ENSURING QUALITY CARE NUTRITION AND FOOD MANAGEMENT Nutrition and - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

NUTRITION AND FOOD MANAGEMENT

• Nutrition and special needs
• Menu planning
• Food handling

September 2019 Safety, Oversight and Quality Unit 2

NUTRITION AND SPECIAL NEEDS

September 2019 Safety, Oversight and Quality Unit 3

PURPOSE AND KEY TERMS

The purpose of this section is to help the learner acquire an understanding of nutritional needs of the residents, including those with special needs or those who refuse to eat.

• Carbohydrates
• Fats
• Minerals
• Nutrition
• Proteins
• Vitamins

September 2019 Safety, Oversight and Quality Unit 4

OBJECTIVES

The learner will be able to:

Understand the elements of good nutrition Complete a nutrition assessment Serve meals that appeal to residents Recognize residents’ special needs regarding eating and nutrition Work with a resident who refuses to eat

September 2019 Safety, Oversight and Quality Unit 5

INTRODUCTION

Purchasing, preparing, and storage of food is an important Adult Foster Home (AFH) function. You are responsible for:

• Planning three well-balanced meals daily that
• Reflect the resident’s preferences
• Incorporate any specific dietary needs

Providing nutritious snacks and liquids, is a rule requirement including safely storing and preparing food.

September 2019 Safety, Oversight and Quality Unit 6

INTRODUCTION CONTINUED

There are new federal requirements around food in Home and Community Based Settings, including adult foster homes:

• You must support the resident’s right to access food at any time
• You must support the resident’s right to eat their meal in their room if that’s

the resident’s preference

• If a resident misses a meal at a scheduled time, an alternative meal must be

made available

September 2019 Safety, Oversight and Quality Unit 7

NUTRITION BASICS

September 2019 Safety, Oversight and Quality Unit 8

NUTRITION BASICS

Good nutrition is critical in caring for individuals with chronic health care needs, as it improves healing and recovery from illness, and helps maintain health. Proper nutrition and hydration are critical in maintaining healthy skin. Poor nutrition can lead to increased risk of pressure sores.

September 2019 Safety, Oversight and Quality Unit 9

NUTRITION BASICS CONTINUED

Good nutrition is eating a well- balanced diet every day. A well-balanced diet includes:

• Proteins
• Fats
• Carbohydrates
• Vitamins
• Minerals
• Water

September 2019 Safety, Oversight and Quality Unit 10

NUTRITION BASICS CONTINUED

A basic well-balanced diet is the same for everyone, including older adults and individuals with chronic health care needs. Older people need the same nutrients as younger people, but they do not need as many calories. The challenge is to choose nutrient-dense foods, i.e., that are high in nutrients in relation to calories. For example, a glass of whole milk and a glass of soda have about the same calories but milk has nutrients that soda does not.

September 2019 Safety, Oversight and Quality Unit 11

NUTRITION BASICS

CONTINUED Water:

• Water prevents dehydration, reduces

stress on the kidneys, and maintains regular bowel function

• Additionally, dehydration has been

shown to double the risk of pressure ulcers

• Dehydration results in a loss of padding
• ver bony points in the body, such as the

tailbone or ankles

September 2019 Safety, Oversight and Quality Unit 12

NUTRITION BASICS CONTINUED

The sensation of thirst may not be adequate or an accurate indicator of the need for fluids. Beginning around age 50, the sensation of thirst begins to diminish and continues diminishing with age.

• This is a factor in the increased risk of dehydration among older adults
• Additional risk factors of dehydration include health conditions such as

diabetes or dementia or when an individual is dependent on others to access food and water.

September 2019 Safety, Oversight and Quality Unit 13

NUTRITION BASICS CONTINUED

Proteins:

• Critical for growth and repair of body tissues
• Can be broken down by the body to supply energy when needed

Fats:

• Store energy
• Regulated body temperature by providing insulation and padding
• Are also a source of energy

September 2019 Safety, Oversight and Quality Unit 14

NUTRITION BASICS CONTINUED

Carbohydrates come from two main food sources:

• Complex starches (breads, cereals and vegetables)
• Simple sugars (table sugar and syrup, as well as fruits, vegetables and milk

products)

Vitamins are components in food that are needed for growth and maintaining good health. This includes:

September 2019 Safety, Oversight and Quality Unit 15

• A
• B6
• B12
• C
• D
• E
• K
• Folic acid
• Biotin
• Niacin
• Thiamin
• Riboflavin
• pantothenic acid

NUTRITION BASICS CONTINUED

Minerals include and are important for:

• Calcium and phosphorous are needed for strong bones and teeth
• Iron for healthy blood
• Iodine for regulating the thyroid and hormones
• Potassium for maintaining a balance of body fluids
• Zinc for wound healing and healthy skin

September 2019 Safety, Oversight and Quality Unit 16

NUTRITION IN AN AFH

The AFH provider’s goal is to enhance independence, decision making, and sense of self-control and involvement in all aspects of care, including meals. Your responsibilities are to:

• Respect a resident’s right to make choices
• Fulfill each resident’s special dietary needs
• Create appealing meals and a pleasant mealtime atmosphere
• Document problems and consult with the resident’s health care practitioner

and other care team members

September 2019 Safety, Oversight and Quality Unit 17

NUTRITION IN AN AFH CONTINUED

The following suggestions can help you meet your responsibilities:

• Assess dietary needs during the screening and assessment
• Gather information about past and present eating, food preferences, recent

changes in these patterns, and current dietary needs

• Provide familiar foods
• Familiar foods can maintain a connection with the person’s past life

experiences, especially those that recall pleasant times

September 2019 Safety, Oversight and Quality Unit 18

NUTRITION IN AN AFH CONTINUED

You are responsible for providing adequate calories. This is important for maintaining body weight. To help you provide adequate calories:

• Weigh and record each resident’s weight at admission
• Keep a record of each resident’s body weight
• Weigh each resident at least once a month:
• A weight change of more than 10 pounds in three months or over a

shorter period of time should be reported to their health care practitioner

• If a resident loses between two and three pounds in one month, monitor

weight weekly

September 2019 Safety, Oversight and Quality Unit 19

NUTRITION IN AN AFH CONTINUED

Plan menus around foods residents prefer. If a resident’s dietary intake is adequate, serve foods the person enjoys and will eat, even if you think the combinations are unusual. Discuss diet concerns. If a resident is clearly overweight or underweight, or experiences undesirable weight gain or loss, discuss your concerns with the resident (if possible), the family and the resident’s physician. A special diet and exercise plan may be needed. Consult a registered dietitian. A professional trained in diet and nutrition can help you modify your regular menu plans to meet a resident’s special needs.

September 2019 Safety, Oversight and Quality Unit 20

NUTRITION IN AN AFH CONTINUED

Serve meals and snacks with needed proteins, carbohydrates, fats, vitamins, and minerals:

• Include foods from www.ChooseMyPlate.gov
• Use mainly fresh foods – processed, packaged foods usually have extra salt,

sugar and/or fat

• Carefully read the nutrition and ingredient labels on all packaged and

processed foods

• Prepare cut, chopped or pureed foods for special diets from the regular

menu.

• In general, a well-balanced meal can be served to all people, including those
• n diabetic, low-sodium, low-fat and most other special diets

September 2019 Safety, Oversight and Quality Unit 21

NUTRITION IN AN AFH CONTINUED

Many older people are reluctant to try or will not eat new foods. Consider:

• Involving residents in meal planning
• If the resident needs to make dietary changes, always include them in the

discussion

• Encouraging them to talk about favorite foods and include those foods in your

meals whenever possible

• Asking for favorite recipes – if some residents cannot participate, family

members may be able to make suggestions

• Consider making small changes instead of changing everything at one time
• Encourage reminiscing about enjoyable mealtime activities – be sensitive to

residents whose past mealtime experiences may not have been pleasant

September 2019 Safety, Oversight and Quality Unit 22

NUTRITION IN AN AFH CONTINUED

• Plan favorite dishes for special events

such as birthdays or holidays, plan meals that include favorite foods

• Encourage family members to bring

and share favorite foods, if appropriate;

• If the residents have different food likes

and dislikes, consider having a group meeting and discuss how meals can be planned:

• The name of a dish may be different

but the ingredients are the same

September 2019 Safety, Oversight and Quality Unit 23

NUTRITION IN AN AFH CONTINUED

People eat for their physical needs, but also to meet social and psychological needs. Think about why and when you eat. Some examples could be:

• The food looks and smells good
• It’s time to eat
• You know you should eat
• The food is on the table
• Friends or family are visiting
• It is a holiday celebration
• Emotional reasons such as depressed, happy, stressed or lonely

September 2019 Safety, Oversight and Quality Unit 24

NUTRITION IN AN AFH CONTINUED

• You feel in control when you make decisions about eating
• You feel out of control such as nervous or anxious
• You enjoy visiting with others over a meal

The residents in your home may eat (or not eat) for many of the same reasons. For some residents, mealtime may be the highlight of their day. They enjoy good food and socializing during the meal.

September 2019 Safety, Oversight and Quality Unit 25

NUTRITION IN AN AFH CONTINUED

The appearance, flavor, aroma of food, and mealtime atmosphere, can have an important effect on residents’ desire to eat. If meals and mealtime are pleasant, your residents will be more likely to eat. Serve attractive meals. Vary foods in color, shape, flavor and texture. For example, serving a meal of baked chicken, brown rice with a little pimento, broccoli and a small wedge of cantaloupe provide a variety in texture and flavor and make a colorful and eye-appealing meal.

September 2019 Safety, Oversight and Quality Unit 26

NUTRITION IN AN AFH CONTINUED

Vary methods of preparation and temperature of foods served.

• Prepare meals that have both hot and cold foods
• Use a variety of cooking methods like bake, broil, sauté, barbecue, poach,

stir-fry, etc.

Season foods with herbs and spices.

• Use flavorings that bring out the natural salt, sweet, sour and tart tastes in

foods

• Consider an herb garden with herbs residents are familiar with and enjoy

September 2019 Safety, Oversight and Quality Unit 27

NUTRITION IN AN AFH CONTINUED

Serve meals family style:

• Let residents select the

foods they like and the amount they want;

• If pre-dished plates or if

assistance is needed, be sensitive to the size of portions desired.

Too much food on the plate can decrease an appetite.

September 2019 Safety, Oversight and Quality Unit 28

NUTRITION IN AN AFH CONTINUED

Accept unusual eating habits:

• Putting jelly on all foods may seem unusual or unhealthy to you, but it may be

a lifelong habit for a resident

• Unusual eating habits are common among residents with dementia
• Do not discourage such habits if they enhance the resident’s eating of an
• therwise healthy diet

Document any concerns. Check with the resident’s primary health practitioner or a registered dietitian if you have concerns.

September 2019 Safety, Oversight and Quality Unit 29

NUTRITION IN AN AFH CONTINUED

Provide a pleasing relaxed atmosphere:

• Serve meals at a dining table,

rather than on trays in the residents’ rooms

• Eating a well-balanced meal

increases when a meal is shared with others – poor dietary patterns are associated with eating alone

• Sharing a meal with others

increases the likelihood of eating a well-balanced meal

September 2019 Safety, Oversight and Quality Unit 30

NUTRITION IN AN AFH CONTINUED

Allow residents to assist you with preparing meals, serving and clean- up if they want to:

• Setting the table, checking on the vegetables, etc.
• Be sure everyone washes hands before handling food, setting the table and

eating

Plan meals around special events. Birthday parties, holiday dinners and ethnic foods add interest to mealtime. Involve residents in planning special events.

• You may want to invite family members for a potluck or barbecue, or ask

them to bring a resident’s favorite dish

September 2019 Safety, Oversight and Quality Unit 31

NUTRITION IN AN AFH CONTINUED

Be aware of cooking odors:

• Residents with nausea may not tolerate food smells – use the kitchen exhaust

fan or open a window

Create an inviting dining area. It should be cheerful and well-lit. If residents want to be involved, let them set and decorate the table. Be flexible about seating arrangements. Allow plenty of room to accommodate elbows and wheelchairs. Be creative:

• Have a picnic in the backyard (or better yet a park). A change in scenery can

stimulate the appetite.

September 2019 Safety, Oversight and Quality Unit 32

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MYPLATE CONTINUED

The main concepts of MyPlate are building a healthy diet (plate) by:

• Increasing the amount of vegetables, fruits and whole grains
• Reducing the amount of fat, salt and sugar in your diet
• Working towards increasing physical activity on a daily basis

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A WELL-BALANCED DIET

To achieve a well-balanced diet, you should:

Balance calories

• Enjoy your food, but eat less. Avoid oversized portions
• Increase the portions of fruits and vegetables to half of your plate
• Increase whole grams
• Decrease fats, sugars and salt

Increase whole grains

• Replace at least half the grains with whole grains

September 2019 Safety, Oversight and Quality Unit 35

A WELL-BALANCED DIET CONTINUED

Increase vegetables and fruits

• Make half your plate fruits and vegetables
• Eat red, orange and dark-green vegetables such as tomatoes, sweet potatoes and

broccoli in both main and side dishes

• Eat fruit, vegetables or unsalted nuts as snacks

Reduce certain foods

• Reduce fats
• Cut back on foods high in solid fats and switch to oils such as olive oil when preparing

foods

September 2019 Safety, Oversight and Quality Unit 36

A WELL-BALLANCED DIET CONTINUED

• Reduce salt intake
• Reduce the amount of red meat – substitute fish, beans or poultry
• Drink water instead of sugary drinks
• Be active every day
• Pick activities you like - start by doing what you can, at least 10 minutes at a time
• Every bit adds up, and the health benefits increase as you spend more time being active

September 2019 Safety, Oversight and Quality Unit 37

WELL-BALANCED DIET CONTINUED

You can provide a nutritious, well-balanced diet for your residents by serving daily meals and snacks made up of foods from ChooseMyPlate. The food groups include vegetables, fruits, grains, proteins and dairy. The pictures used in ChooseMyPlate depict the approximate proportion of servings from each food group recommendation.

September 2019 Safety, Oversight and Quality Unit 38

WELL-BALANCED DIET CONTINUED

Grains

• Foods made from wheat, rice,
• ats, cornmeal, or barley is a

grain product. Bread, pasta, popcorn, oatmeal, breakfast cereals, and tortillas are some examples.

• Whole grains contain the entire

grain kernel – the bran, germ and endosperm. People who eat whole grains as part of a healthy diet have a reduced risk

• f some chronic diseases.

Daily serving: Adults should have a serving

• f grains with each meal. At least half of

the servings of grains should be whole grains.

September 2019 Safety, Oversight and Quality Unit 39

WELL-BALANCED DIET CONTINUED

Shopping tips

• Check the nutrition label for the fiber content of whole-grain foods. Good

sources of fiber contain 10 percent to 19 percent of the daily value.

• Read the ingredients list and choose products that name a whole-grain

ingredient first on the list. Look for “whole wheat,” “brown rice,” “bulgur,” “buckwheat,” “oatmeal,” “whole-grain cornmeal,” “whole oats,” or “wild rice.”

• Terms such as “multi-grain,” “100 percent wheat,” “cracked wheat,” “seven-

grain,” or “bran” may not contain any whole grains.

September 2019 Safety, Oversight and Quality Unit 40

WELL-BALANCED DIET CONTINUED

Fruits – provide nutrients vital for health, such as potassium, dietary fiber, vitamin C and foliate (folic acid):

• Most fruits are naturally low in fat, sodium

and calories. No fruit has cholesterol.

• Fruits may be fresh, canned, frozen or

dried; they may be whole, cut-up or pureed.

Vegetables are low in fat and calories; they also provide fiber and other key nutrients:

• Fresh, frozen and canned are all good

sources of vegetables. Daily serving: Adults should have between three and six cups of fruit and vegetables each day.

September 2019 Safety, Oversight and Quality Unit 41

WELL-BALANCED DIET CONTINUED

Shopping tips

• Buy fruits and vegetables that are in season for maximum flavor at a lower
• cost. Check your local supermarket specials for the best-in-season buy or visit

your local farmers market.

• When using canned vegetables, check the label from the amount of added
• salt. Most frozen vegetables do not have added salt unless the vegetables are

in a sauce.

September 2019 Safety, Oversight and Quality Unit 42

WELL-BALANCED DIET CONTINUED

Dairy:

• Milk, yogurt, cheese and

fortified soymilk all are good sources of dairy.

• Calcium, vitamin D, potassium,

protein and other nutrients are needed for good health through life.

• Choices should be low-fat or fat-

free to cut calories and saturated fat.

Daily serving: Adults need three cups a

• day. What counts as one cup? 1 cup of

milk or yogurt, 1-1/2 ounces of natural cheese; 2 ounces of processed cheese.

September 2019 Safety, Oversight and Quality Unit 43

WELL-BALANCED DIET CONTINUED

Shopping tips:

• If you are lactose intolerant, try lactose-free milk, drink smaller amounts of

milk at a time, or try soymilk (soy beverage). Check the nutrition facts label to be sure the soymilk has about 300 mg of calcium.

• Choose cheeses with less fat. Look for “reduced-fat” or “low-fat” on the label.

Try different brands or types to find the one you like.

• Regular cream cheese, cream and butter are not part of the dairy food group.

They are high in saturated fat and have little or no calcium.

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WELL-BALANCED DIET CONTINUED

Protein

• Includes both animal and plant

sources.

• Protein is a source of B vitamins,

vitamin E, iron, zinc and

• magnesium. Animal protein

includes meat, poultry, seafood and eggs.

• Plant protein includes beans,

peas, soy products, nuts and seeds.

Daily serving: Adults should eat 5-7 ounces of protein each day. What counts as one ounce? One ounce lean meat, poultry or seafood, One egg or one quarter cup of cooked beans or peas; One-half ounce of nuts or seeds; one- half tablespoon of peanut butter.

September 2019 Safety, Oversight and Quality Unit 45

WELL-BALANCED DIET CONTINUED

Shopping tips

• Choose lean or low-fat cuts of meat. Ground beef at least 90 percent lean is

considered lean.

• Eat seafood in place of meat or poultry twice a week. Try beans and peas

instead of animal protein. They are naturally low in saturated fat and high in fiber.

• Check the nutrition facts label to limit sodium. Salt is added to many canned

foods including beans and meats. Many processed meats such as ham, sausage and hotdogs are high in sodium.

September 2019 Safety, Oversight and Quality Unit 46

WELL-BALANCED DIET CONTINUED

Solid fats, sugars and salt (sodium):

• Most people eat food with too many solid fats, added sugars and/or salt

(sodium)

• Added sugars and fats load foods with unneeded extra calories
• Prepared foods frequently have hidden (or not so hidden) amounts of

solid fats, sugar and salt

• Check the nutrition facts label on all prepared food you purchase. There can

be a big difference in the amount of fats, sugars and salt between different

• brands. For example, some brands of spaghetti sauce have lower amounts of

sodium but do not label the product as “low sodium” or “low salt.”

September 2019 Safety, Oversight and Quality Unit 47

MENU PLANNING

September 2019 Safety, Oversight and Quality Unit 48

PURPOSE AND KEY TERMS

The purpose of this section is to help the learner acquire an understanding of how to plan a well-balanced diet for residents using the ChooseMyPlate (formally Food Guide Pyramid.)

• Diet
• ChooseMyPlate (formally Food

Guide Pyramid)

• Menu plan

September 2019 Safety, Oversight and Quality Unit 49

OBJECTIVES

The learner will be able to:

Understand how menu planning for residents is different from planning meals for your family Utilize the ChooseMyPlate when planning a menu Develop a menu plan

September 2019 Safety, Oversight and Quality Unit 50

INTRODUCTION

Menu planning for an AFH, is different than planning meals for your

• family. Residents’ family, religious and cultural background, as well as

medical and age-related conditions, will influence their food

• preferences. Consider:
• Resident’s family traditions
• Religious and cultural backgrounds
• Medical needs and restrictions
• Age-related conditions

September 2019 Safety, Oversight and Quality Unit 51

INTRODUCTION CONTINUED

You will need to plan on:

• Offering residents a greater variety and choice of foods
• Developing menus to ensure residents have at least a week (preferably a

month) advanced notice

• Scheduled meals
• Scheduled and on-demand snacks

September 2019 Safety, Oversight and Quality Unit 52

INTRODUCTION CONTINUED

Shopping to ensure the residents will be offered well-balanced meals and snacks even when you are away and someone else prepares them. Planning and making available food choices:

• In-between meal snacks
• When a resident will want to eat at times other than the AFH-scheduled

meals

September 2019 Safety, Oversight and Quality Unit 53

MENU PLANNING BASICS

Menus should be developed using the serving recommendations for each food group as outlined in the USDA’s MyPlate.

• The MyPlate guidelines are not the only approach to developing a meal plan,

but they are appropriate for most people.

• You may need to make some changes to satisfy special dietary needs and

restrictions for individual residents.

September 2019 Safety, Oversight and Quality Unit 54

MENU PLANNING BASIC CONTINUED

In addition to using the MyPlate guidelines, here are some tips to assist with developing a menu plan for your residents:

• Make sure to include all food groups daily
• Do not use one food group to replace another
• An extra serving of meat will not supply the same nutrients as a serving of

vegetables

• Substitute within the same food group – for example, if a resident does not

like to drink milk, substitute cottage cheese, cheese, yogurt or another dairy food

September 2019 Safety, Oversight and Quality Unit 55

MENU PLANNING BASICS CONTINUED

• Vary the foods you serve – serving different foods each day makes mealtime

interesting

• Try new foods – ask residents for suggestions and ideas
• Use fresh foods whenever possible. Fresh fruits and vegetables in season are
• ften less expensive and fresh vegetables do not have sodium unless salt or a

sauce is added during or after cooking.

• Some of your residents may have grown their own vegetables and enjoy a

wide variety – having a home garden may encourage residents to eat different fresh foods

September 2019 Safety, Oversight and Quality Unit 56

MENU PLANNING BASICS CONTINUED

• Prepare foods in different ways - chicken can be barbecued, baked, broiled or

stewed; it can be served whole or sliced; hot or cold, in a pot pie, soup or salad

• Be creative with combination foods – soup, stew, chili, casseroles, macaroni

and cheese, and lasagna are examples of combination foods that contain multiple food groups

• Leftover meat such as chicken or beef a wonderful start of homemade soup
• Limit foods with high sugar content – try serving healthier desserts and

sweets such as fruits

September 2019 Safety, Oversight and Quality Unit 57

MENU PLANNING

The menu plan must include the minimum recommended servings from each of the food groups as outlined in MyPlate:

• DAILY:
• Provide at least one serving of vegetable or fruit high in vitamin C such as

citrus fruits, cantaloupe, tomatoes, strawberries, broccoli etc.

• THREE OR FOUR TIMES A WEEK:
• Provide at least one serving of vegetables or fruit high in vitamin A.

Vitamin A is found mainly in dark green and yellow vegetables such as carrots, broccoli, spinach, pumpkin and sweet potatoes.

September 2019 Safety, Oversight and Quality Unit 58

MENU PLANNING CONTINUED

Create a menu glossary to assist with menu planning:

• A menu glossary is a list of foods and recipes used to plan daily menus
• Use menu glossary forms to list main dishes for breakfast, lunch and dinner;

vegetables; foods high in vitamins A and C; and nutritious desserts

• The menu glossary should change as you discover new dishes or your

residents’ needs change

• Use the names of prepared food items (e.g., poached eggs) or titles of recipes

– note how often you will want to repeat these items

September 2019 Safety, Oversight and Quality Unit 59

MENU PLANNING CONTINUED

• Keep in mind residents’ usual eating habits, including favorite foods
• Be mindful of any dietary restrictions ordered by the resident’s medical

practitioner and as requested by the resident

• Be aware of, and prepare for any
• Chewing or swallowing problems
• Self-feeding problems (e.g. difficulty cutting their food)

September 2019 Safety, Oversight and Quality Unit 60

MENU PLANNING CONTINUED

Other menu planning tips:

• Follow your basic menu pattern, using different foods from all the food

groups each day

• Use the Seven-day Menu form to write down your daily menus for a week –

try not to repeat a dinner main dish during that period

• Adjust your menus for holidays, birthdays and other special events
• Keep a recipe file – refer to your recipes as you plan your menus so you will

know what foods are included from the different food groups

September 2019 Safety, Oversight and Quality Unit 61

MENU PLANNING CONTINUED

• Ask residents for their favorite recipes
• Make grocery shopping lists based on your menus - this ensures you will have

all ingredients needed for the menu plan

• Write notes on your menus - jot down notes to help you plan future menus

and note if residents liked or disliked something you prepared

• Review recipes to increase nutrient density – add nutritious ingredients

(powdered milk and vegetables) and decrease excess fat, salt and sugar

September 2019 Safety, Oversight and Quality Unit 62

MENU PLANNING CONTINUED

File all your weekly menu plans, along with your notes, shopping lists and receipts:

• Receipts tell how much you spent to prepare a week’s worth of menus
• You may want to price recipe ingredients, particularly main dishes, and note

the cost on the recipe (this procedure will aid you in controlling food costs)

September 2019 Safety, Oversight and Quality Unit 63

MENU PLANNING CONTINUED

Remember it is important to:

• Enhance each resident’s independence by respecting food choices and

preferences

• Provide nutritious, well-balanced, appealing meals and snacks in a pleasant

atmosphere

• Consult with the resident’s primary care practitioner or a registered dietitian

if you have questions or concerns

• Use the menu planning tools found on the EQC website to assure the menus

you develop meet the overall nutritional needs of your residents

September 2019 Safety, Oversight and Quality Unit 64

READING NUTRITION LABELS

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NUTRITION LABELS

The first place to start when you look a the “Nutrition Facts” label is the serving size and the number of servings in the package:

• Serving sizes are standardized to make it easier to compare
• Use familiar units, such as cups or pieces, followed by the metric

amount, e.g., the number of grams The size of the serving on the food package influences the number of calories and nutrient amounts.

• Pay attention to the serving size, especially how many servings there are

in the food package

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1

THE SERVING SIZE

NUTRITION LABELS CONTINUED

Calories provide a measure of how much energy you get from a serving of this food. The calorie section of the label can help you manage your weight (i.e., gain, lose or maintain). General guide to calories

• 40 calories is low
• 100 calories is moderate
• 400 calories or more is high

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2

CALORIES (AND CALORIES FROM FAT)

NUTRITION LABELS CONTINUED

Limit these nutrients:

• Eating an excess of fat, saturated fat, trans fat cholesterol or sodium

may increase the risk of certain chronic diseases such as heart disease, some cancers or high blood pressure Important: Health experts recommend that you keep your intake of saturated fat, trans fats and cholesterol as low as possible as part of a nutritionally balanced diet.

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3

THE NUTRIENTS: HOW MUCH?

NUTRITION LABELS CONTINUED

Get enough of Vitamins A, C, Calcium and Iron:

• These nutrients can improve health and help reduce the risk of

some diseases and conditions such as reducing the risk of

• steoporosis
• Eating a diet high in dietary fiber promotes healthy bowel function

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4

THE NUTRIENTS: HOW MUCH?

NUTRITION LABELS CONTINUED

“Percent Daily Value” (%DV) on the “Nutrition Facts” label refers to the footnote in the lower part of the nutrition label, which tells you “Percent DVs are based on a 2,000 calorie diet.” This statement must be on all food labels. The full footnote may not be

• n the package if the label is too small.

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5

UNDERSTANDING THE FOOTNOTE This doesn’t change from product to product, because it shows recommended dietary advice for all Americans – it is not about a specific food product.

NUTRITION LABELS CONTINUED

The percent of daily values (%DVs) are based on the daily value recommendation for key nutrients but only for 2,000-calorie daily diet – not 2,500 calories. The %DVs helps you determine if a serving of food is high or low in a nutrient.

• The %DVs column doesn’t add up vertically to 100%. Instead each nutrient

is based on 100% of the daily requirements for that nutrient (for a 2,000- calorie diet). This way you can tell high from low and know which nutrients contribute a lot, or little, to your daily recommended allowance (upper or lower).

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6

THE PERCENT OF DAILY VALUE (%DVs)

NUTRITION LABELS CONTINUED

Plain Yogurt Fruit yogurt

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OTHER CONSIDERATIONS

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TABLE SETTINGS

How a table is set can improve eating:

• Plain colored dishes, as opposed to dishes with patterns, make it easier for

residents with vision problems to distinguish food

• Residents with dementia may mistake a design on a plate as something to eat
• Other considerations:
• Contrasting tablecloths or placements make it easier for residents who have

vision problems to tell where dishes end and the table begins

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TABLE SETTINGS CONTINUED

• Colored glasses for water and other clear beverages may make it easier for

some residents to distinguish what they are drinking

• Mugs and cups with large handles are easier to grasp and hold for people who

have arthritis or other needs for hands and finger flexibility and control.

• Special self-help devices such as one-handed knives, knife-fork combinations,
• r a food guard to keep food on the dish may be helpful for residents with

motor ability needs.

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TABLE SETTINGS CONTINUED

• Flatware that is solid, sturdy

and easy to hold is best

• Lightweight or slender-

handled flatware can be hard to grip, hold and control

• Enlarging handles with

foam rubber can make flatware easier to grip for persons who have arthritic or trembling hands

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SPECIAL NEEDS

Age-related changes and health problems often have a negative effect

• n the eating habits and dietary intake of your residents, such as:
• Decreased ability to taste. Aging decreases the ability to taste sweet and

salty foods

• Decreased vision. Those with decreased vision may have a hard time

distinguishing one food from another; a resident may have a blind side due to a stroke or other condition – encourage the resident to look to the blind side

• r to turn the plate so they can see their food

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SPECIAL NEEDS CONTINUED

• Medications that affect how food tastes. Digestion can also be

affected by medications and even plain aspirin can upset the stomach

• Chewing and swallowing difficulties. Older people who have

teeth or gum problems, poorly fitted dentures, dry mouth or sores in the mouth may have problems eating

• Illness, fatigue and pain. Meals may need to be served at unusual

times

• Difficulties with digestion. Some people avoid certain foods or eat

less if they have problems with nausea, heartburn, bloating, diarrhea or constipation

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SPECIAL NEEDS CONTINUED

• Physical changes. Residents who have arthritis or Parkinson’s disease
• r have had a stroke may find it hard to eat because of deformed,

painful or trembling hands, weak arms or drooling.

• Changes in mental abilities. Residents who have Alzheimer’s disease,

stroke or other disorders may have trouble remembering to eat. They may be confused by family-style dining.

• Changes in long-standing patterns and habits. Residents who come

to your AFH have probably been used to preparing their own food, and eating what and when they want. Remember it takes time to adjust to changes to lifelong routines.

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SPECIFIC CONCERNS

A resident may not like the food you prepare or how it’s prepared, or they may not be used to eating at the times you serve meals and

• snacks. Residents used to living and eating alone may not want to eat

with others:

• Eating may be the last area of control in the life of a resident. Complaining

about the food, refusing to eat certain foods, or refusing to eat at all may be an act of independence and self-control.

• If there is a change in appetite, document it. Monitor to determine the cause

and take action to remedy the situation.

• Offer food at other times or offer other food
• Is the concern continues, contact their primary healthcare practitioner

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SPECIFIC CONCERNS CONTINUED

Changes to taste:

• Ask residents what foods taste good and what foods don’t taste good
• Enhance flavor with tart seasonings (e.g., lemon or lime juice)
• Marinate meats in juices, sauces or wine
• Vary meals to include cold or room-temperature foods; they may seem more

flavorful to the resident

• Encourage the resident to rinse the mouth often for a fresh, clean taste

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SPECIFIC CONCERNS CONTINUED

Nausea and vomiting:

• Maintain the resident’s recommended fluid intake – provide resident with dry

foods (e.g., crackers or toast) when the person first wakes up

• Encourage drinking fluids between meals, no with meals; clear, cool

beverages are the best

• Encourage the resident to remain upright (i.e., not to lie down flat) for at least

two hours after eating

• Avoid the smells of cooking as much as possible
• Keep well-linked foods on hand that don’t require much preparations

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SPECIFIC CONCERNS CONTINUED

Mouth and throat problems:

• Be alert for problems with teeth or dentures; get them corrected, if possible
• Provide softer diet (e.g., add gravies or sauces)
• Avoid rough, course foods – use tender cooked and ground meats, fish, eggs,

cheese and legumes

• Allow hot foods to cool slightly before serving
• Provide mild flavored fruits such as bananas or pears

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SPECIFIC CONCERNS CONTINUED

Tiredness, fatigue, pain:

• Encourage the resident to rest before meals
• Offer foods when the resident feels like eating
• Keep foods readily available that don’t require much preparation
• Allow the resident plenty of time to eat or provide smaller and more frequent

meals

• Serve foods when pain-relieving medication is most effective

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SPECIFIC CONCERNS CONTINUED

Diarrhea, bloating, heartburn:

• Encourage the resident to eat more slowly
• Encourage the resident to eat small meals more often
• Establish a routine mealtime
• Encourage the resident to eat sitting up straight and to remain upright after

meals

• Discourage consumption of carbonated beverages, beans and cabbage-family

vegetables

• Avoid caffeinated beverages
• Do not serve fatty or spicy foods
• Encourage drinking of fluids between meals

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SPECIFIC CONCERNS CONTINUED

Constipation:

• Encourage the resident to eat more fruits and vegetables (five to nine

servings a day)

• Encourage the resident to eat more whole grains
• Try gradually adding bran to foods
• Encourage the resident to drink plenty of fluids (eight to 10 glasses per day)
• Provide prune juice or hot lemon water
• Encourage exercise, even if it is only stationary exercise

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SPECIFIC CONCERNS CONTINUED

Heightened emotions:

• Take time to listen to the person, offer positive feedback, compliments and

reassurances

• Let residents know that food is available whenever they feel like eating
• Try to limit times for eating, or limit snacks to nutrient-dense foods, if
• vereating
• Involve the resident in meal planning
• Serve familiar/favorite foods
• Respond to lifelong eating patterns, if possible

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SPECIFIC CONCERNS CONTINUED

A resident may have a physical or mental disability that makes self- feeding difficult. Encourage self-sufficiency. However, a resident may need to be fed or guided through a meal. In these cases:

• Provide adaptive devices
• Provide foods that do not require the use of utensils such as “finger” foods,

soup in a mug, etc.

• Build up handles on utensils
• Serve food in bowls with high sides – keep table setting uncluttered

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SPECIFIC CONCERNS CONTINUED

• Use contrasting colors in place setting
• Be consistent in placing food on the plate in a specific order (and plate on

table):

• For example, for a resident with vision needs– potatoes are at 3 o’clock

position, meat is at 6 o’clock position, etc.

• Maintain a simple, consistent mealtime routine
• Maintain a quiet, unrushed atmosphere
• Serve one course at a time to reduce confusion
• Provide a full apron, rather that a bib, to help keep the resident’s clothes

clean

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EATING WITH ASSISTANCE

You may need to assist a resident with eating. To best assist the resident:

• Take it slow – check with the resident and make sure you aren’t going too fast
• r too slow
• It takes 30 – 45 minutes to safely assist or feed a person
• Offer smaller bites when assisting in feeding
• Relate to the resident – convey caring, understanding and interest in the

resident;

• Preserve the resident’s dignity – do not say things such as, “You can’t have

dessert until you finish your peas.”

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EATING WITH ASSISTANCE CONTINUED

• Talk about the food and what you did to prepare it – it may be better to talk

before or after feeding, so that the person can concentrate on eating

• Comply with food likes and dislikes, when possible
• Avoid mixing food together – if you puree foods, keep them separate
• Offer foods at the right temperature for comfort and safety
• Position the resident properly – they should be sitting upright and learning

slightly forward

• Remind the resident to chew and/or swallow, if necessary

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EATING WITH ASSISTANCE CONTINUED

• Do not rush the resident – rushing increases the risk of choking, spiting out

food or refusing to eat

• Aspiration can occur at anytime but is most common during eating or

drinking

• Keep the resident clean – for instance, gently wipe corners of the mouth and

chin to remove food or saliva

• Offer fluids after the mouth has been emptied

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REFUSAL TO EAT

If you have tried everything and a resident still refuses to eat:

• Consider the resident’s health or medical condition
• Have they been ill or not been feeling well?
• Have they started a new medication?
• Could they be experiencing difficulties related to the progress of a

diagnosed disease?

• Have they experienced a recent loss, perhaps the death of a loved one or

close friend?

• Talk with the resident. Ask, for example, “Are your dentures hurting?” or “Are

you thirsty?”

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REFUSAL TO EAT CONTINUED

• Encourage the resident to propose food options:
• Ask them what the they would suggest to stimulate eating and keep up

strength

• Record any references or suggestions on the resident’s care plan
• Respond to special needs and preferences, if possible:
• Keep favorite foods and healthy snacks readily available (see end of

chapter for snack ideas)

• If appropriate, increase the protein and calorie content of foods eaten
• Consult a registered dietitian for suggestions

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REFUSAL TO EAT CONTINUED

• Document the concerns:
• Make clear notes in the resident’s narrative – include date and time, the

food served and refused, and the approaches you used to encourage eating

• Note other contributing factors, such as illness or pain
• Discuss the concern with an appropriate care team member who may have an

idea you have not tried, or who may be able to entice the resident to eat when your efforts have not worked

• Advice from a registered dietitian, especially one who understands older

adults, can be helpful

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REFUSAL TO EAT CONTINUED

• Report the problem to the resident’s primary health practitioner
• This is especially import and if the resident is losing weight or has a medical

condition, such as diabetes, which requires regular food intake as part of the necessary care

• Sometimes a resident will respond if the physician prescribes a special diet

Remember, you cannot force another person to eat, even if they depend

• n you for care.
• You must respect the resident’s rights.

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EATING OUT

Eating at a restaurant can be still be healthy. Using the following tips you can assist your residents in making healthy choices:

• Drink water or order fat-free or low-fat milk, unsweetened tea or other drinks

without added sugars

• Ask for whole-wheat bread for sandwiches
• In a restaurant, start your meal with a salad packed with veggies to help

control hunger and feel satisfied sooner

• Ask for salad dressing to be served on the side – then use only as much as you

want

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EATING OUT CONTINUED

• Choose main dishes that include vegetables, such as stir fries, kebobs or pasta

with a tomato sauce

• Order steamed, grilled or broiled dishes instead of fried or sautéed foods
• Choose a small or medium portion – this includes main dishes, side dishes

and beverages

• Order an item from the menu instead of heading for the all-you-can-eat

buffet

• Check restaurant websites for nutrition information to assist with planning

ahead

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EATING OUT CONTINUED

If portions at a restaurant are larger than you want, try one of these strategies:

• Order an appetizer-sized portion or a side dish instead of an entrée
• Share a main dish with a friend
• If you can chill the extra food right away, take leftovers home
• When your food is delivered, immediately set aside or pack half of it to go
• Resign from the “clean your plate club” — when you’ve eaten enough,

leave the rest

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EATING OUT CONTINUED

To keep your meal moderate in calories, fat and sugars:

• Order foods without creamy

sauces or gravies

• Add little or no butter to your

food

• Choose fruits for dessert

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DISCUSSION/QUESTIONS

September 2019 Safety, Oversight and Quality Unit