Registered Dietitians' Perspectives on Healthcare Regulations Shaping Menu Planning and Mealtime Environment for Long-Term Care Residents with Dementia
In the United States, long-term care (LTC) facilities regulated by the Centers for Medicare and Medicaid Services (CMS) must meet federal regulations. However, there is a lack of research on the first-hand experiences of Registered Dietitians (RDs) in LTCs and their perceptions on the degree to which the existing healthcare regulations reflect the true needs of residents with dementia. It is important to gather RDs' perceptions as residents with dementia may be unable to voice their nutritional needs. This qualitative research explored how RDs understand the CMS regulations on menu planning (F803) and mealtime environment (F558), and identified how regulations could be modified to better meet the needs of LTC residents with dementia. The Normalization Process Theory (NPT) was used as the theoretical framework. The NPT comprises four domains: 1) coherence - an understanding of an intervention; 2) cognitive participation - investing and contributing to the intervention; 3) collective action - the practical work of implementation in practice; and 4) reflexive monitoring - how practices can be improved. Participants (n = 18) took part in one of five semi-structured focus groups consisting of three to five RDs each. Deductive thematic analysis using the NPT framework explored the perspectives of RDs working with LTC residents with dementia on these regulations. RDs stated that F803 and F558 regulations made sense and RDs were able to explain how they understood these regulations (coherence). RDs supported these regulations (cognitive participation). Therefore, they implemented these regulations both in individually focused (resident-centered) and institutionally focused activities. Interdisciplinary teams and person-centered care were mentioned as contextual factors that helped assist RDs in implementing these regulations successfully (collective action). However, these regulations should be made more clear by adding objective criteria to show how LTC facilities adhere to these regulations. These regulations should work toward patient-centered care and give priority to residents with dementia. A larger budget is also needed to provide consistent care to those residents based on these regulations (reflexive monitoring). The NPT can be useful in future research to understand and improve the implementation of nutrition policies and practices.
Dementia, Long-Term Care Facility, Normalization Process Theory, Older Adult, Registered Dietitian, Resident
Networked Digital Library of Theses and Dissertations