Nutrition Tips from NTE’s Finest
Turning Your Kitchen Staff into Family – by Danelle Wiley RDN
The kitchen staff in your facility work closer together than any other department. They are confined within the walls of the kitchen prepping food, fluids and nourishments for the Residents. They go non-stop from meal to meal with cleaning and prep in between tray line. But how do you change the environment from just co-workers to being a kitchen family and is this beneficial? This is Danelle’s top on the list for nutrition tips.
The benefit of having a family-type environment in the kitchen is that it provides a cohesive, positive atmosphere. The team will work better together, be supportive of each other, and fill in when someone is sick or on vacation. Additionally, tray line will run smoothly because the cook and the aides will have better communication. The family type environment will also provide a better outcome during survey because the kitchen team will work together to ensure the kitchen is clean, items are labeled, and food is out on time. Also, mistakes can be avoided because they will be more aware and looking out for each other.
Some ways to make this change in your kitchen are to have an all staff meeting and discuss the current issues in the kitchen and let everyone speak about their concerns. Also, be active in the kitchen. This includes tasting the food, being available for questions, empowering the staff to voice their thoughts, and assisting on tray line when you can. Your actions of being team player and working on the floor will show the rest of the staff that everyone is equal when in the kitchen.
It may take some time to make this change in your kitchen, there may even be some resistance at first. Over time everyone will get on board and see the benefits. If this is already the environment in your kitchen, continue to keep the environment positive and always strive for improvement. With better attitudes will come better food, which leads to happier Residents and nothing is better than that.
Squash Soup with a Twist – By Paul Ladewig RDN/Chef
It is always our goal to feed our residents in a way that seems perfect for them. With that in mind trying to cook with seasonal food is a must and since we have such a wide array of ethnicities and backgrounds in our homes it is always good to take another look at recipes that we love and maybe put a little twist on them for people. One recipe that seems to scream Fall season is Butternut or Acorn squash soup. The creamy velvety texture and rich flavor is perfect for our crowd and can take on many various identities while still retaining its core flavor.
There are a few core ingredients which we will go over as well as techniques but then we will diverge a bit and explore some alternative ways to flavor our soup. The basic ingredients for any squash soup are as follows:
Butternut squash, Optional carrots, Onions, Celery, garlic, Vegetable stock, Cream, Nutmeg, Thyme, Oregano, Butter and Salt and Pepper to taste.
With that alone cooked in the correct order and pureed till smooth you will have a beautiful product. However, we can do better.
If we want a French flavor we can caramelize and roast fennel and shallots and deglaze with a white wine vinegar before adding the vegetable stock and then finish it off with a brown butter sauce.
To bring in some flavors from the Indian Subcontinent and also make our soup more flavorful and healthy we could stir in Garam Masala and lentils into our already pureed soup and top it off with a dollop of spiced yogurt
By using this concept with all our meals and adding some excitement to our recipes by very simple changes we can enrich the lives of our residents through food.
Food as an Activity – By Sukanya Singh, MS, RDN
Residents who call long term care home have lost control over a lot of aspects of their lives. Some have dementia, some has other physical disabilities and some come for short term rehab. Food is the one thing that they miss the most.
Food brings comfort and ignites so many memories. The Activity department in collaboration with department of nutrition and food services can create new experiences for the residents. These departments can work hand in hand to create food related activities such as candle light dinner, coffee social, Ice cream social, and cooking classes.
These activities can spark interest among residents and help in bringing more residents to the dining rooms. The residents can socialize with each other and the more residents that come to the dining room the more help can be provided to them such as offering an alternate, helping in eating or opening packets. These foods related activities can also provide the residents with additional calories and prevent weight loss. These activities can bring a little bit of home to these residents, help them socialize, and make their stay a more pleasurable experience.
Examples of some of the food related activities:
- Baking Bread in bread maker that will perfume the hallways as it rises and bakes. The only ingredients needed are water yeast water and some salt and sugar. The only equipment needed is a bread maker.
- Making soup as an activity in the morning using produce from their own garden. The ingredients can easily be brought from the kitchen already prepped. The equipment required: an induction stove a slow cooker, a pan and an immersion blender if necessary to make purees.
- Making cookies especially around the holidays can bring residents out of their rooms. The aroma of fresh baked cookies is something that sparks memories of our childhood. The kitchen can provide ingredients like butter, flour, eggs, etc (alternatively dough can be provided to make the process easier. These cookies can be decorated by the residents. The only equipment needed will be a toaster oven.
- Making Smoothies and ice creams can provide the residents with Kcal needed as well as hydration during summer.
- Having cooking classes and recreating a recipe from a resident’s past can bring a lot of confidence and build their self-esteem.
- Having candle light dinner for special occasion give chance to the family members to come spend time with their loved ones. These occasions also help in breaking the monotony of the cyclic menu and help resident to look up to.
- Coffee social with fresh baked cookies.
- Breakfast Buffet where the eggs are cooked to order.
Southern Comfort Food Menu – By Paul Ladewig RDN/Chef
To enliven and enrich the lives of our staff and residents it is always good to have a few special menu days throughout the year. We are often limited because we don’t know if the meal we come up with supplies the needed nutrients for our normal menu.
We also are sometimes a little apprehensive because we aren’t certain that our staff will be able to do an entire menu that hasn’t been already laid out. We are going to propose a new menu every issue that can be researched and discussed with your RDN.
Together you will be able to use these menus as a template and calculate what you need to order, what flavorings you can and can’t use and the nutrient content of each item so that the menu can be adapted for everyone even our residents who require a renal diet.
This menu is Southern comfort food and is perfect for the Fall:
- Pan-fried and slow roasted Cajun chicken legs and thighs
- Shrimp Etoufee
- Savory caramelized Vidalia onion broth with crushed peppercorns
- Creamed Corn
- Maple Bacon Butternut squash soup with praline pecan brittle
- Spicy mustard and collard green salad with warm vinaigrette and fresh tomatoes
How to Properly Document meal Intake – by Danelle Willey
In long term care one of the indicators that we use for determining nutritional status of our Residents is weight and weight loss. We monitor our Resident’s weight each month and based on if they are gaining or losing weight, we provide interventions or education. However, our knowledge and understanding if a Resident is truly consuming enough nutrition is based on what the CNA is documenting for meal intake.
If their documentation is inaccurate, then we are unable to determine if a Resident is consuming enough at meal time or if there is something else going on. Providing an in – service to all CNAs is an easy way to explain why their job of meal documentation is vitally important.
First, without proper documentation we cannot do our job to its full extent. We need to know what and how much our Residents are eating to understand where they are nutritionally. If they are losing or gaining weight and documentation states that they are eating 75-100% of all meals, then we start to think what else is going on in their body.
However, if this Resident is honestly consuming closer to 25-50% of meals then we can try supplementation before talking with the doctor. Weight changes can be due to many reasons, not just nutritional intake. However, interventions regarding intake are easier to address than other possible diagnoses that can cause weight changes.
Second, it is important for the CNAs to understand that proper documentation can show trends in intake. We may notice that a Resident never eats breakfast but consumes all of their lunch and dinner. This information can help us talk with the Resident about their food preferences. Maybe they don’t like the breakfast time or just may not be a breakfast person but they prefer a late morning snack. As long as it is addressed we can happily accommodate this preference. But without that documentation we may have never noticed this.
The important item to stress to the CNAs is that we cannot properly do our job without them. They see these Residents each and every day up close and personal. They are the best source of information second to the Resident. Hopefully the more we encourage and stress the importance of proper meal documentation the more accurate information we can get in time.
CDM is the Bridge: Resolving Disagreements in the Kitchen – By Danelle Willey, RDN
When a disagreement arises in the kitchen, how is it handled? The Dietary Manager is the bridge between the kitchen employees. They are responsible for scheduling, ordering, and maintaining a positive, hardworking environment in the kitchen.
Issues can quickly escalate in the kitchen. One aide does not change the empty juice box, then another retaliates by not finishing the dishes. Suddenly the day crew and the evening crew The Dietary Manager is the bridge that will bring these aides together and have them work together and respect together.
The dietary manager needs to have the respect of the kitchen staff so that they feel confident and comfortable going to them when an issue comes up. If the kitchen staff does not respect the manager, many problems will come to light. They will not be as productive during the work hours or fill in when another worker calls in sick.
But, when the Dietary Manager is a good leader and has the respect of the staff, the kitchen will run smoothly. The staff will want to work hard and go above and beyond because they will know they have the support of their manager.
One of the best ways to for a manager to get respect is to have quarterly mandatory all staff meetings where the staff is free to share their thoughts and concerns. Monthly in-services are another way to work through concerns in the kitchen. This allows all staff to be on the same page and receive the same information. Then there will be no questions or gray areas as to what is expected of them in the kitchen. If the Dietary Manager has control in the kitchen, has the respect of the staff and respects them back, then the kitchen will be the shining star in the facility.