​The Centers for Medicare & Medicaid Services (CMS) has developed protocols for food service in long term care (LTC) communities. These regulations require facilities to provide food that is attractive and appetizing and served at the proper temperature. Additionally, the requirements say that substitutes must be offered to residents who refuse the food being served.
These regulations, as well as a realization that residents deserve to make their own choices have prompted providers to embark on a culture change that requires more resident-centered dining experiences.
This paradigm shift is producing a transformation that includes the implementation of more selective menus, variable dining times, and other individualized preferences.

The Current State

Over time, the administration of a LTC facility dining service has become incredibly complex and institutionalized. It is the dietary department’s responsibility to obtain and understand the food requirements for each resident and then relay the data to the dining services staff.
Because of the demands of preparing meals for large numbers of people, the result can be a resident dining experience that is not pleasurable—both in terms of the meal presentation and the taste of the food.
Traditionally, in many facilities there has been a rigid dining agenda. In some cases, residents are woken up or have their activities or visiting time with family and friends interrupted due to the dining schedule. Additionally, residents may have little or no input about the food set before them and may not like the meal.
This situation becomes even more tenuous when working with residents who have dementia and are unable to accurately articulate whether or not the meal is appealing to them.
Further, the resident population is changing. The next generation of LTC residents consists of baby boomers. They are the least likely to be happy with the traditional format of dining services and are more likely to be verbal about wanting things their way. As a result, LTC facilities will be forced to modify their dining services to adapt to the demands and expectations of these new residents.

The Conundrum

Eating is a central component of a person’s life because of the essential nutrients and social stimulation that meals provide. Unfortunately, some LTC residents eat very little because they don’t like the food, which can result in an alarming weight loss. Health concerns prompt dining services to make changes.
One response to residents’ weight loss has been to start offering supplemental shakes. While there are some nutritional benefits to these dietary options, they are more expensive than serving regular healthy food.
Another solution is to add different (and more) food options to the plate in an attempt to entice residents to return to healthy eating. In practice, however, the newly offered options are usually thrown out and wasted. And, because dining services prepared more food, their costs increased.
To address escalating costs, a center may switch to lower-quality and lower-priced foods. In the process, these changes may affect the taste of the food, once again impacting whether or not the residents eat the meals.
The solution is to reassess the implementation of the procedures outlined in Appendix PP of the CMS State Operations Manual. Section 483.35(d) Food says, “Each resident receives and the facility provides: 1.) Food prepared by methods that conserve nutritive value, flavor, and appearance; 2.) Food that is palatable, attractive, and at the proper temperature.”

Resistance To Menu And Dining Changes

There are valid concerns about making changes to LTC facility menus and the resulting dining experiences. One is that by offering more menu choices, dining services will be serving more food, increasing both cost and food waste. Another concern comes from the additional time it takes to determine which choice each resident wants at every meal.
The problem lies in the current business model and workflow in most LTC facilities. Residents who discard their meals because they do not like what they received must be provided with another option. Then costs rise due to the additional labor and food.
Or, the menu and dining changes are limited by the labor costs associated with determining which resident wants which entrée for each meal. A staff member needs to talk to every single resident daily about the menu options and determine what the resident wants to eat. Dining services must review each selection.
Bernadette Townsend, certified dietary manager of The Arbors, a senior living community that is part of Baptist Community Services in Amarillo, Texas, understands this issue well. “We used to have plastic laminated disposable tray cards that had the likes and dislikes for each resident and what they wanted for a particular meal. So, many times they would get thrown away, and you’d have to keep making new ones,” says Townsend.
It is an arduous task for the dining services team to determine who gets what and how much food to prepare. It becomes an endless cycle of offering choices and then producing too much food because the team was unsure of what residents would choose for their meals.

The Solution

The answer to better menu planning and the food service challenge is to offer resident-centered dining. To do this effectively, consider these recommendations:
  • Offer a more liberalized menu selection. Instead of focusing only on the nutrients every resident needs to eat, which leads to bland food and poor presentation, increase the options to satisfy residents’ tastes. Keep in mind that increasing menu choices does not necessarily mean that dining services will have to prepare more food.
  • Present meals in more appealing ways to entice residents to eat instead of throw away the prepared food.
  • Offer on-demand dining, which is similar to room service or restaurant-style dining.
  • Work with a dietitian or food purveyor to create or purchase menus with options that dining services are comfortable preparing and that also meet the nutrient and dietary requirements of the residents.
In addition to these suggestions, take advantage of advancements in dietary software technology, which takes into consideration the residents’ likes, dislikes, allergies, and nutrient requirements. Further, dietary software can produce reports with the vital information the dining services staff need to customize the menu options.
Townsend’s facility discovered the cost-saving benefits of using a software program. “Before, we would make enough of each menu choice for each of the residents because we didn’t know which choice they wanted. Now, because we know what we need, there is virtually no food waste,” Townsend says.
Technology such as this can save time. Rather than collecting the information from the resident and then recording at a later time, some software programs allow staff to input the information as they are talking to the residents via a tablet device. This reduces both labor costs and data entry errors.

Preparing For The Boomer Generation

According to the U.S. Census, about 3 million baby boomers reach retirement age yearly. Eventually, many of them will need long term and post-acute care. It’s no secret that baby boomers are vocal about their wishes and desires.
Traditional LTC dining services will not satisfy the needs of discerning senior citizens. LTC facilities seeking to attract these residents will update and remodel their food service methods to provide enhanced and engaging dining experiences.
By understanding the advantages of these improvements, LTC providers will reap the benefits of saving money and satisfying residents while still remaining in compliance with government regulations.
Cole Racho, vice president, business development, for Mealtracker Dietary Software, has more than 15 years in sales and marketing experience in the consumer products industry. He has held senior positions at Fisher-Price, Rubbermaid, and Mattel. His experience includes national account management, team leadership, and customer-driven solutions. For more information, call (800) 755-3284 or visit www.mealtracker.com.