According to the 2006 American Community Survey from the U.S. Census Bureau, nearly 12.5%, or 37,000,000 people, are 65 years of age or older. With more of the baby boomer generation joining that population in the coming years, long-term care and continuing care retirement communities are poised to see not only an increase in residents, but also a group of younger residents who expect more from their dining programs.
Casual dining: “Recently, a lot of the new residents are coming in from a younger generation,” says Jason Skinner, foodservice director for Sodexo at Meadow Lakes Retirement Community in Hightstown, N.J. “We are seeing less desire for formal dining and more of a focus on casual dining.” The average age of the community’s 340 residents is 64. Skinner says residents had a concern with the dress code for dinner, which required jackets for male residents. A house committee recently overturned the dress code. Before the change, Skinner had a casual dining night on Mondays as a way to appease the desires of all residents. “We met them half way, and funnily enough, Monday was our busiest night,” Skinner adds.
Barbara Chappetta, corporate director of culinary and nutrition services at the Philadelphia-based ACTS Retirement-Life Communities, also sees the trend toward casual dining. “I think the biggest trend is moving into an environment where there is more of a marketplace look and feel to cafés and incorporating them into the lobby so that way when a guest, a prospect or anyone walks into the building, they are immediately drawn into a marketplace environment,” she says.
These marketplace, or bistro, locations are being developed in the 19 ACTS communities on the East Coast, according to Michael Smith, corporate director of public relations. “In the CCRC industry in particular, traditionally there has been a formal dining room and a causal café,” Smith says. “In companies like ACTS, there has been a trend in developing what we call bistros that are designed with a certain theme. One of our communities in Pennsylvania designed its bistro with a New Orleans-style flair. Another one designed its as a typical Main Street with a grill theme. The residents are helping to name these bistros now so there is interactivity.” Chappetta says another benefit of these bistros is that residents use them throughout the day to hold meetings or gather for social events, and not just during typical mealtimes.
Adding options: Another trend many operators are noticing is the desire for more menu options. “Residents want to have input into the menu,” says Carolyn Cooper, foodservice director at the 700-resident Twin Lakes Retirement Community in Burlington, N.C. “They want to have choices on a daily basis and not just select from a menu a week in advance. When they sit down, they want to be able to select right then what they want. A lot of them prefer to see what they are going to eat instead of ordering off of a menu and then having it brought to them. They like to see it prepared before them.”
To offer more options for residents, as well as to accommodate different eating styles, Cooper implemented a five-a-day meal program when the assisted living side of a new Memory Care building opened in July. The first meal is continental breakfast served from 7:30 a.m. to 8:30 a.m. Brunch is served at 10:30 a.m. and includes an omelet bar, eggs to order, waffles, vegetables and fruits and another entrée. A dessert cart makes rounds at 1:30 p.m. Dinner is served from 4:30 p.m. to 5:30 p.m. and a snack cart with sandwiches, cereals, protein bars and beverages is available at 8 p.m.
Cooper says the dining program allows for more one-on-one interaction in the morning between the nursing staff and residents because some residents choose to sleep in later, allowing nurses to spend time with early risers before the continental breakfast and late with risers afterwards. Cooper adds that buy-in from both the nursing and administrative departments has been key in making the five-a-day program successful.
Along with seniors wanting more choices as a whole, directors also note that the residents, particularly the younger ones, want healthier and environmentally-friendly options. “The younger residents are focusing on green initiatives and healthier foods,” Skinner says, “whereas the older crowd is looking for the heavier foods, things they grew up with.” Skinner says he gets a lot of requests for heart healthy, lower carbohydrate and vegetarian options. “Ten years ago here, you would not see a vegetarian item on the menu, but now we have three on average.” Skinner says to appeal to all residents, he makes sure to menu healthier options as well as the heavier comfort food items every day. Skinner says the demand for healthier items is a resident-driven trend and not necessarily a physician-mandated one.
In addition, Skinner, and other chefs from Sodexo, recently created new healthier dessert recipes. Residents now have many more low-sugar and low-calorie options to select from.
Building a community: Operators agree that one of the most important components of senior dining is the social aspect. At the 473-resident Mt. Carmel Health & Rehabilitation Center in Milwaukee, Director of Foodservices Rich Daehn says special events and display cooking are incredibly valuable because they break up regular routines. Daehn says it is important for residents to feel like they have some of the same social events inside a community that they would when they lived in their own homes, such as attending dinner parties. One event held in conjunction with the presidential election was a meal made from the White House Cookbook. The menu included Carter’s chicken cordon bleu, Betty Ford’s banana bread, White House potatoes and Mary Todd Lincoln’s vanilla almond cake. Local culinary students also did a demonstration on making fudge.
Chappetta says the dynamic between residents and staff members, particularly the younger ones, is also very important. “Residents always form these types of attachments in the community with staff,” Chappetta says. “I think the younger staff in particular serves as the grandchild the residents haven’t seen.”
Skinner says the foodservice employees become like extended family members to the residents. “They all know each other by name,” he says. “Our service staff are primarily younger, high school and college kids. It’s almost enjoyable for the residents to see these younger kids learning and growing in front of them.”
Calling All Chefs
Culinary expertise increases in LTC, CCRCs.
Chefs are becoming commonplace at LTC and CCRC facilities, and not just because they are tired of long workweeks.
“I think there has been a real awakening,” says Barbara Chappetta, corporate director of culinary and nutrition services at ACTS Retirement-Life Communities. “Historically, if we had a chef come to us from a restaurant background, it was because he’d had it with 100-hour weeks and wanted to slow down. They were usually a little bit older. I think more and more chefs are understanding that the needs of our residents are very similar to the needs of guests in a restaurant, with the benefit of not having to work late hours or holidays or weekends to the same degree.” Chappetta says another challenge for chefs coming from restaurants is learning how to deal with residents who are not afraid to voice their opinions and whom they see every day.
For Jill Weinstein, director of food and nutrition services at the 240-resident Regeis Care Center in Bronx, N.Y., bumping up the culinary standard at her location meant partnering with the French Culinary Institute in New York City for training. For two weekends in November, 22 cooks from six different facilities worked alongside a chef instructor at FIC to improve knife skills, seasoning techniques, sauce production, presentation and plating techniques.
“Our goal with the training was to improve our overall dining experience,” Weinstein says. “I think there is a lot of focus on food training in acute care in the hospitals, but in long-term care, I don’t think there is a lot of focus on the food.” Weinstein says that because there is a lot of competition in the LTC market, the dining experience plays a huge part in the decision of which facility people choose to live in.
Another component of the partnership with FIC was to boost employee morale. “I find that most of the continuing education, at least through the union, is geared mostly toward nursing and clinical staff.” Weinstien says following the training she has seen a re-energized staff and that the cooks feel more empowered to create new dishes.
Purees: One challenging aspect of senior dining can be meeting all the different dietary regulations, and for many directors, making pureed foods more appealing is a major initiative.
At the Alzheimer’s Resource Center in Plantsville, Conn., Harry Parlee, director of dining and culinary arts, has spent the last couple of months trying to update his impressive pureed foods program, which includes 40 different items. “Our facility director came to me and said, ‘You go to places like Chili’s and you get a steak and they all grill it really well, but it is the sauce that they put on that really makes it,’” Parlee recalls. Parlee took the comment and developed 19 different sauces for taste testing. Of those, nine have been added to the menu, including a roasted shallot rosemary demi-glace and a fresh berry sherry demi-glace.
Parlee says he sees more LTC facilities looking for people with culinary backgrounds. “Facilities are looking to upgrade not only the quality and diversification of the menus but also the presentation,” Parlee says. “They are actually looking for someone who can present something with garnishes.” He says one of the main reasons behind this is because people entering facilities now have a more sophisticated food background.
“The family members seem to be happy with the program and the new sauces,” Parlee says. ”As long as myself and my chefs stay unhappy so that we are always trying to do better, that’s a good thing.”
Dining for Wellness
Program focuses on education to woo residents toward healthy options.
As corporate director of hospitality services for Chicago-based Senior Lifestyle Corporation, David Koelling wanted to provide healthy options for the 9,000 residents in the company’s 50 communities nationwide. The residents and their families also expressed a desire for healthier choices, but when it came to ordering, the residents more times than not passed up the healthier options. So Koelling decided to focus on education about an illness such as diabetes rather than the menu to make an impact on healthy dining. This is the basis behind Dining for Wellness, a program Koelling started earlier this year.
“We tried to provide our residents with a healthy meal and we started down that road like so many by modifying our menus to offer a healthy choice. Many of our residents and our residents’ families told us that they wanted healthier choices and were looking for the opportunity to eat better. Well, of course what happens is no one orders it.
It became almost like window dressing. You feel like you are doing this more for the family to see that it’s available, but the residents really aren’t choosing to eat that way. We figured if were going to succeed, we had to step back and rethink how to make this of any benefit to the residents. What we figured out was that without education and without making it a community activity and effort, we were never going to get anywhere. And that’s how we came up with Dining for Wellness because we wanted to make it a program rather than a meal choice. And so instead of starting off with the food as the focus, we said let’s start off with illness as the focus.
We focused on a six ailments that affect seniors, but that dietary changes can also have a huge effect on. We offer the program every other month. We do that so we get their attention that it’s a big deal. The problem with doing it all the time it that is loses its importance. We started in January with hypertension and blood pressure. We added modules throughout the year, like macular degeneration, diabetes, arthritis and osteoporosis and so on. We put up posters. One said that studies have shown that people with pets have lower blood pressure than non pet owners, or eating ample amounts of garlic can help decrease high blood pressure.
We have a minimum of two lectures and activity programs during the month on the topic. For our communities, we produce an outline with information about the ailment and about all of the dietary effects of this ailment. During the seminars, the communities will bring in speakers. We also give the residents a packet with information about the ailment and how to manage it. Each community sets up an outside program. One community did cooking demos in the dining room demonstrating some blood pressure menus. Another community took a field trip to a grocery store and did aisle walking to discuss food labels. That gets them engaged.
The month ends with a gala dinner. The whole menu is designed around this particular health issue, so every product on the menu is chosen because of the effect it has on the issue. The menu states how the items effect the ailment. For instance, roasted garlic and white bean soup was on January’s menu. The line says a diet rich in garlic has been shown to lower blood pressure and legumes are a necessary part of a balanced diet. These items are the only things available. Because they are upscale and fun, they go along with it and get it, but again, education is a huge part of the process.
Our menus have a check mark next to the idea that would be the best choice if you were concerned with that month’s ailment. We have seen a significant shift toward those items being ordered. So we have seen a measurable effect in changing their eating habits. It’s been really powerful to see.
We will continue next year. We were surprised by the success of the programming part, so we are going to increase the amount of programming. As we identified early on, without educating and making residents a part of the process, we can’t just put food down in front of them and say this is better for you and this is not and expect them to make the right decision every night. When a resident can feel the immediate effect of eating on the program for a month and they see their blood pressure is down, it gets their attention pretty fast.”