Research has demonstrated the negative nutritional impact of Covid 19 due to the clinical manifestations and psychosocial effects. Specifically, Registered Dietitian Nutritionists (RDN) have seen increased weight loss trends during upticks in the COVID-19 virus over the past few years. Therefore, as an organization, RiverSpring Living took a deeper dive into what specifically were contributing factors in addition to the actual virus itself.

Weight Loss Statistics & Social Isolation

Increased isolation and decreased activity levels due to infection control restrictions, such as visitor restriction and dining hall closure likely also contribute to increased weight loss. Weight loss in older adults has been associated with mortality overall and is a common feature of other geriatric syndromes. The study found weight loss among both COVID-positive and COVID-negative residents. In addition, the study’s findings support the call to proactively address COVID-19–associated weight loss as part of a COVID-19 management strategy within Skilled Nursing facilities. In fact, the study notes that “creative strategies and policies are needed to ensure residents receive adequate mealtime support, symptom management, weight monitoring, and comprehensive nutrition assessments”.

The non-communal dining mandates throughout COVID-19 supported a more isolated dining experience within senior living facilities including RiverSpring Living. Not only were residents eating alone or separated from their peers but also many were eating all of their meals in their rooms which may have contributed to an increased feeling of isolation, reduced appetite, or decreased desire to request assistance or alternates at meals. In addition, RiverSpring had put many of its communal food-related programs on hold such as monthly birthday celebrations, barbeques, or festive celebratory meals.

QAPI

The NEXDINE Hospitality RDN team led by Jennifer Flood-Sukhdeo developed a QAPI which stands for Quality Assurance and Performance Improvement. The team consisted of representatives from administration, quality assurance, dining and nutrition, and nursing. The team brainstormed areas that were negatively impacting weight trends within the organization during monthly QAPI meetings.

First, according to Jennifer as the regulatory restrictions began to lift, the facility did everything possible to create a meal-like environment that fostered communal dining and festive meal celebrations like what our residents remember prior to the pandemic. Secondly, the team identified that our goal was to ensure that staff in all the neighborhoods were aware of our ‘high-risk’ residents. Therefore, the team developed a communication tool that allowed staff on all shifts to be alerted to those residents that may have changes in appetite or weight trends. Lastly, we fostered the help of other staff members within the organization to develop a program called ‘Hands on the Hudson’. This program empowers all staff within the organization to give one hour of their time weekly to a program or task outside of their daily workflow that would support resident care. These assignments include assisting staff at meals, bringing residents off units or outdoors more, or increasing the number of one on one visits for those that welcomed this. An interdisciplinary approach to designing a data-driven performance improvement plan was instrumental in having a clinically meaningful effect on RiverSpring Living residents.

Impact

RiverSpring Living is proud to report that their weight loss trends have decreased tremendously, residents are enjoying more of the special food-related programs, and staff are feeling rewarded by the experiences they share with residents. RiverSpring’s Vice President of Rehabilitation and Quality Assurance; “I agree with the many cultures that believe healing the belly ultimately heals the body!”

 

References
Martinchek M, Beiting KJ, Walker J, Graupner J, Huisingh-Scheetz M, Thompson K, Gleason LJ, Levine S. Weight Loss in COVID-19-Positive Nursing Home Residents. J Am Med Dir Assoc. 2021 Feb;22(2):257-258. doi: 10.1016/j.jamda.2020.11.031. Epub 2020 Nov 28. PMID: 33352194; PMCID: PMC7699303.