Training Volunteers to Work With Older Adults

Volunteers can be a valuable resource to the geriatric ED. After recruiting the right candidates, the next step is onboarding and education. To support you, we’ve provided a sample volunteer training agenda. This agenda was designed specifically for a Meal Mates volunteer role, but can be adapted based on the program you are developing.

Additional Considerations

Dining vs. Eating

• Atmosphere — Hospital versus home, loss of independence.
• Environment — Bed versus chair verses table, alone versus with family.
• Eating Habits — Food preferences, order in which foods are eaten, alternating between eating and drinking.
• Food Quality — Institution versus home cooked, loss of and limited choices, new textures.

Why a Patient May Not Eat

Report any of the above concerns to the nurse.

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Special Populations

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Instructions

The following procedures will guide you during mealtime assistance:

1. Receive patient assignment and information from PAA (Unit Secretary).
2. Wash your hands before entering the patient’s room with the hand solution outside (standard policy).
3. Introduce yourself to the patient and ask permission to check their ID band so you can verify that you have the correct person.
4. Explain who you are and why you have come to visit. Set the tone for a quiet, enjoyable mealtime.
   • Minimize distractions and noise as much as possible by asking the patient’s permission to shut off the television or lower the volume. You can also ask to pull the privacy screen between the beds, or close the door slightly.
   • Take notice of any communication difficulties the patient may be exhibiting — either sensory or cognitive — and apply communication skills you have learned. 
   • The patient may have a listening device such as a hearing amplifier or a hearing aid. Please ensure the patient is wearing their device and that it is working.
   • If the patient needs glasses to eat, these should also be on the patient. 
5. If the tray has not yet arrived, clear the tray table of any items that should not be present for meals, such as urinals, bed pans, and trash. Make sure the call bell is within reach. If necessary, wash the table down with soap and water.
6. When the tray arrives, make sure that the name on the menu matches the ID band on the patient. Check that items on the tray match the menu. Refer to the tray slip and ensure the correct diet and food texture has been provided. If it is incorrect, or if you are unsure, inform the nurse or PCA before beginning the meal. 
7. Appropriate positioning of the patient prior to eating is the responsibility of the nursing staff. Before you begin to assist with the meal, confirm with either the PCA or the RN that the patient is in the correct position to eat (in general, this is an upright position of 90 degrees). Occasionally, patients must have modified positioning for safe swallowing or physical restrictions (hip fractures, for example). However, you are not to position the patient, move the head of the bed up or down, take the patient out of bed to the chair, or adjust side rails — only nursing staff can do this.
   • If the patient wears dentures, confirm with the nurse that the dentures are appropriately applied.
8. Once the patient has been positioned, you may move the clean tray table into a position in front of the patient. 
9. Before you touch the patient’s tray to begin helping with the meal, wash your own hands in the sink in the patient’s room. Use the handwashing wipe supplied on the lunch tray to give the patient an opportunity to wash their hands before eating.
10. Place a towel or a napkin across the patient’s chest to protect their clothing.
11. Attempt to be at eye level with the patient. This may require you to sit in a chair or stand up, depending on their height.
12. Talk about the food choices with the patient. Ask if they would like any of the provided seasonings, dressings, or condiments applied. Open containers, unwrap utensils and prepare drinks with straws, being careful not to touch surfaces that will go into the patient’s mouth.
13. Assist the patient as needed, but promote independence as much as possible. For example, you may need to cut the food for the patient, but they may be able to put the fork into the food, and the food into their mouth.
14. Allow the patient to choose the order in which the food is eaten. When patients must be fed, keep the spoon or fork quantities small (spoon no more than 2/3 full, sometimes less). Offer foods in sequence according to patient’s preference. 
    • Name each food as you move from item to item. This can be done in your conversation with the patient: “Here are some mashed potatoes”, “Let’s try some squash”, or “The beef looks delicious, would you like gravy on it?”
15. Allow the patient time to chew and swallow before offering more food or fluids.
16. Watch for the swallow: look at the throat and make sure you see the swallow before providing the next bite or sip. If you see any signs of discomfort or difficulties, inform the nurse immediately.
17. Adjust your pace to the patient’s and look for cues that the patient is ready for another bite of food. Utilize facial expressions and gestures to communicate non-verbally when necessary.
18. When a patient is given nutritional supplements with a meal, they are in addition to the meal, or in place of a given beverage such as coffee or tea. These supplements provide necessary calories and nutrients in liquid form. Work them into the meal as best you can.
19. Develop a way for the patient to indicate that they are ready for another bite. This could be verbal, or non-verbal, such as a nod of the head.
20. Be aware that your reactions to the foods and drinks can easily be picked up by the patient. For example, if you dislike broccoli and make a face showing disgust, the patient may notice your facial expression and decide not to try it. It is important to avoid conveying your food preferences to the patient. Remember, they may enjoy foods you dislike, and these ingredients may be important contributors to nutrition and health.
21. Ensure the patient is alert before and during feeding. Some patients may experience fatigue during the meal and doze off. Consider whether they need regular breaks.
22. Use a napkin to wipe the patient’s mouth as needed and after the meal.
23. Interact with the patient throughout the meal, but try not to ask questions or cause laughter during chewing or swallowing to reduce risk of choking.
24. Learn to read your patient’s body language when they cannot talk. For example, when you offer the patient food and they close their mouth tightly or turn their head, this probably indicates a dislike, or that the patient is full. After feeding a patient for a time, you will learn to interpret their signals. 
25. When you feel the patient has finished eating, remove the towel or napkin from their lap.
26. Wash the patient’s hands and mouth if they are unable to do this.
27. Leave any items the patient wants in an accessible location. Record the information requested on the documentation sheet regarding your experience.
28. Wash your hands after the meal and before leaving room. Be sure that the patient is in a safe position, and that alarms are activated if necessary. If you have any concerns about leaving the patient, let the PCA or nurse know. Otherwise, you can leave the completed form with the PAA.

AREAS TO TROUBLESHOOT 

• If you suspect the temperature of the food is incorrect, call the PCA. Food may need to be heated, and the PCA would need to do this. If the food appears to be too hot, leave the lid off and allow it to cool down before feeding it to the patient.
• If you suspect the patient is pocketing the food in their mouth and not swallowing it, do not continue to feed them and notify the nursing staff.
• Discontinue feeding a patient who falls asleep.
• If a patient is non-verbal, pay attention to body language and facial expressions.
• For the visually impaired patient, try using numbers on a clock to help them locate food on the table or plate.

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Competency Checklist

COMPETENCY	DEMO	VERB	CONF	COMP
Receives assignment
Washes hands before entering room
Introduces self to patient — identifies correct patient
Ensures patient is wearing sensory aids if needed (glasses, hearing aids/amplifiers) and dentures
Assures the correct positioning of patient has been handled by nurse/PCA
Minimizes distractions (television volume, etc.)
Clears the tray table and cleans if necessary
Washes hands at sink before touching tray items
Identifies meal tray matches patient ID band
Identifies items on tray match the menu
Moves tray table over the patient
Gives patient opportunity to wash hands with wipe
Places towel or napkin across patient’s lap or chest
Positions self at eye level with patient
Makes sure call bell is in reach
Introduce food on tray to patient
Prepares food on tray — opens containers, utensils, straw, etc. (not touching surfaces that will go in patient’s mouth)
Ensures food is correct temperature
Asks patient for preferences on seasoning and condiments
Cuts up food if needed
Utilizes numbers on clock for visually impaired patient to locate food on tray
Identify foods/liquids and allow patient to indicate what they want next
Feeds patient using a spoon no more than 2/3 full
Allows the patient time to chew and swallow before offering more food or fluids
Watches for the swallow
Develops a way for patient to indicate when they are ready for another bite