Like so many aspects of everyday life, dining will take on new dimensions post-pandemic. To ensure that residents stay safe and can again enjoy the social aspects of dining, nursing homes, assisted living communities, and other long term care settings are embracing creative ideas, thinking in fresh new ways, breaking some norms, and making meals a source of health, fun, and celebration.

Creating Dining Options

During the pandemic, many communities devised creative ways to make dining fun for residents. Some took mobile margarita or mimosa carts (often nonalcoholic) around to rooms, while some had restaurant-style dessert carts with an array of tempting sweets.

Some places had live chef demonstrations where residents could enjoy the fresh food they watched being prepared.

“When you’re shut in your room, time gets away from you, and people sometimes forget to eat,” says Lauri Wright, PhD, RDN, LD, national spokesperson for the Academy of Nutrition and Dietetics. “It’s useful to have more touchpoints and opportunities to eat and intake fluids,” she says. Staff have gotten creative in this regard.

For instance, afternoon snacks have taken on a new dimension. Some communities celebrated special events such as National Peanut Butter Day or National Pretzel Month with themed treats. “During the summer, we brought in a snow cone truck,” says Ashley Langley, LBSW, director of social services at Hearthstone Nursing and Rehabilitation in Round Rock, Texas. “We took a few residents at a time out to get snow cones, and we brought in treats for those we couldn’t take outside. It was lots of fun, and everyone loved it.”

Especially where such innovations became popular with residents, they can be continued in some capacity even as the pandemic winds down and buildings open up. For example, in many buildings, activities staff got involved with helping residents to eat.

“For example, our activity team will have late morning activities, such as baking cinnamon rolls, to stimulate appetite,” says Phyllis Famularo, DCN, RD, CSG, LDN, CDP, CADDCT, senior manager of nutrition services for Sodexo. “Having food cooked right on the unit triggers hunger. This is one of the biggest things we can do.”

Safety and Socialization

Dining is back, Wright says. “Slowly we are starting to do small group meals with sparser seating in the dining rooms,” she says. “We also are finding some of those vacant spaces, such as sunrooms, to bring people together in a social but safe way.”

In locations and climates where outside dining is viable, it has become an increasingly popular option. “This can be challenging for residents with memory issues or dementia, but you can monitor people in small groups for a barbeque or picnic,” says Famularo.

Greg Hunteman, AIA, president of Pi Architects in Austin, Texas, agrees. “There will be a lot more opportunities for external dining, including the use of covered patios and enclosed sun porches,” he says. “Inside, there will be a need for cutting-edge air filtration. Ensuring safe, controlled air circulation in buildings will be essential.”

However, he says, residents shouldn’t feel claustrophobic in indoor dining spaces. There should be windows and lots of natural light. At the same time, it will be important to have indoor areas that open onto patios, courtyards, balconies, and decks that enable access to fresh air and sunshine.

Hunteman says color can impact appetite, so splashes of reds and yellows will help trigger hunger as well as create bright, cheerful dining spaces. Ultimately, he suggests, facilities will offer multiple and more varied dining venues—from bistros and coffee shops to takeout windows, food trucks, and pop-up cafes.

Innovations in Fun

As more residents and staff are vaccinated, watch for the return (or the start) of happy hours. “We enjoy going home or out with friends for a glass of wine and a little conversation,” Langley says.

“Residents should be able to do that, too. We limit the amount of alcohol, but residents can have a drink and a snack, and we play music that they grew up with. It has a great impact on mental well-being and mood,” she says.

At least for the time being, gone are the plates of cookies and bowls of fruit in dining halls and common areas. To maximize safety and sanitation, expect to see more prepackaged snacks, including healthy items such as dried fruit and cheese. Shared condiments and items such as cream and sugar likely will be replaced by individual servings in sealed packaging.

The farm-to-table concept has become popular in the dining world, and it is making its way into senior living as well, says Hunteman. “Onsite gardens and orchards are huge. People like to eat fresh foods that are grown in their own backyard and that they have had a hand in producing.”

Opening Doors Is Not Enough

As much as isolation was problematic during the pandemic, the truth is that many people got used to eating in their rooms and are hesitant to come out again. As Famularo says, “Some residents need enticement to get out of their rooms. Things like a happy hour with snacks or someone playing the piano during meals can be helpful.” She suggests that when nursing and other staff are engaged, they can help get residents out and enable them to embrace new routines.

It is important to realize why residents may prefer to stay in their rooms, providers say. After all, they’ve been told for a year that it was necessary to keep them safe. Now managers are telling them it’s safe to come out. This may be confusing for some.

At the same time, Famularo observes, “Many residents are really enjoying going back to group dining; some never really did like it. We need to realize that our outgoing, social residents were impacted the most by having to eat in their rooms.”

Sherry Perry, a long-time nursing home and home care certified nurse assistant, says, “Some residents don’t want to come out because they’re scared. A lot of them know that they got the vaccination, but they don’t necessarily understand it means that they can safely be more social. This needs to be explained to them.”

“Start slow,” she says. “Bring them out a little at a time. Be encouraging and supportive.”

Although many residents may see their room as their safe zone, the warm weather and sunshine could be enticing. “We always see a big change in residents when the seasons change. When the sun is shining and it’s pretty outside, residents are happier to go and sit outside, dig in the garden, and make sure the bird feeders are filled,” Perry says. “If we can get them out now, we can help readjust them to spending time outside of their rooms.”

Of course, if people want to eat in their rooms, that is their right. However, says Wright, “we can make it more homey, with a separate space designated for eating, fewer distractions (turn off the TV), and provide soft music.”

With some residents staying in their rooms to eat, it can be helpful to position small portable ovens in different areas throughout the facility to bake cookies and stimulate appetites with tempting aromas, she says.

Eating Assistance Through Devices

Dining is particularly challenging for residents who have trouble feeding themselves. Assistive devices may help, says Famularo. “The best thing we can do as a team is to identify those who are just beginning to need help and address the issue before they start losing weight.” Devices such as weighted utensils and plates and bowls with lips that making scooping food easier can enable some residents to feed themselves in spite of physical disabilities or limitations, she says.

Anne Royer, president of The Meal Lifter and a family member of a resident in an assisted living community, says that such assistive devices not only can help residents feed themselves but also can help give them dignity.

“My mother-in-law was a lovely, elegant woman who always took pride in her appearance. We had dinner with her after she moved into assisted living, and because of her Parkinson’s tremors, she was spilling food on herself. She didn’t want to wear her meal, and she was embarrassed,” Royer says. “Once we made it easier for her to get food from the plate to her mouth, she was much happier and able to enjoy her meals. She gained back some of the weight she had lost.”

There are many “wonderful assistive devices available,” Royer notes. “It is useful to discuss them with staff and families and try to identify who might benefit from which ones. Then it is essential to train people on their use.”

During the pandemic when family members and volunteers were unable to come into the buildings, teams had to be more creative. Devices helped in some cases. However, Famularo stresses, “What works best is when we have all hands on deck—housekeeping, administrative, and other staff—all trained to help feed residents.”

Putting Back the Fun in Food

“We need to bring back the celebration of food and the joy food can bring in these settings,” says Margaret Roche, MS, RD, CDCES, CSG, FAND, founder of Illinois-based Roche Dietitians. “People will bounce back and fairly quickly if we focus on these things and get them engaged again in eating.

“When we bring back joy—the parties and the celebrations—we create an opportunity to connect with others on a human level, and with that comes the added benefit of improved nutrition,” she says.

Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.
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