The dish on dining

What is the public perception of nursing home dining? Bland, overcooked food? Limited menu choices? An institutional dining venue? When an individual transitions to a long-term care (LTC) setting, his or her lifestyle can change dramatically. Suddenly finding himself or herself in a new and unfamiliar setting can cause an older adult to become withdrawn or depressed. Culture change has come a long way in its promise to make residents feel “at home.” Food is the ultimate expression of contentment and community, which is why chefs—not just cooks—have become key members of LTC staffs.

At Covenant Care, a post-acute care provider operating 57 facilities in seven states with headquarters in Aliso Viejo, Calif., the company’s motto is “We are family serving families.” Part of living up to that philosophy is to provide residents with a pleasurable, nutritional dining experience—the driving force behind Covenant Care’s “Enhanced Dining” program, spearheaded by Karen Reed, RD, director of integrated services.

More than a meal

Reed has been with Covenant Care for nearly two years. “Part of my mission was to improve dining and satisfaction scores. To accomplish this goal, the dining experience had to be taken to the next level,” she says.

Covenant Care already offered tasty, nutritious meals and pleasant surroundings at its facilities located in California, Illinois, Indiana, Iowa, Nebraska, Nevada and Ohio, says Reed.  What more could be done? As Reed inspected her facilities’ dining programs, she looked for ways to get to that next level. No part of the dining experience was overlooked. “Food and nutrition are vital to healing and recovery. I wanted to provide more choices that honor individual preferences in high-quality, friendly surroundings,” she says. Meetings are held with dietary managers and residents to develop a menu that incorporates resident requests. “This might not always be possible,” Reed notes, “but if we can’t always meet the various needs, we do adapt recipes and offer recommendations to fulfill those needs.” After taking a long, hard look at Covenant’s dining options, Reed implemented the hospitality-based Enhanced Dining program to meet resident goals and satisfaction with food service.

Expanded dining platform

Breakfast is known as “the most important meal of the day.” The restaurant-style breakfasts at Covenant Care have delighted residents, Reed says. It gives them the opportunity to match their meal with their appetite. “Every morning, residents can order off a menu and are not locked into being content with regimented fare,” she explains. From a full breakfast of eggs and bacon, hash browns to simple tea and toast, the residents’ taste buds and appetites come first.

Enhanced Dining offers resident what they want most—choice at every meal. “Residents can order off a standard menu or a la carte. A variety of selections, such as burgers and wraps, are more appealing to many of our rehab clients than a regular meal,” Reed says.

Another successful innovation that helped kick “choice” up a notch are the food bars offered at a number of Covenant’s facilities. “Salad bar, taco bar, mashed potato bar…each month treats our residents to a taste experience,” Reed says. The type of food bar changes monthly, which gives residents and guests a chance to customize their meals. It’s never boring for a client to create their ideal potato, salad…whatever,” Reed says. Chief Operating Officer Dava Ashley agrees: “We know that good food and nutrition are vital to recovery and healing. We also enjoy seeing the marvelous skills and creativity displayed by our chefs and dietary staffs.”

Serving certain foods tableside service, such as homemade soups and salads, gives dietary staff a chance to connect, educate and explain the benefits of good nutrition and healthy eating habits to the residents.

Nutrition and creativity blended together

The ultimate goal of a dining program is to maintain health and recovery. Enhanced Dining combines nutrition and kitchen magic to achieve that goal. “We incorporate the national monthly food calendar that is issued by presidential proclamation and trade associations,” Reed notes. “I use the calendar by focusing on a featured food and make it the Dietitians’ Healthy Pick of the Month for our kitchen staffs,” she adds. All Covenant Care facilities are sent a kit to recommend, educate and support that particular food. “For example, if it’s National Blueberry month, our chefs receive posters, nutritional information for the dietitian, recipes and resident handouts that describe the history and facts about blueberries,” Reed explains. Extra steps such as these bring interest to the dining room because residents are educated about what they eat and why certain foods are good for them.  Many of Covenant Care’s properties are in areas where fresh, locally grown produce is available. Resident gardens also contribute their bounty to the kitchens.

It’s the Covenant Care chefs and dietary staff who light up Enhanced Dining with innovative menus and creative presentation, treating the residents to new tastes, smells and textural sensations. Attendance at meals has grown, Reed says. Is today’s soup homemade chicken noodle or sweet potato? Will dinner be lemon tilapia or Valle Vista roasted chicken? Part of the residents’ enjoyment is anticipation.

Dietary staff buys in to Enhanced Dining

The success of the new dining program was incumbent on its acceptance by the dietary and kitchen staff.  “At first the change was a bit intimidating for the kitchen staff,” Reed says. The key, according to Reed, was better planning. “One chef told me that all it took was better organization,” she says.

To excite and encourage staff, Reed initiated a quarterly food presentation award. “This achievement not only recognizes the individual participant, but it inspires creativity and competition so the participants learn from one another,” she says.

Restaurant ambience

Beautifully plated dishes should be enjoyed in elegant, yet homelike, surroundings. At Covenant Care, some dining rooms received what Reed term “makeup”—new china, linens, chairs and glassware. More dramatic changes were made in older dining areas that were scheduled for remodeling, including new equipment.

To be more identifiable, wait staff wear black and white uniforms. “To serve the resident—our customer,” explains Reed, adding that dining room coordinators (usually a department head or certified nursing assistant)  also receive training on how to manage a dining room.

“We have seen the dining room at our La Jolla facility go from serving a handful of residents to bursting at the seams with people, including family members, wanting to enjoy the food and ambience,” Reed says.

Food and fellowship

Enhanced Dining is in place at 16 Covenant Care facilities, and by the end of 2015, that number should grow to 30. Other dining improvements Reed is looking at include expanding room service options. “I’d like to offer residents the same restaurant-style menu in their rooms. Instead of taking an order from a resident, I’d like to initiate a hot cart that could be taken down the hall, increasing the menu options for residents and eliminating the wait,” she adds. Enhanced Dining provides more than healthy nutritious meals in a comfortable atmosphere. Along with good food, it gives residents a place to increase fellowship and enjoy one another’s company.

Sandra Hoban

Sandra Hoban was on I Advance Senior Care / Long-Term Living’s editorial staff for 17 years. She is one of the country’s longest-serving senior care journalists. Before joining Long-Term Living, she was a member of the promotions department at Advanstar Communications. In addition to her editorial experience, Sandi has served past roles in print and broadcast advertising as a traffic and talent coordinator.