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Strawberries for Breakfast

During 12 years of working in long-term care, I have assisted numerous clients, staff and service providers in careplan development and admission profiles, but nothing illustrates some of the difficulties of seeking the right home more than the following story.

During a pre-application tour, I was asked, “Can I have strawberries for breakfast?” This simple question set me on a path that questioned the processes I used and presented me with a complex answer. I posed the strawberries question to members of a multi-disciplinary team that routinely makes up any long-term care facility. The answers were fascinating.

·        The dietary department was concerned about the effect strawberries, especially off-season berries, would have on the daily cost per resident as dictated by the Ministry of Health. Who would wash and cut up the strawberries, as this was a time-consuming process, and would the strawberries at breakfast replace the daily provision of fruit at lunch?

·        The housekeeping and laundry staff members were concerned about the potential of the juice of the strawberries staining the bibs and personal clothing of the residents. They were unsure whether their detergent would rid garments of strawberry stains. In addition, an outbreak of strawberry stains on bibs might necessitate product replacement at a cost beyond their budget.

·        The nursing department expressed concern that the strawberries would require a physician’s order if they were in contradiction to the existing diet order. Would the introduction of this type of request consequently set a precedent, precluding the need to respond to similar requests from others?

·        The activation department was apt in pointing out the strawberry social offered every June and the strawberry ice cream offered every two weeks as part of its ice cream cart.

As amusing and diverse as these concerns may appear, they greatly reflect the system in which many of us work. The standards set out by the Ministry of Health, and subsequently individual facility policies, are in place to ensure fair and supportive provision of care for those entering long-term care.

Much of our attention is focused on eliminating discomfort generally associated with the illness that has precipitated an admission to long- term care.

We are learning that wellness is directly associated with happiness. We are becoming refined in our ability to diagnose and treat depression in the elderly, yet we negate some of the simplest methods of inducing happiness and wellness memories.

The elderly who seek admission to long-term care bring with them a lifetime of practices, knowledge and identity. Their memories are not limited to their ability to verbally recall events; their memories are also experienced through their senses.

Have we as care providers and family members honoured the memories and identities of our residents? Have we provided opportunities to excite the senses of sight, touch, smell, sound and taste to invoke memories and happy sensations? Have we budgeted strawberries, the smell of home-baked bread, the echoes of the ocean?

Have we embraced the right to choice on a daily basis, or have we sold out on the premise of cost? Can we affix a dollar figure to what may be a natural alternative to wellness, or should we even acknowledge strawberries for breakfast as an option, as a plan of care? Can we afford not to?

I encourage care providers and those seeking placement to a long-term care facility to pose the question: “Can I have strawberries for breakfast?” Listen carefully to the answers. You may have fallen upon the best medicine you could ever give or receive. Happiness.

Jayne Harvey, RN Toronto Star – September 11, 1999

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