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What assisted living can learn from long-term care

November 1, 2006
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Nutrition management can become complicated, but not unduly so, for facilities housing residents aging in place

There is no question that the emerging assisted living industry needs to respond to the desires of healthier and wealthier baby boomers, who are significantly more demanding than previous generations in many respects. This is particularly true when it comes to food. And assisted living companies are rightly responding to those desires by giving these residents the “sizzle” that they want—“club level” service inspired by high-end restaurants and hotels, prepared by classically trained executive chefs.

The experience also goes beyond what ends up on the plate. Assisted living communities are providing atmosphere and style, with beautiful dining room design and amenities such as Milwaukee's Jewish Home and Care Center's new dining room, which overlooks Lake Michigan. Some communities are designing more intimate dining spaces. Whatever the hook, today more delicious food served in a more luxurious setting is essential to attracting and retaining residents, and assisted living communities are making substantial investments to ensure that they have this competitive edge.

As residents continue to age, though, those same communities will have to find ways not only to satisfy their desires, but to meet their increasingly complex nutritional needs—needs largely dictated by the medical conditions that come with the normal aging process.

In traditional long-term care settings, registered dietitians (RDs) formulate and customize the dietary plans for each resident, but they are not present at the facility on a day-to-day basis (much less meal-to-meal). Assisted living facilities have even less frequent interaction with dietitians. They rely on Certified Dietary Managers (CDMs), who are trained in food safety and sanitation, nutrition, therapeutic diets, and foodservice management, to interpret, follow, and adjust individual resident dietary plans. It is their job to hit the “sweet spot” between providing appealing food and meeting the nutritional needs of residents who often have complex regimens springing from a wide variety of medical conditions.

Common Medical Issues

When one considers that therapeutic modification of meals can take a great deal of time and expertise, and that some residents require meals at specific intervals that might differ from regular mealtimes, delivery of appropriate nutrition can become logistically complex. Even in assisted living settings, where residents are healthier than in traditional nursing homes, many will have or will develop conditions such as diabetes, respiratory problems, kidney or heart disease, or a myriad of other health challenges of varying severity that will change over time, requiring constant monitoring and dietary modification. Other more severe medical conditions will also occur among assisted living residents, affecting what, when, and how they eat. They include:

  • cardiovascular disease

  • osteoporosis

  • “the anorexia of aging”

  • food/drug interactions that affect nutritional well-being

  • stroke and consequent swallowing issues

  • chronic obstructive pulmonary disease (COPD)

  • cancer

  • gastrointestinal illness

  • malnutrition

It's imperative, therefore, that the foodservice department be run by someone who has the nutrition knowledge required to modify menus based on the Department of Health and Human Services and United States Department of Agriculture's Dietary Guidelines for Americans 2005, which tackle cardiac wellness, hypertension, nutrient density, fiber intake, nutrient status of aging Americans, adequate calcium intake to help prevent bone fractures, etc. A CDM has such training. Other approaches include:

Alternative 1 Support the Chef by Broadening His/Her Skill Base

It is easy to imagine the typical assisted living executive chef becoming overwhelmed by these requirements. Such chefs are not specifically trained in the medical nutrition therapy that is often required for many medical conditions.

Assisted living communities are beginning to address this need. More menus carry standardized heart-healthy items. Others address such chronic health issues such as diabetes, but as the demands for even more customized diets increase, is it reasonable or advisable to saddle an executive chef with these responsibilities?

One solution is to provide executive chefs with the same training that CDMs receive, either at their culinary schools or afterward. This equips them with the knowledge and tools necessary to work effectively with consulting dietitians, who develop individual nutritional care plans. The training also prepares them to manage the foodservice operation on a turnkey basis, including being the point person on food safety and sanitation and adapting specialized diets to the needs and preferences of residents.

Alternative 2 Train Existing Staff

Some administrators worry that providing residents with a foodservice “amenity” requires an intensive search and expense to find an already trained and certified dietary manager. In fact, most traditional long-term care facilities develop dietary managers organically from within. They find that there is usually a “point person” leading the foodservice operation who is appropriate and open to professional advancement.