When addressing assisted living problems and resolution one needs to examine processes. An Internet search on the phrase ″assisted living problems″ will lead to articles and blogs on health and care issues for the elderly. These are important topics; however, the focus of this blog will be on the serving of meals to assisted living residents, which could be a facility’s ″tip of the iceberg″ issue.
Receiving Adequate Assisted Living Services
My wife’s father, whom I will refer to as George, has been to several assisted living facilities over the years. He is a great easy-going guy who lives in another state. I see him once or twice a year, while my wife travels there a few more times a year. My wife and I recently completed a trip where we saw him several times during a vacation. Our observation during these visits is the inspiration for this blog.
A few months ago, George’s assisted-living-care provider said that he needed to move to another facility, which could handle his additional needs requirements. During our last December holiday travels during which we saw George, my wife, her brother (who lives in the same town as George), and I visited several facilities. From this investigation, we selected a new facility, in anticipation of this move requirement. However, as we later discovered, a tour of an assisted living facility that looks desirable often is not necessarily representative of what occurs whenever someone moves into the assisted living facility.
Complaints from my Father-in-law about his New Assisted Living Home
Ever since George moved into the new assisted living facility, he has been complaining about his new home. He has stated many times that he wants to move back to his last assisted living location. My wife’s response to him is that the assisted living facility where he lived previously could not give him adequate assistance for addressing his current needs.
During our recent trip, my wife asked her dad to write down his complaints about his current location, which he did. However, he was not keen on the idea of presenting the issues that he documented to management. My wife still set up a time where we could meet with management and present our unsolicited Voice of the Customer (VOC) input.
The primary issue that George had was the amount of time he spent each day waiting for meals to be served. He also complained about the staff not being as friendly as those in his previous assisted living home.
Assisted Living Meal Service
In George’s previous assisted living home (which I will reference as Facility A), there was a one range of times set for each of their three daily meals. In Facility A, when someone sat down, he/she was immediately given a menu from which to make food selection. My father-in-law never complained about this process, which we observed when we had several meals with him. The meal attendants were also very friendly and would jokingly comment on his ice-cream preference for dessert, which they knew.
This new facility (which I will reference as Facility B) had a different process. Each resident was assigned an early meal or late meal time for each of the three meals. The process at Facility B was that meal orders would be taken for everyone in the dining room at one time.
My father-in-law’s meal time was the second shift for each meal, and his primary complaint was that the time to eat could take two to three hours. When my wife and I ate a few meals with her dad, we appreciated his complaint firsthand about how long it took from the time you sat down to when you could leave after completing a meal. When we randomly stopped by during our vacation, our observation was that most of the time he was sitting at the dining room table. This had not been the case at Facility A’s visits.
Problem with Assisted Living Meal Service Process
Taking meal orders all at one time is basically batch production for the kitchen. What that means is that the primary work of preparing food all comes in at once, which would result in some orders that could take a very long time; i.e., a long cycle time. I did not see the kitchen, but I would think that with this process the staff in the kitchen could have extreme work-load variations. This is unlike George’s previous assisted living location, where people’s orders were taken when they arrived, resulting in a more balanced kitchen workload. This process is not unlike continuous-flow manufacturing with an objective of achieving single-piece flow, which improves the speed of response to the customer; i.e., the assisted living resident.
Unintended Consequences from Assisted Living Meal Service Process
The dining room in Facility B had some large round, large rectangular and small rectangular tables. The number of residents at a table could vary between one to ten people. One time when my wife and I had a meal with him George he commented that he could not sit at those tables, as he pointed to several large round tables. He said that those people were cliquish.
In an assisted living environment, it is most desirable that the residents socialize and attend planned activities. George has always been a social nice guy whom everyone likes. However, at Facility B, my wife and I do not see her dad interacting with as many staff and residence people during meals and throughout the day.
My wife, her brother, and I do not think that the staff at Facility B is as friendly as they were at Facility A. At Facility A, when the kitchen work was slow, the head chef even came into the dining room and talked to the residents. Serving staff at Facility B, for example, almost seemed like robots going through the meal-serving process. Also the staff at Facility B does not encourage my wife’s father to attend activities, which he did regularly at Facility A. One person in Facility A regularly encouraged George and others to participate in planned group events. Neither my wife nor I see any person who served as a ″social-butterfly activity coordinator″ in Facility B.
In my wife’s and my firsthand experience, the culture and services performance between the two facilities was very different. George’s Facility B home did not perform as well as his past Facility A residence.
Assisted Living Problems and Resolution: Our Voice of the Customer (VOC) Input to the Assisted Living Facility Manager
During our last trip to see George, my wife set up a time for us to meet with the Facility B assisted living facility manager. We told the manager how George often stated how he wanted to move back to Facility A because he did not like his new home. We told the manager about how long it took to get served in the dining area.
The Facility B manager said that he had heard some complaints from the first shift dining people; however, he disregarded these inputs because he thought that often they sat down to first-shift dining much earlier than the scheduled meal time; e.g., after an event at their facility.
It appeared that the facility manager had no data and performance metrics to quantify how his facility was performing. I asked if the policies from other facilities in their company followed the same process as his. He did not know. He said that the dining room was the responsibility of someone else, whom we would need to talk to. We are now back home and will see the dining room manager from Facility B follows up with us to get our VOC inputs.
Assisted Living Problems and Resolution
Organizations need to create policies that lead to the best behaviors and with a minimization of risk for unintended negative consequences. Often, when organizations focus only on the financials and creating policies for maximizing profits, customers of their processes suffer. When this occurs in an assisted living facility, negative feelings by the residents can result in the loss of additional people staying at the facility because of word-of-mouth communication or spread of the word through social media.
To illustrate this point, consider the following. The monthly fees to stay at Facility B are very high; however, according to George, at their watermelon social the residents were given a small slice of watermelon but could not have another slice. Another example is that it costs $11.00 for each guest to dine with a resident. My wife asked for a salad with her meal and they said no; Facility A was much more accommodating relative to facilitating what the guest of a resident wants for dinner.
Assisted living residences, like other organizations, benefit when they use the Integrated Enterprise Excellence (IEE) business management system to integrate what they do (processes) with functional performance metrics. IEE in their organization could automatically report-out, for example, the cycle time, in a 30,000-foot-level predictive format. A comparison could be then made between facilities to determine best practices, from which other less-performing facilities could learn.