To maintain or increase occupancy, most nursing homes are looking for ways to improve the satisfaction of residents and their families. In that quest, however, they overlook the most obvious opportunity-the food coming out of the kitchen.
After all, the foodservice department has more daily encounters with residents than any other function within long- term care. In fact, foodservice has an average of five opportunities per day to please or displease its residents. It's often been said that “the way into to a man's heart is through his stomach,” and this is still true for both men and women residing in nursing homes.
Barometer for quality of care
At many nursing homes, mealtime is a social time-a time when residents enjoy visits from family, friends, and other loved ones. Accordingly, it is a time when quality of care will often be assessed. This means that food not only needs to be presented in an appetizing and appealing manner, but also that residents get what they like and expect, mistake free. Nothing agitates and concerns a visiting family member more than seeing a loved one served something that could cause an allergic reaction or something for which the resident has repeatedly professed a dislike. This is one reason why it is important for foodservice professionals to use the appropriate front-end controls to ensure that every resident is provided the proper food at every meal.
From a litigation standpoint, there are three quality-related foodservice hot buttons that most often lead to malpractice and regulatory citations. They are weight loss, dehydration, and pressure ulcers. Good nutrition is one of the best defenses and easily implemented strategies to reduce and guard against these problems. For that reason, surveyors have zero tolerance for residents with unintended weight loss or any possibility that a resident's nutrition is inadequate or unmonitored. To comply with regulations under the Centers for Medicare & Medicaid Services' F-tag 325 (Nutritional Status), surveyors are trained to scrutinize resident nutrition and make sure foodservice professionals are prepared to answer critical questions such as:
How many residents are on therapeutic diets?
Which residents have experienced unplanned weight loss?
How is food and fluid intake monitored?
How are changes in intake, eating ability, or weight reported?
How do foodservice employees become knowledgeable and receive training with regard to therapeutic diets?
For those communities that still rely on manual processes like handwritten, laminated index cards for important resident nutritional information such as allergies, calorie count per day, likes/dislikes, and dietary restrictions, these questions present a real challenge. Moreover, providing the requisite documentation to defend an alleged deficiency is much more difficult in an environment where manual records are the only source of information. That's why nursing homes are beginning to recognize the importance of increased organization through training, education, and automation in the kitchen.
The domino effect
When nursing home leadership focuses its attention on improving foodservice and works with the department to explore opportunities to improve operations, it can breathe new life into the routine task of providing meals. The result will have positive implications for the entire facility. Long-Term Living's 2009 OPTIMA Award winner, Rolling Fields, is a 181-bed facility in Pennsylvania. It had recently revamped its entire foodservice operation and is reaping rewards beyond anyone's expectation. (Long-Term Living September 2009, p. 22). Pressure ulcers, puréed diets, pain, behavioral issues, waste, and employee turnover are all down while resident satisfaction and census are up.
“Our care plan meetings and elder council meetings no longer revolve around food issues,” comments co-owner Cindy Godfrey, “In fact, at our annual state survey in May, there were no elder complaints about food.”
Advantages of technology
But, where to begin? A good starting point is to replace manual processes that often lead to human error. For example, in a typical nursing home tray line, foodservice employees make decisions about what to place on a tray by reading handwritten, laminated index cards with each resident's calorie requirement and comparing that to what is available in the food bins for that meal. While this may not seem difficult, it is often complicated by restrictive diets, allergies, likes, and dislikes. In the best case scenario, an error in translation simply leads to waste and/or resident dissatisfaction. In the worst case scenario, an error in translation leads to poor nutrition and/or an allergic reaction to the improper food on a resident's tray.