Managing Residents Special Diets and Changing Preferences Apri ril 6, , 2016 TWC C Cu Culin linary and Nutrition Summit Ca Carol Do Donovan RD, Pres esident
Appetizer!
Objectives of this Presentation 1 - Define the “New Senior” and their Changing Preferences 2 - Identify Retirement Home Special Diets 3- Manage the Changing Preferences and Special Diets of the Retirement Home Residents
Seasons Care Dietitian Network Caring Committed Creative
Dietitians in Ontario • 4 year undergrad – Bachelor of Science • 1 year internship through DC accredited program or Masters in Nutrition concurrent with Internship • Entrance Exam through College of Dietitians of Ontario • Membership in CDO and Liability Insurance • Dietitians of Canada / Gerontology Network • The “New Senior” relies on RD as part of their personal health care team
RH Dietary Manager • Orchestrates the entire operation • Sets the quality expectations of the department • Is the liaison / advocate for food service on the management team • Accountant, Chef, Manager, Shopper, Peace Keeper, Payroll Clerk, Sanitation Expert, Master Scheduler, etc. • Remember – it’s your kitchen, your staff, your food, your budget and your job! • Make it the way you want it to be
The Retirement Homes Act, 2010 ONTARIO REGULATION 166/11 FOOD PREPARATIO ION • Section 20 came into force on January 1, 2013. See: O. Reg. 166/11, s. 66 (2). PROVISIO ION OF A MEAL • Section 40 came into force on January 1, 2013. See: O. Reg. 166/11, s. 66 (2). Retir tirement Homes Regulatory Authority (“RHRA”)
Objective # 1 of this Presentation Define the “New Senior” and their Changing Preferences
QUESTION! What is your favourite food?
PAST • Seniors were taken care of by extended family at home • Home cooked meals • “Meat and Potatoes” • Personalized family care • Families took care of their loved ones in the home • Decentralized families • Women working outside of home Seniors homes built were based on the medical model of a hospital
PRESENT • Seniors admitted to RH have higher expectation than in past – “get what we paid for” • “Savvy Seniors” – sophisticated • Know what a Dietitian is and does • Can call a “Carb” a “Carb” – more health conscious • Wants individual Care • Restaurant Style Food • Want Choice – Ethnic, Cultural, Religious, Health Options • Meal Service and proper etiquette is important Facilities modeled after hotels • Are expecting hospitality oriented services • Admitted to RH with more complex health problems • Staying longer in RH before progressing to LTC • Increased admission of younger residents with complex medical needs
FUTURE • New trends yet to emerge • Reinvent “Aging” • Demands on Food Service are going to change • “Oyster Shuckers and Martini Shakers” • Internet / Technology – taken away limits on creativity and flavour • Rural vs. Urban “All Inclusive F ive Star” or Cruise Ship experience
Current Popular Food Service Trends • Farm-To-Fork • Local • Organic • Gluten Free • Low Sodium • Low Carb • Cleanses • Internet Influences
Objective # 2 of this Presentation Identify Retirement Home Special Diets
#1 Goal = Positive Outcomes Our Goal is to achieve Positive Outcomes related to the nutritional and hydration well being of each and every individual resident.
Barriers to Nutritional Care Food & • Poor oral intake Fluid Intake • Wounds Wound Dentition Status • Chronic Disease • Weight Status Chronic Dysphagia Disease • Mental Status • Medication Weight/ • Dysphagia Medications Mobility • Dentition Mental Status • Hydration
Malnutrition • of all residents in homes are 23-85% malnourished • of all new residents are 54% malnourished • of new residents have an initial 60% weight loss after they move in
Importance “ Meals ls are re the sin ingle le most consistently accessible le, manageable and effective healt lth-promoting act ctiv ivit ity that we can offer to re residents ” Zgola & Bordillon, 2001
RHA Expectations Related to Special Diets 40 (f) an individualized menu is developed for the resident if the resident’s needs cannot be met through the home’s menu cycle;
Gluten Restricted vs. Gluten Free Gl Gluten Restricted Gl Gluten Fr Free • Non-Celiac gluten • Celiac Disease sensitivity • Hidden sources: • Found in grains (wheat, sausage, processed barley, rye, and a cross foods, soups / bases, between wheat & rye some medications & called triticale. vitamins • Avoid bread, pasta, • Cross Contamination cookies, crackers, cereals, • Difficult to offer in LTC baked goods, & RH setting • Substitute “Gluten Free”
QUESTION! How many different types of Vegetarian Diets do you believe there are?
Vegetarian • Lacto Ovo – will eat eggs, milk and dairy – no meat, poultry or fish • Ovo - will eat eggs – no meat, poultry, fish or dairy • Lacto – will eat dairy, no meat, poultry, fish or eggs • Pescetarians – will eat fish, no meat or poultry, may or may not eat eggs and daily • Vegan – will eat only plant based food and products – no animal foods, eggs or dairy products • Popular at present • Varying degrees of veganism • Some focus on “raw foods” – crosses over into organic – need to find out what regimen the individual follows and make sure you are able to provide it with the labour and budget you have
Textures • Increase demand for the need to texture modify foods in the RH Sector • Do you understand the need ? Dysphagia, Dentition etc. • Do you have the equipment? Can you afford to purchase commercial texture modified foods? • How do you offer choice to modified textures?
Textures • REGULAR – no alterations • MINCED MEAT – no alterations except meat is minced to the consistency of ground beef, no lumps • MINCED – meat, vegetables and fruit are minced to the consistency of ground beef, no lumps • PUREED – all food items are pureed to the consistency of whipped potatoes/mousse. Product should stand up on a plate • CUT UP? • FINGER FOODS?
Thickened Fluids Nectar • Thin milkshake or eggnog. Semi-thick & pourable • Leaves a fine “ribbon” or trail” when poured or stirred. Honey • Like honey at room temperature or a thick milkshake. • Pourable & spoon able, leaving a medium “ribbon” or “trail” when poured or stirred. Pudding • Like pudding, cannot run off a spoon - drops in one mass. • Spoon able but not pourable, leaving a heavy “trail” or “valley” which does not disappear upon sitting.
Objective # 3 of this Presentation Manage the Changing Preferences and Special Diets of the Retirement Home Residents
QUESTION! What is the biggest challenge you face in Managing Special Diets and Changing Preferences in Retirement Homes?
Moral Dilemma • The ADA’s position paper states, “ Nutrit itio ion care for the resid ident is is both driv iven and hin indered by by the regulatory envir ironment. On On one hand, regulatio ions speak of of physic icia ian-prescrib ibed therapeutic ic die iets, and, and, on on the other, they speak of of resid ident rig ights. Both regulatio ions and and ethic ics demand that facil ilit itie ies meet the nutrit itional needs of of residents whil ile main intainin ing their ir dig ignit ity and and quali lity of of li life. ”
ORCA Orientation Checklist Meals: • Do you want cooking facilities available for your use? • Do you want one, two, or all three meals each day? • What kind of food do you like to eat? • Do you have certain dietary restrictions? • Do you want a rotating menu or full service options? • Do you like to eat at the same time each day or would you prefer to have meals when you feel like it? • Do you want to be able to drink alcohol with your meal?
Admission Process Warm rm Welc lcome Each resid sident needs a die iet order th that inc inclu ludes: • History / Preferences / Expectations • Diet Type • Introduction to Food Service at • Texture your home • Fluid Consistency • Height / Weight • Allergies / Intolerances / Dislikes Activ ivit itie ies of Dail ily Livin iving • Interventions rela lated to Eatin ing • Level of Assistance • Positioning • Social – sit alone, sit with friends, • Adaptive Equipment
Menu Planning • Support good nutrition and hydration for all • The menu is varied and changes daily • The menu cycle changes at least every 21 days • The menu includes alternative entrée choices at each meal • The resident is informed of his or her daily and weekly menu options • Menus provide adequate nutrients, fibre and energy for the resident, include fresh seasonal foods and are consistent with standards of good nutrition in Canada
Daily Meals and Snacks • Meals and Snacks must be provided to the Resident according the provisions outlined in the RH ACT. Breakfast HS Snack AM Snack Dinner Lunch PM Snack
Snacks AM Snack PM Snack HS Snack OR OR OR
Choice
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