NUTRITION IN AN AFH CONTINUED People eat for their physical needs, but also to meet social and psychological needs. Think about why and when you eat. Some examples could be: • The food looks and smells good • It’s time to eat • You know you should eat • The food is on the table • Friends or family are visiting • It is a holiday celebration • Emotional reasons such as depressed, happy, stressed or lonely September 2019 Safety, Oversight and Quality Unit 24
NUTRITION IN AN AFH CONTINUED • You feel in control when you make decisions about eating • You feel out of control such as nervous or anxious • You enjoy visiting with others over a meal The residents in your home may eat (or not eat) for many of the same reasons. For some residents, mealtime may be the highlight of their day. They enjoy good food and socializing during the meal. September 2019 Safety, Oversight and Quality Unit 25
NUTRITION IN AN AFH CONTINUED The appearance, flavor, aroma of food, and mealtime atmosphere, can have an important effect on residents’ desire to eat. If meals and mealtime are pleasant, your residents will be more likely to eat. Serve attractive meals. Vary foods in color, shape, flavor and texture. For example, serving a meal of baked chicken, brown rice with a little pimento, broccoli and a small wedge of cantaloupe provide a variety in texture and flavor and make a colorful and eye-appealing meal. September 2019 Safety, Oversight and Quality Unit 26
NUTRITION IN AN AFH CONTINUED Vary methods of preparation and temperature of foods served. • Prepare meals that have both hot and cold foods • Use a variety of cooking methods like bake, broil, sauté, barbecue, poach, stir-fry, etc. Season foods with herbs and spices. • Use flavorings that bring out the natural salt, sweet, sour and tart tastes in foods • Consider an herb garden with herbs residents are familiar with and enjoy September 2019 Safety, Oversight and Quality Unit 27
NUTRITION IN AN AFH CONTINUED Serve meals family style: • Let residents select the foods they like and the amount they want; • If pre-dished plates or if assistance is needed, be sensitive to the size of portions desired. Too much food on the plate can decrease an appetite. September 2019 Safety, Oversight and Quality Unit 28
NUTRITION IN AN AFH CONTINUED Accept unusual eating habits: • Putting jelly on all foods may seem unusual or unhealthy to you, but it may be a lifelong habit for a resident • Unusual eating habits are common among residents with dementia • Do not discourage such habits if they enhance the resident’s eating of an otherwise healthy diet Document any concerns. Check with the resident’s primary health practitioner or a registered dietitian if you have concerns. September 2019 Safety, Oversight and Quality Unit 29
NUTRITION IN AN AFH CONTINUED Provide a pleasing relaxed atmosphere: • Serve meals at a dining table, rather than on trays in the residents’ rooms • Eating a well-balanced meal increases when a meal is shared with others – poor dietary patterns are associated with eating alone • Sharing a meal with others increases the likelihood of eating a well-balanced meal September 2019 Safety, Oversight and Quality Unit 30
NUTRITION IN AN AFH CONTINUED Allow residents to assist you with preparing meals, serving and clean- up if they want to: • Setting the table, checking on the vegetables, etc. • Be sure everyone washes hands before handling food, setting the table and eating Plan meals around special events. Birthday parties, holiday dinners and ethnic foods add interest to mealtime. Involve residents in planning special events. • You may want to invite family members for a potluck or barbecue, or ask them to bring a resident’s favorite dish September 2019 Safety, Oversight and Quality Unit 31
NUTRITION IN AN AFH CONTINUED Be aware of cooking odors: • Residents with nausea may not tolerate food smells – use the kitchen exhaust fan or open a window Create an inviting dining area. It should be cheerful and well-lit. If residents want to be involved, let them set and decorate the table. Be flexible about seating arrangements. Allow plenty of room to accommodate elbows and wheelchairs. Be creative: • Have a picnic in the backyard (or better yet a park). A change in scenery can stimulate the appetite. September 2019 Safety, Oversight and Quality Unit 32
September 2019 Safety, Oversight and Quality Unit 33
MYPLATE CONTINUED The main concepts of MyPlate are building a healthy diet (plate) by: • Increasing the amount of vegetables, fruits and whole grains • Reducing the amount of fat, salt and sugar in your diet • Working towards increasing physical activity on a daily basis September 2019 Safety, Oversight and Quality Unit 34
A WELL-BALANCED DIET To achieve a well-balanced diet, you should: Balance calories • Enjoy your food, but eat less. Avoid oversized portions • Increase the portions of fruits and vegetables to half of your plate • Increase whole grams • Decrease fats, sugars and salt Increase whole grains • Replace at least half the grains with whole grains September 2019 Safety, Oversight and Quality Unit 35
A WELL-BALANCED DIET CONTINUED Increase vegetables and fruits • Make half your plate fruits and vegetables • Eat red, orange and dark-green vegetables such as tomatoes, sweet potatoes and broccoli in both main and side dishes • Eat fruit, vegetables or unsalted nuts as snacks Reduce certain foods • Reduce fats • Cut back on foods high in solid fats and switch to oils such as olive oil when preparing foods September 2019 Safety, Oversight and Quality Unit 36
A WELL-BALLANCED DIET CONTINUED • Reduce salt intake • Reduce the amount of red meat – substitute fish, beans or poultry • Drink water instead of sugary drinks • Be active every day • Pick activities you like - start by doing what you can, at least 10 minutes at a time • Every bit adds up, and the health benefits increase as you spend more time being active September 2019 Safety, Oversight and Quality Unit 37
WELL-BALANCED DIET CONTINUED You can provide a nutritious, well-balanced diet for your residents by serving daily meals and snacks made up of foods from ChooseMyPlate. The food groups include vegetables, fruits, grains, proteins and dairy. The pictures used in ChooseMyPlate depict the approximate proportion of servings from each food group recommendation. September 2019 Safety, Oversight and Quality Unit 38
WELL-BALANCED DIET CONTINUED Grains • Foods made from wheat, rice, oats, cornmeal, or barley is a grain product. Bread, pasta, popcorn, oatmeal, breakfast cereals, and tortillas are some examples. • Whole grains contain the entire grain kernel – the bran, germ and endosperm. People who Daily serving: Adults should have a serving eat whole grains as part of a of grains with each meal. At least half of healthy diet have a reduced risk the servings of grains should be whole of some chronic diseases. grains. September 2019 Safety, Oversight and Quality Unit 39
WELL-BALANCED DIET CONTINUED Shopping tips • Check the nutrition label for the fiber content of whole-grain foods. Good sources of fiber contain 10 percent to 19 percent of the daily value. • Read the ingredients list and choose products that name a whole-grain ingredient first on the list. Look for “whole wheat,” “brown rice,” “bulgur,” “buckwheat,” “oatmeal,” “whole-grain cornmeal,” “whole oats,” or “wild rice.” • Terms such as “multi-grain,” “100 percent wheat,” “cracked wheat,” “seven- grain,” or “bran” may not contain any whole grains. September 2019 Safety, Oversight and Quality Unit 40
WELL-BALANCED DIET CONTINUED Fruits – provide nutrients vital for health, such as potassium, dietary fiber, vitamin C and foliate (folic acid): • Most fruits are naturally low in fat, sodium and calories. No fruit has cholesterol. • Fruits may be fresh, canned, frozen or dried; they may be whole, cut-up or pureed. Vegetables are low in fat and calories; they also provide fiber and other key Daily serving: Adults should have between nutrients: three and six cups of fruit and vegetables • Fresh, frozen and canned are all good each day. sources of vegetables. September 2019 Safety, Oversight and Quality Unit 41
WELL-BALANCED DIET CONTINUED Shopping tips • Buy fruits and vegetables that are in season for maximum flavor at a lower cost. Check your local supermarket specials for the best-in-season buy or visit your local farmers market. • When using canned vegetables, check the label from the amount of added salt. Most frozen vegetables do not have added salt unless the vegetables are in a sauce. September 2019 Safety, Oversight and Quality Unit 42
WELL-BALANCED DIET CONTINUED Dairy: • Milk, yogurt, cheese and fortified soymilk all are good sources of dairy. • Calcium, vitamin D, potassium, protein and other nutrients are needed for good health through life. Daily serving: Adults need three cups a • Choices should be low-fat or fat- day. What counts as one cup? 1 cup of milk or yogurt, 1-1/2 ounces of natural free to cut calories and cheese; 2 ounces of processed cheese. saturated fat. September 2019 Safety, Oversight and Quality Unit 43
WELL-BALANCED DIET CONTINUED Shopping tips: • If you are lactose intolerant, try lactose-free milk, drink smaller amounts of milk at a time, or try soymilk (soy beverage). Check the nutrition facts label to be sure the soymilk has about 300 mg of calcium. • Choose cheeses with less fat. Look for “reduced-fat” or “low-fat” on the label. Try different brands or types to find the one you like. • Regular cream cheese, cream and butter are not part of the dairy food group. They are high in saturated fat and have little or no calcium. September 2019 Safety, Oversight and Quality Unit 44
WELL-BALANCED DIET CONTINUED Protein • Includes both animal and plant sources. • Protein is a source of B vitamins, vitamin E, iron, zinc and magnesium. Animal protein includes meat, poultry, seafood and eggs. • Plant protein includes beans, Daily serving: Adults should eat 5-7 ounces of protein each day. What counts as one ounce? peas, soy products, nuts and One ounce lean meat, poultry or seafood, One seeds. egg or one quarter cup of cooked beans or peas; One-half ounce of nuts or seeds; one- half tablespoon of peanut butter. September 2019 Safety, Oversight and Quality Unit 45
WELL-BALANCED DIET CONTINUED Shopping tips • Choose lean or low-fat cuts of meat. Ground beef at least 90 percent lean is considered lean. • Eat seafood in place of meat or poultry twice a week. Try beans and peas instead of animal protein. They are naturally low in saturated fat and high in fiber. • Check the nutrition facts label to limit sodium. Salt is added to many canned foods including beans and meats. Many processed meats such as ham, sausage and hotdogs are high in sodium. September 2019 Safety, Oversight and Quality Unit 46
WELL-BALANCED DIET CONTINUED Solid fats, sugars and salt (sodium): • Most people eat food with too many solid fats, added sugars and/or salt (sodium) • Added sugars and fats load foods with unneeded extra calories • Prepared foods frequently have hidden (or not so hidden) amounts of solid fats, sugar and salt • Check the nutrition facts label on all prepared food you purchase . There can be a big difference in the amount of fats, sugars and salt between different brands. For example, some brands of spaghetti sauce have lower amounts of sodium but do not label the product as “low sodium” or “low salt.” September 2019 Safety, Oversight and Quality Unit 47
MENU PLANNING September 2019 Safety, Oversight and Quality Unit 48
PURPOSE AND KEY TERMS • Diet The purpose of this section is to help the learner acquire an • ChooseMyPlate (formally Food understanding of how to plan a Guide Pyramid) well-balanced diet for residents • Menu plan using the ChooseMyPlate (formally Food Guide Pyramid.) September 2019 Safety, Oversight and Quality Unit 49
OBJECTIVES The learner will be able to: Understand how menu planning for residents is different from planning meals for your family Utilize the ChooseMyPlate when planning a menu Develop a menu plan September 2019 Safety, Oversight and Quality Unit 50
INTRODUCTION Menu planning for an AFH, is different than planning meals for your family. Residents’ family, religious and cultural background, as well as medical and age-related conditions, will influence their food preferences. Consider: • Resident’s family traditions • Religious and cultural backgrounds • Medical needs and restrictions • Age-related conditions September 2019 Safety, Oversight and Quality Unit 51
INTRODUCTION CONTINUED You will need to plan on: • Offering residents a greater variety and choice of foods • Developing menus to ensure residents have at least a week (preferably a month) advanced notice • Scheduled meals • Scheduled and on-demand snacks September 2019 Safety, Oversight and Quality Unit 52
INTRODUCTION CONTINUED Shopping to ensure the residents will be offered well-balanced meals and snacks even when you are away and someone else prepares them. Planning and making available food choices: • In-between meal snacks • When a resident will want to eat at times other than the AFH-scheduled meals September 2019 Safety, Oversight and Quality Unit 53
MENU PLANNING BASICS Menus should be developed using the serving recommendations for each food group as outlined in the USDA’s MyPlate. • The MyPlate guidelines are not the only approach to developing a meal plan, but they are appropriate for most people. • You may need to make some changes to satisfy special dietary needs and restrictions for individual residents. September 2019 Safety, Oversight and Quality Unit 54
MENU PLANNING BASIC CONTINUED In addition to using the MyPlate guidelines, here are some tips to assist with developing a menu plan for your residents: • Make sure to include all food groups daily • Do not use one food group to replace another • An extra serving of meat will not supply the same nutrients as a serving of vegetables • Substitute within the same food group – for example, if a resident does not like to drink milk, substitute cottage cheese, cheese, yogurt or another dairy food September 2019 Safety, Oversight and Quality Unit 55
MENU PLANNING BASICS CONTINUED • Vary the foods you serve – serving different foods each day makes mealtime interesting • Try new foods – ask residents for suggestions and ideas • Use fresh foods whenever possible. Fresh fruits and vegetables in season are often less expensive and fresh vegetables do not have sodium unless salt or a sauce is added during or after cooking. • Some of your residents may have grown their own vegetables and enjoy a wide variety – having a home garden may encourage residents to eat different fresh foods September 2019 Safety, Oversight and Quality Unit 56
MENU PLANNING BASICS CONTINUED • Prepare foods in different ways - chicken can be barbecued, baked, broiled or stewed; it can be served whole or sliced; hot or cold, in a pot pie, soup or salad • Be creative with combination foods – soup, stew, chili, casseroles, macaroni and cheese, and lasagna are examples of combination foods that contain multiple food groups • Leftover meat such as chicken or beef a wonderful start of homemade soup • Limit foods with high sugar content – try serving healthier desserts and sweets such as fruits September 2019 Safety, Oversight and Quality Unit 57
MENU PLANNING The menu plan must include the minimum recommended servings from each of the food groups as outlined in MyPlate: • DAILY: • Provide at least one serving of vegetable or fruit high in vitamin C such as citrus fruits, cantaloupe, tomatoes, strawberries, broccoli etc. • THREE OR FOUR TIMES A WEEK: • Provide at least one serving of vegetables or fruit high in vitamin A. Vitamin A is found mainly in dark green and yellow vegetables such as carrots, broccoli, spinach, pumpkin and sweet potatoes. September 2019 Safety, Oversight and Quality Unit 58
MENU PLANNING CONTINUED Create a menu glossary to assist with menu planning: • A menu glossary is a list of foods and recipes used to plan daily menus • Use menu glossary forms to list main dishes for breakfast, lunch and dinner; vegetables; foods high in vitamins A and C; and nutritious desserts • The menu glossary should change as you discover new dishes or your residents’ needs change • Use the names of prepared food items (e.g., poached eggs) or titles of recipes – note how often you will want to repeat these items September 2019 Safety, Oversight and Quality Unit 59
MENU PLANNING CONTINUED • Keep in mind residents’ usual eating habits, including favorite foods • Be mindful of any dietary restrictions ordered by the resident’s medical practitioner and as requested by the resident • Be aware of, and prepare for any • Chewing or swallowing problems • Self-feeding problems (e.g. difficulty cutting their food) September 2019 Safety, Oversight and Quality Unit 60
MENU PLANNING CONTINUED Other menu planning tips: • Follow your basic menu pattern, using different foods from all the food groups each day • Use the Seven-day Menu form to write down your daily menus for a week – try not to repeat a dinner main dish during that period • Adjust your menus for holidays, birthdays and other special events • Keep a recipe file – refer to your recipes as you plan your menus so you will know what foods are included from the different food groups September 2019 Safety, Oversight and Quality Unit 61
MENU PLANNING CONTINUED • Ask residents for their favorite recipes • Make grocery shopping lists based on your menus - this ensures you will have all ingredients needed for the menu plan • Write notes on your menus - jot down notes to help you plan future menus and note if residents liked or disliked something you prepared • Review recipes to increase nutrient density – add nutritious ingredients (powdered milk and vegetables) and decrease excess fat, salt and sugar September 2019 Safety, Oversight and Quality Unit 62
MENU PLANNING CONTINUED File all your weekly menu plans, along with your notes, shopping lists and receipts: • Receipts tell how much you spent to prepare a week’s worth of menus • You may want to price recipe ingredients, particularly main dishes, and note the cost on the recipe (this procedure will aid you in controlling food costs) September 2019 Safety, Oversight and Quality Unit 63
MENU PLANNING CONTINUED Remember it is important to: • Enhance each resident’s independence by respecting food choices and preferences • Provide nutritious, well-balanced, appealing meals and snacks in a pleasant atmosphere • Consult with the resident’s primary care practitioner or a registered dietitian if you have questions or concerns • Use the menu planning tools found on the EQC website to assure the menus you develop meet the overall nutritional needs of your residents September 2019 Safety, Oversight and Quality Unit 64
READING NUTRITION LABELS September 2019 Safety, Oversight and Quality Unit 65
NUTRITION LABELS THE SERVING SIZE 1 The first place to start when you look a the “Nutrition Facts” label is the serving size and the number of servings in the package: • Serving sizes are standardized to make it easier to compare • Use familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams The size of the serving on the food package influences the number of calories and nutrient amounts. • Pay attention to the serving size, especially how many servings there are in the food package September 2019 Safety, Oversight and Quality Unit 66
NUTRITION LABELS CONTINUED 2 CALORIES (AND CALORIES FROM FAT) Calories provide a measure of how much energy you get from a serving of this food. The calorie section of the label can help you manage your weight (i.e., gain, lose or maintain). General guide to calories • 40 calories is low • 100 calories is moderate • 400 calories or more is high September 2019 Safety, Oversight and Quality Unit 67
NUTRITION LABELS CONTINUED 3 THE NUTRIENTS: HOW MUCH? Limit these nutrients: • Eating an excess of fat, saturated fat, trans fat cholesterol or sodium may increase the risk of certain chronic diseases such as heart disease, some cancers or high blood pressure Important: Health experts recommend that you keep your intake of saturated fat, trans fats and cholesterol as low as possible as part of a nutritionally balanced diet. September 2019 Safety, Oversight and Quality Unit 68
NUTRITION LABELS CONTINUED 4 THE NUTRIENTS: HOW MUCH? Get enough of Vitamins A, C, Calcium and Iron: • These nutrients can improve health and help reduce the risk of some diseases and conditions such as reducing the risk of osteoporosis • Eating a diet high in dietary fiber promotes healthy bowel function September 2019 Safety, Oversight and Quality Unit 69
NUTRITION LABELS CONTINUED 5 UNDERSTANDING THE FOOTNOTE “Percent Daily Value” (%DV) on the “Nutrition Facts” label refers to the footnote in the lower part of the nutrition label, which tells you “Percent DVs are based on a 2,000 calorie diet.” This statement must be on all food labels. The full footnote may not be on the package if the label is too small. This doesn’t change from product to product, because it shows recommended dietary advice for all Americans – it is not about a specific food product. September 2019 Safety, Oversight and Quality Unit 70
NUTRITION LABELS CONTINUED THE PERCENT OF DAILY VALUE (%DVs) 6 The percent of daily values (%DVs) are based on the daily value recommendation for key nutrients but only for 2,000-calorie daily diet – not 2,500 calories. The %DVs helps you determine if a serving of food is high or low in a nutrient. • The %DVs column doesn’t add up vertically to 100%. Instead each nutrient is based on 100% of the daily requirements for that nutrient (for a 2,000- calorie diet). This way you can tell high from low and know which nutrients contribute a lot, or little, to your daily recommended allowance (upper or lower). September 2019 Safety, Oversight and Quality Unit 71
NUTRITION LABELS CONTINUED Plain Yogurt Fruit yogurt September 2019 Safety, Oversight and Quality Unit 72
OTHER CONSIDERATIONS September 2019 Safety, Oversight and Quality Unit 73
TABLE SETTINGS How a table is set can improve eating: • Plain colored dishes, as opposed to dishes with patterns, make it easier for residents with vision problems to distinguish food • Residents with dementia may mistake a design on a plate as something to eat • Other considerations: • Contrasting tablecloths or placements make it easier for residents who have vision problems to tell where dishes end and the table begins September 2019 Safety, Oversight and Quality Unit 74
TABLE SETTINGS CONTINUED • Colored glasses for water and other clear beverages may make it easier for some residents to distinguish what they are drinking • Mugs and cups with large handles are easier to grasp and hold for people who have arthritis or other needs for hands and finger flexibility and control. • Special self-help devices such as one-handed knives, knife-fork combinations, or a food guard to keep food on the dish may be helpful for residents with motor ability needs. September 2019 Safety, Oversight and Quality Unit 75
TABLE SETTINGS CONTINUED • Flatware that is solid, sturdy and easy to hold is best • Lightweight or slender- handled flatware can be hard to grip, hold and control • Enlarging handles with foam rubber can make flatware easier to grip for persons who have arthritic or trembling hands September 2019 Safety, Oversight and Quality Unit 76
SPECIAL NEEDS Age-related changes and health problems often have a negative effect on the eating habits and dietary intake of your residents, such as: • Decreased ability to taste. Aging decreases the ability to taste sweet and salty foods • Decreased vision. Those with decreased vision may have a hard time distinguishing one food from another; a resident may have a blind side due to a stroke or other condition – encourage the resident to look to the blind side or to turn the plate so they can see their food September 2019 Safety, Oversight and Quality Unit 77
SPECIAL NEEDS CONTINUED • Medications that affect how food tastes. Digestion can also be affected by medications and even plain aspirin can upset the stomach • Chewing and swallowing difficulties. Older people who have teeth or gum problems, poorly fitted dentures, dry mouth or sores in the mouth may have problems eating • Illness, fatigue and pain. Meals may need to be served at unusual times • Difficulties with digestion. Some people avoid certain foods or eat less if they have problems with nausea, heartburn, bloating, diarrhea or constipation September 2019 Safety, Oversight and Quality Unit 78
SPECIAL NEEDS CONTINUED • Physical changes. Residents who have arthritis or Parkinson’s disease or have had a stroke may find it hard to eat because of deformed, painful or trembling hands, weak arms or drooling. • Changes in mental abilities. Residents who have Alzheimer’s disease, stroke or other disorders may have trouble remembering to eat. They may be confused by family-style dining. • Changes in long-standing patterns and habits. Residents who come to your AFH have probably been used to preparing their own food, and eating what and when they want. Remember it takes time to adjust to changes to lifelong routines. September 2019 Safety, Oversight and Quality Unit 79
SPECIFIC CONCERNS A resident may not like the food you prepare or how it’s prepared, or they may not be used to eating at the times you serve meals and snacks. Residents used to living and eating alone may not want to eat with others: • Eating may be the last area of control in the life of a resident. Complaining about the food, refusing to eat certain foods, or refusing to eat at all may be an act of independence and self-control. • If there is a change in appetite, document it. Monitor to determine the cause and take action to remedy the situation. • Offer food at other times or offer other food • Is the concern continues, contact their primary healthcare practitioner September 2019 Safety, Oversight and Quality Unit 80
SPECIFIC CONCERNS CONTINUED Changes to taste: • Ask residents what foods taste good and what foods don’t taste good • Enhance flavor with tart seasonings (e.g., lemon or lime juice) • Marinate meats in juices, sauces or wine • Vary meals to include cold or room-temperature foods; they may seem more flavorful to the resident • Encourage the resident to rinse the mouth often for a fresh, clean taste September 2019 Safety, Oversight and Quality Unit 81
SPECIFIC CONCERNS CONTINUED Nausea and vomiting: • Maintain the resident’s recommended fluid intake – provide resident with dry foods (e.g., crackers or toast) when the person first wakes up • Encourage drinking fluids between meals, no with meals; clear, cool beverages are the best • Encourage the resident to remain upright (i.e., not to lie down flat) for at least two hours after eating • Avoid the smells of cooking as much as possible • Keep well-linked foods on hand that don’t require much preparations September 2019 Safety, Oversight and Quality Unit 82
SPECIFIC CONCERNS CONTINUED Mouth and throat problems: • Be alert for problems with teeth or dentures; get them corrected, if possible • Provide softer diet (e.g., add gravies or sauces) • Avoid rough, course foods – use tender cooked and ground meats, fish, eggs, cheese and legumes • Allow hot foods to cool slightly before serving • Provide mild flavored fruits such as bananas or pears September 2019 Safety, Oversight and Quality Unit 83
SPECIFIC CONCERNS CONTINUED Tiredness, fatigue, pain: • Encourage the resident to rest before meals • Offer foods when the resident feels like eating • Keep foods readily available that don’t require much preparation • Allow the resident plenty of time to eat or provide smaller and more frequent meals • Serve foods when pain-relieving medication is most effective September 2019 Safety, Oversight and Quality Unit 84
SPECIFIC CONCERNS CONTINUED Diarrhea, bloating, heartburn: • Encourage the resident to eat more slowly • Encourage the resident to eat small meals more often • Establish a routine mealtime • Encourage the resident to eat sitting up straight and to remain upright after meals • Discourage consumption of carbonated beverages, beans and cabbage-family vegetables • Avoid caffeinated beverages • Do not serve fatty or spicy foods • Encourage drinking of fluids between meals September 2019 Safety, Oversight and Quality Unit 85
SPECIFIC CONCERNS CONTINUED Constipation: • Encourage the resident to eat more fruits and vegetables (five to nine servings a day) • Encourage the resident to eat more whole grains • Try gradually adding bran to foods • Encourage the resident to drink plenty of fluids (eight to 10 glasses per day) • Provide prune juice or hot lemon water • Encourage exercise, even if it is only stationary exercise September 2019 Safety, Oversight and Quality Unit 86
SPECIFIC CONCERNS CONTINUED Heightened emotions: • Take time to listen to the person, offer positive feedback, compliments and reassurances • Let residents know that food is available whenever they feel like eating • Try to limit times for eating, or limit snacks to nutrient-dense foods, if overeating • Involve the resident in meal planning • Serve familiar/favorite foods • Respond to lifelong eating patterns, if possible September 2019 Safety, Oversight and Quality Unit 87
SPECIFIC CONCERNS CONTINUED A resident may have a physical or mental disability that makes self- feeding difficult. Encourage self-sufficiency. However, a resident may need to be fed or guided through a meal. In these cases: • Provide adaptive devices • Provide foods that do not require the use of utensils such as “finger” foods, soup in a mug, etc. • Build up handles on utensils • Serve food in bowls with high sides – keep table setting uncluttered September 2019 Safety, Oversight and Quality Unit 88
SPECIFIC CONCERNS CONTINUED • Use contrasting colors in place setting • Be consistent in placing food on the plate in a specific order (and plate on table): • For example, for a resident with vision needs– potatoes are at 3 o’clock position, meat is at 6 o’clock position, etc. • Maintain a simple, consistent mealtime routine • Maintain a quiet, unrushed atmosphere • Serve one course at a time to reduce confusion • Provide a full apron, rather that a bib, to help keep the resident’s clothes clean September 2019 Safety, Oversight and Quality Unit 89
EATING WITH ASSISTANCE You may need to assist a resident with eating. To best assist the resident: • Take it slow – check with the resident and make sure you aren’t going too fast or too slow • It takes 30 – 45 minutes to safely assist or feed a person • Offer smaller bites when assisting in feeding • Relate to the resident – convey caring, understanding and interest in the resident; • Preserve the resident’s dignity – do not say things such as, “You can’t have dessert until you finish your peas.” September 2019 Safety, Oversight and Quality Unit 90
EATING WITH ASSISTANCE CONTINUED • Talk about the food and what you did to prepare it – it may be better to talk before or after feeding, so that the person can concentrate on eating • Comply with food likes and dislikes, when possible • Avoid mixing food together – if you puree foods, keep them separate • Offer foods at the right temperature for comfort and safety • Position the resident properly – they should be sitting upright and learning slightly forward • Remind the resident to chew and/or swallow, if necessary September 2019 Safety, Oversight and Quality Unit 91
EATING WITH ASSISTANCE CONTINUED • Do not rush the resident – rushing increases the risk of choking, spiting out food or refusing to eat • Aspiration can occur at anytime but is most common during eating or drinking • Keep the resident clean – for instance, gently wipe corners of the mouth and chin to remove food or saliva • Offer fluids after the mouth has been emptied September 2019 Safety, Oversight and Quality Unit 92
REFUSAL TO EAT If you have tried everything and a resident still refuses to eat: • Consider the resident’s health or medical condition • Have they been ill or not been feeling well? • Have they started a new medication? • Could they be experiencing difficulties related to the progress of a diagnosed disease? • Have they experienced a recent loss, perhaps the death of a loved one or close friend? • Talk with the resident. Ask, for example, “Are your dentures hurting?” or “Are you thirsty?” September 2019 Safety, Oversight and Quality Unit 93
REFUSAL TO EAT CONTINUED • Encourage the resident to propose food options: • Ask them what the they would suggest to stimulate eating and keep up strength • Record any references or suggestions on the resident’s care plan • Respond to special needs and preferences, if possible: • Keep favorite foods and healthy snacks readily available (see end of chapter for snack ideas) • If appropriate, increase the protein and calorie content of foods eaten • Consult a registered dietitian for suggestions September 2019 Safety, Oversight and Quality Unit 94
REFUSAL TO EAT CONTINUED • Document the concerns: • Make clear notes in the resident’s narrative – include date and time, the food served and refused, and the approaches you used to encourage eating • Note other contributing factors, such as illness or pain • Discuss the concern with an appropriate care team member who may have an idea you have not tried, or who may be able to entice the resident to eat when your efforts have not worked • Advice from a registered dietitian, especially one who understands older adults, can be helpful September 2019 Safety, Oversight and Quality Unit 95
REFUSAL TO EAT CONTINUED • Report the problem to the resident’s primary health practitioner • This is especially import and if the resident is losing weight or has a medical condition, such as diabetes, which requires regular food intake as part of the necessary care • Sometimes a resident will respond if the physician prescribes a special diet Remember, you cannot force another person to eat, even if they depend on you for care. • You must respect the resident’s rights. September 2019 Safety, Oversight and Quality Unit 96
EATING OUT Eating at a restaurant can be still be healthy. Using the following tips you can assist your residents in making healthy choices: • Drink water or order fat-free or low-fat milk, unsweetened tea or other drinks without added sugars • Ask for whole-wheat bread for sandwiches • In a restaurant, start your meal with a salad packed with veggies to help control hunger and feel satisfied sooner • Ask for salad dressing to be served on the side – then use only as much as you want September 2019 Safety, Oversight and Quality Unit 97
EATING OUT CONTINUED • Choose main dishes that include vegetables, such as stir fries, kebobs or pasta with a tomato sauce • Order steamed, grilled or broiled dishes instead of fried or sautéed foods • Choose a small or medium portion – this includes main dishes, side dishes and beverages • Order an item from the menu instead of heading for the all-you-can-eat buffet • Check restaurant websites for nutrition information to assist with planning ahead September 2019 Safety, Oversight and Quality Unit 98
EATING OUT CONTINUED If portions at a restaurant are larger than you want, try one of these strategies: • Order an appetizer-sized portion or a side dish instead of an entrée • Share a main dish with a friend • If you can chill the extra food right away, take leftovers home • When your food is delivered, immediately set aside or pack half of it to go • Resign from the “clean your plate club” — when you’ve eaten enough, leave the rest September 2019 Safety, Oversight and Quality Unit 99
EATING OUT CONTINUED To keep your meal moderate in calories, fat and sugars: • Order foods without creamy sauces or gravies • Add little or no butter to your food • Choose fruits for dessert September 2019 Safety, Oversight and Quality Unit 100
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