Guest guest Posted June 20, 2011 Report Share Posted June 20, 2011 Hi Merav - didn't mean to sound condescending but I'll reply offlist.  Barbarar Subject: RE: how much do you honor client's preferences? To: " rd-usa " <rd-usa > Date: Saturday, June 18, 2011, 7:45 AM absolutely true. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: mffrd10019@... Date: Fri, 17 Jun 2011 18:47:49 -0700 Subject: Re: how much do you honor client's preferences?             I have found that my pickiest eaters are the people who were homeless prior to admission. I try to accomodate them as much as possible within the budget and staffing constraints, as being in a facility is sometimes more difficult for them to adjust to than many other residents. Madalyn To: rd-usa <rd-usa > Sent: Wednesday, June 15, 2011 11:07 PM Subject: RE: how much do you honor client's preferences? I completely agree Digna.As someone noted before, this is a requirement to provide verity of food and alternatives as possible. If someone asked for lobster tail and that's the only thing they want to eat....tough, I work in a city hospital and we will not be able to accommodate.On a different token, I have very picky pts. Pts who were homeless before, now are complaining about every food item possible and they have long list of dislikes. So when they eventually complain about poor variety I say: " hey, you eliminated everything else " .I am not the food police (see below) and I refuse to become one. If someone doesn't want to eat something no one should force it down their throat. They are adults, in jail or not. They dont want to eat what is served - fine. I will document how picky the pt is, and that this is the etiology of unplanned wt loss but I will not provide something they won't eat bc it is useless, they will buy in the hospital gift shop (in my facility) or have family bring then whatever they like and if they dont have family/visitors....too bad. The food, if provided against their will, will not be eaten, so what have we accomplished? power game? If someone is not willing to try new foods, if someone is not interested in healthy eating and all they eat is hamburgers and they will have heart attach 5 yrs later, not my problem.My job is to educate the pts/clients (out-pt/whichever setting). Assuming there are no educational/cognitive limitation and pts are alert and oriented X3 (if they are not, education if even less useful and they will also eat only what they like, healthy or not) What they do with this information is their choice and their choice only. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: dignacassens@... Date: Wed, 15 Jun 2011 19:02:53 -0700 Subject: RE: how much do you honor client's preferences?             I’m glad you were successful, however, what would have happened if someone truly allergic received the food they were listed as being allergic to? I’ve never been to an MD for a shellfish allergy – except back in the 60’s before knowing I was deadly allergic. How would I produce that documentation now? Certainly not by eating it to prove it. Digna From: rd-usa [mailto:rd-usa ] On Behalf Of tnordin@... Sent: Wednesday, June 15, 2011 10:20 AM To: rd-usa Subject: RE: how much do you honor client's preferences? When I used to consult at the Jail in our area, we had numerous people try to list foods as allergies so they wouldn't get foods they didn't like. To handle this we required them to produce documentation from an allergist/ MD that they had been tested for allergies or it was not adhered to. Policy was made with this so if they tried to sue for not meeting their needs in court. We were covered. Worked well for us and eliminated a lot of issues. From: rd-usa <mailto:rd-usa%40yahoogroups.com> [mailto:rd-usa <mailto:rd-usa%40yahoogroups.com> ] On Behalf Of Digna Cassens Sent: Tuesday, June 14, 2011 6:46 PM To: rd-usa <mailto:rd-usa%40yahoogroups.com> Subject: RE: how much do you honor client's preferences? In the skilled or long-term MH facilities I have been in charge of we treat the residents just like we do those in other facilities, unless their requests compromise their health and welfare. The behavioralists and treat their issues as well in conjunction w the RD and dietary manager since often they do revolve around food. I've always provided a semi-select menu with a standard list of 2 or 3 alternates per meal plus the main entrée and a second popular entre. There's no point in serving food they'll not eat or throw away, and exacerbate their negative behaviors. In the acute MH facility there were levels of choice; if on a 72 hr hold, no choices as most had lost their rights through their outside behavior, and 3 days don't make that much difference in the long run. For those on long-term treatment, 2 weeks to 3 months, then the choices were layered, or based on their behavioral earnings, until they earned the final choice to be able to go to the cafeteria escorted with the group. The only items they could not chose were soft drinks, caffeinated beverages and chocolate (I wisely kept chocolate off the menu and nobody noticed). For the psychotic clients I suggest working with the treatment team. I also found that in those that earned attendance at the locked dining program were better behaved (of course, bc otherwise they'd be kicked off it) but also their food preferences reduced significantly. I don't see the problem of giving 2 choices; coleslaw or lettuce? One green and one other color vegetable? You can bring the horse to water................. Digna From: rd-usa <mailto:rd-usa%40yahoogroups.com> <mailto:rd-usa%40yahoogroups.com> [mailto:rd-usa <mailto:rd-usa%40yahoogroups.com> <mailto:rd-usa%40yahoogroups.com>] On Behalf Of Lawson Sent: Tuesday, June 14, 2011 9:25 AM To: rd-usa <mailto:rd-usa%40yahoogroups.com> <mailto:rd-usa%40yahoogroups.com> Subject: how much do you honor client's preferences? Let me preface this with I work at a mental health facility. And we have a non-select menu. We are CONSTANTLY getting client's complaining about what is being served that they don't like certain foods. " I don't like coleslaw... " " I don't like green vegetables... " I imagine you get what I'm talking about here. Most of the time we are able to accommodate these preferences, but it appears that it has gotten out of control. So my question is at what point do you say ENOUGH? And another question... we have quite a few clients that are psychotic and give us a long list of preferences. Almost to the point of only eating a few select items. At what point are we held accountable for only sending a small amount of food variety to help make sure that they are eating (as they would refuse to eat all other foods) but not providing the correct RDA's? Thanks! This message, including any attachments, is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. 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