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5/22/2018

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Dining Trends in Senior

Living Communities

Lee Wolf-James, RD, LD

ANFP Annual Conference & Expo | Orlando, Florida | 2018

Long term care communities are moving away

from the medical model

Facilities are trying to create more “home-like”

environments, especially with the dining

experience

Dining is a key component in looking at the

quality of care of a facility

What is Happening in 2018?

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New Dining Practice Standards

http://www.pioneernetwork.net/Providers/DiningPracticeSta

ndards/

Requirements of Participation, CMS regulations

https://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/GuidanceforLawsAndRegulations/Nursing -

Homes.html

Two New Factors Influencing Dining

Trends in 2018

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http://www.pioneernetwork.net/Providers/DiningPracticeStandards/

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

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Co sponsored by the Pioneer Network

Focus: individualized care

self directed living

Evidence based research



Diet determined by the resident

All decisions default to the person

Real food before supplements



Choices determined by the person………….all

day long.

when to awaken

when to eat

what to eat

where to eat

what to do

when to bathe

when to retire

what to wear, etc.

New Dining Practice

Standards

This Photo by Unknown Author is licensed under CC BY-SA

http://ssmgrp.com/blog/topic/independent-living

https://creativecommons.org/licenses/by-sa/3.0/

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Who is the Pioneer Network?

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Dining Practice Standards:

A set of nationally agreed upon

standards to support individualized

care and self-directed living vs.

traditional diagnosis-focused

treatment.

Pioneer Network recognizes food & dining play a major

role in providing individualized care and self-directed living.


Who is the Pioneer Network?

8

Pioneer Network is group of organizations who are leading the way in culture

change. Their goal is to create a culture of aging that is life-affirming, satisfying,

humane and meaningful.


Culture Change: What is it?

9

“Culture Change” is a national movement for the

transformation of older adult services from institutional-

directed care to person-directed care.

Choice

Dignity

Respect

Self-determinationPurposeful Living

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Success in Culture Change:

10

A story of foodservice

Libby Sarro, Riverview Healthcare Community in Rhode Island


Old Culture vs. New Culture

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Old Culture New Culture

Diets by diagnosis Individualized & liberalized diets

Protecting residents Risk is a part of life

Goals set by professionals All decisions default to the person

Set meal times All day dining

No choice on food Multiple meal choices

“Feeders” Dining assistance

Bibs Napkin, clothing protector

Diets Dining

Dietary, food service Dining services



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Why were they written? Research proves that:

50-70% of residents leave 25% or more of

their food uneaten at most meals…

60-80% of residents have a physician or

dietitian order to receive dietary supplements.

The prevalence of protein-energy under

nutrition for residents ranges from 23%- 85%

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The older population is growing

• Number of adults over the age of 65 in long term care facilities is expected to double by 2020 (U.S. Census)

Facilities are admitting younger rehabilitation residents

Savvy “clients” are expecting more

• More options

• More exotic dishes

• More home like atmosphere

Reasoning Behind these Changes

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THE CHANGING POPULATION


MEAL TIMESMeal times are one of the most important part

of the day:

•Time spent with family and friends

•Good conversations

•Enjoyment of a good balanced meal

•Time of accomplishment

• Planning and serving a meal to others

•The kitchen is one of the rooms where

people spend the most time

Reasoning Behind these Changes

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For seniors no longer in their

homes, meals need to be…

A time of socialization

A time of pleasure

A time of purpose



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These standards are supported by:

National Association of Directors of Nursing Administration in Long Term Care

Association of Food & Nutrition Professionals

Academy of Nutrition & Dietetics

American Medical Directors Association

American Speech-Language-Hearing Association

American Association for Long Term Care Nursing

American Occupational Therapy Association

American Society of Consultant Pharmacists

Gerontological Advanced Practice Nurses Association

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How the new Regulations affect Nutrit ion Services

……and how they compliment the new Dining Practice Standards

New name for Dietary: Nutrition Services

CDM: f irst qualif ication for a Food and Nutrit ion Manager in LTC

Sufficient Staff is essential to accomplish appropriate competencies

Qualifications for Food and Nutrtion Manager are defined

Full t ime RD

or CDM, Certif ied Food Manager

Associate’s Degree in appropriate f ield

New CMS Regulations : Rules of Participation

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Important Menu Changes: Honor resident’s personal preferences

▪Cultural

▪Religious

▪Ethnic

▪Allergen and intolerances honored with choices provided

▪Appropriate Adaptive equipment

▪Facility Gardens

▪Food brought in from family

New CMS Regulations :: Rules of Participation

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What do Our Seniors Want Today?

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ANFP Annual Conference & Expo | Orlando, Florida | 2018 19

Food in Long Term Care

Communities needs to

change to attract the Baby

Boomers


Elder Care Philosophies

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Pioneer Network

•Focuses on facility culture

change

•Transforms traditional facilities

into more open and diverse

communities

Person Centered Planning

•Promotes personal satisfaction for

residents

•Respects individual life patterns and

preferences

•Personalizes living spaces

•Creates a relationship with the

community outside of the facility


Elder Care Philosophies

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Eden Alternative

•Addresses the three plagues:

loneliness, helplessness, and

boredom

•Creates living habitats for the

Elders instead of institutions

Wellspring Model

•Puts residents at the center of

the decision making process

•Focuses on staff education

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THE DINING ROOMDécor and atmosphere:

•Use tablecloths

•Consider cloth napkins

•Change to seasonal centerpieces

•Create a comfortable environment

•Use regular chairs instead of wheelchairs

•Play age appropriate soft music

•Look at the wall decorations

• Consider a mural

Long Term Care Dining Trends

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Consider a theme for

the room…

Outdoor bistro

Italian restaurant

Cozy café

Diner

Homelike kitchen


Colored Dinnerware

Contrasts with the served food

Residents with dementia tend to eat better with

colored plates

Less strict serving schedules

Breakfast upon rising

Flavor enhancers

Meatier gravies

Fruit extracts/juices in gelatins


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Restaurant style

• Having a hostess and waiter in the dining room

• More individualized menus

Family style

• Serving dishes for each table

Buffet style

• Allows residents to see the food and make their own choices

• Gives the residents some control over portion sizes


SERVING METHODS

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SMALLER SPACES• Smaller kitchens and dining rooms

• Creating a family feel to the meal

• Creates a central kitchen table

• Gets the residents involved

• Meal planning

• Meal preparation

•Creates relationships with staff and other residents


Meal planning

More special meals

Holidays

Family nights

Ethnic days

Gardens that residents tend

Resident cooking classes and clubs


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RESIDENT CENTERED


Smells of home stimulate hunger

Bread baking

Cookies fresh out of the oven

Coffee brewing

Making toast

Essential oils sprayed in dining areas

Caution: If using an essential oil with an

individual resident, check with a

physician first for possible interactions


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AROMATHERAPY

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•Cafés

•Coffee shops

•Fine dining room

•Grab and go

•Small grocery stores

•Lounges

Assisted Living and Other Senior

Living Communities Dining Trends

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MORE DINING ATMOSPHERES


But how about the Food?

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How do we support the

nutritional needs of

the older adult

through person

centered dining and

real food choices?


Do our residents want food or supplements

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Ideally:

Real Food

-the food they are used to

-the food they ate growing up

-the food to support their nutritional needs

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Work with their preferences

“Our staff takes so much time in preparing good food. Why add to volume and cost by giving supplements when we can serve real food?”

Fortify the regular food

Soup

Coffee

Milk

Mashed Potatoes

“Eating is one of our greatest pleasures and one of the last things we have control of”

31


Goal of food service:

create a meal situation

natural and independent

comparable with eating at home

many choices

tailored to the resident’s wants

seeking input from residents, family and staff

The Case for Food First

(ADA Liberalization of the Diet

Prescription Improves Quality of Life

for Older Adults in LTC, 2005; 2010.)

32


Our goal for our healthcare community

residents

Dignity

Choice

Control

Family

Friends

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The Case for Food First

•The Elderly want

•Good food, well prepared

•Menu choices

•Accessibility

•Individualization

•24/7

•Eliminates the need for

commercial supplements

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In Missouri, the administrator DON at a Nursing Home determined that by giving residents foods they like to eat, you can minimize use of supplements.

They calculated a savings of $1,164.00/month by serving real foods residents wanted to eat vs. supplements.

Bottom line: Save money, improve nutrition

Relevant Case Study

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Choices

Individuals should be

offered more control

over Who, What, Where,

When and How:

• Who they eat with

• What they eat

• Where they eat

• When they eat

• How they are served

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“Research has not demonstrated benefits

of restr ict ing sodium, cholesterol, fat ,

and/or carbohydrate in older adults.”

“It is often beneficial to

minimize restrictions

consistent with a

resident’s condition,

prognosis, and choices” CMS SOM

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Individualized approaches to

nutritional care and person

centered dining are top priorities!

Food First

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Improving intake via wholesome foods is generally preferable

to adding nutritional supplements!

(CMS State Operations Manual Appendix PP

483.25(i) Tag F325 Nutrition 2008 Revised

Guide

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•More ethnic cuisine

•A restaurant style menu

•Extended serving hours

• No longer only three meals

•Catering options for residents

• Family meals

• Tea with friends

Assisted Living and Other Senior

Living Communities Dining Trends

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May negatively affect variety/flavor of food

Unpalatable food may ▪ reduce the pleasure of eating

▪ decrease food intake

▪ contribute to weight loss

“Is a restrictive therapeutic

diet necessary?”

“Will it offer enough benefits

to justify its use?”

Therapeutic Diets:

Risk versus Benefit

Academy of Nutrition and Dietetics

Evidence Analysis Library

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An expanded list of alternatives

More variety and control over their food choices

Made to order items

Offered to all residents

The Bistro Menu Concept

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Bistro Menu Development

Menu based on food preferences

Casual, All-AmericanGriddle to Grill Fresh The “WOW” Factor TOP 10 Tailored to short term stay

residents


Popular Menu Items

Thick ‘N Juicy Pub Burger

Grilled Chicken Sandwich

Cottage Cheese Fruit Plate

Pasta with Meat Sauce

Western Omelet

Pan-Seared Tilapia

Soup of the Day

Choice of Side Dishes


Restaurant Style Menus

Creating a cruise ship on land!

A dining experience!

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Nursing and Activity departments assist

Orders taken at “real time” or meal before

‘Daily Special’ meets nutritional needs

How Choice Works


Big Bang For Small Buck

Create a rapid cook station

▪Charbroiler, grill top (infrared)

▪Sandwich prep unit with refrigerated base

▪Fryer

▪Panini grill

▪High speed, ventless oven (Turbo Chef)

▪Hot holding cabinets

▪Upgrades <$5000


Free choice philosophy: Nutrition value of an uneaten meal is zero!

Decrease waste – Eliminate deliberate overproduction

Demand Forecasting – Using historical data

Meal item consumption follows a pattern over time

Use like ingredients and products already on the menu

Menu Planning is the Road Map to staying on budget!

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Supports New Guidelines

Resident focused

Increased menu rotation (seasonal)

Resident Satisfaction

Less food wasted

Advantages of Bistro Menu


Dining Trend Ideas


Dining Trend Ideas

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Dining Trend Ideas


Dining Trend Ideas


Dining Trend Ideas

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Culture change

• Plan trainings

Change in purchasing and storage

• Ordering in smaller sizes

• Due to smaller kitchens

• May have more food stored throughout the building

instead of one storeroom

• Need to do thorough inventories

• May need more coordination for the order each week

How to Implement Culture Change

56


Food safety

• More dining rooms and small kitchens

• Close temperature monitoring

• Different serving methods

• More staff involvement other than the dietary department

• In-services

• Need to continue to follow regulatory guidelines


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Flexibility

• Different serving times

• Different serving locations

• Staff role changes

• Becoming more like restaurant wait staff

Continuous training


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Assess what is right for your community

Remember the plan has to be resident

centered

Must be led by Administrator

Get everyone involved

Residents

Family

Every department

How to Move Forward…

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Work together to come up with a plan

Get started

Baby steps

Make changes as necessary

Remember there will be bumps in

the road


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Don’t forget about customer service

Meal time is show time

Food might be great………….but if the

customer service is a problem, there are

issues to be solved!


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www.edenalt.org

www.wellspringis.org

www.pioneernetwork.net

What’s New in Long-Term Care Dining? NC Med Journal July/August 2005, Volume

66, Number 4

The Changing Senior Dining Market Dietary Manager May 2006

What Does the Future Hold for CCRCs? www.food-management.com/article/9203

The Dining Experience in Nursing Homes NC Medical Journal July/August 2005,

Volume 66, Number 4

Nutrition and the Dining Experience in Long-Term Care NC Med Journal July/August

2005, Volume 66, Number 4

Enhancing the Dining Experience in Senior Living Nursing Homes 0ct 2006

Restaurant-style Dining at an Affordable Price

www.nursinghomemagazine.com/Past_Issues.htm?ID=5810

Resources

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Lee [email protected]

Questions?

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