​Everyone, no matter your age or who you are, needs to have a balanced diet along with exercise to maintain a good and healthy lifestyle. As we get older, the body changes and many different food requirements are added and/or changed through the years depending upon a person’s health criteria. These include areas such as sugar and glucose levels, blood pressure, cholesterol, other cardiac issues, or perhaps it’s about cancer prevention. These are taken into account for seniors and others who are living long-term or short-term at skilled nursing facilities (SNF), as well as assisted living housing.

The Importance of Dietary

At a typical SNF, the dietary department is the second largest department after nursing. What goes into having a robust and successful dietary and nutrition department is more complex than meets the eye. Kitchen preparation for three meals a day at a SNF that can host either 60 or 560 residents, no matter the amount, the kitchen staff needs to meet all of their food needs. There’s so much more.

This department oversees everything food-based, from production to calories and fluid intake. It’s a highly complex system, and its importance cannot be taken for granted. The head of dietary oversees it all, they need to be on top of the kitchen staff at all times, making sure the residents have their food, that it’s healthy, on time, and the taste makes them happy. So much is happening behind the scenes when it comes to food that the average person doesn’t realize, and it’s always changing. Staying on top of it is the challenge but a system where dietary listens to what the residents want and need is a successful program.

Residents’ Wide Range of Dietary Intake and Needs

At SNFs, one of the biggest areas that dietitians look at are carbohydrates in the diet, especially for people with diabetes and cardiac issues. Additionally, salt content, portion control, monitoring calorie count and fluid amount in the diet are areas that are followed within the daily recommended allowances.

If a resident requires more food, the dietary staff adheres to that after reviewing with clinical staff. If there are residents who require more calories or they just want more food, the facility does provide double portions and even healthy conscious snacks, some fortified foods like super puddings, super mashed potatoes, or super cereals for extra calories. If they need a supplement or something with more protein, dietary provides that as well.

From a dietitian’s point-of-view, these areas are considered requirements, but happiness may not be 100 percent fulfilled because taste is also a big factor. Taste leads to happiness and one of the biggest areas in feedback from families comes from food complaints. According to management at SNFs, complaints can be easily handled through communication and open dialog between the families, their loved ones, and the facility. Drawing the balance between healthiness and taste may be the million-dollar question because of it being highly individualized and subjective, but easily tackled through family and resident council meetings.

Food Prep and Menus

Whether a SNF is a stand-alone or part of a large network, a massive amount of food is prepared and served each day three times a day. The trick is to have an organized food service director who plans and leads the kitchen staff professionally, as well as gets to know the residents over time. This director is key to a successful dietary program. Residents are given menus, many times a regular menu and an alternative food menu, but some residents may want something that’s not on the menu.

At a large network of multiple SNFs, the corporate dietary department also includes regional directors and the facility’s dietitian. On a monthly basis in a food committee meeting, they gather to talk about changes, additions, and edits to the menu while also taking into account requests. The food menu will also be brought up at resident council meetings so anytime a food service director wants to change or improve something that’s on the menu, the clinical staff will be aware and informed.

Sometimes the residents will have a home recipe that they request. Dietary can add it into production, but they need to make sure that the calories and the overall nutrition pieces work out. SNFs are always trying to balance the types of foods because often the long-term residents prefer comfort food and short-term folks choose wraps, salads, and food they can pick at. It’s a constant push-and-pull with menu items. The provider wants the food to be the best it can be and gives the residents that choice, keeping in mind that the food needs to be highly nutritional and palatable.

Regular Meals vs Alternative Means

From time to time, families may bring food for their loved ones when they visit. They do this from the goodness of their heart as an alternative to the resident’s everyday meals. The dietary department suggests that whatever is brought in should have a nutritional value.

Additionally, dietary receives questions regarding food supplements. The facility’s dietary department know that these supplements may have value, but they should not take the place of food and regular meals. The bottom line is that residents need vitamins and minerals from all of the food groups in order sustain strength, health, and longevity, especially for those of advanced age and who are fighting diseases.

There are residents who cannot feed themselves so placing a straw into a supplement is much easier, but the residents may need more to meet their nutritional needs. Regular food can be better absorbed in the body; it’s better for their muscle mass and bone structure. The dietary staff may recommend more fortified, enhanced foods.

Room for Improvement and the Need for Change

Dietary personnel at SNFs are always looking to improve their food in terms of spicing it up, so many health institutions investigate outside food vendors exploring new tastes for their residents. In many markets throughout the country, vendors invite SNFs in for taste tests so the facility can get a new flavor perspective on many new items they can offer, such as soups, cooked vegetables, and different types of desserts. These taste tests are attended by the SNF’s nutritionists, dietitians, purchasing managers, and members of leadership.

Like restaurants, the kitchen at SNFs needs to be aware of food items that are not ordered or are even complained about. When this occurs, the dietary staff will meet with the kitchen staff and try to figure out how to improve the item or remove it. The dietitian will also speak to their vendor about ways to improve that item.

Feedback, Social Media, and the Future

In today’s world of social media, the field of nutrition and dietary in post-acute care are not immune from feedback over social media. Families who are on social media have discussions about the food where their loved one lives. Dietary leaders need to take that seriously and look at these discussions as an education about how to change or improve.

Looking into the future, dietary and nutrition leaders would like to see better options for the residents who need to have mechanically altered diets—food that is pureed and blended—geared towards to those who have ongoing, advanced age illnesses. These menu options need to be more visually and tastefully appealing and present on the menu. Simultaneously, foods need to have that overall “home” appeal where the residents can connect with the food better, mirroring foods that they would have in their home. Nursing home and assisted living residents are someone’s family so offering them healthy food with a balanced diet 365 days a year is the overall goal.

Tonja Werkman is a registered dietitian nutritionist and corporate director of food and nutrition at Centers Health Care​. Werkman oversees the heads of dietary and food services in all of Centers Health Care’s 45 skilled nursing facilities throughout the Northeast, making sure the residents’ food intake is healthy and plentiful so they can maintain a strong and healthy life. She has been a leader in the dietary field for over 25 years.