Mealtimes are a big deal.

There's more than meets the eye when feeding your residents

FOODSERVICE TYPICALLY TAKES UP 25-30 PERCENT OF A LONG term care facility's budget, making it the second highest expense, behind nursing. And what's for dinner is only a portion of it. Who serves it, when is it served, and where is it served are factors to be considered. Here is a brief Overview of what goes into the meals you provide for your residents.

How important is "the food there"? Potential residents and their families want to know what dining facilities are available and how meals are served. Bill Lutz, vice president, Optimum Solutions & Strategies Inc., foodservice consultants, suggests inviting them to have a meal in your dining room as a way to answer their questions about the food and service at your facility. It can serve as a marketing tool. Once living in your facility, residents need to be able to let you know what they think of the food.

The objective of special diets also changes. For instance, at 65 years of age, a resident with coronary artery disease would need a low-fat diet. But at 85 years of age, that same resident's dietary needs would now focus on weight maintenance, making a diet that is not low-fat more beneficial.

Food choices. As their energy level goes down, residents need to consume fewer calories. But as people age, their digestive systems become less efficient in processing the foods they eat. Foods that are high in nutritional value and low in fat are needed by the elderly to maintain adequate nutrition while eating less. Disease states such as heart disease, diabetes, and hypertension can limit the variety of foods from which residents should choose.

Physical limitations. Almost all elderly people will suffer from some degree of dysphagia, or the inability to swallow their food properly. Their meals need to consist of softer foods such as cooked vegetables rather than raw ones, or have their foods prepared with additives that change the consistency of the food. Residents' oral health can affect their eating habits. If a resident is having a problem with his teeth, he may need to be eating softer foods. Likewise, dentures that don't fit properly make it difficult for a resident to chew his food.

Arthritis can make it very difficult to use utensils. With many facilities facing staffing shortages and federal regulations mandating that only nursing staff can feed residents, it often becomes more challenging for the staff to serve meals than it is for the residents to eat them. Their sense of taste and smell diminish, making many foods less palatable.

Residents with Alzheimer's disease and dementia are distracted easily and may forget that they're eating. Weight gains or losses result because they can't remember if or when they last ate and either eat another meal or skip a meal.

As in younger adults, chronic diseases such as heart disease, diabetes, kidney disease, and high blood pressure are improved with better food choices. The elderly are just as likely to reduce the needed dosages of medications to control these conditions as their younger counterparts.

It's good for them, too. Poor nutrition increases the likelihood of residents developing infectious diseases such as pneumonia and influenza. Wound healing is poor as well. Poor nutrition also contributes to weight gain, resulting in joint problems such as gout, hypertension, and diabetes. It has also been shown that poor nutrition contributes to decreased mental and physical dexterity, measured as activities of daily living (ADL).

There's more to feeding your residents than putting a tray of food in front of them. This department will focus on the challenges your residents face in eating. The physical and mental effects of aging such as arthritis, dysphagia, and dementia can have a dramatic impact on how residents eat and what they will and can eat. The challenges you face in feeding them will also be addressed. An exchange of ideas and techniques can be the best tool for meeting those challenges. And, as in all aspects of long term care, changes in the rules and regulations will consequently alter the way you feed your residents.

Dining in style. The presentation of the food is important. A tray with an entire meal on it can be intimidating to some residents. They become confused by the amount and varieties of foods placed in front of them. Providing choices at the point of service and serving only what is chosen is more cost-effective than providing a serving of each food and throwing away what's not consumed.