CHOICE Plus Program: Supporting Relationship-centred Mealtimes for Long-term Care

This study employs a stepped wedged design that includes three long-term care homes (Site A, Site B, Site C) located within Southern Ontario. Each LTC home will have approximately 12 months to implement the CHOICE+ Program and demonstrate sustainability for the last few weeks; the study will run for 18 months due to the staggered entry of sites into the intervention (Site A: Month 1; Site B: Month 4; Site C: Month 7).

Over the course of 12 months for each Site, the CHOICE+ Program components will be delivered to a single care unit using a 4-phase approach. Transitions from one phase to the next will be entirely dependent upon the context and readiness of those participants involved in the study (i.e., timing between phases may differ amongst LTC homes). A single external facilitator from the University of Waterloo will lead this implementation process. The principal investigator (PI; H. Keller) will assist in guiding the external facilitator through the implementation process and support debriefing sessions. A blinded trained assessor will conduct mealtime experience audits (Mealtime Scan Plus) every 12 weeks starting at Month 1 for Sites A, B, and C, regardless of the implementation start times (i.e., Site A at Month 1; Site B and Month 4; Site C and Month 7). A physical dining room audit will be conducted at four time points (Dining Environment Audit Protocol). Staff, resident and family/volunteer dining experience questionnaires will be completed at four time points as well. Below is sequential description of the implementation process of the CHOICE+ Program in a single site, while accounting for pre-implementation activities:

PHASE 1: PRE-DEVELOPMENT (Week 0)

• PI and facilitator meets with LTC home management/administrators (i.e., Unit Care Coordinators (UCC), Director of Food Service (DFS), Registered Dietitian (RD), and General Manager (GM)) to describe purpose of CHOICE+ Program, address questions and ensure commitment. Once roles and responsibilities are discussed and agreed upon, the researchers will tour the care unit to obtain an understanding of specific contextual factors. A CHOICE+ Newsletter item for residents, family, and volunteers will be distributed to raise awareness of the program. A CHOICE+ Information Letter will be distributed to all staff members, posters with information session dates and times will be posted, and information brochures will be available around the care unit for care staff, residents, family members, and volunteers.

PHASE 2: DEVELOPMENT (Week 1 - Week 8)