Globally, malnutrition affects 12-54% of residents in long-term care (LTC). A primary cause of malnutrition is poor dietary intake. The mealtime environment (i.e., social interactions, eating assistance, and physical environment) can affect residents' intake, but little is known about the mealtime environment in Northern Health LTC homes. The objective of this study was to observe the mealtime environment in two Northern Health LTC homes to identify current strengths and areas for improvement.

A naturalistic observational study was conducted at two LTC homes in northern British Columbia. In one dining room at each facility, two trained raters assessed mealtime practices in three domains (social interactions, eating assistance, and physical environment) using a modified version of the CHOICE+ Mealtime Practices Checklist. This checklist includes mealtime practices associated with person-centered care. Nine meals were observed at each facility. For each mealtime practice, raters recorded the proportion of meals at which the practice was observed. Interrater agreement was assessed by calculating percent absolute agreement.

All raters observed the following practices during at least 67% of meals: 1) staff addressed residents respectfully, 2) food was served in a timely manner, 3) staff supported residents to dine at their own pace, and 4) residents were included in social conversations. The least frequently observed practices (fewer than 20% of meals) included 1) asking residents if they wanted a clothing protector, 2) offering residents their choice of beverage or first course, 3) delivering medications before meals, and 4) playing music in the dining room.

Many of the mealtime practices on the CHOICE+ checklist were regularly observed at both LTC homes. Potential areas for improvement were also identified.

The results of this study will inform quality improvement initiatives to enhance the mealtime environment in these Northern Health LTC homes.