To determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation.
Secondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study.
Setting and Participants
Thirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Brunswick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units.
Trained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit.
In general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F9,48 = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F5,18 = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units.
Conclusion and Implications
Number of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice.
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- Transforming long-term care to keep residents healthy and safe. 2018.(Available at:)https://rnao.ca/sites/rnao-ca/files/Transforming_long-term_care_backgrounder.pdfDate accessed: May 4, 2020
- “Leisurely Dining”: Exploring how work organization, informal care, and dining spaces shape residents’ experiences of eating in long-term residential care.Qual Health Res. 2018; 28: 126-144
- Skills of workers in long-term residential care: Exploring complexities, challenges, and opportunities.Ageing Int. 2018; 43: 110-122
- Exploring personhood in dining experiences of residents with dementia in long-term care facilities.J Aging Stud. 2011; 25: 1-12
- Eating well in care homes: Testing the feasibility of a staff training programme aimed at improving social interaction and choice at mealtimes.Int J Older People Nurs. 2019; 14: e12247
- Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis.Int J Nurs Stud. 2019; 92: 144-153
- Effects of a relationship-enhancing program of care on outcomes.J Nurs Scholarsh. 2003; 35: 151-156
- Dining experience, foodservices and staffing are associated with quality of life in elderly nursing home residents.J Nutr Health Aging. 2009; 13: 565-570
- Shaping nursing home mealtimes.Ageing Soc. 2017; 37: 823-844
- “You can’t be forcing food down ‘em’: Nursing home carers” perceptions of residents’ dining needs.J Health Psychol. 2016; 21: 619-627
- A Norwegian view on Canadian long-term residential care.J Can Stud. 2016; 50: 491-498
- Exploring the mealtime experience in residential care settings for older people: An observational study.Health Soc Care Community. 2013; 21: 442-450
- Mixed methods developmental evaluation of the CHOICE program: a relationship-centred mealtime intervention for long-term care.BMC Geriatr. 2018; 18: 277
- The effect of dining room physical environmental renovations on person-centered care practice and residents’ dining experiences in long-term care facilities.J Appl Gerontol. 2016; 35: 1279-1301
- Memories, identity and homeliness: The social construction of mealtimes in residential care homes in South Wales.Ageing Soc. 2014; 34: 753-789
- Is the mealtime experience in nursing homes understood? A qualitative study.Geriatr Gerontol Int. 2013; 13: 482-489
- The role of physical environment in supporting person-centered dining in long-term care: a review of the literature.Am J Alzheimer Dis Other Dementias. 2013; 28: 491-500
- Attitudes, perceptions and experiences of mealtimes among residents and staff in care homes for older adults: A systematic review of the qualitative literature.Geriatr Nurs. 2017; 38: 325-333
- Making the Most of Mealtimes (M3): Grounding mealtime interventions with a conceptual model.J Am Med Dir Assoc. 2014; 15: 158-161
- Dining culture change in long-term care.Ann Long-Term Care. 2015; 23: 28-36
- Organisational and environmental characteristics of residential aged care units providing highly person-centred care: A cross sectional study.BMC Nurs. 2017; 66: 44
- Dignity and care for people with dementia living in nursing homes.Dementia. 2015; 14: 825-841
- Moving the agenda forward: A person-centred framework in long-term care.Int J Older People Nurs. 2012; 7: 303-309
- Person-centered dementia care and the cultural matrix of othering.Gerontologist. 2013; 54: 952-993
- Associations between person-centred climate and perceived quality of care in nursing homes: A cross-sectional study of relatives’ experiences.J Adv Nurs. 2019; 75: 2526-2534
- Beyond “person-centred” care: a new vision for gerontological nursing.J Clin Nurs. 2004; 13: 45-53
- Feasibility of LifeFul, a relationship and reablement-focused culture change program in residential aged care.BMC Geriatr. 2018; 18: 129
- A person-centred and thriving-promoting intervention in nursing homes—Study protocol for the U-Age nursing home multi-centre, non-equivalent controlled group before-after trial.BMC Geriatr. 2017; 17: 22
- Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: a cross-sectional survey.Int Psychogeriatr. 2018; 30: 1279-1290
- Promoting patient care: Work engagement as a mediator between ward service climate and patient-centred care.J Adv Nurs. 2012; 68: 1276-1287
- Dementia in home and community care. n.d.(Available at:)https://www.cihi.ca/en/dementia-in-canada/dementia-across-the-health-system/dementia-in-home-and-community-careDate accessed: May 4, 2020
- An enhanced dining program for persons with dementia.Alzheimers Care Q. 2006; 7: 258-267
- Making the Most of Mealtimes (M3): Protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.BMC Geriatr. 2017; 17: 1-15
- Mealtimes in nursing homes: Striving for person-centered care.J Nutr Elder. 2009; 28: 327-347
- Person-centered care training in long-term care settings: Usefulness and facility of transfer into practice.Can J Aging. 2013; 32: 57-72
- How nurses and their work environment affect patient experiences of the quality of care: A qualitative study.BMC Health Serv Res. 2014; 14: 249
- This is long-term care 2018.(Available at:)https://www.oltca.com/OLTCA/Documents/Reports/Thisislongtermcare2018.pdfDate accessed: May 4, 2020
- Marketization in long-term care: A cross-country comparison of large for-profit nursing home chains.Health Serv Insights. 2017; 10: 1-23
- Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis.BMJ. 2009; 339: 381-384
- Staffing in Ontario’s long-term care homes: Differences by profit status and chain ownership.Can J Aging. 2016; 35: 175-189
- Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies.Health Serv Res. 2012; 47: 106-128
- The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes.Int Psychoger. 2020; 32: 863-873
- Development and inter-rater reliability of the Mealtime Scan for Long-Term Care.Gerontol Soc Am. 2018; 58: e160-e167
- Construct validity of the Mealtime Scan: A Secondary data analysis of the Making Most of Mealtimes (M3) Study.J Nutr Gerontol Geriatr. 2018; 37: 82-104
- Construct validity of the Dining Environment Audit Protocol: A secondary data analysis of the Making Most of Mealtimes (M3) study.BMC Geriatr. 2018; 18: 20
- Validation of the Minimum Data Set Cognitive Performance Scale: Agreement with the Mini-Mental State Examination.J Gerontol A Biol Sci Med Sci. 1995; 50: M128-M133
- The Edinburgh Feeding Evaluation in Dementia Scale: Determining how much help people with dementia need at mealtime.Am J Nurs. 2008; 108: 46-54
- Ensuring quality care for all seniors 2018.(Available at:)http://www.healthcoalition.ca/wp-content/uploads/2018/11/Seniors-care-policy-paper-.pdfDate accessed: May 4, 2020
- Person centred langugae guidelines 2017.(Available at:)https://alzheimer.ca/sites/default/files/2017–11/Person_Centred_Language_Guidelines-e.pdfDate accessed: May 4, 2020
- Special care units and traditional care in dementia: Relationship with behavior, cognition, functional status and quality of life - A Review.Dement Geriatr Cogn Dis Extra. 2013; 3: 360-375
- Making the Most of Mealtimes (M3): effect of eating occasions and other covariates on energy and protein intake among Canadian older adult residents in long-term care.J Hum Nutr Diet. 2020; 33: 3-11
- Inter-rater reliability of the Mealtime Scan+.J Nutr Heal Aging. 2019; 23: 623-627
Published online: December 15, 2020
The authors declare no conflicts of interest.
The original data collection for M3 was funded by the Canadian Institutes of Health Research, Canada (201403MOP-326892-Nut-CENA-25463). This secondary analysis did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.