Book Review: Bon Appetit! The Joy of Dining in Long-Term Care

Bon Appetit! is a dining program developed to restore the simple pleasures of eating to residents in long-term care. The authors of this resourceful book have created a comprehensive and informative guide to revamp dining in long-term care facilities. How better to improve quality of life than to bring the sensuality and rewards of fine dining into the nursing home! We all love delicious and fancy food—indeed, eating is a high point of the day for most people. But for individuals with cognitive impairment, food consumption takes on an even greater importance as other enjoyable events decrease in number. In spite of this, institutional food is known for its blandness, limpness, and lack of flavor and texture. The Bon Appetit! dining enhancement program changes all that. It is a wonderfully creative, well-written, and researched program that has the potential to improve quality of life for nursing home residents. How could we professionals have failed to realize that something as simple as meals could be employed as a medium to naturally provide stimulation, activities, sensations, occupational therapy, physical therapy, nutrition, dignity, social support, and relationships with others? All long-term care facilities have to do is learn to embrace this kind of change. The industry’s growing commitment to quality-of-life issues and to personoriented care overriding strictly medical care continues to evolve as more and more of the population reach their older adult years. Overall, this kind of programming is cost-effective, efficient, and natural. The beginning chapters of this delightful book argue effectively for changes in the existing dining experience typical of long-term care facilities. Highlights include the need for residents to be involved in the planning and preparation for all mealtimes including menu choice, pre-meal activities, environmental cues, transitions from other activities, serving methods, social interactions and after-meal rituals. Atmosphere and other environmental issues are described in detail (i.e., seating, access, wheelchairs, lighting, sounds, movement, air quality, temperature, aroma, and décor). Introduced in Chapter 4 are specific foods and their ingredients, characteristics, nutritional value, and cooking methods, with an emphasis on using spices, herbs, condiments, and fruits to enhance food dishes instead of sugar, salt, and fat. Many creative food choices are suggested for residents with dysphagia, chewing problems, and motor difficulties. Preserving autonomy in feeding is the topic of Chapter 5, where it is recommended that information be gathered about each resident’s eating history. Staff must assess each resident’s functional abilities to determine if there is a problem with feeding, as well as the underlying reasons for it when it exists. The proper investigation usually results in figuring out a way to motivate, assist, or enable residents to self-feed. Retaining the ability to self-feed preserves dignity and eliminates the need for extra time in meal preparation. Details of many successful case studies are described that exemplify the effectiveness of the Bon Appetit! program. Chapter 6 covers restorative dining—individually planned group and one-to-one activities, exercises, and applications of assistive equipment and/or techniques for helping clients regain skills lost due to illness or accident. This can take the form of speech or occupational therapy aimed to restore a person’s mealtime performance. Other types of restorative programming include supportive interventions, such as asking the resident to prepare part of the menu or set the table. In addition, preventive interventions are described, such as an individual staff member providing proactive attention, a facility-wide commitment to upholding the joy of dining in a daily mealtime routine, and special events to give meals added spice. The idea of providing meals composed of nutritional finger foods is the wonderful creative focus of Chapter 7. It is devastating to people when motor coordination problems result in the loss of the ability to use utensils properly. Finger foods allow residents to maintain their dignity and to still feed themselves. This chapter contains an extensive overview of the principles and logistics of developing and maintaining a finger food line. Finger foods are introduced that have nutritional balance, variety, taste, and aroma. Many, many menus and recipes for finger foods and soft foods are included. Supportive and assistive dining techniques are covered in Chapter 8. Good helping techniques enable people. When a resident experiences difficulty doing something, a frequent impulse among caregivers is to take over the task and to simply do it for the person. However, this may be an immense intrusion that threatens the person’s control over their environment. Caregivers are taught how to help, but not take over completely. Techniques include changing the circumstances, or location, or environment; simplifying the task; changing the equipment; showing, modeling, cueing or guiding, or