1 NUTRITION AND FOOD HANDLING - oregon.gov · 7 NUTRITION BASICS CONTINUED ... eating, food...

NUTRITION AND FOOD HANDLING1

REV October 2016 DHS – APD’s Safety, Oversight and Quality Unit

2 INTRODUCTION

Purchasing, preparing, and storage of food is an important Adult Foster Home (AFH) function. You are responsible for:

Planning three well-balanced meals daily that:

Reflect the resident’s preferences; and

Incorporate any specific dietary needs.

Providing nutritious snacks and liquids, is a rule requirement;

Safely storing and preparing food.


INTRODUCTION CONTINUED

There are new federal requirements around food in Home and Community Based Settings, including adult foster homes:You must support the resident’s right to access

food at any time;

You must support the resident’s right to eat their meal in their room if that’s the resident’s preference; and

If a resident misses a meal at a scheduled time, an alternative meal must be made available.

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4 NUTRITION BASICS


5 NUTRITION BASICS

Good nutrition is critical in caring for individuals with chronic health care needs:

Improves healing and recovery from illness, and helps maintain good health.

Proper nutrition and hydration are critical in maintaining healthy skin:

Poor nutrition can lead to increased risk of pressure sores.


6 NUTRITION BASICS CONTINUED

Good nutrition requires a well-balanced diet and proper hydration every day.

A well-balanced diet includes:

Proteins;

Fats;

Carbohydrates;

Vitamins;

Minerals; and

Water.



A basic well-balanced diet is the same for everyone, including the elderly and individuals with chronic health care needs.

Older people need the same nutrients as younger people, but they do not need as many calories.

The challenge is to choose nutrient-dense foods, i.e., high in nutrients in relation to calories.

For example, a glass of whole milk and a glass of soda have about the same calories, milk has important nutrients.



Water:

Water prevents dehydration, reduces stress on the kidneys, and maintains regular bowel function;

Dehydration has been shown to double the risk of pressure ulcers:

Dehydration results in a loss of padding over bony points in the body, such as the tailbone or ankles.



The sensation of thirst may not be adequate or an accurate indicator of the need for fluids:Beginning around age 50 the sensation of

thirst begins to diminish and continues to diminish with age:

This is a factor in the increased risk of dehydration among the elderly.

Additional risk factors include health conditions such as diabetes or dementia and when an individual is dependent on others to access food and water.



Proteins:

Critical for growth and repair of body tissues;

Can be broken down by the body to supply energy when needed.

Fats:

Store energy;

Regulate body temperature by providing insulation and padding;

Fats are also a source of energy.



Carbohydrates:Come from two main food sources:

Complex starches (breads, cereals and vegetables); and

Simple sugars (table sugar and syrup, as well as fruits, vegetables and milk products).

Vitamins:Are components in food that are needed for

growth and maintaining good health;

The vitamins include:A, B6, B12, C, D, E, K, folic acid, biotin, niacin,

thiamin, riboflavin and pantothenic acid.



Minerals:

Calcium and phosphorous are needed for strong bones and teeth;

Iron for healthy blood;

Iodine for regulating the thyroid and hormones;

Potassium for maintaining a balance of body fluids; and

Zinc for wound healing and healthy skin.


13 NUTRITION IN AN AFH

The AFH provider’s goal is to enhance independence, decision making, and sense of self-control and involvement in all aspects of care, including meals. Your responsibilities are to: Respect a resident’s right to make choices;

Fulfill each resident’s special dietary needs;

Create appealing meals and a pleasant mealtime atmosphere;

Document problems and consult with the resident’s health care practitioner and other care team members.


14 NUTRITION IN AN AFH CONTINUED

The following suggestions can help you meet your responsibilities:

Assess dietary needs during the screening and assessment:

Gather information about past and present eating, food preferences, recent changes in these patterns, and current dietary needs.

Provide familiar foods:

Familiar foods can maintain a connection with the person’s past life experiences, especially those that recall pleasant times.



Provide adequate calories. This is important for maintaining body weight. To help you provide adequate calories:

Weigh and record each resident’s weight at admission;

Keep a record of each resident’s body weight;

Weigh each resident at least once a month:

A weight change of more than 10 pounds in three months or over a shorter period of time should be reported to their health care practitioner;

If a resident loses between two and three pounds in one month, monitor weight weekly.



Plan menus around foods residents prefer. If a resident’s dietary intake is adequate, serve foods the person enjoys and will eat, even if you think the combinations are unusual;

Discuss diet concerns. If a resident is clearly overweight or underweight, or experiences undesirable weight gain or loss, discuss your concerns with the resident (if possible), the family and the resident’s physician. A special diet and exercise plan may be needed;

Consult a registered dietitian. A professional trained in diet and nutrition can help you modify your regular menu plans to meet a resident’s special needs.



Serve meals and snacks with needed proteins, carbohydrates, fats, vitamins, and minerals:

Include foods from www.ChooseMyPlate.gov;

Use mainly fresh foods. Processed, packaged foods usually have extra salt, sugar and/or fat;

Carefully read the nutrition and ingredient labels on all packaged and processed foods;

Prepare cut, chopped or pureed foods for special diets from the regular menu. In general, a well-balanced meal can be served to all people, including those on diabetic, low-sodium, low-fat and most other special diets.


http://www.choosemyplate.gov/


Many older people are reluctant to try or will not eat new foods. Consider:

Involving residents in meal planning;

IF the resident needs to make dietary changes,

always include them in the discussion;

Encouraging them to talk about favorite foods and

include those foods in your meals whenever possible;



Asking for favorite recipes. If some residents cannot participate, family members may be able to make suggestions;

Consider making small changes instead of changing everything at one time. If the resident needs to make dietary changes, include them in the discussion;

Encourage reminiscing about enjoyable mealtime activities. Be sensitive to residents whose past mealtime experiences may not have been pleasant;



Plan favorite dishes for special events such as birthdays or holidays, plan meals that include favorite foods:

Encourage family members to bring and share favorite foods, if appropriate;

If the residents have different food likes and dislikes, consider having a group meeting and discuss how meals can be planned:

The name of a dish maybe different but the ingredients are the same.



People eat for their physical needs, but also to meet social and psychological needs. Think about why and when you eat: The food looks and smells good;

It’s time to eat;

You know you should eat;

The food is on the table;

Friends or family are visiting;

It’s a holiday celebration;

Emotional reasons such as depressed, happy, stressed or lonely;



You feel in control when you make decisions about eating;

You feel out of control such as nervous or anxious;

You enjoy visiting with others over a meal.

The residents in your home may eat (or not eat) for many of the same reasons. For some residents, mealtime may be the highlight of their day. They enjoy good food and socializing during the meal.



The appearance, flavor, aroma of food, and mealtime atmosphere, can have an important effect on residents’ desire to eat. If meals and mealtime are pleasant, your residents will be more likely to eat:

Serve attractive meals. Vary foods in color, shape, flavor and texture. For example, serving a meal of baked chicken, brown rice with a little pimento, broccoli and a small wedge of cantaloupe provide a variety in texture and flavor and make a colorful and eye-appealing meal.



Vary methods of preparation and temperature of foods served:

Prepare meals that have both hot and cold foods;

Use a variety of cooking methods: bake, broil, sauté, barbecue, poach, stir-fry.

Season foods with herbs and spices:

Use flavorings that bring out the natural salt, sweet, sour and tart tastes in foods;

Consider an herb garden with herbs residents are familiar with and enjoy.



Serve meals family style:

Let residents select the foods they like and the amount they want;

If pre-dished plates or if assistance is needed, be sensitive to the size of portions desired.

Too much food on the plate can decrease an appetite.



Provide a pleasing relaxed atmosphere:

Serve meals at a dining table, rather than on trays in the residents’ rooms;

Eating a well-balanced meal increases when a meal is shared with others. Poor dietary patterns are associated with eating alone;

Sharing a meal with others increases the likelihood of eating a well-balanced meal.



Accept unusual eating habits:

Putting jelly on all foods may seem unusual or unhealthy to you, but it may be a lifelong habit for a resident;

Unusual eating habits are common among residents with dementia;

Do not discourage such habits if they enhance the resident’s eating of an otherwise healthy diet.

Document any concerns. Check with the resident’s primary health practitioner or a registered dietitian if you have concerns.



Allow residents to assist you with preparing meals, serving and clean-up if they want to:Setting the table, checking on the vegetables, etc.;

Be sure everyone washes hands before handling food, setting the table and eating.

Plan meals around special events. Birthday parties, holiday dinners and ethnic foods add interest to mealtime. Involve residents in planning special events:You may want to invite family members for a

potluck or barbecue, or ask them to bring a resident’s favorite dish.



Be aware of cooking odors: Residents suffering from nausea may not

tolerate food smells. Use the kitchen exhaust fan or open a window.

Create an inviting dining area: It should be cheerful, well-lit. If residents want to

be involved let them set and decorate the table.

Be flexible about seating arrangements; Allow plenty of room to accommodate:

“Elbows”; andWheelchairs.

Be creative: Have a picnic in the backyard (or better yet a park). A

change in scenery can stimulate the appetite.


30 USDA’s MYPLATE


31 MYPLATE CONTINUED

The main concepts of the USDA’s MyPlateis building a healthy diet (plate) by:

Increasing the amount of vegetables, fruits and whole grains in your diet;

Reducing the amount of fat, salt and sugar in your diet; and

Increasing physical activity on a daily basis.


32 A WELL-BALANCED DIET

Balance calories:

Residents should enjoy their food, but need to eat less. Avoid oversized portions;

Increase the portions of fruits and vegetables to half the plate;

Increase whole grains;

Decrease fats, sugars and salt.

Increase whole grains:

At least half of the grains eaten should be whole grains.


33 A WELL-BALANCED DIET CONTINUED

Increase vegetables and fruits:

Make half your plate fruits and vegetables;

Eat red, orange and dark-green vegetables such as tomatoes, sweet potatoes and broccoli in both main and side dishes;

Eat fruit, vegetables or unsalted nuts as snacks.

Reduce certain foods:

Reduce fats;

Cut back on foods high in solid fats and switch to oils such as olive oil when preparing foods;


34 A WELL-BALANCED DIET CONTINUED

Reduce salt intake;

Reduce the amount of red meat. Substitute fish, beans (kidney beans, pinto beans, black beans and garbanzo beans) or poultry;

Drink water instead of sugary drinks.

Be active every day:

Pick activities you like. Start by doing what you can, at least 10 minutes at a time;

Every bit adds up, and the health benefits increase as you spend more time being active.


WELL-BALANCED DIET

You can provide a nutritious, well-balanced diet for your residents by serving daily meals and snacks made up of foods from ChooseMyPlate:The food groups include

vegetables, fruits, grains, proteins and dairy.

The pictures used in ChooseMyPlate depict the approximate proportion of servings from each recommended food group.

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WELL-BALANCED DIET CONTINUED

Grains:Foods made from wheat, rice, oats, cornmeal,

or barley is a grain product. Bread, pasta, popcorn, oatmeal, breakfast cereals, and tortillas are some examples.

Whole grains contain the entire grain kernel —the bran, germ and endosperm. People who eat whole grains as part of a healthy diet have a reduced risk of some chronic diseases.

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WELL-BALANCED DIET CONTINUED37

Daily servings of GRAIN: Adults should have a serving of grains with

each meal. At least half of the servings of grains should be whole grains.



Shopping tips:

Check the nutrition label for the fiber content of whole-grain foods. Good sources of fiber contain 10 percent to 19 percent of the daily value;

Read the ingredients list and choose products that name a whole-grain ingredient first on the list. Look for “whole wheat,” “brown rice,” “bulgur,” “buckwheat,” “oatmeal,” “whole-grain cornmeal,” “whole oats,” or “wild rice;”

Terms such as “multi-grain,” “100 percent wheat,” “cracked wheat,” “seven-grain” or “bran” may not contain any whole grains.

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Fruits - provide nutrients such as potassium, fiber, vitamin C and foliate:Most fruits are low in fat, sodium and calories;Fruits may be fresh, canned, frozen or dried.

Vegetables are low in fat and calories; they also provide fiber and other key nutrients:Fresh, frozen and

canned are all good sources of vegetables.

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Daily servings of FRUIT and VEGETABLES: Adults should

have between three and six cups of fruit and vegetables each day.



Shopping tips:

Buy fruits and vegetables that are in season for maximum flavor at a lower cost. Check your local supermarket specials for the best-in-season buy or visit your local farmer’s market.

When using canned vegetables, check the label for the amount of added salt. Most frozen vegetables do not have added salt unless the vegetables are in a sauce.

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Dairy:

Milk, yogurt, cheese and fortified soymilk all are good sources of dairy.

Calcium, vitamin D, potassium, protein and other nutrients are needed for good health throughout life.

Choices should be low-fat or fat-free to cut calories and saturated fat.

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Daily servings of DAIRY: Adults need three cups a day. What

counts as one cup? 1 cup of milk or yogurt; 1-1/2 ounces of natural cheese; 2 ounces of processed cheese.



Shopping tips: If lactose intolerant, use lactose-free milk, drink

smaller amounts of milk at a time, or try soymilk (soy beverage). Check the nutrition facts label to be sure the soymilk has about 300 mg of calcium.

Choose cheeses with less fat. Look for “reduced-fat” or “low-fat” on the label.

Regular cream cheese, cream and butter are not part of the dairy food group. They are high in saturated fat and have little or no calcium.

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Protein:

Includes both animal and plant sources.

Protein is a source of B vitamins, vitamin E, iron, zinc and magnesium. Animal protein includes meat, poultry, seafood and eggs.

Plant protein includes beans, peas, soy products, nuts and seeds.

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Daily servings of PROTEIN: Adults should eat 5-7 ounces of

protein each day. What counts as one ounce? One ounce lean meat, poultry or seafood; One egg or one-quarter cup of cooked beans or peas; One-half ounce of nuts or seeds; One-half tablespoon of peanut butter.



Shopping tips:

Choose lean or low-fat cuts of meat. Ground beef at least 90 percent lean is considered lean.

Eat seafood in place of meat or poultry twice a week. Try beans and peas instead of animal protein. They are naturally low in saturated fat and high in fiber.

Check the nutrition facts label to limit sodium. Salt is added to many canned foods including beans and meats. Many processed meats such as ham, sausage and hot dogs are high in sodium.

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Solid fats, sugars and salt (sodium): Most people eat food with too many solid fats,

added sugars and/or salt (sodium):

Added sugars and fats load foods with unneeded extra calories;

Prepared foods frequently have hidden (or not so hidden) amounts of solid fats, sugar and salt.

Check the nutrition facts label on all prepared foods you purchase:

There can be a big difference in the amount of fats, sugars and salt between different brands.

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MENU PLANNING49


INTRODUCTION

Menu planning for an AFH is different than planning meals for your family. You must take into consideration resident preferences. Factors that influence a person’s food preferences include:

Resident’s family traditions;

Religious and cultural backgrounds;

Medical; and

Age-related conditions.

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You will need to plan on:

Plan on offering residents a greater variety and choice of foods;

Developing menus to ensure residents have at least a week (preferably a month) advanced notice;

Scheduled meals;

Scheduled and on-demand snacks;

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Shopping to ensure the residents will be offered well-balanced meals and snacks even when you are away and someone else prepares them;

Planning and making available food choices:

In-between meal snacks; and

When a resident will want to eat at times other than the AFH-scheduled meals.

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MENU PLANNING BASICS

Menus should be developed using the serving recommendations for each food group as outlined in USDA’s MyPlate:

The MyPlate guidelines are not the only approach to developing a meal plan, but they are appropriate for most people;

You may need to make some changes to satisfy special dietary needs and restrictions for individual residents.

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MENU PLANNING BASICS CONTINUED

In addition to using the MyPlate guidelines, here are some tips to assist with developing a menu plan:

Make sure to include all food groups daily;

Do not use one food group to replace another:

An extra serving of meat will not supply the same nutrients as a serving of vegetables.

Substitute within the same food group. For example, if a resident does not like to drink milk, substitute cottage cheese, cheese, yogurt or another dairy food;

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Vary the foods you serve. Serving different foods each day makes mealtime interesting;

Try new foods. Ask residents for suggestions and ideas;

Use fresh foods whenever possible. Seasonal fresh fruits and vegetables are often less expensive. Fresh vegetables do not have sodium unless salt or a sauce is added during or after cooking: Some residents may have grown their own

vegetables. Having a home garden may encourage residents to eat different fresh foods.

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Prepare foods in different ways. Chicken can be barbecued, baked, broiled or stewed. It can be served whole or sliced; hot or cold; in a pot pie, soup or salad;

Be creative with combination foods. Soup, stew, chili, casseroles, macaroni and cheese, and lasagna are examples of combination foods that containing multiple food groups;

Leftover meat such as chicken or beef makes a wonderful start of homemade soup;

Limit foods with high sugar content. Try serving healthier desserts and sweets such as fruits.

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MENU PLANNING

The menu plan must include the minimum recommended servings from each of the food groups as outlined in MyPlate: DAILY:

Provide at least one serving of vegetable or fruit high in vitamin C such as citrus fruits, cantaloupe, tomatoes, strawberries, broccoli etc.

THREE OR FOUR TIMES A WEEK:Provide at least one serving of vegetables or fruit

high in vitamin A. Vitamin A is found mainly in dark green and yellow vegetables such as carrots, broccoli, spinach, pumpkin and sweet potatoes.

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MENU PLANNING CONTINUED

A number of online tools can assist you when planning a menu:

The USDA has a tool called “MyFood-a-pedia” found at www.myfoodapedia.gov that allows you to enter in the name of a food or foods for quick access to food information such as calories, servings and food groups;

This website also allows you to compare two foods and enter information for add-ons such as butter. This website can also be accessed through ChooseMyPlate.gov.

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Create a menu glossary to assist with menu planning:

A menu glossary is a list of foods and recipes used to plan daily menus;

Use menu glossary forms to list main dishes for breakfast, lunch and dinner; vegetables; foods high in vitamins A and C; and nutritious desserts;

The menu glossary should change as you discover new dishes or your residents’ needs change;

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Use the names of prepared food items (e.g., poached eggs) or titles of recipes. Note how often you will want to repeat these items;

Keep in mind residents’ usual eating habits, including favorite foods;

Be mindful of any dietary restrictions ordered by the resident’s medical practitioner and as requested by the resident;

Be aware of, and prepare for any:

Chewing or swallowing problems;

Self-feeding problems (e.g. difficulty cutting their food.)

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Other menu planning tips: Follow your basic menu pattern, using different

foods from all the food groups each day;

Use the Seven-day Menu form to write down your daily menus for a week. Try not to repeat a dinner main dish during that period.

Adjust your menus for holidays, birthdays and other special events.

Keep a recipe file. Refer to your recipes as you plan your menus so you will know what foods are included from the different food groups.

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Ask residents for their favorite recipes;

Make grocery shopping lists based on your menus. This ensures you will have all ingredients needed for the menu plan;

Write notes on your menus. Jot down notes to help you plan future menus. Note if residents liked or disliked something you prepared;

Review recipes to increase nutrient density. Add nutritious ingredients (powdered milk and vegetables) and decrease excess fat, salt and sugar;

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File all your old weekly menu plans, along with your notes, shopping lists and receipts:

Receipts tell how much you spent to prepare a week’s worth of menus;

You may want to price recipe ingredients, particularly main dishes, and note the cost on the recipe. This procedure will aid you in controlling food costs.

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Remember:

Enhance each resident’s independence by respecting food choices and preferences.

Provide nutritious, well-balanced, appealing meals and snacks in a pleasant atmosphere.

Consult with the resident’s primary care practitioner or a registered dietitian if you have questions or concerns.

Use the menu planning tools found on the EQC website to assure the menus you develop meet the overall nutritional needs of your residents.

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READING NUTRITION LABELS65


NUTRITION LABELS

1 THE SERVING SIZE The first place to start when you look at the

“Nutrition Facts” label is the serving size and the number of servings in the package:Serving sizes are standardized to make it easier to

compare;Use familiar units, such as cups or pieces, followed

by the metric amount, e.g., the number of grams.

The size of the serving on the food package influences the number of calories and nutrient amounts. Pay attention to the serving size, especially how

many servings there are in the food package.

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NUTRITION LABELS CONTINUED

2 CALORIES (AND CALORIES FROM FAT) Calories provide a measure of how much

energy you get from a serving of the food. The calorie section of the label can help you manage your weight (i.e., gain, lose or maintain). Remember, the number of servings you consume determines the number of calories you actually eat (your portion amount).

General guide to calories: 40 calories is low. 100 calories is moderate. 400 calories or more is high.

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3 THE NUTRIENTS: HOW MUCH?

Limit these nutrients:

Eating too much fat, saturated fat, trans fat, cholesterol or sodium may increase your risk of certain chronic diseases such as heart disease, some cancers or high blood pressure.

Important: Health experts recommend that you keep your intake of saturated fat, trans fat and cholesterol as low as possible as part of a nutritionally balanced diet.

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4 THE NUTRIENTS: HOW MUCH?

Include enough of these:

These nutrients can improve health and help reduce the risk of some diseases and conditions such as reducing the risk of osteoporosis.

Eating a diet high in dietary fiber promotes healthy bowel function.

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5 UNDERSTANDING THE FOOTNOTE

“Percent Daily Value” on the “Nutrition Facts” label refers to the footnote in the lower part of the nutrition label, which tells you “Percent DVs are based on a 2,000 calorie diet.”

This statement must be on all food labels. The full footnote may not be on the package if the label is too small.

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6 THE PERCENT OF DAILY VALUE (% DVs)The percent of daily values (% DVs) are based

on the daily value recommendations for key nutrients but only for a 2,000-calorie daily diet — not 2,500 calories.

The % DVs helps you determine if a serving of food is high or low in a nutrient. The % DVs column does not add up vertically to

100%. Instead each nutrient is based on 100% of the daily requirements for that nutrient (for a 2,000-calorie diet). This way you can tell high from low and know which nutrients contribute a lot, or a little, to your daily recommended allowance (upper or lower).

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NUTRITION LABELS CONTINUED72


73 OTHER CONSIDERATIONS


74 TABLE SETTINGS

How a table is set can improve eating:

Plain colored dishes, as opposed to dishes with patterns, make it easier for residents with vision problems to distinguish food;

Residents with dementia may mistake a design on a plate as something to eat.

Other considerations:

Contrasting tablecloths or placemats make it easier for residents who have vision problems to tell where dishes end and the table begins;


75 TABLE SETTINGS CONTINUED

Colored glasses for water and other clear beverages may make it easier for some residents to distinguish what they are drinking;

Mugs and cups with large handles are easier to grasp and hold for people who have arthritis or other problems with hands and finger flexibility and control;

Special self-help devices such as one-handed knives, knife-fork combinations, or a food guard to keep food on the dish may be helpful for residents with motor impairments.


76 TABLE SETTINGS CONTINUED

Flatware that is solid, sturdy and easy to hold is best:

Lightweight or slender-handled flatware can be hard to grip, hold and control;

Enlarging handles with foam rubber can make flatware easier to grip for persons who have arthritic or trembling hands.


77 SPECIAL NEEDS

Age-related changes and health problems often have a negative effect on your residents: Decreased ability to taste. Aging decreases the

ability to taste sweet and salty. Food may taste sour, bitter or bland, especially for persons who are on low-salt diets;

Vision impairments. Those with vision problems may have a hard time distinguishing one food from another. A person may have a blind side due to a stroke or other condition. Encourage the resident to look to the blind side or to turn the plate so they can see their food.


78 SPECIAL NEEDS CONTINUED

Medications that affect how food tastes. Digestion can also be affected by medications. Even plain aspirin can upset the stomach.

Chewing and swallowing difficulties. People who have teeth or gum problems, poorly fitted dentures, dry mouth or sores in the mouth may have problems eating.

Illness, fatigue and pain. Meals may need to be served at unusual times.



Difficulties with digestion. Some people avoid certain foods or eat less if they have problems with nausea, heartburn, bloating, diarrhea or constipation.

Physical changes. Residents who have arthritis or Parkinson’s disease or have had a stroke may find it hard to eat because of deformed, painful or trembling hands, weak arms or drooling.



Changes in mental abilities. Residents who have Alzheimer’s disease, stroke or other disorders may have trouble remembering to eat. They may be confused by family-style dining.

Changes in long-standing patterns and habits. Residents who come to your AFH may have been used to preparing their own food, and eating what and when they want. It takes time to adjust to changes to lifelong routines.


81 SPECIFIC CONCERNS

A resident may not like the food you serve or how it’s prepared and may not be used to eating at your AFH’s scheduled times:Eating may be the last area of control in the life of a

resident. Complaining about the food, refusing to eat certain foods, or refusing to eat at all may be an act of independence and self-control.

If there is a change in appetite, document it. Monitor and take action to remedy the situation:Offer food at other times or different food;

If continues contact their primary healthcare practitioner.


82 SPECIFIC CONCERNS CONTINUED

Changes to taste:Ask residents what foods taste good and what

foods don’t taste good;

Enhance flavor with tart seasonings (e.g., lemon or lime juice);

Marinate meats in juices, sauces or wine;

Vary meals to include cold or room-temperature foods; they may seem more flavorful to the resident;

Encourage the resident to rinse the mouth often for a fresh, clean taste.



Nausea and vomiting:

Maintain the resident’s recommended fluid intake. Provide resident with dry foods (e.g., crackers or toast) when the person first wakes up;

Encourage drinking fluids between meals, not with meals; clear, cool beverages are best;

Encourage the resident to remain upright (i.e., not to lie down flat) for at least two hours after eating;

Avoid the smells of cooking as much as possible;

Keep well-liked foods on hand that don’t require much preparation.



Mouth and throat problems:

Be alert for problems with teeth or dentures; get them corrected, if possible;

Provide softer diet (e.g., add gravies or sauces);

Avoid rough, coarse foods. Use tender cooked and ground meats, fish, eggs, cheese and legumes;

Allow hot foods to cool slightly before serving;

Provide mild flavored fruits such as bananas or pears.



Tiredness, fatigue, pain:

Encourage the resident to rest before meals;

Offer foods when the resident feels like eating;

Keep foods readily available that don’t require much preparation;

Allow the resident plenty of time to eat or provide smaller and more frequent meals;

Serve foods when pain-relieving medication is most effective.



Diarrhea, bloating, heartburn:Encourage the resident to eat more slowly;Encourage the resident to eat small meals

more often;Establish a routine mealtime;Encourage the resident to eat sitting up straight

and to remain upright after meals; Discourage consumption carbonated beverages,

beans and cabbage-family vegetables;Avoid caffeinated beverages;Do not serve fatty or spicy foods; Encourage drinking of fluids between meals.



Constipation:Encourage the resident to eat more fruits and

vegetables (five to nine servings a day)

Encourage the resident to eat more whole grains;

Try gradually adding bran to foods

Encourage the resident to drink plenty of fluids (eight to 10 glasses per day)

Provide prune juice or hot lemon water

Encourage exercise, even if it is only stationary exercise.



Heightened emotions:Take time to listen to the person; offer positive

feedback, compliments and reassurance;

Let residents know that food is available whenever they feel like eating;

Try to limit times for eating, or limit snacks to nutrient-dense foods, if overeating;

Involve the person in meal planning;

Serve familiar/favorite foods;

Respond to lifelong eating patterns, if possible.



A resident may have a physical or mental disability that makes self-feeding difficult. Encourage self-sufficiency. However, a resident may need to be fed or guided through a meal:

Provide adaptive devices;

Provide foods that do not require use of utensils such as “finger” foods, soup in a mug, etc.;

Build up handles on utensils;

Serve food in bowls with high sides;



Use contrasting colors in place setting.

Be consistent in placing food on the plate in a specific order (and plate on table):

For example, for visually impaired -potatoes are at 3 o’clock position, meat is at 6 o’clock position, etc.

Maintain a simple, consistent mealtime routine;

Maintain a quiet, unrushed atmosphere;

Serve one course at a time to reduce confusion;

Provide a full apron, rather than bib, to help keep the resident’s clothes clean.


91 EATING WITH ASSISTANCE

You may need to assist a resident with eating. This can be awkward at first:Take it slow; check with resident and make sure

you aren’t going too fast or too slow:It takes 30 – 45 minutes to safely assist or feed

a person;

Offer smaller bites when feeding someone.

Relate to the resident. Convey caring, understanding and interest in the person;

Preserve the person’s dignity. Do not say “You can’t have dessert until you finish your peas”;


92 EATING WITH ASSISTANCE CONTINUED

Talk about the food and what you did to prepare it. It may be better to talk before or after feeding, so that the person can concentrate on eating;

When possible, comply with food likes and dislikes;

Avoid mixing food together. If you puree foods, keep them separate;

Offer foods at the right temperature for comfort and safety;

Position person properly. The person should be sitting upright and leaning slightly forward;

Remind the person to chew and/or swallow, if necessary;


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Do not rush the resident. Rushing increases the risk of choking, spitting out food or refusing to eat:

Aspiration can occur at anytime but is most common during eating or drinking.

Keep the person clean. For instance, gently wipe comers of the mouth and chin to remove food or saliva.

Offer fluids after the mouth has been emptied.

Encourage any effort the resident can make to self-feed.


94 REFUSAL TO EAT

You have tried everything and a resident still refuses to eat: Consider the resident’s health condition:

Has the person been ill or not been feeling well?

Has the person started a new medication?

Could the person be experiencing difficulties related to the progress of a diagnosed disease?

Has the person experienced a recent loss, perhaps the death of a loved one or close friend?

Talk with the resident. Ask, for example, “Are your dentures hurting?” or “Are you thirsty?”


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Encourage the person to propose food options: Ask the person what the resident would suggest

to stimulate eating and keep up strength;Record any references or suggestions on the

resident’s care plan.

Respond to special needs and preferences, if possible:Keep favorite foods and healthy snacks readily

available (see end of chapter for snack ideas);If appropriate, increase the protein and calorie

content of foods eaten;Consult a registered dietitian for suggestions.



Document the problem:Make clear notes in the resident’s narrative.

Include date and time, the food served and refused, and the approaches you used to encourage eating;

Note other contributing factors, such as illness or pain.

Discuss the problem with an appropriate care team member who may have an idea you have not tried, or who may be able to entice the person to eat when your efforts have not worked:Advice from a registered dietitian, especially one who

understands older people, can be helpful. REV October 2016 DHS – APD’s Safety, Oversight and Quality Unit


Report the problem to the resident’s primary health practitioner:

This is especially important if the resident is losing weight or has a medical condition, such as diabetes, which requires regular food intake as part of necessary care;

Sometimes a resident will respond if the physician prescribes a special diet.

Remember, you cannot force another person to eat, even if they depend on you for care.

You must respect the resident’s rights.


EATING OUT

Eating at a restaurant can be still be healthy. Using the following tips you can assist your residents in making healthy choices:Drink water or order fat-free or low-fat milk,

unsweetened tea or other drinks without added sugars;

Ask for whole-wheat bread for sandwiches;

In a restaurant, start your meal with a salad packed with veggies to help control hunger and feel satisfied sooner;

Ask for salad dressing to be served on the side. Then use only as much as you want;

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EATING OUT CONTINUED

Choose main dishes that include vegetables, such as stir fries, kebobs or pasta with a tomato sauce;

Order steamed, grilled or broiled dishes instead of fried or sautéed foods;

Choose a small or medium portion. This includes main dishes, side dishes and beverages;

Order an item from the menu instead of heading for the all-you-can-eat buffet;

Check restaurant websites for nutrition information to assist with planning ahead.

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If portions at a restaurant are larger than you want, try one of these strategies:

Order an appetizer-sized portion or a side dish instead of an entrée;

Share a main dish with a friend;

If you can chill the extra food right away, take leftovers home;

When your food is delivered, immediately set aside or pack half of it to go;

Resign from the “clean your plate club” — when you’ve eaten enough, leave the rest.

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To keep your meal moderate in calories, fat and sugars:

Order foods without creamy sauces or gravies;

Add little or no butter to your food;

Choose fruits for dessert.

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QUESTIONS?102

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