Fresh Fare and Variety: Enhancing the Patient Dining Experience for Pressure Ulcer Prevention Protection Status
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by Mary Ellen Posthauer RDN, CD, LD, FAND

"Our food should be our medicine and our medicine should be our food."

This statement by Hippocrates rings true today as hospitals, rehabilitation centers and nursing homes strive to improve the quality of their meals. The day of “bland, cold, tasteless hospital food with limp vegetables and hard, dry meat” should be distant memory. When the meals and supplements served are not consumed, poor intake often results in weight loss and inadequate consumption of calories required for pressure ulcer prevention and healing.

Hospitals in some communities have adopted the Healthy Food in Healthcare Pledge. The objective is to increase the amount of fresh fruits and vegetables offered and decrease the amount of processed foods served. Hospital food service has moved from standard service to high-end restaurant style including room service, and cook-to-order menus. Allowing patients control over their meal preferences and timing has resulted in improved quality and service temperatures and increased satisfaction, which improve consumption. Increasing intake at meals may decrease the need for supplements, which often end up on the window ledge unopened. I have often wanted to offer the suggestion to hospitals that they remove the window ledge in rooms since that is where the supplements and wound care devices (cushions, etc.) reside.

The majority of nursing facilities have embraced culture change, which advocates creating a new model of aging that is satisfying, humane and meaningful. The move is from a medical model to a social model with a focus on person centered decision-making, and normal everyday living in a homelike environment in a community of caring that allows individuals to live the way they want to live. Culture change is all about choice: choice of what to eat, when, where and who to eat with; accessibility of food 24/7; selecting the type of food, favorite foods, comfort food, ethnic choices, food first before supplements, along with quality service and enhanced dining options. Food and dining are an integral part of individualized care and self-directed living. To meet the challenge, nursing facilities are offering a variety of dining options such as selective menus, buffets, restaurant style (ordering at the point of service), and family style. It is the position of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) that “the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets.”

Research indicates that restrictive diets may exacerbate poor food intake thus leading to malnutrition and unintended weight loss. Nursing facilities are recognizing this fact and less restrictive diets are common.

On a personal note, the 200 bed nursing facility where I am a member of the wound care team and consult weekly has a very low percentage of wounds. Part of the credit rests with the dining services department, which has four kitchens and eight dining rooms. There are no restrictive diets but rather minor individual adjustments as needed. Selective menus are in place, tray service was eliminated and each person is served in their dining area when they are ready to eat, not when the staff wants them to dine. The three satellite dining rooms are served from a superior system that maintains the temperature and quality of the food. Beverages offered include soft drinks along with the traditional selections. We acknowledged that younger residents admitted for short-term rehab expect and demand more variety and choice. Each nursing unit has a juice machine accessible to the residents and offers several choices. Hydration stations pass with a choice of beverages served three times a day. Does this dining enhancement increase food cost? Yes, but it has decreased food waste and improved meal satisfaction. Food service is more cost-effective than expensive wound care treatments and support surfaces. Food should be our medicine!

American Dietetic Association. Position paper with companion practice paper of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. J Am Diet Assoc. 2010; 110:1549-53.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association’s Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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