Trends in Long-Term Care Dining
When one thinks of the food served in long-term care homes, gourmet is far from the first word that comes to mind. In fact, food in long-term care may even have a worse reputation than hospital food. In long-term care facilities, meals are served on a three-week menu rotation, and residents choose between two options at lunch and dinner, which are served at the same time each day. Even regardless of the lack of variation in the food being served, the dining experience in long-term care can leave a lot to be desired. Dining rooms themselves are often very institutional in appearance, and can pack in upwards of 100 residents; the opposite of a comfortable, home-like environment.
The above factors can exacerbate the fact that the dietary intake amongst institutionalized older adults already tends to be quite low. Chronic disease, dementia, dysphagia, depression, fatigue… the list of health issues contributing to poor dietary intake in older adults can go on and on [1]. While factors such as chronic illness and age-related difficulties (ie. chewing, dentures) are much more difficult, if not impossible to rectify, the industry has begun to look environmental factors that can be modified in order make the dining and eating experience more pleasurable, and thus increase dietary intake.
Approximately 50% of seniors residing in long tern care homes are malnourished, which is primarily related to low food and beverage intake [2]. Malnutrition has a profoundly negative impact on resident quality of life. It also contributes to higher costs for patient care, increasing the amount of medical intervention and making residents more susceptible to illness and infection.
Mealtime is often the highlight of each day for residents of long term care facilities, meaning that both the meal itself and the dining experience can have a major impact on resident quality of life. Making mealtimes more enjoyable for residents is part of the shift towards “person-centered care”, which aims to make services more flexible and focus on the needs of the resident.
The recent and continued influx of Baby Boomers into long-term care facilities has also driven a need for higher quality care. Baby Boomers have higher expectations for their long-term care experience than those of previous generations. Thus, there is increased demand for gourmet foods, more diverse food choices, flexibility in meal-timing, and modernized dining facilities.
This begs the question, how can we make positive changes to the resident dining experience in long-term care within the confines of regulations and funding restrictions? While there are no simple answers to this question, many facilities are finding ways to improve resident experience, and hopefully increase dietary intake, through modifications to their menus, dining rooms, and current practices.
Below are listed some of the current trends in long-term care dining.
Imagine consuming the same foods on a three-week rotation, and only being able to choose between two entrée options at each meal; even if you don’t like either of them. There has been a recent push to provide a more patient-centered approach to mealtime by offering both more variety and culturally appropriate options. Utilizing fresh and local foods is also becoming increasingly common, which enhances the quality of meals and adds variability depending on season.
Smaller dining spaces that seat approximately 20 residents are becoming increasingly common. Having a smaller dining space provides a more intimate dining experience and creates a more home-like environment. Including an adjoining kitchen or re-therm cart as part of the dining room enables cookies and muffins to be baked on each unit. Smells such as these stimulate appetite, and again, contribute to creating a more home-like environment [3].
While it may sound too simple, sitting down to eat in pleasant surroundings has actually been shown to positively impact intake. A warm paint color, decorations such as plants and wall hangings, and attractive tableware are pleasing to the eye and can make the dining experience more pleasurable [3].
What if Mr. Jones is hungry when he wakes up at six am, but his hunger dissipates by the time breakfast is served at eight? A recent trend has seen a few facilities serve meals over a period of time rather than just at one sitting. For instance, breakfast could be available from 6 to 10 am rather than having a single sitting at 8 am. Having meals available when residents are hungry increases intake by providing food when they actually feel like eating.
On the same note, providing access to snacks 24/7 also capitalizes on a resident’s appetite when they are hungry. Having a cart available on each unit with beverages and snacks such as fruit, sandwiches, muffins, cheese and crackers can increase dietary intake, and provide a person-centered approach to resident care.
Finally, many facilities are encouraging family members or volunteers to sit with residents during meals. Volunteers can sit eat with residents who do not require assistance with eating, but may need help with cutting up food or other tasks. They can also provide light conversation, which can increase intake and enhance overall dining experience. Seating residents with higher cognitive capabilities together can also be a way of helping facilitate conversation at meals [3].
While these changes certainly won’t occur overnight, the culture of mealtime in long-term care is certainly beginning to shift. Meals and dining experience have a major impact on nutritional status and quality of life, and can even have financial implications for facilities. The benefits of considering person-centered care at mealtimes are obvious, and will continue to facilitate changes in long-term care dining.
