the journey, of it and make them feel valuable.
Speaker 3:Wow, you are an amazing advocate, suzanne, so thank you, thank you. We're very, very honored that you decided to give us a little bit of your time today to the interview, and we will, of course. You mentioned a couple of resources and we'll post with you after the interview and we'll be posting links. We will have a podcast page and your episode, so we'll share a whole bunch of things that you mentioned on that page as well.
