Harry Parlee, director of dining and culinary arts at the 134-resident Alzheimer’s Resource Center in Plantsville, Conn., knows the challenges that Alzheimer’s patients can have with meal times. To combat these frustrations, the Alzheimer’s Resource Center has developed Dining with Friends, a program that brings the enjoyment of dining back to residents and staff alike.
What is the Dining with Friends program?
Dining with Friends starts off with recognizing that each resident is an individual so you need to learn each resident’s individuals likes and dislikes. It is a person-centered approach to dining that offers innovative solutions to overcome the roadblocks that dementia has on nutrition, hydration and socialization.
What are the core concepts of Dining with Friends?
The program focuses on four areas: dining is social, independence, nutrition and environment.
Dining is social: It’s not just about the food but the interaction. Getting to know each individual resident is important because the more you know about them the better the conversation you can have at the table. It’s also about incorporating residents into meal preparation and making sure staff eats with the residents.
Independence is about helping the residents do what they can do on their own. By using verbal and visual cues, you can help a resident eat or drink on their own. If you start eating and drinking with residents, it helps them to remember how to eat. If you just sit there, they just sit there. They need little nudges, but they can do it. If you just put your hand under their hand and help them, then they can get it. Without that kind of help they won’t get it.
Nutrition focuses on adapting menu preparation as the disease progresses so that residents still enjoy eating so they maintain good nutrition. We do this with our Caring Hands Cuisine.
To enhance the environment we use real cups and plates because paper products remind residents of something that is temporary. We don’t want trash from wrappers on the table because it creates clutter. No one wears whites. There is nothing sterile. There is a player piano on each unit that is programmed to play music. There are no lazy Susans; there are no trays. There are fresh flowers. There are no bibs. We use dining scarves instead.
It’s a total coordinated effort across all departments. The recreation people bring in different activities. There was a fourth-grade class that came in to sing once.
For me, it’s never enough. We can never do enough for them.
What is the Caring Hands Cuisine?
Caring Hands Cuisine is an attempt to keep quality culinary products even though you are working with challenging variations of diets. I have to take into consideration color contrast and flavor garnishing just like I did when I was the executive chef at a restaurant. Eye appeal is very important because you eat with your eyes first.
Some residents need finger foods. One of the creative ways we have found to turn our chicken dishes into finger foods is to take the chicken pot pie, dice it into small dices, fold it into a puff pastry, brush it with egg wash and bake it in the oven until golden brown.
I was the director at The Ethel Walker School (an exclusive all-girls boarding school in Simsbury, Conn.) for five years and there is very little difference in this menu and the menu we served there for girls whose parents pay $30,000 a year for school.
What changes do you make in dining services as the disease progresses?
On 2A and 2B there are residents who are further along, and the amount of activity, involvement and distractions that we try to inject to upgrade the quality of dining and life changes. On 1A and 1B, you can have music and you can be down there sautéing and hitting the residents with aromatherapy. We’ll carve roast turkeys for the holidays. Those units enjoy that kind of activity, but as they progress distractions are bad.
We can do some things to enhance the dining quality for residents as the disease progresses. We always try to keep in mind what activities they enjoy. For some residents, the quality of the puree is what they enjoy. We sauce, paint and garnish our foods. Some residents can’t enjoy that, but we have a lot of people who visit their family members and they can see and appreciate the efforts that go into our dining program. That’s why we do a ton of functions to keep the spirits of the family members up because Alzheimer’s is a really horrible disease. We try to do everything that we can to make the families forget. We do ‘50s sock hops to hoe downs.
What is the biggest misconception about food in long-term care facilities?
The stigma has always been that pureed food is horrible so why make an attempt to improve because it’s bad from the start. Or that you can’t do anything out of the ordinary or improve the quality of the appearance because it’s too hard. All it takes is a little effort and thinking out of the box. It takes as much effort to do something really upscale as it does to complain about wanting to do it.