This article was downloaded by: [University of Auckland Library] On: 13 February 2015, At: 11:28 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Nutrition For the Elderly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjne20
Are You Feeding the Patient or the Garbage Can? a
Anna Maria Intintoli & Debra Woulfin MA, RD
a
a
Food Consultant, Plainview, NY, 11803 Published online: 18 Oct 2008.
To cite this article: Anna Maria Intintoli & Debra Woulfin MA, RD (1990) Are You Feeding the Patient or the Garbage Can?, Journal of Nutrition For the Elderly, 9:3, 63-68, DOI: 10.1300/J052v09n03_05 To link to this article: http://dx.doi.org/10.1300/J052v09n03_05
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
CURRENT PRACTICE
Are You Feeding the Patient or the Garbage Can? Anna Maria Intintoli Debra Woulfin, MA, RD
ABSTRACT. In a question and answer format, frequent clinical and food production problems that occur in long term care facilities are addressed. Subject matter includes the handling of food complaints, accommodating food preferences, maintaining safe food temperatures despite a wide variety of food 'consistencies, accommodating a resident's small appetite and maintaining the n"tritiona1 adequaw of the puree diet. The emphasis is on simplified food production hhich uiilizes menu items ihat fit many dikt consistendies. Various tested solutions to these problems are offered. The authors welcome additional questions.
All of a sudden, food complaints in the facility have escalated without apparent cause. How can I alter this discontent? Anna Maria Intintoli and Debra Woulfin are food service consultants. Correspondence may be addressed to: D. Woulfin, RD, 14 Relda Street, Plainview, NY 11803. Journal of Nutrition for the Elderly, Vol. 9(3) 1990 O 1990 by The Haworth Press, Inc. All rights resewed.
63
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
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JOURNAL OF NUTRITION FOR THE ELDERLY
Food complaints are often a disguise for general dissatisfaction with a resident's placement. Food is the one area over which an institutionalized person still has some control. There are many approaches to this problem. 1. Examine your dining room for such environmental conditions as good lighting, adequate space, soothing atmosphere with soft music, cleanliness, attractive decor and freedom from off odors. Then look at the seating arrangements to ensure that your residents can socialize to the best of their abilities. Separate those residents who are disruptive. Plan your tray service to feed an entire table at one time. Therefore all the tablemates are eating together. A daily rotation of table service may be necessary to accommodate your clientele. Be alert to personality conflicts between staff and residents, especially if the same staff always serves the same table. A staff rotation may also be necessary. Feeder stations provide the best service for both staff and residents. These tables may not be included in any rotation schedule. 2. ker the complainer offer some suggestions to the food committee. If you don't have a food committee, then consider starting one. They usually meet monthly. Another option is to institute a suggestion box. Then start a program of suggestion meals based on the kind of responses you get from the suggestion box or from the food committee. Even simply changing the menu a bit with surprise or ethnic meals can alleviate the predictqbility of the cycle menus. These programs are in addition to the holiday meals. Therapeutic diets are not suspended for the suggestion, surprise or ethnic meal programs. Usually a monthly program is all that is needed to spruce up the cycle menus. Carry the theme further whenever possible with centerpieces, placemats, music, banners, and an attractive menu with large print. 3. All of this may require more resources than are available to you. When this is the case, think of little changes such as going outside for a barbecue. Even changing an ordinary piece of baked chicken into a chicken supreme with mushroom gravy is a treat. A vegetable can be enhanced with blanched almonds, pimentos, fried onions or a cream sauce. Instead of mashed potato, consider a stuffed or dlichess potato.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Current Practice
65
4. It is common practice to serve the heavier meal at noon, contrary to the American dietary pattern. There is nothing wrong with occasionally serving the main meal at night. Try this to see if the complaints become less. 5. Incorporate an occasional glass of wine or beer witha special meal. Of course, this is not appropriate for everyone; approval should be obtained. 6 . Lastly, even if all this fails, let the residents know that you care about their food preferences. Attend resident council meetings when invited. Explain to the residents some of the practical concerns you have to consider when planning a menu. Satisfying economic, production and sanitation requirements while meeting resident's food preferences is indeed a rewarding challenge.
When more than 20% of mypopulation wants their own ethnic food, how do I meet the likes and dislikes of the remaining residents? Menu planning is an ongoing task. First understand the total ethnic mix of your facility. Then suggest the involvement of'a food committee to openly discuss food preferences. Conduct periodic food intake studies to ascertain which foods are truly eaten. A simple way to do this, is for the dishroom dietary staff to record the amount of waste for meals. This provides an overall picture and should be ongoing as a quality assurance procedure. The dietitians, charge nurse and nursing assistants can pinpoint the individuals who have not consumed a satisfactory meal. First be sure that the individual's food preferences are accommodated before discounting the meal as unacceptable. Be careful not to judge the acceptance of a whole type of food by one meal. For instance, baked ziti may not be acceptable while meatballs and spaghetti is a favorite. Each meal should be tested individually. Introduce a variety of familiar ethnic foods as alternates. throughout the menu cycle to satisfy the 20% that eat it.
66
JOURNAL OF NUTRITION FOR THE ELDERLY
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Many of our residents are discouraged by the quantity of food sewed. Instead of generating good nutrition, all this food is turning off their appetite. How do we deal with this problem? It is the responsibility of the facility to serve nutritionally adequate diets. With careful planning, meal size can be reduced and still meet these requirements. However, to ensure that the diets served are sufficient, we suggest a nutritional analysis be conducted. It is well known that small portions can stimulate appetite. Below are some guidelines we have used in our practice for lunch or dinner meals. Breakfast is usually accepted well and requires little or no modification. FOOD GROUP
protein source protein source carbohydrate source vegetable source
PORTION SIZE
SMALL PORTION SIZE
2 oz 3 oz 4 oz 4 oz
Soup, dessert, bread, margarine, milk and beverage stay the same. Generally, this small portion protocol is adapted for the heaviest meal of the day. When the menu pattern includes a lighter lunch or dinner meal, you may wish to leave the lighter meal unchanged. This small portion program can be enriched by an evening snack. The evening snack is an ideal time for additional nutrients because these snacks do not interfere with the next meal served. Sometimes a resident would rather drink, than eat. Consider 3 cups of milk a day. Be careful not to overload the resident with nonnutritive liquids such as coffee, tea or water before the meal. The quantity of food served can compound the frustration of eating for the institutionalized resident with self feeding problems. The inclusion of finger foods such as sandwiches, or use of self feeding devices should be evaluated. How do I maintain food temperatures when I don't have enough room on the steam table for all the different food consistencies that are required for each meal?
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Current Practice
67
Requirements have changed over the years, necessitating a larger steam table than might have been originally planned for. If updating your steam table is impractical, then consider basing the menu on a food consistency that will meet the most diets. For example, instead of baked sweet potato, give mashed sweet potato or instead of spaghetti serve millet or' orzo to everyone. Other foods that are easily served to regular, chopped, ground and even puree diets are pastina, mashed squash, meat sauce, cheese blintz souffle, pear sauce, graham cracker mousse, cheese omelets and cream soups. Incorporate the use of chopped or diced vegetables. Be sure your alternates also fit this rule, or you may have three pans to accommodate one alternate item. Keep the number of consistencies to the minimum necessary to meet your residents needs. Combine puree and minced into one consistency. Clarify the chopped diet. Is it to simply be cut up or is it to be put through a Buffalo machinc? What is the difference between chopped and ground at your facility?. What do I give my residents on puree diets who can't tolerate bread?
Too frequently, a double portion of mashed potatoes is routinely given in place of bread. With a little imagination the savvy menu planner can utilize other carbohydrate sources to add color and variety to their meals. This practice serves a dual purpose. The second carbohydrate source is also the alternate carbohydrate source for all other diets. See chart below. One facility we know simply purees the bread and serves it in a separate dish. Two liquids that would add flavor are milk when served cold or broth when served hot. Whole grain breads would be an additional source of fiber. Another alternative is to follow a recipe that incorporates the bread into the meal itself. General guidelines are to put 112 slice bread into the vegetable and 1/2 slice bread into the protein. This adds substance to the puree diet. The type of equipment used will determine the texture of the final product.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
68
JOURh'AL OF NUTRITION FOR THE ELDERLY
Regular Diet
Puree Diet
Puree Diet, No Bread
macaroni
pastina
mashed potato
mashed potato
rice
cream of rice
bread stuffing
bread stuffing
bread (sandwich) corn on the cob
puree sandwich white corn meal
pastina puree peas mashed potato winter squash cream of rice polenta bread stuffing sweet potato puree sandwich white corn meal mashed yam
Journal of Nutrition For the Elderly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjne20
Are You Feeding the Patient or the Garbage Can? a
Anna Maria Intintoli & Debra Woulfin MA, RD
a
a
Food Consultant, Plainview, NY, 11803 Published online: 18 Oct 2008.
To cite this article: Anna Maria Intintoli & Debra Woulfin MA, RD (1990) Are You Feeding the Patient or the Garbage Can?, Journal of Nutrition For the Elderly, 9:3, 63-68, DOI: 10.1300/J052v09n03_05 To link to this article: http://dx.doi.org/10.1300/J052v09n03_05
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
CURRENT PRACTICE
Are You Feeding the Patient or the Garbage Can? Anna Maria Intintoli Debra Woulfin, MA, RD
ABSTRACT. In a question and answer format, frequent clinical and food production problems that occur in long term care facilities are addressed. Subject matter includes the handling of food complaints, accommodating food preferences, maintaining safe food temperatures despite a wide variety of food 'consistencies, accommodating a resident's small appetite and maintaining the n"tritiona1 adequaw of the puree diet. The emphasis is on simplified food production hhich uiilizes menu items ihat fit many dikt consistendies. Various tested solutions to these problems are offered. The authors welcome additional questions.
All of a sudden, food complaints in the facility have escalated without apparent cause. How can I alter this discontent? Anna Maria Intintoli and Debra Woulfin are food service consultants. Correspondence may be addressed to: D. Woulfin, RD, 14 Relda Street, Plainview, NY 11803. Journal of Nutrition for the Elderly, Vol. 9(3) 1990 O 1990 by The Haworth Press, Inc. All rights resewed.
63
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
64
JOURNAL OF NUTRITION FOR THE ELDERLY
Food complaints are often a disguise for general dissatisfaction with a resident's placement. Food is the one area over which an institutionalized person still has some control. There are many approaches to this problem. 1. Examine your dining room for such environmental conditions as good lighting, adequate space, soothing atmosphere with soft music, cleanliness, attractive decor and freedom from off odors. Then look at the seating arrangements to ensure that your residents can socialize to the best of their abilities. Separate those residents who are disruptive. Plan your tray service to feed an entire table at one time. Therefore all the tablemates are eating together. A daily rotation of table service may be necessary to accommodate your clientele. Be alert to personality conflicts between staff and residents, especially if the same staff always serves the same table. A staff rotation may also be necessary. Feeder stations provide the best service for both staff and residents. These tables may not be included in any rotation schedule. 2. ker the complainer offer some suggestions to the food committee. If you don't have a food committee, then consider starting one. They usually meet monthly. Another option is to institute a suggestion box. Then start a program of suggestion meals based on the kind of responses you get from the suggestion box or from the food committee. Even simply changing the menu a bit with surprise or ethnic meals can alleviate the predictqbility of the cycle menus. These programs are in addition to the holiday meals. Therapeutic diets are not suspended for the suggestion, surprise or ethnic meal programs. Usually a monthly program is all that is needed to spruce up the cycle menus. Carry the theme further whenever possible with centerpieces, placemats, music, banners, and an attractive menu with large print. 3. All of this may require more resources than are available to you. When this is the case, think of little changes such as going outside for a barbecue. Even changing an ordinary piece of baked chicken into a chicken supreme with mushroom gravy is a treat. A vegetable can be enhanced with blanched almonds, pimentos, fried onions or a cream sauce. Instead of mashed potato, consider a stuffed or dlichess potato.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Current Practice
65
4. It is common practice to serve the heavier meal at noon, contrary to the American dietary pattern. There is nothing wrong with occasionally serving the main meal at night. Try this to see if the complaints become less. 5. Incorporate an occasional glass of wine or beer witha special meal. Of course, this is not appropriate for everyone; approval should be obtained. 6 . Lastly, even if all this fails, let the residents know that you care about their food preferences. Attend resident council meetings when invited. Explain to the residents some of the practical concerns you have to consider when planning a menu. Satisfying economic, production and sanitation requirements while meeting resident's food preferences is indeed a rewarding challenge.
When more than 20% of mypopulation wants their own ethnic food, how do I meet the likes and dislikes of the remaining residents? Menu planning is an ongoing task. First understand the total ethnic mix of your facility. Then suggest the involvement of'a food committee to openly discuss food preferences. Conduct periodic food intake studies to ascertain which foods are truly eaten. A simple way to do this, is for the dishroom dietary staff to record the amount of waste for meals. This provides an overall picture and should be ongoing as a quality assurance procedure. The dietitians, charge nurse and nursing assistants can pinpoint the individuals who have not consumed a satisfactory meal. First be sure that the individual's food preferences are accommodated before discounting the meal as unacceptable. Be careful not to judge the acceptance of a whole type of food by one meal. For instance, baked ziti may not be acceptable while meatballs and spaghetti is a favorite. Each meal should be tested individually. Introduce a variety of familiar ethnic foods as alternates. throughout the menu cycle to satisfy the 20% that eat it.
66
JOURNAL OF NUTRITION FOR THE ELDERLY
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Many of our residents are discouraged by the quantity of food sewed. Instead of generating good nutrition, all this food is turning off their appetite. How do we deal with this problem? It is the responsibility of the facility to serve nutritionally adequate diets. With careful planning, meal size can be reduced and still meet these requirements. However, to ensure that the diets served are sufficient, we suggest a nutritional analysis be conducted. It is well known that small portions can stimulate appetite. Below are some guidelines we have used in our practice for lunch or dinner meals. Breakfast is usually accepted well and requires little or no modification. FOOD GROUP
protein source protein source carbohydrate source vegetable source
PORTION SIZE
SMALL PORTION SIZE
2 oz 3 oz 4 oz 4 oz
Soup, dessert, bread, margarine, milk and beverage stay the same. Generally, this small portion protocol is adapted for the heaviest meal of the day. When the menu pattern includes a lighter lunch or dinner meal, you may wish to leave the lighter meal unchanged. This small portion program can be enriched by an evening snack. The evening snack is an ideal time for additional nutrients because these snacks do not interfere with the next meal served. Sometimes a resident would rather drink, than eat. Consider 3 cups of milk a day. Be careful not to overload the resident with nonnutritive liquids such as coffee, tea or water before the meal. The quantity of food served can compound the frustration of eating for the institutionalized resident with self feeding problems. The inclusion of finger foods such as sandwiches, or use of self feeding devices should be evaluated. How do I maintain food temperatures when I don't have enough room on the steam table for all the different food consistencies that are required for each meal?
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
Current Practice
67
Requirements have changed over the years, necessitating a larger steam table than might have been originally planned for. If updating your steam table is impractical, then consider basing the menu on a food consistency that will meet the most diets. For example, instead of baked sweet potato, give mashed sweet potato or instead of spaghetti serve millet or' orzo to everyone. Other foods that are easily served to regular, chopped, ground and even puree diets are pastina, mashed squash, meat sauce, cheese blintz souffle, pear sauce, graham cracker mousse, cheese omelets and cream soups. Incorporate the use of chopped or diced vegetables. Be sure your alternates also fit this rule, or you may have three pans to accommodate one alternate item. Keep the number of consistencies to the minimum necessary to meet your residents needs. Combine puree and minced into one consistency. Clarify the chopped diet. Is it to simply be cut up or is it to be put through a Buffalo machinc? What is the difference between chopped and ground at your facility?. What do I give my residents on puree diets who can't tolerate bread?
Too frequently, a double portion of mashed potatoes is routinely given in place of bread. With a little imagination the savvy menu planner can utilize other carbohydrate sources to add color and variety to their meals. This practice serves a dual purpose. The second carbohydrate source is also the alternate carbohydrate source for all other diets. See chart below. One facility we know simply purees the bread and serves it in a separate dish. Two liquids that would add flavor are milk when served cold or broth when served hot. Whole grain breads would be an additional source of fiber. Another alternative is to follow a recipe that incorporates the bread into the meal itself. General guidelines are to put 112 slice bread into the vegetable and 1/2 slice bread into the protein. This adds substance to the puree diet. The type of equipment used will determine the texture of the final product.
Downloaded by [University of Auckland Library] at 11:28 13 February 2015
68
JOURh'AL OF NUTRITION FOR THE ELDERLY
Regular Diet
Puree Diet
Puree Diet, No Bread
macaroni
pastina
mashed potato
mashed potato
rice
cream of rice
bread stuffing
bread stuffing
bread (sandwich) corn on the cob
puree sandwich white corn meal
pastina puree peas mashed potato winter squash cream of rice polenta bread stuffing sweet potato puree sandwich white corn meal mashed yam
