The vegetarian option: cost-effective and healthy.
Delivery times notwithstanding, the scenario isn't far-fetched With boomers on the verge of long term care, however, changes in the dining room have already begun.
Let's talk numbers
"Vegetarian food is certainly less expensive than serving somebody four ounces of steak," said Mary Jo Kurko Coyne, director of nutrition development at Aramark Health Care Management Services of Philadelphia. "One of our jobs is to meet our clients' cost parameters, and I don't expect that adding vegetarian selections would cost our clients any more."
Dr. Suzanne Havala Hobbs, clinical assistant professor, University of North Carolina at Chapel Hill and Nutrition Advisor for the VRG, agreed with Kurko Coyne. "There are menu items that can be made from very inexpensive ingredients. A bean chili or Caribbean black beans with rice are two items that people love, and what could be cheaper than beans and rice? Plus, they hold up well on a steam table, the level of spiciness can be adapted to the population, they are super nutritious and easy to prepare, and the canned varieties are just fine to use, so storage is easy--no refrigeration or freezing needed."
Such a meal could cost a facility serving 100 people $1.36 per resident, according to Todd Hershberger, director of dining services at Glacier Hills CCRC, a 392 unit facility in Ann Arbor, Mich., serving sub-acute, assisted living and independent residents.
Why go veggie?
Though many who opt to become vegetarian do so because of concern for animal welfare and the environment, others do so for their health. "Adding vegetarian options almost invariably helps menus comply with the dietary guidelines for Americans," Havala Hobbs said.
It also helps remedy a common complaint among residents--constipation. When Havala Hobbs managed nutrition services for Intermediate Care for the Mentally Retarded group homes, she updated the menus to increase the fiber content of meals.
"The result in some homes was that the monthly usage of stool softeners and laxatives greatly diminished," she said.
"In LTC, people think about beans and gas. Many people have complaints about gastrointestinal conditions, but with their high fiber content, beans are actually good for what ails you."
High fiber isn't the only benefit of a meatless diet. In 1999, the FDA gave soy food manufacturers approval to make heart healthy claims on all products that delivered 6.25 grams of soy protein per serving. Its decision was based on the ability to lower cholesterol by consuming 25 grams of soy protein per day (or four servings at 6.25 grams each).
If these points weren't convincing enough, the American Dietetic Association's position states "appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases."
Easy does it
"First, we have to demystify this whole vegetarian entree initiative," sad Bill Stewart, president of Real Food Services, manufacturer of MoonRose Vegetarian Foods, a trademark brand of the Sysco Corporation of Boulder Colo. "We need to help people realize that vegetarian protein is the same as chicken, pork or beef. They are simply flavor carriers that will adapt to whatever flavor sauces you put them in.
"A soy protein cutlet can replace a pork or chicken cutlet, and you've accomplished that task with a low fat, easy to digest, high protein product without antibiotics, hormones or steroids and without sacrificing flavor or texture.
MoonRose calls its vegetarian options "chameleon products" because they're versatile. The aim, said Stewart, is that each be used in five ways. Tofu, for instance, can be diced for a stir fry, sliced and grilled for a sandwich, blended with chocolate sauce for an easy-to-swallow pudding, jazzed up as a cheesecake, or put in a food processor with chickpeas and Calamata olives for a Mediterranean dip.
It might look like a challenge, but with adequate planning and a few adjustments, any LTC facility can easily go from never having served a vegetarian entree to including meatless options, even if it's only one per week. Here's how:
Step One: Survey residents. Food professionals agree that a survey is the only way to begin. The results will help determine residents likes and dislikes among the myriad meatless options available.
Step Two: Identify leaders. Buys critical, said Havala Hobbs. "There is always a small group of leaders among the residents, so the person spearheading the menu changes should identify these people." Convene a Residents' Council to periodically meet with those who will prepare and serve the food.
Step Three: Develop recipes. With the input from the Resident Survey (Step One) and the Residents' Council (Step Two), recipes must be developed that are tailored to the people each facility serves. Jonn P. O'Connor is the executive chef at Glacier Hills CCRC in Ann Arbor, Mich.
"The chef needs to do his home work in creating exciting new dishes that will work with his particular establishment," O'Connor said. "In a retirement community, they don't want surprises. They want to know that what they expect is what they'll be getting."
O'Connor added that an important part of the development process is naming the recipes. "You must make sure it's identifiable. In this community, people don't want to be dazzled with fancy names. They just want great food that they can look forward to enjoying." As a case in point the vegetarian lasagna that was served in New York City's Vegetarian initiative co-sponsored by the city's Meals on Wheels program didn't go over well until it was renamed "Spinach Lasagna."
Also watch out for ease of preparation, said Linda Rhodes-Pauly, vice president of development for HDS Services of Farmington Hills, Mich. "When you're constructing a menu, you shouldn't have too many dishes on the same day that require a lot of chopping."
Step Four: Educate residents and train staff.
"You really need to get out and help people understand the variety of foods that they might not think would be used in a vegetarian main entrees. We want to come up with creative ideas, but not overwhelm them. We want to say 'This is what we're doing and this is what we'd like to try.' Talk to them, then move into the process," O'Connor said.
Staff must be trained across the board. Wait staff needs to know what a vegetarian diet tastes and looks like since they'll assist residents with their choices.
Nurses need to understand complementary proteins and nutritional composition since they work with residents who will be substituting menu items.
"The replacement issue is a big thing because you have to replace menu items with similar nutrient density. You wouldn't want to replace a bean soup with a potato soup because they don't contain the same nutrients," Rhodes-Pauly said.
Ongoing training is necessary for the entire kitchen staff. Just one aspect, said Kurko Coyne, is the handling of grain products "because you want to offer a true risotto to a resident, as opposed to giving him something that's mushy." Also in line for education are members of the direct care staff.
Step Five: Conduct taste tests Too bland? Too spicy? Texture a little off? Before a full menu rollout, this is the time to make adjustments. Havala Hobbs suggested testing different manufacturers' products. "Taste five or six brands of veggie burgers and have residents weigh in on their favorites."
Step Six: Consider it a work in progress. "Meet with your residents frequently," said Glacier Hills' Hershberger. "Ask them how things are going, if they'd like to see anything else and if they're happy with their meals."
Growth Of The Trend
The number of older vegetarians is on the rise, said Reed Mangels, Ph.D.. R.D. In fact, the increase has been a least a decade in the making.
In "A Dietitian's Guide to Vegetarian Diets" (Mangels, Messina and Messina; Jones and Bartlett Publishers, 2004), Mangels cited a 1992 study of the vegetarian marketplace conducted by Vegetarian Times, Inc., that noted the rapid growth of seniors and of vegetarians and seniors favoring meatless diets.
More recent research supports Mangels' view, as a 2003 Harris Interactive poll indicated that 5.7 million adults forgo meat, poultry and fish and more than 12 million never eat meat
A 2002 report from Mintel Consumer Intelligence put vegetarian food sales at $1.5 billion. Mangels said that includes "foods like soy milk. vegetarian entrees and meat analogs (products that resemble meat's taste and texture)." It's an impressive figure, considering it doesn't include traditional vegetarian fare such as fruit, vegetables, rice and pasta.
Evidence of an emerging comfort level with vegetarian foods among seniors is The Vegetarian Initiative. a collaboration formed in the late 1990s by the National Meals on Wheels Foundation, the National Association of Nutrition and Aging Services Programs and the Vegetarian Resource Group.
The tide has already turned at the Glacier Hills CCRC in Ann Arbor,
Mich. Todd Hershberger, director of dining services, has spent three years with the facility and said that near-daily vegetarian entrees predate him. "At first, we didn't offer meatless options on an everyday basis, but as more and more people come in, Glacier Hills has taken on a wellness philosophy. So now we have more health conscious residents move in here, and we've adjusted or menu to accommodate them." --TSC
Tobi Schwartz Cassell is a Cherry Hill, N.J.--based freelance writer She co-authored "Adding Value to Long Term Care" (Jossey-Bass).
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|Publication:||Contemporary Long Term Care|
|Date:||Sep 1, 2004|
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