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New Dining Practice Standards


Pioneer Network is pleased to announce that its Food and Dining Clinical Standards Task Force: A Rothschild Regulatory Task Force has finalized new Dining Practice Standards. These nationally agreed upon new food and dining standards of practice support individualized care and self-directed living versus traditional diagnosis-focused treatment for people living in nursing homes. The Food and Dining Clinical Standards Task Force made a significant effort to obtain evidence and thus the New Dining Practice Standards document reflects evidence-based research available to-date.

The complete document may be accessed or downloaded here. (PDF)
The document includes the following new Standards of Practice:

  • Individualized Nutrition Approaches/Diet Liberalization   

  • Individualized Diabetic/Calorie Controlled Diet             

  • Individualized Low Sodium Diet                     

  • Individualized Cardiac Diet                      

  • Individualized Altered Consistency Diet              

  • Individualized Tube Feeding                        

  • Individualized Real Food First                              

  • Individualized Honoring Choices                    

  • Shifting Traditional Professional Control to Individualized Support of Self Directed Living

  • New Negative Outcome

Organizations Agreeing to the New Dining Practice Standards

  • American Association for Long Term Care Nursing (AALTCN)

  • American Association of Nurse Assessment Coordination (AANAC)

  • American Dietetic Association (ADA)

  • American Medical Directors Association (AMDA)

  • American Occupational Therapy Association (AOTA)

  • American Society of Consultant Pharmacists (ASCP)

  • American Speech-Language-Hearing Association (ASHA)

  • Dietary Managers Association (DMA)

  • Gerontological Advanced Practice Nurses Association (GAPNA)

  • Hartford Institute for Geriatric Nursing (HIGN)

  • National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC)

  • National Gerontological Nursing Association (NGNA)


CMS notes that the most frequent questions and concerns received by their staff focus on the physical environment and dining/food policies in nursing homes.  Therefore, in 2010  Pioneer Network and CMS held their second co-sponsored national symposium Creating Home II National Symposium on Culture Change and the Food and Dining Requirements , sponsored by the Hulda B. & Maurice L. Rothschild Foundation.  The Symposium brought together a wide diversity of stakeholders, including nursing home staff, regulators, provider leadership, researchers,  registered dietitians, vendors, and advocates for culture change.

Food and dining are an integral part of individualized care and self-directed living for several reasons, including: (1) the complexity of food and dining requirements when advancing models of culture change; (2) the importance of food and dining as a significant element of daily living, and (3) the most frequent questions and concerns CMS receives from regulators and providers consistently focus on dining and food policies in nursing homes. Therefore, we believe this area is one most in need of national dialogue if we are to improve quality of life for persons living in nursing homes while maintaining safety and quality of care.

In order to gather input from the many key stakeholders, the Creating Home II National Symposium on the Food and Dining Requirements and Culture Change was co-sponsored by Pioneer Network and CMS, in collaboration with the American Health Care Association. A set of research papers were commissioned with a wide variety of experts as well as a series of webinars, hosted by Carmen Bowman under contract with CMS, and all were posted online. This process allowed many members of interested organizations, associations, regulatory departments, and others to participate. The Hulda B. & Maurice L. Rothschild Foundation supported a Stakeholder Workshop on May 14, 2010 that was attended by 83 national leaders, which reviewed the feedback from all stakeholders, expert speakers and individual participants.  Two of the numerous recommendations at the Creating Home II symposium for future consideration were:

  • National stakeholder workgroup develop guidelines for clinical best practice for individualization in long term care living to provide regulatory overview and interpretive protocol and investigative guidance, and prepare related education materials to facilitate implementation.

  • Each profession serving elders in long-term care develop and disseminate standards of practice for their professional accountability that addresses proper training, competency assessment, and their role as an active advocate for resident rights and resident quality of life from a wellness perspective in addition to quality of care from a medical perspective.

These recommendations were acted upon at least in part thanks to the generous funding of the Hulda B. and Maurice L. Rothschild Foundation to Pioneer Network in 2011 by forming the Food and Dining Clinical Standards Task Force.  The Food and Dining Clinical Standards Task Force is comprised of symposium experts, representatives from Centers for Medicare and Medicaid Services Division of Nursing Homes, the US Food and Drug Administration and the Centers for Disease Control and Prevention as well as national standard setting groups. Pioneer Network expresses its sincere appreciation and gratitude to Rob Mayer of the Hulda B. and Maurice L. Rothschild Foundation for his continued support of these efforts.

Letter of support from Matt Younger of the Missouri Department of Health and Senior Services