Food service as a marketing tool.

A quality food service is basic to a nursing home's image. A national vendor offers observations and examples

In today's competitive business environment, the nursing home administrator must consistently communicate the facility's marketing message to seniors, their families, and the medical community. One of the best ways for a facility to differentiate itself from its competitors is through its food and nutrition services.

While quality medical care is certainly the most important consideration for prospective residents, quality of life issues like food service are crucial to the nursing home selection process. Food service is the highlight and focus of the resident's day. It only makes good business sense, then, for nursing facilities to take full advantage of the food service and use it as a major marketing tool.

When a nursing home administrator thinks about the facility's "image" and how to market it, he or she may think of hard-sell advertising or aggressive sales techniques. In fact, most nursing homes use marketing in very subtle, non-intrusive ways. According to Gerald A. Sohn, a partner in Glen Ridge Nursing Care Center (Malden, MA) and University Commons Nursing Care Center (Worcester, MA), marketing for his facilities means "participating in our community, not advertising. A nursing home needs to create an ongoing awareness of the facility, since the selection process is very short-term. We offer seminars on estate planning, run open houses, participate in walkathons, and so on." Beyond this, however, Sohn adds, "the quality and diversity of our food service also builds our image in the community. It is one of the most important ways we maintain our reputation."

Kathy Donohoe, M.Ed., R.D. is the Food Service Director at Sohn's University Commons, and a Regional Operations Manager for Sodexho, a national vendor for such services. Donohoe says University Commons markets to two distinct groups, and food service is important to both: "We market our services to physicians and other medical professionals. To them, our full-time Registered Dietitian and ability to handle restricted diets is crucial." The other key target market is prospective residents and their families. University Commons provides tray service to residents and also operates an elegant dining room with cathedral ceilings and a grand piano. A wait staff serves residents seven days a week for lunch and dinner. White linens cover the tables. China, silver and stemware are standard at every meal. Donohoe says this presentation is crucial to residents and their families. "Our image in the community is one of elegance, with a home-away-from-home feeling. The way we present meals and snacks is central to this image.

"After every meal," she adds, "our chefs go into the dining room to get feedback from the residents. We review the results daily and make changes if necessary. Satisfied residents mean satisfied families and continued positive word-of-mouth."

At Glen Ridge Nursing Care Center in Malden, MA, a computerized program called GeriMenu allows residents to have a say in their meal planning, and because of the consumer choice factor, assures physicians that their patients will be well-nourished. Food Service Director Barbara McCarthy explains that new residents' food preferences and special dietary requirements are entered into the computer, which prints out a meal ticket for each resident each day, taking into account likes and dislikes. "If today's dinner is Chicken Davio with red bliss potatoes and bean medley, residents who don't like chicken will be given the daily alternative meal," McCarthy explains.

GeriMenu also monitors residents' weight and prints out graphs showing any fluctuations, providing a basis of discussion with physicians and dietitians. The result, says McCarthy, is "a great marketing tool for the medical community, and it also helps us maintain customer satisfaction with our residents."

On the West coast, Ted Van Pembroke, Sodexho's Resident Regional Operations Manager for Charming House, agrees that food service plays a major role in marketing. Channing House is a graciously appointed life care facility in Palo Alto, California. Residents must be able to live independently at the time of arrival, but the facility offers comprehensive medical care for those who later become ill.

The Channing House dining room resembles a fine restaurant, and there are also private dining rooms for entertaining guests. Residents of the Personal Care and Skilled Nursing section also take lunch and dinner in a light and airy dining room, with a choice of two entrees.

Channing House has recently implemented a new dining program for residents on pureed diets. With Sodexho's Contemporary Cuisine program, chefs form fresh, canned or frozen foods that have been pureed into natural-appearing presentations. The program uses an ingredient called ThickenUp, a product created by Sandoz. For breakfast, residents can enjoy pancakes, waffles, and biscuits. Lunch may bring chicken salad or a pizza burger. And dinner might feature Yankee pot roast or seafood Newburg.

Van Pembroke says the program has been a great success. "One of our residents had dental surgery and was unable to chew. She didn't want pureed foods, which she referred to as 'baby food.' All she was eating was eggs, and consequently, her nutrition was suffering. We introduced her to the Contemporary Cuisine program, and she started to eat meals again. She was on the pureed program for three months, and it really made a difference to her quality of life and her health." Van Pembroke says this approach to food service maintains Channing House's image as a quality, upscale facility.

Another new food service program has been implemented at the Martha & Mary Nursing Home in Poulsbo, Washington. Martha & Mary was originally established as a children's home in 1891, but has been a nursing facility since 1951. Of its 190 residents, 140 have Alzheimer's disease or other forms of dementia, and 55 of them reside on a Special Care Unit to meet their physical or psychosocial needs. To ensure that this special population was adequately cared for and was not disruptive to others, administration reconfigured the facility, including its dining services. As a result, says Director of Nursing Merridith Back, R.N., the Special Care Unit takes an individualized dining approach.

"We now have three dining rooms on the unit, corresponding to the different stages of dementia," she explains. "For those residents who are still social and communicative, we have a kitchen set up with tables. A second room is small, for those who get upset being in large groups. The third dining room is larger, for those residents requiring extensive meal-time assistance."

Central to the success of this new approach is Sodexho's IDEA Program for residents with dementia (IDEA stands for Innovative Dining Environmental Approach.) The program is keyed to the progressive stages of dementia, and accommodates residents as they lose certain functions. According to Florence Fong, M.P.A., R.D., Director of Nutrition Services for Sodexho USA West Division, IDEA "provides more structure for residents. It makes families happy, and also improves staff morale. While it wasn't specifically developed as a 'marketing tool' for nursing homes, it clearly helps facilities position themselves as leaders in their target markets."

Nursing homes can also use food service in more direct ways to market themselves to referral "influencers." At University Commons in Worcester, MA, administrators invite area healthcare executives to the Executive Dining Room for breakfast or lunch, in the process showcasing the facility. Kathy Donohoe explains that, if physicians, social workers, and dietitians "experience the quality of our dining services for themselves," and like what they see, they'll be more inclined to recommend University Commons to their patients.

Donohoe adds the important point that even vendors and repair people can be "word-of-mouth" marketers to the community. "Food service vendors see the quality of the food we purchase. Drivers comment on the cleanliness of our kitchen. All of this contributes to our reputation in the community."

As facilities compete for private pay patients and the world of long-term care choices expands every year, administrators must use every method available to enhance their good image. Food and nutrition services can play a major role in this effort, and nursing home operators and their food service contractors must work together to ensure continued success.

IDEA Program for Dementia Residents Restores Dignity to Dining

One of the greatest challenges for nursing home dietitians is ensuring that patients with Alzheimer's Disease and other forms of dementia are adequately fed and nourished. As the disease progresses, residents who previously enjoyed eating with their friends may refuse food or be physically unable to eat. They pace and wander, making regular dining schedules difficult.

To assist its clients, Sodexho developed a cutting-edge program for residents with dementia called IDEA (Innovative Dining Enviromental Approach.) IDEA accomodates various degrees of deficit in progressive dementia and restores quality of life and dignity to residents while ensuring they are well-nourished at every stage of their illness.

According to Florence Fong, M.P.A., R.D., Director of Nutrition Services for Sodexho USA West Division, 20% of the American population over the age of 80 has moderate to severe dementia. By the year 2000, 14 million Americans will suffer from dementia, including 75% of those in nursing homes. (The current percentage of nursing home residents with dementia is 50%.) "Unfortunately, as the 'baby boom' generation's parents age, and then as they themselves age, dementia will be much more prevalent," says Fong. "The IDEA Program anticipates this demographic change and will restore a little bit of dignity to people with this illness." She notes that the program helps clients with marketing to families and medical facilities. "The IDEA Program gives our clients a competitive edge. It is clinically sound, which medical professional require, but IDEA also improves residents' quality of life, which is so important to family members," says Fong.

Dementia is a progressive illness which can take from one to 20 years to run its course. Throughout the course of the illness, residents lose certain functions or capabilities, and the IDEA program is keyed to these changes. For example, a resident with Stage 2 dementia who has trouble making decisions is given a very structured, limited menu from which to choose. Someone in the late stages of dementia who has lost chewing capability is fed pureed foods, in a program also developed by Sodexho. Sodexho manages IDEA in concert with a facilty's nursing and therapy professionals. An interdisciplinary approach is essential to the program's success.

As long-term care facilities seek ways to enhance their reputations in the community and build bridges to medical professionals, programs like IDEA will provide facilities with that crucial point of difference to attract new residents.

Chuck Shea is President, Healthcare Management Services East, Sodexho USA.