Trends in foodservice

To maintain or increase occupancy, most nursing homes are looking for ways to improve the satisfaction of residents and their families. In that quest, however, they overlook the most obvious opportunity-the food coming out of the kitchen.

After all, the foodservice department has more daily encounters with residents than any other function within long- term care. In fact, foodservice has an average of five opportunities per day to please or displease its residents. It's often been said that “the way into to a man's heart is through his stomach,” and this is still true for both men and women residing in nursing homes.

Barometer for quality of care

At many nursing homes, mealtime is a social time-a time when residents enjoy visits from family, friends, and other loved ones. Accordingly, it is a time when quality of care will often be assessed. This means that food not only needs to be presented in an appetizing and appealing manner, but also that residents get what they like and expect, mistake free. Nothing agitates and concerns a visiting family member more than seeing a loved one served something that could cause an allergic reaction or something for which the resident has repeatedly professed a dislike. This is one reason why it is important for foodservice professionals to use the appropriate front-end controls to ensure that every resident is provided the proper food at every meal.

From a litigation standpoint, there are three quality-related foodservice hot buttons that most often lead to malpractice and regulatory citations. They are weight loss, dehydration, and pressure ulcers. Good nutrition is one of the best defenses and easily implemented strategies to reduce and guard against these problems. For that reason, surveyors have zero tolerance for residents with unintended weight loss or any possibility that a resident's nutrition is inadequate or unmonitored. To comply with regulations under the Centers for Medicare & Medicaid Services' F-tag 325 (Nutritional Status), surveyors are trained to scrutinize resident nutrition and make sure foodservice professionals are prepared to answer critical questions such as:

• How many residents are on therapeutic diets?

• Which residents have experienced unplanned weight loss?

• How is food and fluid intake monitored?

• How are changes in intake, eating ability, or weight reported?

• How do foodservice employees become knowledgeable and receive training with regard to therapeutic diets?

For those communities that still rely on manual processes like handwritten, laminated index cards for important resident nutritional information such as allergies, calorie count per day, likes/dislikes, and dietary restrictions, these questions present a real challenge. Moreover, providing the requisite documentation to defend an alleged deficiency is much more difficult in an environment where manual records are the only source of information. That's why nursing homes are beginning to recognize the importance of increased organization through training, education, and automation in the kitchen.

The domino effect

When nursing home leadership focuses its attention on improving foodservice and works with the department to explore opportunities to improve operations, it can breathe new life into the routine task of providing meals. The result will have positive implications for the entire facility. Long-Term Living's 2009 OPTIMA Award winner, Rolling Fields, is a 181-bed facility in Pennsylvania. It had recently revamped its entire foodservice operation and is reaping rewards beyond anyone's expectation. (Long-Term Living September 2009, p. 22). Pressure ulcers, puréed diets, pain, behavioral issues, waste, and employee turnover are all down while resident satisfaction and census are up.

“Our care plan meetings and elder council meetings no longer revolve around food issues,” comments co-owner Cindy Godfrey, “In fact, at our annual state survey in May, there were no elder complaints about food.”

Advantages of technology

But, where to begin? A good starting point is to replace manual processes that often lead to human error. For example, in a typical nursing home tray line, foodservice employees make decisions about what to place on a tray by reading handwritten, laminated index cards with each resident's calorie requirement and comparing that to what is available in the food bins for that meal. While this may not seem difficult, it is often complicated by restrictive diets, allergies, likes, and dislikes. In the best case scenario, an error in translation simply leads to waste and/or resident dissatisfaction. In the worst case scenario, an error in translation leads to poor nutrition and/or an allergic reaction to the improper food on a resident's tray.

To contrast, consider the operation of a tray line that uses foodservice management technology. First, every meal is supported by a complete nutritional analysis. This electronic analysis calculates exactly what food items, and how much of each item, should be placed on each resident's tray by automatically accessing each individual resident's nutrition profile and producing an individual meal ticket. The resident profile contains all the pertinent information such as required calorie count, likes, dislikes, allergies, and any dietary restrictions. Thus, the technology takes the guesswork out of which food items the foodservice employees should place on each tray. In addition to avoiding errors, the automation allows the entire tray line process to run more smoothly and that gets the food to the residents quicker and warmer.

Remember, poor resident nutrition is rarely caused by the menu itself.

Remember, poor resident nutrition is rarely caused by the menu itself. On the contrary, by contracting with expert dieticians to procuring the best possible ingredients, facilities spare no expense in creating nutritionally balanced menus. But, even the most carefully prepared menus will result in problems when not executed correctly.

For foodservice management, this same technology offers the tools necessary to execute improved cost analysis, control production, and eliminate costly waste. For example, when a menu is selected for production, the quantity produced is driven by the resident profiles and how much of each menu item should be prepared based on what each resident will consume. This precision production can easily cut food costs by 5% to 10% depending on how facilities currently calculate production.

Correct technology

Keep it simple. Make sure to choose a foodservice management program that is easy for employees to learn and operate. Ideally, the technology selected should look and feel like commonly used software that people are generally comfortable with. Be thorough when asking questions about customer support. Any software is only as good as the available customer support. Finally, make sure the system pays for itself. With nursing homes under constant pressure to do more with less, automation should offer a relatively quick payback period. Generally, this is easily accomplished with just a small reduction in waste.

Honor residents' preferences

Good nutrition strengthens not only the residents but also the entire nursing home facility. Recognizing this, many homes have already risen to the challenge of improving food service through education, organization, and automation. These early adapters are reaping the rewards of more satisfied residents, family members, and employees as well as improved quality measurements. While serving every resident more of what they like and less of what they don't like will never be simple in the complex environment of today's nursing home, it is more possible with the assistance of foodservice management technology.

Cole Racho, Vice President, Business Development for Mealtracker Dietary Software, has more than 15 years in sales and marketing experience in the consumer products industry. His experience includes national account management, team leadership, and customer-driven solutions. For more information, call (800) 755-3284 or visit www.mealtracker.com Long-Term Living 2010 September;59(9):34-36

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