Food and the Transition to a Long Term Care Environment

March 14, 2017

·Nursing, Residents

After working for 20+ years in the long term care environment I think that I have perhaps seen and did it all, but there is always that “first” or that “new challenge.”

Quite honestly every time a new resident is admitted to a facility it is a “first” or a “new challenge”, not only for that particular resident and their family but for our Food Service staff.  From allergies, to dislikes and preferences, to therapeutic diets and mechanically altered diets each new admission presents a new challenge, a new goal to achieve, a new need to be met, a new expectation from that resident and their family.

Sound daunting?  Well it really is.  We strive to put our best foot forward, to make that transition from home to the manor as easy and pleasing as possible.  Do we meet every goal, every expectation?  We do not and that is the challenge.  We want to provide the most nutritious, the best tasting, closest to home cooking as possible.  We want to help make every resident “better”.  The unfortunate reality is that won’t always be the case.  But we have to put our best foot forward and work interdisciplinary to achieve our goals.

I’d like to take you on a trip through our process…our road to success for attempting to please each of the residents who come through our Dining Room doors.

One may believe it all starts upon admission.  That when a resident is admitted to our facility we are provided with a physician ordered diet which we must follow. But prior to admission we have a lot of behind the scenes processes that we use to prepare for that new resident.

We have Dietitian approved cycle menus which change seasonally.  Each meal has a main and alternate offering along with five permanent menu item options.  We have diet manuals which spell out what foods are permitted for certain diets, scratch recipes for every food item, production sheets and records that we use to prepare the correct amount of food each meal, order guides for each of our vendors that we set up to allow us to order the correct and proper amounts of food, trained and experienced staff who strive to meet the residents needs, ServSafe certified cooks who prepare the meals, monthly department inservices for staff so they may be educated in resident food service needs, and we have software packages to make everyone’s life easier in preparing all of this information.  That’s a great deal of preparation and that only scratches the surface!

Let’s move on to the next step, when a resident actually crosses our threshold.  That’s when the real fun begins!  As I said, we receive a physician ordered diet upon admission which we must follow.  This diet could range from a Regular Diet to something as complex as a resident requiring a Puree, Honey Thick Liquid, Diabetic, Low Salt Diet with specific allergies.  But thankfully all of our prior preparation has allowed us to meet these challenges.

The first thing we do is enter this resident into our software, assign their diet, their dining location and get them a spot to eat.  Once the resident has been here for a short period of time, generally within 72 hours we visit that resident and hopefully their family to find out about their preferences, things they enjoy, things they used to eat at home, explain to them how our menu and meal time works, and ask them how things have been going thus far.  Once we obtain this information from a resident, we enter it into their profile and it creates a customized picture of what they want and desire or require for each meal.  This information is then included in all of that paperwork we discussed earlier- production sheets, tray cards, etc. so that we know what to produce and package for each resident.  We attempt to meet as many individual needs as possible while thinking of the general population as a whole.

As the resident is here for a longer period of time, we get to know them and they get to know us.  We learn more about them, more about their habits and preferences and we continually take that knowledge and information and build it into their profile so that we can better meet their needs.  We take family suggestions and input and use it to our advantage to hopefully help the resident even more.  Some residents may require a bit more attention than others. We take the time to continue to visit them, to get their preferences and requests and meet their needs.

Residents are monitored daily at each meal.  Their intake percentages are tracked, their liquid consumption is tracked.  This information is then used by our Dietitian to form a plan of care for the resident. The information is used to evaluate any weight loss or gain, monitored to determine if more interventions are needed to assist the resident to reach adequate nutrition levels, and assists in making the decision of whether to place them on perhaps a more strict or liberal diet.  Liberalization is our goal- to allow as many residents as possible to eat and select what they may want from the offerings available.  Quarterly or sometimes more often each resident is assessed for their status and a meeting is held with the family in the form of a care conference to discuss any changes, progress and overall well being of the resident.  And the process continues as such for as long as we have a resident with us.

Upon discharge from our facility, our dietitian is able to construct a plan for a home diet if the resident or family opts for this assistance.  We hope that the resident can continue the good habits established here or to provide assistance for smarter choices to lead a more healthy lifestyle.

Each day provides a new goal, a new challenge, a new person to care and provide for.  Food is a tough topic. Some people will eat just about anything, while others…not so much!  Some people are terrific cooks and others…not so much!  Here at Arbutus we don’t claim to be the best but we will always strive to meet your individual needs, get to know you as a person and provide you with whatever we have available at any given time in an attempt to satisfy you.  I invite you to come visit me sometime in the Dietary Department. I’d love to show you our operation or answer any questions that you might have! – br

Contributor: Buddy Roth is the Food Service Director at Arbutus