On Oct. 5, the Schlegel-University of Waterloo Research Institute for Aging launched CHOICE+, a new program designed to improve mealtime experiences for older adults living in long-term care and retirement communities.  

The CHOICE+ training program uses a person-centered approach to changing when and how meals are served, creating opportunities for residents to be more engaged in meal preparation. 

Heather Keller, professor and Schlegel Research Chair in Nutrition & Aging at the Research Institute for Aging (RIA) and Kinesiology and Health Sciences professor at the University of Waterloo, led the program’s creation.  

Keller is a registered dietician and has spent the last 35 years researching older adult nutrition. RIA is a charitable organization that supports research and knowledge sharing to support healthy aging. 

She said the idea for CHOICE+ evolved from seeing the importance of mealtimes for families of people with dementia. 

People with dementia experience a major change, especially in terms of communication. Activities and routines must be adjusted around changing needs. 

“What was important to them was honoring their individual identities. It was about being and staying connected to their family,” Keller said. 

Seeing how mealtimes could positively affect dementia patients, Keller looked into whether the same improvements could be found in long-term care and retirement community settings.  

“There’s so much more to mealtimes than just food. It’s that social connection and even a sense of purpose. People like to cook and now they’re no longer touching food, how frustrating that must be,” Keller said. 

Between 2014 and 2016, Keller had the opportunity to survey 32 nursing homes across four provinces to collect data and create a standardized measure of what she calls the social, physical and relational environment of dining environments. This included aspects like the size of the dining room, the noise levels that made it difficult for team members to help residents and so on. 

The survey data provided Keller with some interesting insights. She saw better food intake levels in facilities that used a person-centered approach to care, including in the dining room. Facilities with a better dining environment score reported patients eating more of their meals, a critical factor in resident well-being. 

Keller and her team completed a series of studies, including settings like in-home, long-term care and retirement homes, to create the CHOICE+ program principles.  

Today, the CHOICE+ program provides checklists, virtual dining room tours and an e-learning course for anyone who may be interested in improving their residents’ mealtime experiences. 

“We realized there’s some things we know that are better practices, like mealtime should be about connecting with who you want to be connecting with—loved ones, friends and people you’re familiar with. That’s one of the principles we came up with for CHOICE+,” Keller said. 

The tactics in CHOICE+ are designed to foster interactions and engagements between residents, staff and families.  

Staff can involve residents in something as simple as meal planning to create a sense of ownership and involvement in mealtime.  

Keller said these dining room and mealtime improvements can benefit residents’ mental and physical health by creating an environment where residents want to eat and feel connected. 

“CHOICE+ is really about empowering team members and management homes to work with residents and families to make positive changes to dining rooms so they are a place that everybody wants to eat and a place that is meaningful to them,” Keller said. 

“It’s really about connecting the honor and dignity of individuals at mealtime and offering opportunities for engagement and support,” Keller said. 

For more information about CHOICE+, visit