Nina Dubman: Change Maker

The Apostolic Christian Church, which believes in and promotes the doctrines of the gospel found in the Bible, operates 10 nursing homes for the elderly in five states, in addition to two hundred apartment units for elderly persons not requiring specialized care. When one of them—Apostolic Christian Resthaven, serving 50 residents as well as those in 18 independent apartments in Elgin, Ill.—sought a director of dietetic service eight years ago, a warm, experienced and enthusiastic Jewish dietitian was promptly hired for the job.

As the administrators knew—and the dietitian soon found out—religious beliefs have nothing to do with qualifications for the job. Now, about the only time Nina Dubman, RD, LD, CFE, thinks about hers is when she leaves work early on Fridays and takes all major Jewish holidays off, as agreed to in her contract.

Hearing aid: To know Dubman at all is to realize that she's an unflappable, can-do, low-key person who can be depended upon to get the job done without losing her cool. And—possibly most important of all attributes—she's a good listener. It's a trait that her employees as well as the residents have come to value. In fact, without it, a total revamp of the facility's recipes and menus undertaken this year could have caused great dissension both back- and front-of-the-house in this 20-year-old, upscale facility.

According to Dubman, upon her arrival at Resthaven in 1996, there had not been a revamp of menus in more than a decade—"and I felt it was overdue." Using her distributor's software package, she and her staff created a menu that was, and is, individualized for the facility's needs and focused almost entirely on scratch-cooking; about 95% of items on the menu are homemade, from soups to entrees to breads and cakes.

In addition, "my arrival added more continuity to the department because I'm also a clinical dietitian," Dubman explains. "We were able to eliminate the consultant dietitian position and I'm therefore responsible for doing menu planning and patient documentation. I do each quarterly assessment, annual assessments, lab results and new admissions assessments. Plus, if there's any improvement or deterioration in a resident's status, we have to do assessments as well as calorie counts if they're not eating well."

With the introduction of the new menu this year, Dubman expected complaints, especially when it came to such relatively "nouvelle" items as stuffed salmon, but they didn't materialize. The most she heard were a few questioning, "what's that?"

Carb counting key: The fact that only 25% of residents are on a regular, non-restricted diet doesn't seem to faze the staff, who turn out diabetic, mechanical, dysphagia, puree, low-sodium, diabetic and calorie-restricted meals, as well as versions featuring no concentrated sweets. "The most challenging aspect of 'special diets' is that we use carbohydrate counting," Dubman points out.

"This actually allows diabetics and those on 'no concentrated sweets' to have more items than they could before. I started this when I instituted the new menus. Now, there are new diabetic desserts and upgraded puree diets—including puree breads for sandwiches and slurried cakes so they're like the real thing."

Puree breads have proven to be a successful addition from the residents' perspective and not too time-consuming for the kitchen. A commercially packaged puree bread mix is put into a loaf pan along with hot water. It sets within 20 minutes and can also be shaped with a scoop to make rolls. For breakfast, residents on puree diets can now enjoy scrambled eggs with "toast."

Dubman believes she's got the full support of administrators, since they'd rather have the residents satisfied with good quality food—as highlighted in the facility's promo brochures—than dining services striving to be a profit center. Since administration favors the made-from-scratch approach emphasis over the use of convenience items, no staff reduction has been necessary.

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