Offering an Excellent Dining Experience While Managing Nutritional Care

Transcription

1 Offering an Excellent Dining Experience While Managing Nutritional Care Linda Crandall RD, LD CEO Jon Williams RD, LD COO Randolph Valdez West Regional Director of Dining Services

2 Statistics Regarding Aging Current Senior Population: 13.8% 1 in 8 people is a senior Average life expectancy is 79 years By 2030 people the age of 65 and older will comprise as much as 20% of the population At least 80% of the people in this age group live with at least one chronic illness

3 Numbers of Person / Millions Aging Population Year

4 Nutritional Risks in Older Populations Weight Loss Malnutrition Pressure Ulcers Broken Bones Decreased Immune System

5 Why Are Seniors at Higher Nutritional Risk The Immune System & Aging The GI Tract & Aging Can lead to malnutrition Decreased Mobility Compromised Eye Sight Reduced Taste & Desire to Eat

6 The New Dining Practice Standards The nationally agreed upon standards are: Self-directed care Individualized care These standards are recommended for people living in senior care communities, however are not required Source:

7 Standards of Practice Individualized Nutrition Approaches / Diet Liberalization Individualized Diabetic / Calorie- Controlled Diet Individualized Low-Sodium Diet Individualized Cardiac Diet Individualized Altered Consistency Diet Individualized Tube Feeding Individualized Real Food First Individualized Honoring Choices Shifting traditional professional control to Individualized support of self-directed living

8 Agencies that Support the New Dining Practice Standards Academy of Nutrition & Dietetics American Medical Directors Association American Nurses Association National American Occupational Therapy Association American Speech Language Hearing Association of Nutrition & Foodservice Professionals Association (ASHA) Association of Activity Professionals National Association of Social Work

9 Trends in Senior Dining Person centered care Liberalization of therapeutic diet restrictions Move from hospital model to hospitality model Decentralized dining options / choices Gluten-Free VS Gluten- Restricted Lactose-Free VS Lactose- Restricted

10 Trends in the Industry Restaurant service should be the goal Service oriented staff Wide variety of food to select from Focus on food preparation Residents are seeking a culinary experience Residents & family are seeking nutritious menus that are healthier lower in sodium 10 points of service How does Sunrise provide hospitality to residents

11 Restaurant Service

14 Providing Purees & Mechanically Altered Diets Regular Benefits of using premolded foods Molds 2.0 Challenges of molding your own foods Presentation of the plate Family often comment on the presentation and are surprised the food is pureed Pureed

18 10 Points of Service

19 Hospitality

20 Hospitality

21 State Regulations & Restaurant Service Presetting Tables Time Some states have regulations about pre-setting tables, i.e. Colorado Tables cannot be pre-set if the room is actively being used between meals Setting Colorado regulations also require that the glasses must be inverted and silverware protected by being wrapped, if the dining room is being used between meal services

22 Resident Choice

23 What are your company standards related to resident choice? Questions?

24 The New Dining Practice Standards Regular diet is the goal Residents have the right to refuse prescribed diets Resident s choice is paramount Examples: 1. Resident with diabetes requested black forest chocolate cake with Frosting 2. Resident on NAS diet adding additional salt at table What should the wait staff do?

25 Defining Therapeutic Diets A diet intervention ordered by a health care practitioner as part of a treatment: For a disease or clinical condition To eliminate, decrease, or increase certain nutrients in the diet (e.g., sodium, potassium) Source: Academy of Dietetics

26 Benefits of a Liberalized Diet Residents tend to consume more of their meals Aids in prevention of malnutrition Maintains stable body weight Preserves residents dignity while dining by allowing the resident to choose what food & beverages they want Is more home-like

27 Typical Diets in Assisted Living Communities Regular No restrictions No Added Salt (NAS) No salt added at table Food is cooked with salt No foods restricted Consistent Carbohydrate (CCHO) Consistent amount of carbs throughout the day Mechanical Soft Foods that are difficult to chew, i.e. meats, are sliced thin or ground Puree All foods smooth and of pudding-like consistency

28 Resident Choice: Low Carbohydrate

29 Strict VS Liberalized VS Regular Diets Strict / Not Liberalized Diet Liberalized Diet Regular Diet 1800 Kcal Diabetic Diet Consistent Carbohydrate Diet (CCHO) Regular diet with diet desserts and *sugar substitute * Advise resident regarding sugar use 2 Gram Na Diet No Added Salt (NAS) Regular diet with resident limiting *salt use at the table * Advise resident regarding salt use Cardiac Diet (Low-Fat / Low-Cholesterol, 2 Gram Na) Low-Fat / Low Cholesterol, NAS Regular diet with skim milk, limit eggs 3 x week, no fried foods, limit gravies, cream sauces, & cream soups; For dessert fruit, gelatin, low-fat cake or cookies i.e. angel food cake,

30 Strict VS Liberalized VS Regular Diets Strict / Not Liberalized Diet Liberalized Diet Regular Diet Strict Renal Diet (80 Gram Protein, 2 GM Na, 2 GM K+) Liberal House Renal (80 GM Pro, 3 GM Na, 3 GM K+) Allows use of potato & tomato products sparingly Regular Diet with dairy limited to ½ cup per day (no other dairy products) Avoid: Bananas, cantaloupe, honeydew, oranges & orange juice Dysphagia Levels Level 1 - Puree Level 2 - Dysphagia Mechanically Altered Level 3 - Dysphagia Advanced Thickened Liquid Levels: Thin Nectar-Like Honey-Like Pudding-Like Mechanical Soft Puree (Omit level 2 Dysphagia Mechanically Altered) Food are offered to the resident that are naturally of appropriate consistency Beverages are offered to the resident that are naturally of appropriate consistency Individualized consistency per resident s preference & tolerance i.e. Ground meats with regular consistency vegetable & starch sides Frazier's Free Water Protocol allows thin water 30 minutes after a meal & between meals with excellent oral care Source: Mayo Clinic

31 Do the diets you offer follow the new liberalized approach? Questions?

32 States that Require Nutritional Monitoring & Documentation in Assisted Living Alabama Dietitian must be available to any resident receiving a therapeutic diet Massachusetts Requires a dietitian to review dietary plans at least every 6 months Mississippi Assisted Living: Must have dietitian assess food preparation areas Dementia Care: An initial nutritional assessment must be completed on all residents Montana If the resident has additional nutritional needs that are identified, i.e. weight loss; the dietitian must assess the resident and document nutritional approaches and education provided in the resident s medical record Nevada Dietitian must visit the community a minimum of every 90 days

33 States that Require Nutritional Monitoring & Documentation in Assisted Living (Continued) New Jersey If the resident has additional nutritional needs that are identified, i.e. weight loss; the dietitian must assess the resident and document nutritional approaches and education provided in the resident s medical record Ohio Documentation of Special & Complex Diets Utah Documentation by the dietitian on therapeutic diets at least quarterly Virginia Documentation of Special diets Wyoming Dietitian must visit monthly if the community serves therapeutic diets

34 States that Require Dietitian Approval of Menus Alabama Arkansas California Delaware District of Columbia Florida Hawaii Idaho Illinois Indiana Iowa Kansas West Virginia Wyoming Louisiana Maine Maryland Massachusetts Mississippi Missouri Nevada North Carolina South Carolina South Dakota Texas Utah Virginia

35 Food Allergies Top 8 Food Allergies: 1. Egg 2. Fish 3. Milk 4. Peanuts 5. Shellfish 6. Soy 7. Tree Nuts 8. Wheat Source: The Food Allergy & Anaphylaxis Network

36 Gluten-Free / Gluten-Restricted Gluten-Free Gluten-Restricted Level of Difficulty Difficult to manage Resident managed Criteria All foods must be below 20 *ppm of gluten *Parts Per Million Source: U.S. Food & Drug Administration Individualized to resident Steps to Follow Have in Place if Accepting Residents Avoid cross-contamination i.e. Toasting Bread Gluten-free spreadsheets Inservice staff Coordination of interdisciplinary team Gluten-restricted preferences should be assessed & documented on diet board Inservice staff on resident s preferences Coordination of interdisciplinary team

37 Lactose-Free / Lactose-Restricted Lactose-Free Lactose-Restricted Level of Difficulty Difficult to manage Resident Managed Criteria Steps to Follow Have in Place if Accepting Residents Avoid all foods containing lactose, (casein, caseinate, whey), i.e. margarine, butter, instant cereal & potatoes Close coordination of physician, nurse & dietitian to direct staff Lactose-free Spreadsheets Inservice staff Coordination of interdisciplinary team Lactose-restricted preferences should be assessed & documented on diet board Lactose-restricted preferences should be assessed & documented on diet board Inservice staff on resident s preferences Coordination of interdisciplinary team

38 Gluten-Restricted & Lactose-Restricted Corporations / Communities Should: Determine if the residents needs can be met Medical diagnosis VS. Preference Work with residents and family to identify food and beverages that the resident can tolerate The culinary director or designee should work with the dietitian to meet the resident s nutritional needs Goal is for resident to enjoy food and have the best quality of life possible

39 How do you manage gluten-restricted & lactose restricted diets? Questions?

40 Thickened Liquids Most corporations purchase pre-thickened beverages

41 Benefits of Purchasing Pre-Thickened Liquids Achieves more accurate consistency Served to the resident faster than traditionally thickened beverages Some products are fortified and provide vitamin C & electrolytes Enhanced flavor to increase resident acceptance Maintains appropriate temperature longer Thoughts to Remember Use glasses that are at least 1 ounce more than the beverage serving size Example 4 ounce beverage = 5 ounce glass

42 Common Survey Issues Survey & Menu Compliance Diet boards & books not up to date (California, New York, Ohio & Virginia) Diet manual not available or does not correlate with menu program (California) Recipes not followed (California & New York) Spreadsheets not followed (California & New York) Staff unaware of resident s prescribed diet (California, New York, Ohio & Virginia) Disaster Food Supply (California, Florida & New Jersey)

43 Strict Therapeutic Diets Quality of Life Medical Needs

44 Liberalized Diets Tipping the Scale Quality of Life Medical Needs