atomalliance.orgatomalliance.org/wp-content/uploads/2016/07/session-… · web viewwe will also...

Event ID: 2988059Event Started: 7/6/2016 2:44:03 PM ET

[Please stand by for real time captions]

Hi, everyone. It is a little bit before 2:00 and we will give people a few more minutes to get signed on before we start.

We will get started. This is Emily. I will be your chat pane monitor and will give you housekeeping before I turn it over to our Speaker. First, all of your phone lines are on mute at this point for a better listening experience. If you have a question or comment, please use the chat pane on the right-hand side of your screen. Just a reminder that state and federal regulation require that you record attendance. Someone at your facility should be recording your attendance for this webinar today. If you need attendance tracking sheet, we have a template on our website under the toolkit page. Also I ask you to be patient today as we will show you a video clip. It has been a file since I have worked the Speaker system and what not in our conference room. Please be patient with us. At this point, I will talk a bit about our Speaker. Today we have Dr. Linda Beuscher with us. She is system professor at the school of nursing at Vanderbilt. She is also a geriatric Nurse Practitioner. She has a good bit of experience and long-term care and dementia care and also is where her research interests are. I will turn it over to her now.

Welcome, everyone. As we get started, I want to add a little bit. Thank you, Emily, for the lovely introduction. I worked for 15 years in long-term care with experience with residents and staff. I started out as a nursing assistants in a long-term care facility before I went to nursing school. I have had first-hand experience and have a great appreciation for you, your work and your new role as a feeding assistant. Today we are going to cover the third session of our Feeding Assistant Training. In this session we will review what the import aspects are making positive dining experience for the residence and your cell. We will demonstrate proper resident and staff positioning for feeding assistance. We will also illustrate the various types of feeding assistance you will provide for the residence. Will explain specific techniques for feeding and then discuss the required performance evaluation that must be completed to receive your certification. Before we get started, let's revisit the activity you had from Session number one. Close your eyes. Now, imagine the last good meal that you had. What made that meal memorable? Now that you have that meal in your mind, focus specifically on what was going on in that environment. We'll kind of noise was there are around the about me? What are you comfortable? Could you talk to each other? What was the lighting like? Was it dark or did you have it will lit so that you can see things. What about aromas? Could you smell the food -- third. When you walk in the

kitchen, could you smell the food or the dining room. Cleanliness, was the table or counter clutter? Did you have to clear stuff off to be able to sit down? Now you can open your eyes. I'm guessing most of you thought of a positive -- positive experience where you could easily talk to your family or friend without much distraction. And also with a place that smelled really good and very inviting. Let's now compare that experience of that memorable meal with what you might see in long-term care setting. How often are there distractions to the residence? Who are they seating and eating with? What does the table looked like? What does it smell like in that area. You could probably sit and discuss that a bit. If you are wanting to chat you can do that. Average long-term facility has less than ideal eating environments. We will start our discussion first by describing what could be removed to make the environment more positive. These are simple things to eliminate an approved the residents experience. Firstly, most important and simply reduce noise and distractions. Some of that can be easy such as turning down or off the TV or radio. Some may not be as easy as limiting staff to staff conversations. It's incredibly common for us to observe a meal periods and see staff talking to one another and never speak to the resident they are assisting. Typically, those staff conversations are not work-related. This is a problem for many reasons. Number one it is rude. It's not respectful to the residents. It also increases the noise in the dining room. 'S Stasi to far away from one another, you can imagine trying to talk to one another over the dinner with the usual noise, silverware on the table, classes and people trying to talk. He becomes distracting. The person that becomes easily distracted will not be focused on eating and concentrating on the third. It's important you be watchful of distractions. Also, limit how many times you get up and down from the table. If you think about a person eating and forgot to put the glass down and have to get up going back-and-forth which distracts the residents as well. You can do these things to make it more positive. If you are in the dining room are likely to face these challenges. You can set the example and politely limit staff-to-staff conversations are redirecting the worker to say, hey, we will talk about it later. Or shift conversations back to the resident, which you should be doing. Also, as a reminder, very inappropriate when discussing with a resident to discuss any personal problems with a resident or negative work-related issues. That should not be in the conversation with the resident. On the second point, removing excess clutter. I bet you would not sit down to eat-in the midst of a bunch of trash. By removing the trash makes it feel more homelike and keep residents from eating and edible objects. May seem silly but truly a person with dementia may not recognize that is something that is not edible. It's important. As far as table decorations, you want to make sure there not impeding residents ability to reach food or impeding them to see other people at the dining table. Also to see them when they are able -- to see them when they are talking. Now lets switch to a positive dining environment and it what you can do to make it a more positive environment. First of all, good aromas. They help activate the appetite. Think about Thanksgiving dinner or, for me, was Sunday dinner going to my

grandparents house. It was inviting. You could smell the delicious food as soon as you walked into the door. That's important for our residents as well. The couple of things we see a different facilities is keeping a pot of soup, cooking in the dining area or baking cookies and activities in the dining area. That helps increase a person's appetite. It increases their anticipation. It increases there and the patient that it's going to be a good meal. You want to be able to see what is going on around you. Soft music. I know the last point may be intuitive -- counterintuitive after talking about reducing noise but sometimes soft general music in the background can be relaxing without a person focus on their meal. You need to be conscientious of the volume and, please, select music the residents and joint rather than the staff preference. We see that happen as well and facilities. Just as you would prepare the environment for mealtime, you also need to make sure that the resident is ready to eat. There is several considerations. First, had the resident had the care there -- Benny. For instance, the person that they have a problem controlling their bladder/bowels. You do not want to be sitting at the dining room table someone who is in wet close. It would be unpleasant them for the resident and would also be unpleasant for the person sitting nearby. Also, if you take them into the dining room before having opportunity for bathroom care, it makes it harder for them to find the nurse aide too come get them, take resident back to the bathroom and bring them back to the dining room. They lose interest in the food. The food will be called. You will have to repeat the food and it disrupts the meal. Best to make sure to check with the nurse's aide that the resident has been to the restroom and can go through the rest of the meal. Medications, it takes a strong work for the Nurse two try to tech -- tracked the residents down. Some medications are given with males, some right before meals and some right after meals. Check with the Nurse two be sure they have had their medicines before going to the dining room. It's important to check with the nurse's aide also if the resident uses any of these items before coming to the dining room. For instance, do they need glasses? It's important for them to be able to see what they are reading, see who they are sitting next to and even the environment. Does the resident where hearing aids? Be sure they are wearing hearing aids to make sure they can hear what is being talked about around them. As [Indiscernible] mention, important for mealtime to be socialization. Thirdly, does resident wear dentures? Gingers are important to properly chew your food. If they do not properly chew their food -- Jen -- dentures are important to properly chew their food. If they don't have their dentures they cannot properly food -- to their food. If their dentures are being repaired, let the nurse know. That the cafeteria and dietary folks know so that they can provide an alternate meal cost something soft for the resident to chew. Other considerations: Be sure resident is comfortable in the dining room. Sometimes they get very cold. Asked the resident if they need a sweater. You can also bring a sweater or jacket to the dining room in case the resident wants to wear it later. This will be helpful also if they want to stay for music or activities as well. Be sure their hands are clean. Make sure they are clean before bringing them to

the dining room. Would you want to eat your food with dirty hands Lex some residents use a clothing protector. Check with the nurses A. the word bid should not be used. This is a resident dignity issue. This is worth repeating. The word bid should not be used as for resident dignity. Asked if they have a favorite place to sit. People enjoy their meal better if they are seated in a preferred place. They can enjoy conversations with other residents or may even enjoy a certain view. We had one resident that loved sitting by the window because she loved to see all of the cars coming and going. It did not distract her from her meal. It was pleasant for her meal experience. This is a resource. If we have time later in the series we will show you part of the. It's the Alzheimer Resource Center of Connecticut. It's called dining with friends Burkitt's not necessarily typical long. -- lawncare tears -- well-care -- Long Term Care Setting. It's for Alzheimer's care. It creates a warm environment such as staff sitting at the table with the residents, even those needing very little feeding assistant. As well as creative, unique ways too meet dietary needs which was talked about during the last session. You can see the link on the screen and I will put it in the chat box for you. It will be on our website as well. If we have time during the series we will show it to you.

Thanks, Emily.

Proper positioning is very important when assisting for feeding with a resident. The resident needs to be sitting upright. If they are in a feature needs to be close enough to the table so that they can reach the utensils and the food. Also, if they are seated in a wheelchair which some will be, you want to make sure they are not slumped to one side. This is important to make sure they are in proper position to make sure that they can swallow correctly and the flu can pass down through the esophagus to their stomach. If you are assisting a resident while they are lying in bed or seated in a Geri-chair, make sure the resident's head is raced 60 degrees to 90-degree angle. As you can see in our figure, that's a 60-degree angle. If you want to [Indiscernible] again, important for them to have the food pass properly from the esophagus into the stomach. If a resident's head should be centered midline or if they are not straight in the bed or over to the one side, pillows are very helpful to prop the resident into proper position. If resident needs to be repositioned, please find the nurses and or the Nurse two help you. If in doubt, always ask about the position of the patient. Some patients may only be in that position because they have some type of skeletal condition. It's important to make sure that you check with the nurse. Let's shift are focus from the positioning of the resident to your positioning as feeding assistant. When assisting resident with mills, be conscientious of how you are seated yourself. You should always be at the resident's level. Seat yourself in consideration with the resident's impairment. Particularly, if you were watching this webinar with a co-worker, I encourage you to do quick role-playing with each other with one standing

and at one sitting. For the person sitting, how does it feel to have someone towering over you? Is it intimidating? Do you feel nervous? We will give you a second to do that.

Feel free to share your answers with everyone on the chat pane or with me. We will read them out to you. How would you feel if someone stood over you while trying to provide you with assistance?

I encourage you to use the chat pane. If you do not, you will have to listen to me more. I will share how I have felt. Linda and I have led this activity many times. I have been the person being fed with someone standing over me. It intimidating as Linda said. It's also very uncomfortable because you are at an awkward angle. You cannot really make eye contact with the person helping you. You wouldn't want your family member to feel that way. You wouldn't want to make the resident feel that way. There is a strain on your neck, your whole upper body when someone stands over you rather than sitting next to you.

Someone also said it would make me feel less than. I think that's true.

Very good, absolutely. It certainly is a dignity and respect issue. For you, as some of the feeding assistance, it's been positioning for you as you are constantly having to lean forward and that's it proper positioning. You will also end up with a strain in your arm and neck as well. Proper positioning should be seated next to or across from the resident. As Emily said, you don't want to put extra burden on the resident. If you are doing that, there may be a tendency to put food in and not see if they are swallowing completely. They could get choked. That is an issue. We will next look at several video clips we will show now. None of the clips are ideal examples of feeding assistance. They are not scripted scenarios. They are actions between residents and nurses eight. The nurses aides face the same competing demands that your eighth and yourselves will face in facilities. As you watch the clip, big about the positive aspects and point out some of the negatives as well. How could the staff have done better? We are going to switch now. Please be patient.

I should say, these will all be available on our YouTube channel which is linked on our project website.

[Participants watching video clip]

[Silence] .

[Captioner remains on stand by] .

All right, thank you. You had trouble hearing? I am so sorry. What you can see are the actions. Let's talk about that. What did the staff do well? You probably noticed there was both good verbal stimulation that they used. The staff was engaging with the resident. Did you notice the environment? Was the environment dark or will lit? -- well lit.

Easy pace in feeding and correct position of the assistant and also for the resident and the resident's head. In the first clip we saw the resident's head slid to the side and the aide was able to gently push it back upright so that she was in a correct position. On the second slide notice the head of the bed was elevated up to the 60-degree angle properly. Is there anything else you thought they might have done better? You can chat with us and I will talk as well. What -- I will talk as well. One thing I noticed to was in the second one, you don't usually wear gloves when feeding a resident. The staff member put on gloves which you don't normally do. She was also talking to the resident behind the curtain rather than the person she was feeding. That could have been done better. I think also when the first clip, something that was hard to notice is the resident had puréed food. You could tell that by the different colors. The staff member did a nice job of not mixing the different food. That's important, I think, sometimes we see a lot of staff mix the pureed food together on one play. Think about it. You don't want your chicken, your squash or whatever else mixed together in one by. It's important for the resident's own dignity and with respect to serve each food individually and not be mixing the pureed food together. I apologize. We will try to get the audio working for the second clip. You also noticed in the clip that the person had a clothing protector on. In case you are not familiar with those, that is what you will frequently see at a facility.

Let's now talk about the different types of assistance. This is pretty simple. The first type is tray set up. This should be done for all residents. The tray setup should be done for all resident's. The tray should be easy for residents to reach and they should be open so residents able too A. for example, spill and dining room could have been prevented if they had spent time opening the containers are putting the containers within reach to keep something from getting knocked over. Something maybe not get touched because it's not open. The other thing is removed plastic lids or wrap from bowls as they come out on the trays. We often forget to do this for the residents that really do not need a lot of physical assistance. It's important to acknowledge the majority of the residents will benefit from this type of help. Notice in the clip what was on the trade. Notice -- tray.

The plated different items. The silverware and the cap was right there. She did not have to get up and go get something and come back. That was important as well. It's important to butter bread if they need the assistance. It's nice to have that done for them also, cut the meat. That they meet in pieces small enough to chew. Again, if it's

something that is too hard and seem to have problems with chewing on it or they do not have their dentures, you can get a substitute, something softer for them to eat. Also opening milk cartons and putting straws in their drinks is all-important to have as the tray setup. The next assistance is verbal assistance. Even a person that is not trained can walk through the dining room and provide verbal assistance and help with the trays. All residents will benefit from this. It can be something as simple as, that looks really good. How are you doing today? Helping them with there third. Do you like the soup? Those type of cues are important. Some of the words that signals the resident to help them is if the food is out there and say, this is good vegetable soup they have for you. Can you smell it? Store it and that helps them to encourage them they are ready to eat. It may be a cue to say, why don't you try a bite of this and see how you like it? We fixed it up special for you today. Those are verbal cues that will help them to continue to eat. The other type of assistance is called social stimulation. This is conversation with the resident unrelated to the meal or snack being provided. Conversations such as, how are you doing today? I like the red sweater you have on. These are things that will help encourage them. How are you feeling today? Did you see the sunshine? Too you like the music they were playing? These are all social stimulation's. Sometimes when you ask questions, it will help them become more engaged during mealtime. That's so important for these residents. Talking about the verbal cues, residents really need verbal cues to orient them and encourage them to eat. Orienting them to the food that is on the tray or what meal it is, if you recall, the second clip and she came in and say, your food is here. She mentioned the mealtime. Someone else said, it's only 6:00. Don't know what meal it is. It's important to tell the resident, this is lunch time. Time for dinner. Then describe the food being served. You will see that in the clip coming up. Describing what food is there, particularly if it's pureed food, food that is more -- mashed. Food that are pureed, maybe all you see is the color and may not know what it is. What is yellow? It could be corn or squash. It's important to describe what food is being served. You can say, we've got some delicious piece today. You can say, this is some fish that was fried today. Describe the food being served to them. You can talk about the textures. We will talk about that a bit more as we get into some of the sensory impairment as well. Another example would be, sometimes the resident is not able to see will enough to see the third. It's important to describe what food is being served. Ask the resident what food they would like first. It's important that they have a choice. All of our facilities person-centered care, facility centered care, we offer choices. Ask the resident what food they prefer first. We will have something to talk about later about those who have dementia, about how to offer them choices. Ask the residents which foods they may want first rather than assuming they would want the vegetable first, or as Emily mentioned, you do not want to mix the food. Provide them the opportunity. Sometimes facilities will try new been used. Describing what is being served is important for them. The food can be unfamiliar. For example, in one facility they

served taco salad and the resident did not know what it was. It was something different. That was important. The way you describe food, for instruments -- for instance, if you say neutral gray bark, you can say a cereal bar similar to fruit would help them understand it. When asking the resident what food they would like to week, talk about more when they are in the local driver seat ." Resident may have dementia and may need to be reminded to swallow or open their mouths to eat. Sometimes they will pocket the food. This can be common. When it's pocketed they can swallow it all together and become choked. Remind them to chew after each bite that they receive. Again, verbal cues are providing encouragement say, take another bite. Try these vegetables. This encouragement is imported and the food improves their overall health. It the resident does not like the food, refused to eat or drink, it would be important to offer another choice. Another choice might be a sandwich. Just remember to check with the kitchen for which foods are available. As we talk about the social stimulation, think about your own situation. You probably eat more in a socially welcoming environment. That about your day. When you are with a resident, ask them how they are doing. What's going on? It helps if you know the resident a little bit. Talking to them helps them engage that socialization which is important. It helps them to feel valued as a person. Realize your conversation may be totally one-sided, especially if a resident has a cognitive impairment. Such as the lady in the first clip. I don't know if she had dementia and was able to communicate but she could smile. She had a beautiful smile. You can even say that to her to encourage her such as, I love your smile. You have a beautiful smile. Encourage the resident.

I included in the woman in the first clip, it was a Jewish community nursing home. At the end of the meal they sang -- the staff saying to her [Indiscernible]. You can see just the engagement. She ended up finishing her meal after that. It was as if she needed a break and something to re-engage her, get our excited. -- getting her excited. It was another opportunity for her to connect.

As you talk about, you don't want to ask the resident a question when they are trying to swallow something. Be mindful of the timing as well when you are talking and having conversation with them.

The next type of assistance is physical assistance. There are two types of physical assistance. We will first talk about physical guidance. You will see in some of the videos, sometimes you will put your hand over the resident hand and guide them. That is the Hand Over Hand. In some locations, trying to get them to take a few bites is important. That will physically help them, putting their hands forward, putting their hands forward on the item on the plate guiding them. Let them be as independent as possible. Giving them cues the entire time will be important. Sometimes you will see if you are starting to get them a glass to hold, they may be jittery. They may have Parkinson's disease. Be mindful that it's not going to be perfect but it's okay. If they

start spilling it then that becomes a dignity issue as well. You do not want them to feel embarrassed. Guide them with it and when they get it to their mouths, let them finish themselves. Most people say [Indiscernible]. We talk about feeding assistance, this is what people think of but there are many types. Sometimes you may have more assistance than is needed for them or you are actually feeding them from the spoon or feeding them every single bite. They are not able to grab or hold the cup. They may not know what they are reaching or doing at that point and may need more physical assistance. Specific feeding techniques that are very important: When you are providing physical assistance, these are important. Provide manageable bites. One-half teaspoon to 1 teaspoon of food may not seem like a lot. That is about what they could fit into their mouth and be able to chew. Give them small amounts, manageable bites. Feed them at a slow rate. Allowed time to chew and swallow. Provide time for pauses in-between. Sometimes -- for some folks, especially people that may have COPD, eating is exhausting. Give them a break. It's okay to do that. You may need to reheat the food because it gets cold in-between. That's important. Also check to make sure they are swallowing. You can let them have a bite then give liquids in-between. That was illustrated very well in the first video clip. If they are not and seem to be holding the food in their mouth, gently touch or stroke their cheek which seems to stimulate the nerve to say, I am supposed to be swallowing or chewing. Sometimes you will have a resident that as a good side or a bedside. That could be related too if they had a stroke; although, you may not be feeding stroke patients as they would be high-risk for aspiration and you would not be feeding that resident. Know what their good side is. The resident having something to touch their lips as a reminder to swallow. Could be something very cool. We will now look at another clip. This time, notice the interactions between the resident and staff. What staff could do better. And notice what type of assistance is being provided.

We will try this again. Let me know in the chat pane if you cannot hear it.


[Indiscernible - low audio]


[Indiscernible - background noise]


Fish with ketchup?


Good.

It's kosher, yes.



There you go.



Okay.


Do you like the fish? Yes?


Soup, a little bit of soup.

Here, try it. Try it yourself.



[Indiscernible - multiple speakers]


Fish, try it.

Here.

Try it, try it. There you go.


Right. [Indiscernible - low audio]

Here.


There you go.

What did you notice on the clip? What type of assistance was provided?

We have one comment about the second video. That was, he was forcing him to eat to fast, taking big bites or offering big bites of food.

Very good, absolutely.

Anybody else?

You might have noticed in the second, or in both clips, the seeding assistant set next to the person. The second clip, the young man gathered all of the items I bought them there, which is important. Before you sit down, you want to grab everything. He did not mention anything about what was on the trade. He did not -- the tray.

He did not talk about what was on the trade to orient to the meal. -- on the tray.

I felt sorry for the resident because he was rushing. Give them a break.

Certainly, he was offering big bites as well. What we also saw was, it was a noisy environment. Did you notice how noisy the second one was Lex there was so much commotion and noise going on in the background -- the second one was? There was so much commotion and noise going on in the background. Fairly typical of long-term care facility dining rooms. That's why it's important to try to remove some of that distraction and excessive noise. We also saw some verbal assistance. Notice he said, do you like the fish? He was talking to him trying to get them to acknowledge the food. And also the physical assistance he provided. He probably could have done more physical guidance. I noticed the gentleman was able to pick up and feed himself part of that time. He may have been able to encourage him to do they look -- that a little bit more. He was doing the physical assistance there. He mixed the foods. I don't know if you noticed that or not but he was mixing all of the foods together. Just to allow the foods to remain in their own entity rather than mixing the foods. A person will not recognize what they are reading. There was -- they are eating.

There was not much social stimulation. He was on track with feeding. There was no time to socialize because he cap feeding the food and himself very, very quickly.

We will show a couple of more clips here.


What do you want? I am going to help you eat.

Okay.

Sounds good.


Do you want to start with the soup or [Indiscernible - low audio]?

Let's try it. If it's too hot we will start with the [Indiscernible - low audio]. Here. Is a good? Good temperature? Okay. There you go.

Do you want sugar in your coffee?




Is that okay?


I don't know. She is mumbling. Okay, let's drink some coffee.


Okay. I am going to get you a different piece of bread because this one is too hard for you. I will get you a piece of white bread and you can do that better.

Do you want something else?

Coffee?



Do you want to hold it?


Water.



[Indiscernible - low audio] water.



Vegetable soup. Do you like it?



Finish your soup. Finish your soup.


Karis, good?


-- are the carrots good?


Do you like tomatoes?


Okay. What did you notice in those two clips that was really will done? Particularly -- well done.

Particularly anything we talked about earlier.

I will comment while waiting for your comments. This is a nice -- nice juxtaposition clip. Relatively similar meals but the way they were presenting the meals were different. In our first clip, the staff person offered choice of soup or to know. Whereas in the second the CNA arbitrarily decided the resident was going to start with the soup. Comparison of the two situations.

Thank you.

Certainly, we started talking today about the environment, notice the second clip how love the music was. They just increases the difficulty to hear. Something they could have done a better job to decrease some of the sound that there. The lighting was good but notice the centerpiece on the table. It was nice. It was not interfering with the food and it was off to the site. That was helpful and it made the table look friendly and nice and provided a nice environment for them. In the first clip, she started out with, is this good? That was good verbal cueing, is this for good? Then asked about the sugar. She said no and put it in any way. She overruled what the resident had asked for. Offered, did we want to hold the cup? She tried to get them to do that physical assistance that was being offered.

Anything else?

Moved the cherub closer which was important. Did you notice on the very -- moves the Chair closer which was important.

She was standing above the resident before feeding and is incorrect. Those are some of the key pieces we hope that you observed in those two clips.

We are getting close to time. We may run a couple of minutes over but we want to go over this. It's an example of a performance evaluation that we have up on the website of the training toolkit page. You have to do it or Performance Evaluation or written evaluation in order to be certified. This is one example. You can see how we talked about a lot of the today.

We discussed the types of assistance today. We watched several different episodes so that you could see should have been greeting residents by name. Some was and some was not. Introduce themselves but we did not see anyone do that on the clips. I want to say that this evaluation tool will be used. You will have somebody that will be able to observe when you are offering snacks or offering feeding assistance at a meal. Someone will be there to observe, yes/no, if it was applicable. Ensure the resident is sitting upright so that they can swallow correctly. Seat yourself as the feeding assistant either beside or across from the resident. Social interaction with the resident. Provide them with verbal cues, orientation to the food or maybe orientation to help

them to eat. Provide them opportunities by either cutting their meat into smaller pieces to provide manageable bites. One-half teaspoon or 1 teaspoon of food on a spoon is important. Be able to spend time with the resident, allowing them to take that moment to rest is important. I think that was one critique we would have of the second clip, the very last clip. The resident was trying to swallow and eat so fast and the person feeding them was shoving it down way to fast. The resident was not even able to take a breath to swallow correctly. That puts the resident at-risk of choking. It's important to provide the time to them.

We will review this again in the future. We will review this again in the future so that you will not be surprised at the end. After the meal, it's kind of like when you are at home. Don't take off and leave. It's an opportunity to reflect with the resident, making sure that they have had enough to eat and they are ready to go back and done eating. It's important for you to communicate with the nurse how the resident has eaten, how much they have had to eat or drink. We will have a chart for that information. The reason that's important is we monitor their weight and their behavior. We will go into that in further detail in another session. If there's anything out of the ordinary when communicating with the resident, where they sleeping? Refusing their food? These are important clues. We will get into this further but these are important clues to communicate with the nursing staff. Make sure the resident has transportation from the dining room back to his/her room other next activity. -- or they're next activity.

We have seen were the resident is sitting by themselves and kind of lost. It your responsibility to make sure that they have transportation from the dining room. [Indiscernible] transports them back to the room but it your responsibility to make sure that they get back to their room. We have gone through this quickly. We have reviewed some features of what a positive dining environment should be for the resident. We discussed proper positioning both for resident and the person providing the feeding assistance. We demonstrated the different types of assistance, verbal assistance and physical assistance. We have also discussed specific feeding techniques that you are to use. If you have any questions right now, please put them on the chat line and we will respond back too them.

If you should have questions after the session that you think of later, I will contact information is listed there. I put the website through the chat pane which is [Indiscernible]. Our next session will be same time next week. Linda Detwiler will be back with us and we will talk about how to best communicate with residents. Residents with cognitive impairment. We look forward to that. Hopefully, within the next week or two, the session will be posted on the site. You can share this with other persons at your facility. If you have comments about the video clip, let us know about that or any technical issues. You can send us a message on that as well. Thank you. I applaud you for what you are doing. I appreciate that you are willing to take on this

new role. I know this will be wonderful for your facility and benefit the residents. Goodbye.

[Event Concluded]

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