Creating a five-star dining experience: by the staff of Glen Cove center for nursing and rehabilitation, Glen Cove, Long Island, New York.

Maybe it's the seductive aroma of a juicy steak, or the feeling of delight when the nostrils detect a delicious smell, or even the radiating satisfaction of having eaten a scrumptious meal--but whatever the reaction, there is no debating that food is more than just bodily sustenance. Food can change a mood, evoke a smile, and inspire the uninspired. The pleasure of eating a delicious meal can have a deliriously positive effect on anyone, synergizing satisfaction and delight.

It is unfortunate that so many residents of nursing homes are denied this proverbial spice of life. Institutional foods traditionally consist of unappealing meat, watered down sauces, and uncreative staples. The residents at out facility were no exception--they complained about many aspects of the dining experience. The food was boring and tasteless, they said, and was frequently served at less than the ideal temperature. Residents voiced their dissatisfaction at the resident council meetings, and these same sentiments were echoed in the resident satisfaction questionnaire. Figure 1 shows just how severe that dissatisfaction was.

[FIGURE 1 OMITTED]

Once the satisfaction questionnaire clearly quantified a myriad of food service problems, our Performance Improvement Committee met to address the issues. Our program, "Creating a Five Star Dining Experience," began in October 2002. The program continues to evolve, but it was basically in shape by January 2003.

Planning

Our Performance Improvement Committee met and established a focus committee, which would meet weekly to conceive, develop, and implement changes designed to meet the food service objectives. The focus committee consisted of the Food Service Supervisor, Director of Nursing, Administrator, and Director of Therapeutic Recreation. The locus committee was determined to bring the variety and subtlety of food to our residents, leading toward a time when meals would be more than a temporary diversion in the day, but instead an adventure to the far corners of the palate.

We admitted that our previous menu was dull and dreary. Bringing "ambrosia and nectar" to our table would not only make mealtime a delight, but cast upon our institutional walls a glowing sense of comfort and harmony.

The focus committee quantified our objectives as follows:

Implementation

The focus committee established four basic interventions:

1. Waiter/waitress: At your service. The focus committee determined that the reason the food was served at less than ideal temperature was the lack of expedience with which the food was served. The hot food arrived in the dining rooms hot, and the cold food was cold, but the untimely distribution of the food trays resulted in most food being lukewarm. The locus committee determined that if additional workers besides CNAs and nurses distributed trays, the trays could be delivered to the residents in a matter of minutes. The Administrator met with all staff (excluding housekeeping and maintenance) and discussed the new plan and each person's involvement. It was decided that no one would take lunch during resident mealtimes. Rather, every clerk, social worker, medical records employee, business office staffer, secretary, and all other ancillary personnel would be assigned to one of two dining rooms. Every day they would report to the assigned dining room five minutes before the scheduled meal. Dining room captains and cocaptains were selected from management employees; they would coordinate the extra staff in an orderly and efficient manner.

As the food carts rolled into the main dining rooms, the captains would have the "waitstaff" line up. In a methodical manner, a captain would take a tray from the food cart and give it to the first waitstaff person in the line. He or she would deliver the tray and return to the line for another tray. In this manner, all 60 trays were served within 10 minutes. The hot food was hot and the cold food was cold. After 15 minutes, total, of service, the employees (now no longer serving as waitstaff) would return to their respective jobs, although the nurses and nursing assistants who routinely stayed with the residents and assisted them with eating would continue to do so.

2. Mood is magic: Addressing the ambience. The focus committee recognized that there are subtleties in food service that certainly add to the overall dining experience. To this end, the captains and cocaptains ensured that recommendations by the focus committee were implemented. These recommendations included turning off any TVs in the main dining rooms at least 15 minutes before the start of the meal, at which point the Recreation Department would start playing recorded classical music, which continued throughout the meal. Two of the nursing assistants assigned to the dining room would walk around with pitchers of water, offering cool drinks to the residents as they waited for their food. Linen tablecloths were purchased and placed on every table about an hour prior to the meal. The local florist provided fresh-cut flowers weekly for the tables, which also added to the overall decor. The Social Services Department met with the residents individually to try to work out an optimal seating arrangement to enhance social interaction. All of these interventions served to create a warm and inviting atmosphere for dining.

3. Creative cooking: Making use of culinary experts. Although our food met the necessary criteria for nutrition and dietary restriction, its taste and variety needed some help. The Administrator, together with the Food Service Supervisor, placed an ad in a local newspaper looking for some type of culinary expert. Although the initial plan was to find a consultant, the facility was lucky enough to find a graduate of the Culinary Institute of America, who had spent years working in the nursing home industry. He was clearly just as comfortable cooking for a five-star restaurant as he was cooking in an institutional setting. The facility hired him as the Director of Food Services. He worked closely with the new Dietitian, also trained at the Culinary Institute of America.

Within weeks, lunchtime menus of meatloaf and mashed potatoes were transformed into menus advertising beef teriyaki with vegetables tempura. The sudden metamorphosis from bland to grand was incredible. Without any increase in food cost or labor intensity, these two trained individuals were able to teach the dietary staff some simple but elegant tips for food preparation. The menus were totally redone, adding many delicious and unique foods. Variety was significantly enhanced, and the flavors came alive. Even those residents on restricted diets were able to enjoy a more varied selection thanks to the knowledge of these culinary school graduates.

4. A democracy: Voting for food. The focus committee established a food committee designed to serve as a collective voice for the residents. The monthly meeting, chaired by the Director of Food Services and Dietitian, invites any interested resident to come and voice his or her opinions of the food, the menu, and the service. New dishes prepared by the Director of Food Services are offered to the residents as "tasters" to see if they should be included in an upcoming menu. Residents can also vote to eliminate certain meals or foods from the menu. Most importantly, the residents' opinions are heard and acted upon. It is their input and their decisions that help to shape the cuisine for their fine dining experience.

Obstacles

Initially, some of the employees who did not generally interact with residents were reluctant to assist at mealtimes. Excuses, including "I have no time" or "It is not my job," were heard repeatedly during the first week of the program. But, as the new dining experience progressed, all of the participating employees began to develop a rapport and a relationship with the residents. Employees who had not had significant interactions with the residents found themselves enjoying their conversations, and the employees became eager to take a break from their regular workday routines to come and mingle with the residents.

Since this facility provides on-site laundry service, there was concern over washing additional linen, such as tablecloths. Once the program began, however, the Laundry Department was able to handle the washing of the additional tablecloths without a problem.

Evaluation

Tiffs program has become a huge success. We have transformed our food service from distributing mundane meals to serving elegant cuisine. With music helping to create a relaxing atmosphere, and attention to such nuances as tablecloths and flowers, the residents now enjoy a warm, inviting ambience for their dining pleasure.

With the use of staff from throughout the facility to assist in the distribution of trays, the residents now enjoy a sufficient and attentive waitstaff. Good conversation and hearty laughs have become an integral part of the dining experience.

Including residents' opinions in the development of the weekly menus is conducive not only to the pleasing of their palates, but also serves to bolster their psyches.

A comparison of residents' opinions regarding the four aspects of the food service pre- and postprogram is delineated in Figure 2. The bar graphs quantify clearly the positive impact this program has had on the residents' perception of the toad service. All of the objectives set forth for this program have been met--or exceeded: Overall, 97% of those residents responding to the questionnaire were extremely satisfied with the food taste, the variety of food, the food temperature, and the overall dining experience.

[FIGURE 2 OMITTED]

Ten months after the inception of this program, the dining experience at our facility has become an exciting focal point for residents. The menus continue to change and load preparation and presentation continue to evolve. Eggplant rollatini with penne a la vodka has become a favorite food for residents who now enjoy a five-star dining experience.

For further information, phone Jill Smoller, administrator, at [phone]. For more information on the OPTIHA Award, visit www.nursinghomesmagazine.com. To comment on this article, please send e-mail to [e-mail].

* At least 95% of the residents will be extremely satisfied with the taste of the food.

* At least 90% of the residents will be extremely satisfied with the variety of food offered.

* At least 95% of the residents will be extremely satisfied with the food temperature.

* At least 95% of the residents will be extremely satisfied with the overall dining experience.

PROGRAM STAFF

Jill Smoller, Administrator

Ron Goodman

Director of Nursing

Debbie Maraldo

Assistant Director of Nursing

Jeffrey Marcus

Assistant Director of Nursing

Helen Andrikopolous

Director of Social Services

Frank Dano

Director of Nutritional Services

David Post

Director of Food Services

Tina Morgan

Director of Therapeutic Recreation