Foodservice Operation - The Association of Nutrition ...€¦ · Nutrition & Foodservice Edge®...

&The Big Six When to Report Symptoms of Employee Illness

Eating Disorders in the Aging Population Intervention Strategies

Time for Tea A Soothing and Satisfying Hydration Option

FEBRUARY 2015

FoodserviceOperation

50 Ways to Improve Your

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Nutrition & Foodservice Edge | February 2015 1

®P U B L I S H E D B Y

CONTENTS FEATURES

16 NutritionandEatingDisordersinthe AgingPopulation by Brenda Richardson, MA, RDN, LD, CD, FAND

Anorexia, bulimia, and other eating disorders prevalent in the aging population are discussed here, along with evidence-based nutritional interventions.

24 50WaystoImproveYour FoodserviceOperation by Wayne Toczek

Fifty tips that can improve your foodservice systems are presented. Pick and choose the tactics that can benefit your operation.

28 TimeforTea by Linda Eck Mills, MBA, RDN, LDN, FADA

Keeping residents hydrated is an important goal in long-term care facilities. Tea is a satisfying and viable option, delivering both hydration and health benefits.

32 NutritionTherapyforWoundHealing by April Irvine, MS and Julie Moreschi, MS, RD, LDN

Pressure ulcers are an unfortunate reality in the elderly nursing home population. Understanding the important role of nutrition in wound healing is key to improving quality of life for those affected.

4 Food File

10 Food Protection Connection

38 ANFP Leadership Spotlight

40 Meet a Member

Nutrition &FoodserviceEdge

DE PA RTMENTS

16

24

28

10

February 2015 / Volume 24 / Issue No. 2

1 HOUR SAN

Nutrition & Foodservice Edge | February 20152

BestofLeaders&Luminaries

Nutrition & Foodservice Edge®isthepremier

resourcefornutritionandfoodservice

professionalsandthoseaspiringtocareers

inthisindustry.Itispublishedbythe

AssociationofNutrition&FoodserviceProfessionals.

Editor . . . . . . . . . . . . . . . . . . . . . . . Diane J. Everett

[email protected]

Senior Writer . . . . . . . . . . . . . . . .Laura E. Vasilion

[email protected]

Advertising Sales . . . . . . . . . . . . . . . . . Paula Fauth

[email protected]

Design . . . . . . . . . . . . . . . . . . . . . . . . . Mercy Ehrler

[email protected]

Nutrition & Foodservice Edge® (ISSN 21649669)

is published monthly except combined issues

in July/August and November/December.

©2015 by the Association of Nutrition &

Foodservice Professionals, 406 Surrey

Woods Drive, St. Charles, IL 60174.

Phone: (630) 587-6336. Fax: (630) 587-6308.

Web site: www.ANFPonline.org

Periodicals postage paid at St. Charles, IL and

additional mailing offices. POSTMASTER:

Send address changes to Nutrition & Foodservice Edge®, 406 Surrey Woods Drive,

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SubscriptionRatesEdge subscription rate for ANFP members is $15,

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Subscriptions are available to other interested

parties for $40/year or $5/issue. Outside U.S.,

contact ANFP for pricing.

EditorialPolicyReaders are invited to submit manuscripts for

publication consideration. Please contact the

editor for specific publishing guidelines. Views

expressed by contributors do not necessarily

reflect the opinion of the association.

Printed in the U.S.A.

LynneEddy,MS, RD,

FAND, CHEAssociate Professor, Business Management, The Culinary Institute

of America,

Hyde Park, NY

RichardHynes

Director, Consultant Services, Hobart Corp.,

Franklin, MA

KevinLoughran

Director of Support Services for Food and Dining, Healthcare

Services Group,

Bensalem, PA

RubyPuckett, MA, FFCSI

Director, Dietary Manager Training, University of Florida Div

of Continuing Ed.,

Gainesville, FL

MartyRothschildPresident, Aladdin Temp-Rite,

Hendersonville, TN

BobSala

Founder and Director at Large, Distribution Market

Advantage,

Hoffman Estates, IL

ReneeZonka, CEC, RD,

MBA, CHE

Dean, School of Culinary Arts, Kendall College,

Chicago, IL

E D ITORIA L A DVISORY BOA RD

®

ALSO

I N

OUR

PAGE S

7 37

More ANFP news, inspiration, and education at www.ANFPonline.org

E DITOR ’S NOTEBOOK

LegislativeReport

Nutrition &FoodserviceEdge

February 2015 / Volume 24 / Issue No. 2

Soundnutritioniscrucialtowellbeing,andseveralfeaturesthis

monthoutlinehowmedicalnutritiontherapycanenhancequality

oflifeforpeoplefacinghealthchallenges.Elderlyindividualswith

eatingdisorders,residentssufferingfromthepainofpressureulcers,

andclientswhorejectwaterbutneedhydrationallrequirenutri-

tioninterventionstoimprovewellness.Checkoutthearticlesinour

pagesaddressingthesetopics.Qualitycareimprovesqualityoflife!

Listsofferagreatvisualreminderofthetasksweneedtotackle.

Thelistonpage24presents50thingsfoodservicemanagerscan

dotoimprovetheiroperationandperformatpeakefficiencyfroma

budgeting,staffing,orqualitystandpoint.Pickandchoosetheinitia-

tivesthatresonatewithyou,orusethisresourceasanideastarter

andcreateacustomizedchecklisttomeettheuniqueneedsofyour

foodserviceprogram.

ThismonthweoutlineTheBigSix—specificpathogensidentified

bytheCentersforDiseaseControlandPreventionastransmissible

throughfoodbyinfectedemployees.Staffmembersfacingthese

illnessesareputtingyourclienteleatrisk—especiallyclientswhoare

elderly,veryyoung,orimmunocompromised.Whatistheemploy-

ee’sandemployer’sresponsibilityinreportingsymptomsordiag-

noses?FindoutinourFoodProtectionConnectioncolumn,andbe

proactiveaboutsafeguardingyourfacility’spopulationfromillness.

Andfinally,thisissuefeaturesa“bestof”compilationofquotesfrom

prominentandinspiringindividualswhohavebeenprofiledinour

Leaders&Luminariescolumnoverthepastthreeyears.Ienjoyedre-

readingtheircollectivewisdom,andIhopeyouwilltoo.

Diane Everett, Editor [email protected]

SESSION TITLES • The First and Last Motivational Guide for Humans in the Workplace!• 2015 Surveys: Are You Prepared?• Creative Food Presentations• Be a Leaner, Stronger, Hungrier Leader • Food Safety: Current Hot Trends• The 8 Steps to Controlling Food Costs• New Pressure Ulcer Guidelines for Nutrition• The Foodservice Department as a Revenue Center• How to Market and Promote Yourself• EXPO

® ® ANFP SPRING REGIONAL MEETINGS Become a leader in the foodservice industry

®

REGISTER ONLINE TODAY | www.ANFPonline.org/Events ®

“The recent ANFP Regional Meeting

provided me with wonderful opportunities

to not only attend a wide variety of

interesting educational sessions that match

my career needs, but also to gain valuable

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I

T

FOOD F ILE

IN NOVEMBER AND DECEMBER theOrangeCountyPublicSchoolsFood

andNutritionServices(OCPSFNS)food

truckvisitedCentralFloridamiddleand

highschools,servingthreenewmenu

itemsselectedbystudentvote.

Theentrees—WarmAsianChickenSalad,

GreenBeanChickenCaesarBowland

AsianBeefTeriyaki—weredeveloped

inpartnershipwithfoodvendorUncle

Ben’stoencouragestudentstoeatmore

school-providedmeals.

THE START OF THE NEW YEAR oftenrousesaresolvetoloseweight—

agoalthat’sespeciallyimportantfor

peoplepronetoheartdisease,reports

theJanuary2015HarvardHeartLetter.

Carryingtoomanypoundscanboost

bloodpressure,bloodsugar,andcholes-

terol,allofwhichburdentheheart.

Formanypeople,coachingthattrans-

formseating,exercise,andotherhabits

canmakeadifference.Knownasin-

Food Truck Encourages StudentstoEatSchoolLunch

WeightLossGoesBeyond“Eat Less, Move More”

ORANGE COUNTY PUBLIC SCHOOLS FOOD AND NUTRITION SERVICES

hit the road last fall with its Truck of the Month tour.

“TheTruckoftheMonthtourgivesusa

waytoeducatestudentsonthetasty,

nutritiousmealsbeingservedinourcaf-

eterias,”saidLoraGilbert,seniordirector

ofOCPSFNS.“Weknewwehadtoget

creativetoattractourstudents’atten-

tion—andafoodtruckwasanaturalfit

tocombineourserviceswithaneye-

catchingpopculturetrend.”

Afterpurchasinglunchfromthefood

truck,studentscantakeaniPadsurvey

tosharefeedback.Attheendofthe

tour,themostpopularitemwillbe

addedtocafeteriamenusforthe2015-

2016schoolyear.

Schoolofficialsarealreadyseeingposi-

tiveresultsfromtheprogram.Onaver-

age,afterthefoodtruckvisitsacampus,

46percentofstudentswhopreviously

didnoteat,orateinfrequently,inthe

cafeteriaincreasedtheirparticipationto

threetofivetimesperweek.

“Studentsalwayslookforwardtoeat-

ingfromthefoodtruck,”Gilbertsaid,

addingthatitservesabout400meals

duringeachcampusvisit.“It’sbeena

bighit!”

Infactitwassopopular,anothertouris

settostartinFebruary2015andcon-

cludeattheendoftheschoolyear. E

Forinformation

aboutOCPSFNSvisit

www.ocpsmealapp.com

tensivelifestyleintervention,itinvolves

workingcloselywithoneormoretrained

experts,includingadietitianornutrition-

ist,exerciseprofessional,healtheduca-

tor,andpsychologist.

Agoodgoalistoloseatleast1percent

ofbodyweightaweekforthefirstfour

weeksofsuchaprogram.“Reach-

ingthatgoalrequiresamajorlifestyle

change,andthattakesalotofwork,”

saysDr.GeorgeL.Blackburn,professor

ofnutritionatHarvardMedicalSchool

anddirectoroftheCenterforNutrition

MedicineatBethIsraelDeaconessMedi-

calCenter.

Manymajormedicalcentersthrough-

outthecountryofferintensivelifestyle

coaching.Forexample,aprogramat

Harvard-affiliatedMassachusettsGen-

eralHospital,knownasHealthyHabits

forLife,costs$550andincludes12

groupsupportandeducationsessions,


Consulting Dietitians, Menu & Meal Card Programs,

and Support for Dining Services in Long Term Care

www.ht-ss.com

Continued on page 6

acustomizedeatingplan,andtwovisits

withapersonaltrainer.Someprograms

alsoincludecounselingbytelephone,

email,ortextmessage.

Lifestylechangesandtipsthatcanhelp

withweightlossinclude:

• Plan ahead. Pickonedayaweekto

devotetoplanning,shopping,and

preppingthecomingweek’smeals

andsnacks.

• Go for convenience.Takeadvantage

oflow-caloriefrozendinnersandsu-

permarketsaladbars.

• Pay attention to portion size.Measure

commonfoodslikecereal,peanutbut-

ter,andsaladdressingtoavoideating

morethanaserving.Usingsmaller

plates,bowls,andevenutensilsalso

helpspeopleeatless.

• Exercise in 10-minute bursts.Burstsof

moderateactivity—briskwalking,bik-

ing,orevenjustmarchinginplaceor

doingjumpingjacks—for10minutes,

threetimesaday,isjustaseffectiveas

exercisingonceadayfor30minutes.

• Keep a food diary.Smartphoneapps

canmakethistaskeasier.Lookfor

auser-friendlyonethathasalarge

databaseoffoods.

• Track daily activity.Pedometersand

digitalfitnessmonitors—whetherworn

aswristbands,clippedontoclothing,

orslippedintoapocket—canhelp.

Basiconesmeasurestepsandcalo-

ries,whileotherscaptureheartrate,

skintemperature,andsleeppatterns.

• Step on the scale. Regularweight

checks,donedailyorweekly,aid

weightloss. E

Readthefull-lengtharticle:“DoYou

NeedWeightLossCoaching?”at

www.health.harvard.edu/heart


Continued from page 5

WWITH THE NEW YEAR HERE, resolutionstoeathealthierareonevery-

one’smind.Masonjarsaladsare2015’s

lateston-the-gotrendforahealthyand

quicklunch.SaladspackagedinMason

jarsareportable,easytomake,canbe

preppedinadvance,andofferawideva-

rietyofrecipes.LukeSaunders,founder

ofFarmer’sFridge,anewhealthyvend-

ingkioskconcept,offerstipsonmaking

aMediterraneanMasonJarSaladthat

willstayfreshandcrispintheworkplace

fridgeuntillunchtime.

1) Prepthedressingearly.Startsalad

constructionbycombiningthedress-

ingingredientsthenightbeforeto

allowalltheflavorstomarinateand

meldtogether.TomaketheRedWine

VinaigrettefortheMediterranean

Salad,whisktogetherallingredients

(exceptoil)inamedium-sizedbowl.

Whilewhisking,slowlypourinthe

oliveoil.

Fresh New Lunch TrendfortheNewYear

2)Chooseyourgreens.Insteadofthe

standardromaineoriceberglettuce,

swapoutthegreenswithsomething

new.Experimentwithvarietieslike

arugula,kale,andspinach.Eachtype

ofleafygreenoffersdifferenthealth

benefitsrangingfromimprovingim-

munedefenses,loweringcholesterol,

strengtheningbones,combattingheart

disease,andpromotinghealthyvision.

3)Startthejarwithheartyveggies.

Byreverselayeringsaladingredients

withinthejars,thesaladwillberight

sideupandreadytoeatwhenthe

jarisflipped.BaselayersofMasonjar

saladsshouldincludetheheartierveg-

etablesthatcantaketheweightofthe

otheringredients.Whenthesaladis

flippedontoaplate,thelettucewillbe

onthebottomandothervegetables

willbeontop.

4)Layeritup.Aftertheheavyingredi-

ents,packtherestoftheMasonjar

withgreensandgarnishessuchas

croutons,berries,protein,ornuts.Top

theingredientswithmixedgreensand

pinenuts.Tofinish,storeseparate2

oz.containerofdressingontopofthe

salad,screwonthejar’slid,andthe

saladisreadytogo.

5)Knowhowtostorethesalad.To

preventsoggysalad,packeverything

intothejarastightlyaspossibleto

keepingredientsfrommovingaround.

Leavingthegreensforlastcreatesa

moisturebarriermakingthesaladable

tostayinthefridgeforafewdays.

Saladscanbeenjoyedonaplateorin

abowl,oringredientscanbeshaken

upandthesaladcanbeeatendirectly

fromthejar. E

M E D ITE R R AN E AN MA SO N JAR SAL AD

DRESSING

• 1/2cupRedWineVinegar

• 6Tbsp.Water

• 2Tbsp.OliveOil

• 2tsp.Honey

• 1tsp.DijonMustard

• 1/2tsp.Salt

• 1/4tsp.BlackPepper

• 1tsp.Oregano

• 1/2tsp.Basil

SALAD

• 4quartersArtichokes(canned)

• 2eachGrapeTomatoes(slicedinhalf)

• 1/4cupEnglishCucumbers(quarteredand

thinlysliced)

• 1/4cupCannelliniBeans(canned)

• 1Tbsp.ParmesanCheese(grated)

• 2Tbsp.KalamataOlives(sliced)

• 1-1/2cupsMixedGreens

• 1Tbsp.PineNuts(roasted)

Startbylayeringthequarteredartichokesfollowedbygrapetomatoes,cucumbers,beans,cheese,olives,mixedgreens,

andpinenuts.Tomakethedressing,whisktogethertheredwinevinegar,water,honey,Dijonmustard,salt,pepper,

oregano,andbasilinamediumsizebowl.Whileyouarestillwhisking,slowlypourintheoliveoil.Dressingcanbestoredin

a2ounceportioncupontopofthesalad.

DIRECTIONS

Formoreinformation,visit

farmersfridge.com


LEADERS & LUMINARIES

CollectiveWisdom

by Laura Vasilion

INSP I RAT ION

FROM LE ADERS

& LUMI N ARIES

When we began this column in January 2012, our goal was to profile inspirational leaders and luminaries in the food industry. We reached that goal many times. With each person we interviewed—peo-ple with a passion for the important role food plays in our daily lives—we learned something.

As we enter this column’s fourth year, we thought it would be a great time to recap some of our favorite insights from these impressive movers and shakers. Their full interviews can be found on the ANFP website in the Nutrition & Foodservice Edge archives under Publications: Magazine Index & Archive section (visit www.anfponline.org/Publications/Dietary_Manager_magazine_articles.shtml).

Here is just a small sampling of their collective wisdom and inspiration. Enjoy!

Continued on page 8


On the Challenges and Importance of Leadership

“We, as an organization, must look for ways to make the organization relevant and member-worthy. The give and take of the non-profit world makes it much more important that we do this right. Our programs expect much of us as a membership organization, and my biggest chal-lenge is to get them to understand that we must expect something in return besides dues. We must all understand how high the stakes are—not only locally, but nationally, as well.” —Enid Borden, Then-President and CEO of Meals on Wheels Association of America, Alexandria, Va. (January2012)

“We focus a lot on leadership. It’s important our staff gets to know their employees’ strengths and weaknesses. You do that by pairing them up together on team projects accordingly. When your employees trust you and know you’re not go-ing to be vindictive, they will give you their best. But they have to be assured they’re going to be acknowl-edged for their ideas and that you’re not going to steal them. That is crucial.” —Renee Zonka, CEC, RD, MBA, CHE, Dean of The School of Culinary Arts, Kendall College, Chicago. (April2012)

“I believe everyone should always feel better after meeting with you. Regard-less of whether it was a positive or negative meeting, you should have them leave the room feeling better. And also, sometimes you have to give up things you’re really good at to give others a chance to rise to the occa-sion. So you have to be charismatic, but also able to let things go so mem-bers of your team can really shine.” —Ryan Conklin, Executive Chef, Culi-nary & Nutrition Services, Rex Health-care, Raleigh, N.C. (June2012)

On Following Your Dreams

“When I went to culinary school in the 1990s, there was a certified master chef who was in the Navy in the 1960s. He had all these great sea stories and they stuck in my head. I didn’t think too much about them until I started thinking about career options. After competing and working in restaurants for a while I decided to give the mili-tary a try because I always wanted to serve my country.

The other thing that pushed me toward the Navy was the master chef telling me that the Navy is the only military branch that cooks for the president on the West Wing of the White House. So that was a goal of mine. It is still a goal of mine.” —Derrick Davenport, CEC, CEPC. 2013 Armed Forces Chef of the Year and Ex-ecutive Chef/Enlisted Aide for General Martin Dempsey, Chairman of the Joint Chiefs of Staff in Washington, D.C. (September2013)

“My cousin was working in the (Chi-cago) Bulls front office in basketball operations at the time. She knew I did catering and stuff so she called me one day and asked if I’d like to cook a meal for the team. Unbeliev-able. I did, they liked it, and then the trainer called me back and asked if I wanted to be the team chef. It’s still surreal to me, being in the ‘House of Jordan’ and all.” —Steve Jackson, Personal Chef for the Chicago Bulls, Owner of The Con-venient Chef, Chicago. (March2012)

On Giving Back

“Honestly, finger foods in the industry—what is being served to memory care communities in senior assisted living—are very much like the food you would serve your tod-dler. Fish sticks, French fries, peanut butter and jelly sandwiches, grilled cheese. We thought we could come up with something better. Inde-pendence, dignity, and accessibility. That is what we think of when we are trying to provide a better quality of life for those who have cognitive or physical limitations. Individuals who can’t use their fingers or use utensils anymore.”—Sarah Gorham, Chef, Co-Founder/Co-Owner of Grind Dining, Inc., Atlanta, Ga. (November/December2014)


Enid Borden Renee Zonka Ryan Conklin Derrick Davenport


On Beating the Odds

“Once I entered culinary school, the weight came on in a slow pro-gression. Maybe it was because I wasn’t working it off anymore. But it wasn’t like I sat down at a buffet and kept eating. It was very gradual.

That is when I saw the bad side of food, what it can do to your body. I developed sleep apnea, neuropathy, and hypertension. The airlines wanted me to buy two seats because no one wanted to sit next to me. At the amusement park with my nieces and nephews, I couldn’t go on rides because the harnesses wouldn’t fit me. Twice I almost died because of my weight, but my doc-tor saved me. That’s when I knew I had to do something serious.

When I lost the first 186 pounds, I didn’t need to sleep with a machine anymore. When I went down to 205, my diabetes went away.” —Todd Henri Daigneault, Executive Chef at Overlook Medical Center and Union Medical Centers for Atlantic Health Care Systems of New Jersey. (March2014)

“I’m a huge fan of irony. A chef without a stomach? I totally get, on some level, the dark humor of it.

But I missed being around food so I started walking with my family every day, three meals a day, to the hospital cafeteria. At first they felt really guilty that they were having a meal in front of me. I had two IV poles and tubes coming out of me everywhere. I had no strength, but I would push my way down the halls just to sit in the caf-

eteria and watch them eat. To see food and smell food and sort of eat vicariously through them. But also, because eating is not just about eating, it’s about the ephemeral connection we have to food. It’s so powerful. If you think about certain foods, you remember where you were and who you were with when you were eating it.” —Hans Rueffert, of Jasper, Ga., Chef, Restaurateur, Educator, Motivational Speaker, and Author of “Eat Like There’s No Tomorrow.” (April2013)

Laura Vasilionisaseniorwriterfor

Nutrition & Foodservice Edgemaga-

zine.

Steve Jackson Sarah Gorham Todd Henri Daigneault Hans Rueffert

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FOOD PROTECT ION CO NNEC T ION

The Big Sixby Melissa Vaccaro, MS, CHO

One of the duties of the Person in Charge (PIC) is to ensure that employees understand and report impor-tant health information in order to protect the health of consumers and employees. This is never a pleasant subject. Both employees and the PIC are often hesitant to discuss illness or symptoms of illnesses. “Oh, and by the way, I have had diarrhea for three days now” is not something that just pops up during the course of the day.

Both the PIC and the employee (or conditional employee who has been made an employment offer) have a respon-

sibility to report when these un-pleasantries happen. The employee has the duty to report illness, exposure to certain illnesses, or certain symptoms of illness to the PIC. The PIC has a duty to contact the regulatory agency should a food employee exhibit certain symptoms or be diag-nosed with one of the ‘Big Six’ diseases.

REPORTABLE SYMPTOMS

The symptoms listed in the Food Code cover the com-mon symptoms experienced by persons suffering from the pathogens identified by the CDC as transmissible through

1 HOUR SAN


PAT H O G E N S T R A N S M IT T E D

There are numerous pathogens that may cause foodborne illness, but there are six that the Centers for Disease Control and Prevention (CDC) bring to the forefront of conversation when it comes to food safety.

T H E B I G S IX PAT H O G E N S

So why does the FDA Food Code and the CDC single out these six pathogens?

The CDC has designated the six organisms listed in the Food Code as having high infectivity (able to invade at low doses) by contamination of food by infected food employ-ees. These organisms are also virulent (able to produce severe disease).

Following is a summary of the Big Six. (Sources: 19th Edi-tion of Control of Communicable Diseases Manual, the CDC website, and the FDA Bad Bug Book, 2nd Edition.)

N O R OV I R U S

Noroviruses are recognized as the most common cause of epidemic and spo-radic gastroenteritis across all age groups worldwide. Noroviruses are the leading cause of food-borne illness in the United States.

Transmission

Transmission occurs primarily through the fecal-oral route, in-cluding direct person-to-person con-tact and indirect transmission through contaminated food, water, or environ-mental surfaces. Vomitus-oral transmission can also occur through aerosolization followed by direct ingestion or environmental contamination.

Food handler contact with raw or other ready-to-eat foods is the most common means of transmission. Norovirus contamination of produce and shellfish can also occur during production. Secondary household transmission is common.

Noroviruses are environmentally stable, able to survive both freezing and heating (although not thorough cook-

food by infected food employees. A food employee suffer-ing from any of the symptoms listed presents an increased risk of transmitting foodborne illness.

• Vomiting

• Diarrhea

• Jaundice

• Sore throat with fever

• A lesion containing pus on the hands, wrists, or exposed portions of the arms

Continued on page 12

UN D E RSTANDING

THE B I G S IX

PATHOGENS



ing), are resistant to many common chemical disinfectants, and can persist on surfaces for up to two weeks. Proper hand hygiene and exclusion of food employees exhibiting symptoms of norovirus disease (i.e., diarrhea or vomiting) are critical for norovirus control.

Incubation Period

In volunteer studies, the range is 10 to 50 hours.

Symptoms and Complications

Symptoms include acute-onset of vomiting, watery non-bloody diarrhea, abdominal cramps, and nausea, or a

combination of these issues. Low grade fever and body aches may also be associated. Symptoms

typically last 24 to 72 hours.

Infectivity

Noroviruses are highly contagious, and it is thought that an inoculum of as few as 18 viral particles may be sufficient to infect an individual. Shedding of the virus can continue for three weeks after recovery. Peak

viral loads may be as high as 100 bil-lion viral particles/g feces. That means

that it takes very few virus particles to get the disease, but you shed a lot of virus

particles while ill.

N O N -T Y P H O I DA L S A L M O N E L L A

This disease is caused by serotypes other than S. Typhi and S. Paratyphi A. The 2013 Food Code now requires food employees to report a diagnosis of non-typhoidal Sal-monella (NTS). Nontyphoidal Salmonella (NTS) enterica are bacteria that cause a diarrheal illness called salmonel-losis. NTS are among the most common and important causes of enteric disease. An estimated 1.2 million cases occur annually in the United States. Most infections are thought to be acquired through consumption of con-taminated food. According to studies, NTS are estimated to cause more than one million domestically acquired foodborne illnesses in the United States each year and are the leading cause of hospitalizations and deaths due to foodborne illness in the United States.

Transmission

Salmonella lives in the intestines of animals or humans. It can be found in water, food, soil, or surfaces that have been contaminated with the feces of infected animals or humans. People can become infected with Salmonella by:

• Eating foods contaminated with the bacteria.

• Contacting farm animals or pets, animal feces, or ani-mal environments.

• Touching contaminated surfaces or objects and then touching one’s mouth or putting a contaminated object into one’s mouth.

• Drinking contaminated water.

Incubation Period

Symptoms often begin 12 to 72 hours after being exposed to the bacteria, although it can take up to a week or more for symptoms to develop in some people.

Symptoms

Symptoms of salmonellosis include diarrhea, abdominal cramps, and fever. The illness usually lasts 4 to 7 days. Persons with NTS infections usually recover without treat-ment.

Infectivity

The minimum infectious dose of NTS for humans is gener-ally described as 100 to 1,000 organisms. However, doses of fewer than 10 organisms have caused illness in multiple outbreaks. Shedding of the bacteria can occur 4 to 5 weeks after the onset of the illness, even if symptoms of the ill-ness are gone.

S A L M O N E L L A T Y P H I

Salmonella enterica subspecies enterica serovar Typhi (commonly S. Typhi) causes a systemic bacterial disease, with humans as the only host. This disease is relatively rare in the United States, with fewer than 500 sporadic cases occurring annually in the U.S.

Incubation Period

Generally 1 to 3 weeks, but may be as long as 2 months after exposure.


Symptoms

Symptoms include high fever, from 103° to 104°F; lethargy; gastrointestinal symptoms, including

abdominal pains and diarrhea or constipation; headache; achi-

ness; loss of appetite. A rash of flat, rose-colored spots

sometimes occurs.

Infectivity

The minimal infectious dose is estimated to be less than 1,000 bacterial

cells. An individual in-fected with S. Typhi is con-

tagious as long as the bacilli appear in the excreta, usually

from the first week throughout the recovery; variable thereafter.

S H I G A TOX I N - P R O D U C I N G E S C H E R I C H I A C O LI

E. coli O157:H7 is the most commonly identified sero-type of Shiga toxin-producing Escherichia coli (STEC) as a cause of foodborne illness in the United States. E. coli O157:H7 is a zoonotic disease derived from cattle and other ruminants. However, E. coli O157:H7 also readily transmits from person-to-person, so contaminated raw ingredients and ill food employees both can be sources of foodborne disease. The Food Code definition of STEC covers all E. coli identified in clinical laboratories that produce Shiga toxins.

Incubation Period

Symptoms usually begin 3 to 4 days after exposure, but the time may range from 1 to 9 days.

Symptoms

Hemorrhagic colitis is characterized by severe cramping (abdominal pain), nausea or vomiting, and diarrhea that initially is watery, but becomes grossly bloody. In some cases, the diarrhea may be extreme, appearing to consist entirely of blood and occurring every 15 to 30 minutes. Fever typi-cally is low grade or absent. Infections from EHEC may range from asymptomatic to mild diarrhea to

severe, life threatening complications (e.g., hemorrhagic colitis, hemolytic uremic syndrome).

Infectivity

The infective dose of E. coli O157:H7 is estimated to be very low, in the range of 10 to 100 cells. Children under 5 years old are most frequently diagnosed with infection and are at greatest risk of developing hemolytic uremic syn-drome (HUS). The elderly also experience a greater risk of complications. The duration of excretion of STEC in the stool is typically 1 week or less in adults, but can be up to 3 weeks or longer in one-third of infected children.

S H I G E L L A S P P.

Shigella spp. causes an acute bacterial disease, known as shigellosis, and primarily occurs in humans, but also occurs in other primates such as monkeys and chimpanzees. An estimated 300,000 cases of shigellosis occur annually in the U.S. Shi-gella spp. are highly infectious and highly virulent.

Transmission

Outbreaks occur in overcrowding conditions where personal hygiene is poor, including institutions such as prisons, mental health facilities, day care centers, and refugee camps. Water and RTE foods contaminated by fe-ces, frequently from food employees’ hands, are common causes of disease transmission.

Incubation Period

The incubation time is 8 to 50 hours.

Symptoms

Abdominal pain, diarrhea, fever, nausea, and sometimes vomiting, toxaemia, and cramps can occur. The stools typi-cally contain blood, pus, or mucus resulting from mucosal ulcerations. The illness is usually self-limited, with an aver-age duration of 5 to 7 days. Infections are also associated




with rectal bleeding, drastic dehydration, and convulsions in young children.

Infectivity

The infectious dose for humans is low, with as few as 10 bacterial cells, depending on age and condition of the host.

H E PATIT I S A V I R U S

Hepatitis A virus (HAV) has been classified as a member of the family Picorna-

viridae. The exact pathogenesis of HAV infection is not understood,

but the virus appears to invade from the intestinal tract and is subsequently transported to the liver. The hepatocytes are the site of viral replication and the virus is thought to be shed via the bile.

Transmission

HAV is most commonly spread by the fecal-oral route through person-

to-person contact. Although numerous means of transmission can take place, a common

source of outbreaks can occur through ingestion of water or food that has fecal contamination.

HAV Immunization

Immune globulin (IG) can be used to provide passive pre-exposure against hepatitis A. Hepatitis A vaccination of food employees has been advocated, but has not been shown to be cost-effective and generally is not recom-mended in the United States, although it may be appropri-ate in some communities.

Melissa Vaccaro, MS, CHOisaFood

ProgramSpecialistforthePADepart-

mentofAgricultureandanExecutive

BoardMemberfortheCentralAtlantic

StatesAssociationofFoodandDrug

Officials(CASA).Sheisco-authorofthe

SURE™CompleteHACCPFoodSafety

Series.

[email protected]

Incubation Period

Incubation averages 28 to 30 days (range 15 to 50 days).

Symptoms

Illness usually begins with symptoms such as nausea/vom-iting, diarrhea, abdominal pain, fever, headache, and/or fatigue. Jaundice, dark urine or light colored stools might be present at onset, or follow illness symptoms within a few days. Jaundice generally occurs 5 to 7 days after the onset of gastrointestinal symptoms. The disease varies in severity from a mild illness to a fulminant hepatitis, rang-ing from 1 to 2 weeks to several months in duration.

Infectivity

The infective dose of HAV is presumed to be low (10 to 100 viral particles), although the exact dose is unknown. The viral particles are excreted in the feces of ill people (symptomatic and asymptomatic) at high densities (106 to 108/gm) and have been demonstrated to be excreted at these levels for up to 36 days post-infection.

CO N C LU S I O N

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1. WhichofthefollowingisNOToneoftheBigSix

Pathogens?

A. HepatitisA

B.Norovirus

C.HepatitisB

2. TheleadingcauseoffoodborneillnessintheUnited

Statesis/are:

A. Salmonella

B. Noroviruses

C. E.Coli

3. Whichareillnesssymptomsthatanemployeemust

reporttothePIC?

A. Fever,abdominalcramps,vomiting

B. Vomiting,diarrhea,jaundice

C. Vomiting,diarrhea,fever

4. WhichofthefollowingisoneoftheBigSixPathogens?

A. Listeria

B. Campylobacter

C. Shigella

ReadingThe Big Six andsuccessfullycompletingthesequestionsonlinehasbeenap-

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FOOD PROTECTION CONNECTIONReview Questions

1 HOUR SAN

5. Whichfoodbornevirushasavaccination?

A. Norovirus

B. HepatitisA

C. HepatitisC

6. WhichpathogencancauseHUS(hemolyticuremic

syndrome)?

A. E.Coli

B. HepatitisA

C. Botulinum

7. WhenmustaPICcontacttheirregulatoryagency?

A. Ifafoodemployeeexhibitscertainsymptomsoris

diagnosedwithoneofthe‘BigSix’diseases

B. Ifafoodemployeeexhibitscertainsymptomsoris

diagnosedwithanyfoodborneillnessdisease

C. Ifafoodemployeecallsinsick

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Nutrition and


As healthcare providers focused on nutritional services, our goal is to help our clients maintain—to the extent possible—acceptable parameters of nutritional status. We are expected to follow “best practice” to include:

• Providing nutritional care and services to each client, consistent with the client’s comprehensive assessment;

• Recognizing, evaluating, and addressing the needs of the client, including—but not limited to—the client at risk or already experiencing impaired nutrition; and

• Providing appropriate medical nutrition therapy that takes into account the client’s clinical condition, and preferences, when there is a nutritional indication.

In the State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care for §483.25(i) Nutrition F325 Nutrition, there is an excellent overview on nutrition and the critical role of nutrients. Nutrients are essential for many critical metabolic processes, the maintenance and repair of cells and organs, and energy to support daily functioning. Nutrition, Food and Dining all emerge into a very complex arena that affects the daily quality of life for each of our clients.

So as we are seeing a very rapid increase in our aging population, we look to improve our nutritional care and services. We continue to learn about the importance of

in the Aging Population

NUTRIT ION CONNECT ION

Eating Disorders

by Brenda Richardson, MA, RDN, LD, CD, FAND

UN D E RSTANDING

E AT I N G

D I SORDERS IN

THE E LDERLY


E ATI N G D I S O R D E R S I N T H E AG I N G P O P U L ATI O N A R E R E A L

• While often overlooked, when eating disorders occur significant morbidity and mortality result.

In a study published in the Journal of the International Psychogeriatrics (June 2010), a literature search of 48 published cases of eating disorders in people over the age of 50 years was conducted. The study shared that the mean age was 68.9 years, and the majority of the cases were female (88 percent). The majority of the cases had anorexia nervosa and 10 percent had bulimia nervosa. Late onset eating disorders were more com-mon than early onset. Comorbid psychiatric conditions existed in 60 percent, most commonly major depression. The most successful interventions included a combina-tion of behavioral and pharmacologic interventions. Mortality was high (21 percent) secondary to the eating disorder and its complications.

• Up to 24 million of all ages and gender suffer from an eating disorder (anorexia, bulimia and binge eating dis-order) in the United States.

• An estimated 10-15 percent of people with anorexia or bulimia are male.

• The elderly develop eating disorders for a number of reasons. These can range from loss of independence to the death of loved ones and a feeling of isolation. Refus-ing food can be a way of regaining control, or passively ending their own lives. Other reasons might include un-diagnosed depression, unresolved past issues, stress, at-tention seeking, etc. Remission can also occur in elderly people who have previously experienced the disorder.

• Women are more likely than men to develop an eating disorder.

T Y P E S O F E AT I N G D I S O R D E R S

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and exces-sive weight loss.


“resident choice” and that each client has the right to be actively involved in their care. We are learning more about decision making and the power of letting clients make decisions. So as we improve at identifying and monitoring weight changes and food issues, do we include consider-ation of the presence or risk our clients may have related to an eating disorder? Is there a need to improve our understanding of eating disorders and appropriate inter-ventions for the elderly? This article presents some key aspects of eating disorders to consider when caring for the aging population.



Symptoms:

• Inadequate food intake leading to a weight that is clearly too low.

• Intense fear of weight gain, obsession with weight, and persistent behavior to prevent weight gain.

• Self-esteem overly related to body image.

• Inability to appreciate the severity of the situation.

• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.

Warning Signs:

• Dramatic weight loss.

• Preoccupation with weight, food, calories, fat grams, and dieting.

• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohy-drates, etc.).

• Frequent comments about feeling “fat” or overweight despite weight loss.

• Anxiety about gaining weight or being “fat.”

• Denial of hunger.

• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

• Consistent excuses to avoid mealtimes or situations involving food.

• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.

• Withdrawal from usual friends and activities.

Health Consequences of Anorexia Nervosa:

Anorexia nervosa involves self-starvation. The body is de-nied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing and in-creasing the risk for heart failure.

• Reduction of bone density (osteoporosis), which results in dry, brittle bones.

• Muscle loss and weakness.

• Severe dehydration, which can result in kidney failure.

• Fainting, fatigue, and overall weakness.

Binge Eating Disorder (BED)

Binge Eating Disorder (BED) is a type of eating disorder that is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Symptoms:

• Frequent episodes of consuming a very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.

• A feeling of being out of control during the binge eating episodes.

The elderly develop eating disorders for a number of reasons, ranging from loss of independence to the death of loved ones.



• Feelings of strong shame or guilt regarding the binge eating.

• Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

Health Consequences of Binge Eating Disorder:

The health risks of BED are most commonly those associ-ated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

• High blood pressure

• High cholesterol levels

• Heart disease

• Diabetes mellitus

• Gallbladder disease

• Musculoskeletal problems

About Binge Eating Disorder:

• The prevalence of BED is estimated to be approximately 1-5 percent of the general population.

• Binge eating disorder affects women slightly more often than men. Estimates indicate that about 60 percent of people struggling with binge eating disorder are female, 40 percent are male.

• People who struggle with binge eating disorder can be of normal or heavier than average weight.

• BED is often associated with symptoms of depression.

• People struggling with binge eating disorder often ex-press distress, shame, and guilt over their eating behav-iors.

• People with binge eating disorder report a lower quality of life than those who don’t have the disorder.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Symptoms:

• Frequent episodes of consuming a very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.

• A feeling of being out of control during the binge-eating episodes.

• Self-esteem overly related to body image.

Warning Signs of Bulimia Nervosa:

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.

• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vom-iting, presence of wrappers or packages of laxatives or diuretics.

• Excessive, rigid exercise regimen-—despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.

• Unusual swelling of the cheeks or jaw area.

• Calluses on the back of the hands and knuckles from self-induced vomiting.

• Discoloration or staining of the teeth.

• Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.

• Withdrawal from usual friends and activities.

• Behaviors and attitudes indicating that weight loss, diet-ing, and control of food are becoming primary concerns.

Health Consequences of Bulimia Nervosa:

Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can damage the entire digestive system, and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heart-beats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potas-sium and sodium from the body as a result of purging behaviors.

• Inflammation and possible rupture of the esophagus from frequent vomiting.


• Tooth decay and staining from stomach acids released during frequent vomiting.

• Chronic irregular bowel movements and constipation as a result of laxative abuse.

• Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa:

• Approximately 80 percent of bulimia nervosa patients are female.

• People struggling with bulimia nervosa usually appear to be of average body weight.

• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.

• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.

OT H E R S P E C I F I E D F E E D I N G O R E AT I N G D I S O R D E R

Other Specified Feeding or Eating Disorder (OSFED) is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Examples of OSFED include:

• Atypical anorexia nervosa (weight is not below normal)

• Bulimia nervosa (with less frequent behaviors)

• Binge-eating disorder (with less frequent occurrences)

• Purging disorder (purging without binge eating)

• Night eating syndrome (excessive nighttime food con-sumption)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious prob-lems in maintaining quality of life and care.

CO M M O N S I G N S A N D S Y M P TO M S O F E AT I N G D I S O R D E R S

Eating disorders in the elderly may present the same symp-toms as those in younger populations but the causes may appear a little different. Just like the younger population, the elderly may develop eating disorders to feel in control. As they see their bodies becoming frail and experience loss of autonomy, they may turn to their diet as one of the few things they feel they can control.

• Weight changes (significant and insidious)

> Weight loss whether it is voluntary or involuntary is well known to predispose them to muscle wasting, frailty, diminished immunocompetence, depres-sion and increased susceptibility to diseases and disorders, and strongly correlates with consequent morbidity and mortality.

• Depression with loss of appetite (or other anxiety disorders)

• Changes in behavior, such as disappearing right after a meal or using the restroom after eating

• Presence of laxatives, diet pills, or diuretics

• Missing, unused, or unopened food

• Fixation on death

• Chronic dizziness

• History of using one or more compensatory behaviors to influence weight after eating (fasting, dieting, etc.)

• History of using/abusing appetite suppressants, excessive caffeine, diuretics, laxatives, enemas, prescription meds, or a variety of complementary and alternative supplements.

N U T R IT I O N A L I N T E RV E N TI O N S

• Early recognition and timely intervention based on evidence-based and an interdisciplinary team approach (medical, nutritional, and psychological).

• Conduct a comprehensive nutritional assessment to include review of weight changes, anorexia, socioeco-nomic factors, medications, and appropriate labs/tests.

• Remember that clients with eating disorders may not recognize they are ill and they may be reluctant about accepting treatment.

• Always refer to appropriate healthcare providers for ad-ditional services as needed.

• Conduct an assessment for psychiatric risk, including suicidal and self-harm thoughts, plans, and/or intent.

• Liberalize dietary restrictions and adjust the diet to serve more of the foods they like.

• Serve several small meals throughout the day, rather than just a few big meals.

• Use flavor enhancers to improve the smell, appearance, or taste of food.



• Encourage the person to socialize and be active, includ-ing eating with others.

S U G G E S T I O N S FO R O N G O I N G M A N AG E M E N T

• Nutritional rehabilitation, weight restoration and sta-bilization, physiologic restoration, management of any refeeding complications, and interruption of purging/compensatory behaviors should be the immediate goals of treatment.

• Consider additional psychological and other therapeutic goals in parallel when possible.

• Work towards achieving an appropriate healthy weight, which assists in improving the physical, psychological, social, and emotional functioning of the client.

• Ongoing monitoring and support is needed. Distorted body image and eating disorder thoughts may persist after achieving a healthy weight and may require longer therapy.

CO N C LU S I O N

There are many issues underlying the growth of eating disorders in the elderly. As healthcare providers we need to recognize that our clients will benefit from prompt identification and evidence-based interventions. Risk of death from suicide or medical complications is markedly increased for individuals with eating disorders. Remember that eating disorders in older adults can be treated, thus improving a person’s health and hopefully allowing them to live longer with an improved quality of life. Nutrition plays a critical role in successful treatment. E

REFERENCES

Brenda Richardson, MA, RDN, LD,

CD, FANDisalecturer,author,and

consultant.SheworkswithDietary

ConsultantsInc.inbusinessrelations

anddevelopment,andispresident/

ownerofBrendaRichardsonAssoci-

ates,Inc.

[email protected]

iDanielleGagne,AnnVonHolle,KimberlyBrownley,CristinRunfola,SaraHofmeier,KatelandBranch,CynthiaBulik,Eating

DisorderSymptomsandWeightandShapeConcernsinaLargeWeb-BasedConvenienceSampleofWomenAges

50andAbove:ResultsoftheGenderandBodyImageStudy(GABI),InternationalJournalofEatingDisorders,Wiley-

Blackwell,DOI:10.1001/eat.220121

Dudrick,MD,FACS.EatingDisorders’PrevalenceIncreased,Today’sGeriatricMedicine,July/August2013.Pp.18-22.

Dudrick,MD,FACS,OlderClientsandEatingDisorders,Today’sDietitian,Vol.15No.11P.44,Nov.2013.

EatingDisordersStatistics.NationalAssociationofAnorexiaNervosaandAssociatedDisorderswebsite.http://www.

anad.org/get-information/about-eating-disorders/eating-disorders-statistics/.Accessedonline1/3/2015.

Lapid,MI,PromMC,etal.EatingDisordersintheElderly.IntPsychogeriatr.2010Jun;22(4):523-36.

StateOperationsManualAppendixPP-GuidancetoSurveyorsforLong-TermCareFacilities(Rev.127,11-26-14)(Rev.

130,12-12-14).Accessedonline1/2/2015.http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-

Only-Manuals-IOMs-Items/CMS1201984.html

WEBSITES FOR MORE INFORMATION:

http://www.nationaleatingdisorders.org/TheNationalEatingDisordersAssociation(NEDA)

http://www.iaedp.com/TheInternationalAssociationofEatingDisorders

http://www.aedweb.org/web/index.phpTheAcademyforEatingDisorders

http://unceatingdisorders.orgUniversityofNorthCarolinaCenterofExcellenceforEatingDisorders

http://renfrewcenter.com/TheRenfrewCenters


1. Oftenoverlooked,eatingdisordersresultin: A. Rulesthatmustbefollowedbythepractitioner B. Significantmorbidityandmortality C. Theneedtohavefoodinlockedcontainers

2. IntheUnitedStates,upto______ofallagessufferfromaneatingdisorder:

A. 10million B. 14million C. 24million

3. Theelderlycandevelopeatingdisordersforanumberofreasonsincluding:

A. Dislikeofchocolateandbananas B. Lossofindependence,togaincontrolorpassivelyend

theirlives C. Lackofavailabilityofunprocessedfoods

4. Typesofeatingdisordersinclude: A. AnorexiaNervosa,BingeEatingDisorder,BulimiaNervosa,

OtherSpecifiedFeedingorEatingDisorder B. Anorexia,Overeating,Fasting,Supplementation C. AnorexiaNeurosis,BingeWasting,EatingDyslexia

ReadingNutrition and Eating Disorders in the Aging Population andsuccessfullycompletingthesequestionsonlinehasbeenapprovedfor1hourofCEforCDM,CFPPs.CEcreditisavailableONLINEONLY.Toearn1CEhour,purchasetheonlineCEquizintheANFPMarketplace.Visitwww.ANFPonline.org/market,select“Publication,”thenselect“CEarticle”atleft,thensearchthetitle“Nutrition and Eating Disorders in the Aging Population”andpurchasethearticle.

NUTRITION CONNECTIONReview Questions

5. Screeningfornutritionalriskshouldbecompletedfor: A. Groupsettingsforthoseatrisk B. Familymembers C. Eachindividualatriskorwithaneatingdisorder

6. Provideindividualizednutritionalinterventionsbasedon: A. Interdisciplinaryteamapproachformedical,nutritional,and

psychologicalneeds B. Idealbodyweightinthepastsixmonths C. Averageofthetotalnutrientsinthemenusoffered

7. Theimmediatetreatmentgoalsforaclientatriskorwithaneatingdisorderinclude:

A. Additionalfluidsandlargeportionsdiet,dietarysupplement(s) B. Nutritionalrehab,weightrestorationandstabilization,

physiologicandcompensatorybehaviorsinterrupted C. Restrictingdietarychoicestoreducesodium,sugar,andfat

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IDEA STARTERS

It’s the first quarter of 2015—a good time to evaluate how you can improve your foodservice operation in the year ahead. Consider the following 50 tips that can stream-line or improve your systems, and may ultimately enhance your resident satisfaction scores and bottom line.

1. Invest in dish racks if you don’t have them or have the wrong kind. Replace broken racks. This is the single best way to protect your investment in china and allow items to air dry properly.

2. Limit garbage cans to the number actually needed and attach lids. Connect lids with cleanable nylon cords.

3. Check cleanliness of the dumpster area. Take or request action as needed. Make this part of your daily routine, not just when preparing for your state survey.

4. Interview applicants periodically even if you’re fully staffed. Having a back-up plan is a great safety net if employee issues arise and you need to hire on short notice.

5. Use your chemical vendor to in-service and orient staff. Establish core points to cover: cleaning and sani-tizing methods, de-liming the dish machine, proper chemical dilution ratios, and more.

to Improve Your Foodservice Operation

50 Ways

by Wayne Toczek


9. Request a monthly velocity report from your prime ven-dor. Meet monthly and look for purchasing opportunities.

10. Meet with your prime vendor rep quarterly to discuss savings strategies and new products.

11. Keep all recipes for the current menu cycle in both electronic and hard copy format. Look into produc-tion software that can easily expand recipe yields to desired amounts.

12. Commit to a consistent calendar of special events. Plan holiday meals and specific theme days in ad-vance. Example: Every third Thursday of the month is an ice cream social or is Taste of the World Day.

13. Update policies and procedures. Keep them current at all times and inform staff of any changes.

14. Change sanitizer solutions in buckets and sinks ac-cording to a schedule, such as every four hours. In heavy use times, replace more often.

16. Find one item in your kitchen that has not been used in six months and remove it. Reduce clutter daily.

17. Offer beverages in bulk. Save money and time with this practice.

18. Offer a dessert cart every week or every month.

19. Stop worrying about the 14.5 hours between dinner and breakfast by offering continual breakfast begin-ning at 6:30 am. Investigate the possibilities and think outside the box.

6. Download the state or local Food Code and use as your go-to food safety guide.

7. Jot down an agenda for each food show you attend. Target vendors based on specific food and menu items you want to learn about.

8. Monitor your preventive maintenance program. Pre-pare a preventive maintenance schedule if you don’t have a maintenance department. Don’t wait for equip-ment to fail—help avoid breakdowns with a proactive plan.


15.Create an opening and closing checklist and use it every day. This allows y our department to always be ready for inspection.


21. Purchase a wet vac. Use it to clean out such items as non-drainable steam tables and other types of equipment.

22. Communicate with email, especially work orders. This gives you an electronic “paper trail” should questions arise.

23. Keep a maintenance log. Include every work order and follow-up request.

24. Calculate a return on investment for each piece of equipment you need. Present those figures to your boss with the purchase order.

25. Remove all drawers periodically. These are hiding places for dirt and clutter.

26. Designate specific areas for sanitizer buckets and keep them there.

27. Develop your in-service calendar and stick to it. Add extra programs as needed.

28. Visit 10 percent of your customers every day and document it. This means a different 10 percent until all have been visited; then start over. This is the best way to determine customer satisfaction and create a communication line to your department. Commit to resolving issues promptly and documenting steps.

29. Review the waste in your dish room, document and track it. Determine how it can be reduced.

30. Orient all new employees completely. Follow up and repeat until new staff members are competent. Allow employees to do each job independently before train-ing for another position.

31. Write a department business plan. Address such ques-tions as: How will your services look, feel, or perform differently? What is your timeframe for achieving results/change? What resources do you need to achieve your results – and what are the costs of those resources? How will you measure success? How does your plan support the company’s Mission Statement?

32. Track everything that leaves the department and cost it out. Your food cost is the cost of your meal and all the extra things like cookies for special events. Track staff meals. This analysis allows informed decision-making on budgeting.

33. Keep a log of all leftovers. Develop a game plan to use, and adjust production as needed for the next menu cycle. Add these items to your production sheet to communicate with staff.

34. Establish a par stock shelf for china and stop panic buying when a dozen pieces break all at once. De-velop and follow a formula that includes pattern and supplier for all tableware to avoid mismatched service ware and reduce breakage.

36. Update all signs posted in your kitchen to improve clarity and appearance.

37. Track your invoices every week and assess how you are doing in relation to the budget. Share this infor-mation with staff.

38. Understand what technology can do to make your job easier and make time to learn to use it.


20.Get creative with supplements and offer a variety of foods. Other items have similar protein and calories, like health shakes.

35.Keep steam table pans in good condition. Bend pan edges back to normal every week so they lay flat on the steam table. Creating a good seal helps ensure proper temperature retention.


40. Perform QA audits according to the schedule because it’s the right thing to do. By completing these audits and taking action when indicated you will always be prepared for inspection.

41. Support and encourage your staff to become ServSafe or CDM certified.

42. Make sure everyone in your department can calibrate a thermometer.

43. Mount your thermometer in the warmest spot in your cooler(s). Read internal temperature in freezer and cooler to ensure your foods are not in the danger zone.

44. Update resident preferences six months after admis-sion and every six months thereafter. Requests and preferences change over time.

45. Cable tie any cord or hose up off the floor. This allows for proper cleaning and also avoids food collecting on cords lying on the ground.

46. Learn about functional garnishing and teach your staff. Functional garnishing is a great, cost-effective way to present food. Offer food in a fashion that is function-ally garnished in presentation and with condiments.

47. Take the temperature of food at the beginning, middle, and end of service. The best way to test your temperature retention efforts is to read the thermom-eter in the middle and at the end. This allows you to determine whether your steam tables are staying hot, or if staff is turning steam tables off early to allow for easier cleaning.

48. Develop a program to greet all new residents. Create a plan that allows you to introduce yourself, give them a business card, and tell them about meal times and menus, and establish that direct contact relationship.

49. Make simple enhancements to the dining service for your rehabilitation customers. Enhance your room service trays. Consider keeping the condiments in a small, attractive caddy, instead of laying them on the tray. If feasible, use linen napkins instead of paper napkins to upgrade the appearance of your tray service.

There you have it! Fifty suggestions for a more efficient, effective operation in 2015. Pick and choose the ideas that best meet your unique needs, and brainstorm additional tactics with your staff to make your food service the best it can be! E

Wayne ToczekisCEOofInnovations

Services,Norwalk,Ohio.Contacthim

at(419)663-9300orvisit

www.innovaservices.info.

[email protected]

50.Read four good business books per year. Read magazines such as Edge to learn from your peers and professionals in the industry.

39.Sell your value to your boss every month. Present a report of what you have done and achieved.


HYDRAT ION IN LONG-TER M C AR E

TeaHydration is a common concern in long-term care. Drinking more water is often recommended. But why not consider tea as an option? The Food and Nutrition Board of the Institute of Medicine in its most recent refer-ence intakes for water in 2005 states, “caffeinated bever-ages appear to contribute to the daily total water intake similar to that contributed by non-caffeinated beverages.” Studies show no effect on hydration with intakes up to 400 mg of caffeine or the equivalent of 8 cups of tea.

Why is hydration important? The adult body is 50-65 per-cent water and needs a balance of water and electrolytes to properly function. Water controls body temperature, impacts blood pressure, removes waste through urine, and

much more. How much water the body needs varies with health conditions, environment, and exercise. When suf-ficient fluids are not consumed dehydration can cause con-fusion, problems with balance, headaches, faintness. Foods such as soup, yogurt, milk, pudding, ice cream, vegetables, and fruits all contain some amount of fluid. The more variety of fluids consumed, the less likely the individual is to be dehydrated. However, even with all of these options, many seniors become dehydrated because of decreased intake of food and fluids or drinking less to minimize the need to urinate. Tea is one option for variety in fluids that is not often considered.

Time for

by Linda S. Eck Mills, MBA, RDN, LDN, FADA


ages should really be called by more appropriate names, such as herbal tea, herbal infusions, or tisanes. Tea is not a ready-to-drink powder, a ready-to-drink bottled beverage, or a hyper-caffeinated ‘quick shot.’

There are six classifications of tea—green, yellow, white, oolong, black, and Pu-erh. The classification is determined by the production method.

Green Tea

The leaf retains its green color both dried and in the cup. The best green teas are made in the spring from young tender leaves or buds. Green tea is the specialty of China, Japan, and Korea. The best way to drink green tea is with-out milk or sugar.

Yellow Tea

Most yellow teas are made from fat, juicy spring-plucked tea buds; a few are made from large, leafy basket-fired teas. Yellow tea is made in just a few places in China. Even though yellow tea is included as one of the six classes of tea, it is a rare commodity. The best way to drink yellow tea is without milk or sugar.

White Tea

This is a spring-plucked, bud-only tea. The flavor of true white tea is soft and light, and slightly reminiscent of a light black tea. The best way to drink white tea is without milk or sugar.

Oolong Tea

This variety is a tea enthusiast’s dream. Oolong teas are re-freshing and generally described as lush and floral. Oolong teas are best drunk without milk or sugar.

Black Tea

This is the most popular tea among Western tea drinkers. Black teas are flexible, made to be drunk black, with milk and sugar, or with a squeeze of lemon or honey.

Pu-erh

This is China’s most famous fermented tea and is made exclusively in the tea mountains of the Yunnan Province. It can be sweet and light or strong and toothsome. This tea is the daily tea of millions of people in China.

S T E E P I N G T E A

The goal in preparing a delicious cup of tea is to have the right amount of tea, with the right amount of water, for the right amount of time. For most teas, 2-3 grams of leaf and 6 ounces of water for every 6 ounces of capacity in your teapot or steeping cup is recommended. The amount

T I M E FO R T E A FAC T S

Until the early 1800s, only three countries produced tea. To-day that number has risen to over 41 countries. Tea is both the dried leaves and buds of the Camellia sinensis genus of plants, and the caffeinated beverage made from these leaves and buds. Tea is also all wild-growing and ancient tea trees and generations of indigenous tea bushes and tea trees naturally growing in southwest China, Laos, Burma, Thai-land, and Vietnam.

It’s important to note that tea is not a beverage made from or an infusible dried mixture comprised of roots, stems, flowers, seeds or the fruit of any other plant such as pep-permint, chamomile, lavender, etc. As such, these bever-

OPT I ONS TO

MA I N TAIN

HYD RAT ION



most consumed types of tea. Green tea studies primarily have been with Asian populations who have a different lifestyle and diet than Americans. Studies of individual ingredients to tea – such as caffeine and flavonoids – may not apply to brewed tea consumed in normal amounts. The type of tea, brewing time, and method can affect amounts of compounds present in a cup of tea. Flavonoids in black and green tea prevent oxidation of LDL “bad” cho-lesterol and reduce blood clotting. Black tea can suppress salivary amylase and reduce the cavity-causing potential of starch. Tea catechins have antibacterial properties. Tea polyphenols enhance bone formation and inhibit bone re-sorption resulting in greater bone strength. Fluoride in tea and water can strengthen bones. Tea catechins and caf-feine stimulate thermogenesis and fat oxidation. Regular ingestion of green, white, and oolong teas increase energy expenditure by 4-5 percent and fat oxidation by 10-16 percent. One gram of instant black tea in 250ml of water significantly lowered plasma glucose levels at 120 minutes compared with caffeinated and control beverages.

So, for hydration and health benefits, consider tea as a deli-cious and viable beverage option for your residents. E


of tea in 2-3 grams can vary from 1 teaspoon to 2 table-spoons, depending on the leaf size. The measure will be a greater volume of leaf when the leaf is large than when the leaf is small. Some types of loose-leaf tea can be re-steeped several times, which will increase the number of cups of tea obtained from the same 4 ounce quantity of tea.

Water temperature is a critical factor in extracting the best flavor from the tea leaves. Most tea leaves do not like to be blasted with boiling hot water, and more delicate grades of tea such as green and white teas can easily be scorched. To avoid over-extracting the flavor components of the leaf, it is better to steep the leaves slightly longer at a cooler temperature than with water that is too hot.

The final variable in making good tea is the amount of time that the tea leaf is steeped. Tea that is either under-steeped or over-steeped is disappointing. Each type of tea has a steeping time that it responds to best. Black teas prefer steep times of 3-5 minutes; green, white, and yellow teas prefer short steep times of 1-2 minutes; oolong teas prefer steep times of 2-4 minutes; Pu-erh tea prefers steep times of 3-4 minutes.

T E A R E S E A R C H A N D H E A LT H B E N E F IT S

Many studies are observational or epidemiologic so they don’t necessarily show cause and effect. However, caffeine is one of the most-researched substances in the food sup-ply. Caffeine has a long history of safe use. Most studies have been done on green and black teas since they are the

Linda S. Eck Mills, MBA, RDN, LDN,

FADA isaprofessionalspeaker,aca-

reercoach,andco-authorofthebook

Flavorful Fortified Food – Recipes

to Enrich Life.MillsdirectstheANFP

programatLehighCarbonCommu-

nityCollege(Schnecksville,Pa.),and

worksincorrectionalfoodservice.

[email protected]

TeaTime:CulturalTraditionsandHealthBenefitssessionatAND’s2014FoodandNutritionConferenceandExpo

Teatrekker.com

DietaryReferenceIntakesforWater,Potassium,Sodium,Chloride,andSulfate.InstituteofMedicine,TheNationalAcademies

Press,Washington,DC,2005http://www.nap.edu/openbook.php?isbn=0309091691

REFERENCES

Comfort Foods and Comfort Care

Food Allergies

When is Weight Loss Really Weight Loss?

Fortification vs. Supplementation

For many, the long-term care facility is the final living situation for the elderly. Provid-ing for comfortable living in the “golden years” should be of the utmost importance. Food plays a very important role in the quality of life. Comfort Foods and Com-fort Care allows the CDM to discuss the current trends in providing comfort foods, how to incorporate these foods into the healthcare menu, and to understand the relationship between comfort foods and comfort care in the elderly population.

The concept of “liberalized diets” is now mainstream in long-term care. Standards of Practice for Individualized Diet Approaches outlines the recommenda-tions of the Dining Practice Standards from the Pioneer Network. The Standards help CDMs identify dining requirements, the importance of food selection, and under-stand CMS requirements.

Food allergies have been a “hot topic” in the nutrition literature and seem to be on the rise in the United States. Through this Food Allergies course, the CDM will be able to identify common aller-gens, read labels looking for specific food allergens, and discuss food preparation challenges that may be faced in the food-service setting.

Obesity is now considered a public health crisis and epidemic in the United States. It is interesting, though, that in the healthcare world unintentional weight loss is also a serious condition. When is Weight Loss Really Weight Loss? looks at the obesity epidemic in the U.S. It then discusses the concepts of intentional and unintentional weight loss in health care and how to manage it.

Recently, the concept of “Real Food First” is one that examines the use of real food as a supplement for a client who may be los-ing weight. So what is the role of fortified foods or nutrition supplements in nutrition care? Fortification vs. Supplementa-tion will examine the common terms used for this discussion, and how these foods can be used in patient care in the health-care setting.

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Healing

WOUND HEAL ING STRAT EG IES

According to the Centers for Disease Control and Prevention National Nursing Home Survey, 159,000 (11 percent) of US nursing home residents had a wound, of which, pressure ulcers were the most prevalent.1 Wounds can lower overall quality of life, increase length of stay, and increase risk of mortality.2, 3 Therefore, clinical nutrition practice guidelines have been developed as adequate nutri-tion plays a critical role in the wound healing process and contributes to reduced cost of wound care and improved quality of life.4

P R OT E I N FO R WO U N D H E A L I N G

Protein, in particular, plays the most important role in nutrition wound therapy. It is involved in all phases of the healing process and aids in tissue growth and repair. Protein is used in the synthesis of enzymes involved in healing, cell multiplication, and collagen and connective tissue.4 Sufficient caloric intake is required to prevent protein from being utilized as a source of energy.4 Intake of dietary protein is especially important in older adults due to changes in body composition that are associated

Nutrition Therapy for

Woundby April Irvine, MS and Julie Moreschi, MS, RD, LDN

LE A RN MORE . . .

...about pressure ulcers at ANFP’s

Annual Conference & Expo, Aug

2-5 at the Hyatt Regency Grand

Cypress in Orlando. A panel

discussion and an educational

session will address nutrition in

the prevention and treatment of

pressure ulcers.

Register for the conference

at www.ANFPonline.orgClick

“Events”


serum albumin levels to evaluate nutritional status of patients. However, recent research concluded that while serum albumin may be useful to help establish overall prognosis (i.e. morbidity and mortality), it is no longer appropriate to use as a marker of visceral protein status.6, 7 Many non-nutrition related variables affect serum albumin levels including dehydration, acute stress, inflammation, metabolic stress, burns, surgery, and cancer.8

Medical nutrition therapy (MNT) for wound healing in-cludes the following: 9

1. Increase energy requirements to 35 to 40 kcal/kg for wound healing. According to the National Pressure Ul-cer Advisory Panel, adjust calorie level based on weight changes and/or obesity.

2. 1.25-1.5 g protein/kg to achieve positive nitrogen bal-ance. Assess renal function to ensure appropriate pro-tein intake.

3. 30 ml fluid/kg to prevent dehydration. Increase fluid requirements due to heavily drained wounds, fever, vomiting, and sweating.

4. Provide sufficient vitamin and mineral intake through a balanced diet. If dietary intake is poor or deficiencies occur, provide a vitamin and mineral supplement that includes zinc and vitamin C.

• Due to the draining of wounds, zinc deficiency may occur. Include a multi-vitamin and mineral supple-ment with zinc.

• Vitamin C is also important in wound healing because it is needed to make collagen, and repair tendons and ligaments.10

I N E X P E N S I V E WAYS TO I N C R E A S E C A LO R I E S A N D P R OT E I N

It is necessary to individualize nutritional approaches or interventions to ensure that individuals will receive food they like or are willing to eat. While food supplements such as nutritional shakes and drinks may be one method to increase calories and protein, it is often a more expen-sive approach. Try food first, using items already served, and fortify it to increase calories and protein with every bite eaten.

with aging, decreased physical activity levels, and reduced immune function. These changes can lead to impaired wound healing and inability to fight infection.4 Arginine becomes a conditionally essential amino acid in stressed adults. Arginine promotes wound healing by increasing collagen deposition and improved immune function.5

B I O C H E M I C A L A N A LYS I S

Laboratory value analysis is one component of nutrition assessment for wounds. Historically, dietitians have used Continued on page 34


April Irvine, MS,registrationeligible,receivedhermas-

ter’sdegreeinNutritionandWellnessfromBenedictine

University,Lisle,Ill.,andherbachelor’sdegreeinCulinary

NutritionfromJohnson&WalesUniversity,DenverColo.

Julie Moreschi, MS, RD, LDNistheDieteticInternship

DirectoratBenedictineUniversityinLisle.Shehasbeen

anRDforover29years,andholdsamaster’sdegreein

NutritionfromRushUniversity,Chicago.


• Add peanut butter on bread or apples, blend into milk-shakes, or bake in cookies as a healthful approach to increase calories and protein.

• Coat vegetables with olive oil or butter to increase calories.

• Use sour cream in mashed potatoes or as a dip to increase calories.

• Add skim milk powder to oatmeal or hot cereals, soups, puddings, milkshakes, or other beverages to increase protein.

• Offer additional portions of meat, poultry, fish, eggs, yogurt, and/or cottage cheese to increase protein.

S U M M A RY

Enhancing quality of life for individuals with—or at risk for—pressure ulcers is of the utmost importance. Tap into the resources available to you, several of which are cited here, to learn more about the role of medical nutrition therapy in preventing and treating pressure ulcers. E

REFERENCES

i1.Park-LeeE,CaffreyC.Pressureulcersamongnursinghomeresidents:UnitedStates,2004.NCHSdatabrief,no14.

Hyattsville,MD:NationalCenterforHealthStatistics.2009.

2.BriggsM,CollinsonM,WilsonL,etal.Theprevalenceofpainatpressureareasandpressureulcersinhospitalised

patients.BMCNurs.2013;12(1):19.

3.GoreckiC,LampingDL,BrownJM,MadillA,FirthJ,NixonJ.Developmentofaconceptualframeworkofhealth-related

qualityoflifeinpressureulcers:apatient-focusedapproach.IntJNursStud.2010;47(12):1525-34.

4.DornerB,PosthauerME,ThomasD.Theroleofnutritioninpressureulcerpreventionandtreatment:NationalPressure

UlcerAdvisoryPanelwhitepaper.AdvSkinWoundCare.2009;22(5):212-21.

5.BrownKL,PhillipsTJ.Nutritionandwoundhealing.ClinDermatol.2010;28(4):432-9.

6.WhiteJV,GuenterP,JensenG,etal.ConsensusstatementoftheAcademyofNutritionandDietetics/American

SocietyforParenteralandEnteralNutrition:characteristicsrecommendedfortheidentificationanddocumentationof

adultmalnutrition(undernutrition).JAcadNutrDiet.2012;112(5):730-8.

7.IizakaS,SanadaH,MatsuiY,etal.Serumalbuminlevelisalimitednutritionalmarkerforpredictingwoundhealingin

patientswithpressureulcer:twomulticenterprospectivecohortstudies.ClinNutr.2011;30(6):738-45.

8.MuellerC,CompherC,EllenDM.A.S.P.E.N.clinicalguidelines:Nutritionscreening,assessment,andinterventionin

adults.JPENJParenterEnteralNutr.2011;35(1):16-24.

9.NationalPressureUlcerAdvisoryPanel,EuropeanPressureUlcerAdvisoryPanel.Pressureulcertreatment

recommendations.In:Preventionandtreatmentofpressureulcers:clinicalpracticeguideline.Washington(DC):National

PressureUlcerAdvisoryPanel;2009.p.51-120.

10.InstituteforClinicalSystemsImprovement(ICSI).Pressureulcerpreventionandtreatmentprotocol.Healthcare

protocol.Bloomington(MN):InstituteforClinicalSystemsImprovement(ICSI);2012Jan.88.


Many doctors’ offices across the country have a resolution for the New Year: switching to a team-based model of care called the patient-centered medi-cal home, reports the January 2015 Harvard Health Letter.

“It’s the highest and best version of primary care, specifically designed to take care of people’s preven-tive needs as well as complex chronic conditions,” says Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Harvard-affiliated Massachusetts General Hospital.

The patient-centered medical home model turns a doctor’s practice into a physician-led team that helps patients meet their health goals by getting to know them, developing long-term treatment plans for them, focusing on prevention, educating them about how

to reach their goals, and coordinating care with other specialists if necessary. The team must be available, at least by telephone, 24 hours a day, seven days a week. Several national accreditation programs hold the team accountable to these high standards.

The patient-centered medical home concept was introduced by the American Academy of Pediatrics in the 1960s and took off in the late 2000s among fam-ily practice and internal medicine doctors. Since then, thousands of doctor’s offices have made the switch. Employers are driving the change because they know this model provides high-quality and efficient care for their workers and reduces care people don’t need. “Also, doctors know it decreases burnout among physi-cians and staff,” says Edgman-Levitan. “They’ve now got a team of people helping them do their job better.” E

Patient-Centered Medical Homesto Increase in 2015

Readthefull-lengtharticle:“NewYear,NewApproachto

HealthCare”at:www.health.harvard.edu/health

i


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LEGISLAT IVE REPORT

by Craig Brightup

ANFPGovernmentAffairsUpdate

ANFPPresidentandCEOJoyceGilbert,PhD,

RDNcametoWashington,DC,formeetings

Dec.2-3topreparefortheSafeFoodforSe-

niorsActtobereintroducedinthe114thCon-

gress;augmentANFP’spresenceonCapitolHill;

andgeneratemoresynergywiththeAcademy

ofNutritionandDietetics(theAcademy).Se-

curingsupportinthenewCongresswastheba-

sisformeetingswithstaffforSen.BobCorker

(R-TN),amemberoftheSpecialCommitteeon

Aging,andReps.ReidRibble(R-WI)andLynn

Jenkins(R-KS).

Rep.JenkinshadpreviouslycosponsoredH.R.

2181andisontheWaysandMeansCommittee,

whichhasjurisdictionoverthebill.Rep.Tom

Latham(R-IA)hadintroducedH.R.2181inthe

lastCongressbutisretired,soRep.Jenkins’

staffofferedtospeakwithheraboutintroduc-

ingthebillinthisCongress.Thisofferwas

reiteratedbystaffatRep.Jenkins’swearing-in

openhouseonJan.6(thestartofthe114th

Congress),andIexplainedthattheLegisla-

tiveCounsel’sOfficedraftedH.R.2181atRep.

Latham’srequestandthetextisgoodtogoin

thisCongress.

WealsodroppedbytheofficesofSen.Al

Franken(D-MN)andRep.PeterRoskam(R-IL),

whosedistrictincludesANFP’sheadquarters.

JoiningusforallofthesemeetingswasEStreet

PartnerThadHuguley,whoisnowpartofour

Washingtonoffice.Huguleyhadarrangedthe

meetingwithSen.Corker’sofficeandiswell-

positionedtohelpgeneratecosponsorswhen

thebillisreintroduced.

BringingHuguleyonboardispartofANFP’s

advocacyshifttoWashingtontoallowmore

outreachtoCapitolHillandwithorganizations

thatsharemutualinterestswithANFP.The

Academywasoneofsixorganizationsthat

officiallysupportedH.R.2181duringthelast

Congress,andwehadaproductivemeeting

withitsVicePresidentforStrategicPolicyand

Partnerships.WewillworkwiththeAcad-

emyonissuessuchasimplementationofthe

ImpactAct(ImprovingMedicarePost-Acute

CareTransformationActof2014),andlook

forwardtotheAcademy’sactivehelponthe

SafeFoodforSeniorsAct.

Whenreintroduced,theSafeFoodfor

SeniorsActwillgetanewnumberforthis

Congress.IfRep.Jenkinsintroducesthebill,

wewillaskRep.EarlBlumenauer(D-OR)to

againbetheleadcosponsor.Wewillalso

askRep.SanfordBishop,Jr.(D-GA)tobe

acosponsoragain,andmoveaggressively

togeneratemorecosponsorsbyjumpstart-

ingour“Gimme10”grassrootscampaignto

generate10morecosponsors. E

When the 113th Congress ended Dec. 31, 2014, the Safe Food for Seniors Act came to an end,

too, at least insofar as being H.R. 2181. Thus, the first step for ANFP in the 114th Congress is to

get the Safe Food for Seniors Act reintroduced with a new bill number, and preparations to do

so began in December.

Watch for Legislative Updates onANFP’sAdvocacyWebsite

ANFP has a dedicated website devoted

to boosting awareness of the CDM

credential and providing ANFP mem-

bers with a voice in legislative issues

impacting foodservice management

and safety.

Look for progress updates on the bill,

ways to help at the grassroots level, and

more at www.safefoodcdm.org.

Craig Brightupis

ANFP’sgovern-

mentaffairs

consultantin

Washington,DC.


ANFP LEADERSHIP SPOTL IG H T

Meet Certifying Board MemberYvonneFoyt

NewsfromtheCertifying Board

Yvonne Foyt, CDM, CFPP

C E R T I F Y I N G B OA R D M E M -

B E R YvonneFoyt,CDM,CFPP,is

DietarySupervisoratParksideLu-

theranNursingHomeinLisbon,N.D.

LikemanyCDMs,herfirstbrushwith

thefoodserviceindustrycameinhigh

school,whenshewaitressedatlocal

restaurantstoearnspendingmoney.

Herbigbreakcamein1980,whenshe

tookajobasacookatCommunity

MemorialHospitalandNursingHome

inLisbon.FellowANFPmemberKristi

Salisbury,RD,CDM,CFPPwasher

supervisoratthetime.

“Kristiwasawonderfulmentor.She

gavemetheopportunitytotakethe

DietaryManagersCoursethroughthe

UniversityofNorthDakota,forwhich

Iwillbeeternallygrateful.Ifinished

thecoursein1988,joinedANFP,and

becameDietarySupervisoratCom-

munityMemorialin1990,”saidFoyt.

OfherjobatParkside,Foytsaysitis

thebestintheworld.Listeningintently

CDM CREDENTIALING EXAM OFFERED YEAR-ROUND

TheCDMcredentialingexamisofferedyearroundatmore

than190approvedcomputertestingcenters.Thismeanscan-

didatescanscheduletheirexamonthedateandatthetesting

locationoftheirchoosingaftertheymeetCBDMrequirements

andreceiveconfirmationfromANFPthattheirapplicationhas

beenapproved.

The CDM Credentialing Exam Candidate Handbook contains

examdetails,includingtheeligibilityrequirementsandapplica-

tion.Downloadtheexamhandbookatwww.ANFPonline.org.

EXAM SCHOLARSHIPS AVAILABLE

TheNutrition&FoodserviceEducationFoundation(NFEF)is

offeringscholarshipstocovertheCDMCredentialingExam

fee.March 1, 2015isthenextdeadlineforapplications.Learn

moreatwww.NFEFoundation.org

toherclientstellthestoriesoftheirlives

isadailyjoy.Inheropinion,thereisno

greaterreward.

“Theyarethemostheartwarmingpeople

Ihaveevermet.Theyhavesomuch

wisdomandinterestinglifestoriesto

share.Everymomentspentwiththemis

special,”shesaid.

Thereare,ofcourse,struggles.There

isthedailychallengeofmeetingthe

dietaryandfoodpreferenceneedsof

peoplewhoareusedtobeingincontrol

oftheirmeals.Thentherearethebud-

get,time,andstaffconcernsthataffect

allfacilities.Todealwiththepressures,

Foytoftenturnstoherpeersforsupport

andurgesanyoneconsideringdietary

managementtodothesame.Building

astrongpeersupportnetworkisoneof

herkeystosuccess.Soisjoiningprofes-

sionalorganizations,likeANFP.

“MymembershipinANFPmeansthe

worldtome.Ithashelpedmegrowmore

confidentinmyprofessionalandper-

sonallifeandshownmethatweare

animportantpieceofthehealthcare

team.ANFPhasgivenmesomany

toolstouseinmywork.Ihaveloved

everyminuteofbeinganANFP

volunteer,”saidFoyt.

Duringheroffhours,Foytlikesto

crochetandreadDanielleSteelro-

mancenovels.Shespendsthebulk

ofherfreetime,though,withtwo

specialpeople:hergranddaughters.

“Ilovespoilingthem,”shesaid. E

The Certifying Board for Dietary Managers (CBDM) announces

news and policy changes of interest to CDMs.

AUDITING OF CE SELF-REPORTING RECORDS BEGINS IN JUNE

CDMsarenowresponsiblefortrackingtheirowncontinuing

education(CE)hours,andsubmittingthemattheendoftheir

three-yearcycle.Withself-reportingnowineffect,auditing

ofCErecordswillbegininJune2015.CDMsshouldsaveall

continuingeducation-relateddocumentation(proofofat-

tendance,certificatesofcompletion,etc.)fortwothree-year

certificationcyclesincaseofaCEaudit.

The CBDM Guide to Maintaining Your CDM, CFPP Credential,

whichcontainsstep-by-stepinstructionsforself-reporting

andincludesCEdocumentationrequirements,isavailable

fordownloadatwww.anfponline.org/Docs/CE_SelfReport-

ing_Guide.pdf.


NEED CONTINUING EDUCATION HOURS AND NOT SURE ABOUT

YOUR OPTIONS?

ANFPhasanewresourceguideforCDMswhowanttolearnabouttheCE

programs,publications,andcoursesavailabletoyoufromyourprofessional

association.

Optionsandformatsforeducationabound.Whetheryoupreferonline

courses,webinars,PDFdownloads,ortraditionalprintedmaterials,there

areresourcesgearedforyourlearningstyleandschedule.Andeducation

topicsarediverseandcoversubjectsrangingfromleadershiptomedical

nutritiontherapytosanitation&safety.

Meetings Preview2015 ANFP

REGIONAL MEETINGS

ANFPRegionalMeetingsprovidetop-notcheducationat

affordableandconvenientlocationsacrossthenation.

13 CE Hrs. per Regional Meeting

March 12-13: NorthCentralRegionalMeeting,Embassy

SuitesO’Hare,Rosemont(Chicago),IL

April 16-17: NortheastRegionalMeeting,HiltonGardenInn

Downtown,Richmond,VA

May 7-8:WestRegionalMeeting,EmbassySuites,

LasVegas,NV

ANFP IS YOUR PROFESSIONAL PARTNER forcontinuingeducation!ChoosefromRegionalMeetings,theAnnualConference&Expo,and/orChapterMeetingsin2015.

®

ANNUAL CONFERENCE & EXPO

JoinyourfriendsandcolleaguesforANFP’snational

meeting.Enjoyqualityeducationandprogramsthat

buildonthetheme:BringingValuetotheTable.

20 CE Hrs.

August 2-5: HyattRegencyGrandCypress,Orlando,FL

SAV E T H E DAT E S FO R T H E S E A N F P E D U C ATI O N A L & N E T WO R K I N G E V E N T S

L E A R N M O R E AT: w w w. A N F P o n l i n e . o r g C l i c k “ Eve n t s ”

CHAPTER MEETINGSManyANFPstatechaptershostspringandfall

meetings.VisittheANFPwebsiteperiodicallyto

learnaboutchaptermeetingsasdatesandlocations

becomeavailable.

www.ANFPonline.org/Chapters

ACE&&ORLANDO, FL | 2015


ANFP’s2015-2016Products & Services Catalog

M A K EYO U R C E H O U R S AU D I T P R O O FAttentionCDMs!PurchaseyouronlineCEproductsintheANFPMarketplaceandyourcompletedCEhourswillbeautomaticallyreportedinyourcontinuingeducationrecord.ThisincludesallANFPonlinecourses,archivedwebinars,andCEonlinearticles.

®

PRODUCTS & SERVICES CATALOG | 2015-2016OFFICIAL RESOURCE GUIDE OF THE CDM® | CFPP®

EARN CE CREDIT / DEVELOP LEADERSHIP SKILLS /

GAIN BEST PRACTICES / NURTURE YOUR CAREER /

IMPROVE QUALITY OF CARE / GAIN MASTER TRACK

KNOWLEDGE / ACCESS IMPORTANT REFERENCES,

TEXTBOOKS, AND ONLINE COURSES / START TODAY!

G O L D S TA N DA R D

CE

C B D M A P P R OV E D

NOW AVAILABLE! Download at www.ANFPonline.org


MEET A MEMBER

by Laura Vasilion

PayingHisDues

Laura Vasilionisa

seniorwriterforNu-

trition & Foodservice

Edgemagazine.

[email protected]

SendMeetaMem-

berideasto:

Inaneraofhigh

expenses,lowprofit

margins,andtight

budgets,being

efficientwhilestill

providinghigh-

qualityfoodand

serviceisvery

challenging.

Neil Steuer, CDM, CFPP

NEIL STEUER, CDM, CFPP,ofAthens,

Ga.,isFoodandNutritionDirectorat

AthensRegionalMedicalCenter,a343-

bedacutecarefacility.Previously,hewas

CulinaryDirectorandExecutiveChefat

SuperiorCulinaryCenter,inMilwaukee,

Wisc.

Steuer,whobeganhislongcareerasa

chef,hasworkedinawiderangeoffood

industrysettingsincludingcountryclubs,

hotels,cateringcompanies,andrestau-

rants.Havingtransitionedintohealthcare

foodservicenow,hefacesthesamechal-

lengesalldietarymanagersdo.

“Inaneraofhighexpenses,lowprofit

margins,andtightbudgets,beingeffi-

cientandcosteffectivewhilestillprovid-

inghighqualityfoodandserviceisvery

challenging.Thenthereistheefficient

andcontinualtrainingofstakeholders,

coupledwithfindingtherightpersonnel

withinashrinkingpoolofcandidates,”he

said.

Tobeasuccessinthishighlycompetitive

field,Steuerstressestheimportanceof

goodcommunicationskillsandthecom-

pleteknowledgeofallbusinessaspects

ofhisoperation,fromplanning,pur-

chasing,preparing,costing,selling,and

servicingtomodifieddietplanning,food

safety,scheduling,forecasting,andregu-

latoryreadiness.Theseskills,acquired

overtime,formthecrucialfoundationof

acareerindietarymanagement,Steuer

says.Anyonewhoisconsideringenter-

ingthisfieldshouldbeawareofthistime

spent“payingyourdues,”ashecallsit.

“WhenIapprenticedasachef,thatis

whatIwastold.ThatIwas‘payingmy

dues.’Myadvicetopeopleconsider-

ingthisfieldistogetexperienceinfood

serviceinboththebackofthehouseand

frontofthehouseareaswithasmany

jobdescriptionsaspossible.Thetransi-

tiontomanagementwillbesmoother

whenstaffknowsyouhavebeeninthe

‘trenches.’Learnthebusinessendof

managing—policies,humanresources,

budgets,forecasting,foodsafety,

diets,scheduling,hiringprocedures,

etc.Getcertifiedandgetabachelor’s

degree.Manyyearsago,Ithoughtmy

associate’sdegreeinculinaryartswas

allIneededtomoveuptheladder.

Today,thisisnotpossiblewithoutcre-

dentials,nomatterwhatyourexperi-

ence,”Steuerexplained.

Hisadvicetofuturedietarymanag-

ersalsostressesbeingaparticipant

inprofessionalorganizationsand

networks.Steuerciteshisinvolvement

inANFPasanotherwayhehaspaid

hisdues.

“Thereisnoquestionaboutit.Beinga

memberofANFPisveryimportantto

me.Theforums,thewebsite,andNu-

trition&FoodserviceEdgemagazine

arejustafewwaysthatANFPhelps

usCDMsstaycurrentwithinarapidly

evolvingfield,”saidSteuer.

Withthesamededicationheadminis-

terstohiscareer,Steuerlistsanumber

offreetimepursuits.Besidesculinary

instructing,heenjoysboating,camp-

ing,andisanavidcyclist. E

Join FoodService Director at MenuDirections for educational workshops, culinary demos and keynote presentations, all designed to help you push the boundaries of your menu

and operations while boosting the reputation of your brand.

Rob BellCertifi ed Speaking

Professional & Business Humorist

Dr. James Painter, R.D.Professor Emeritus

Eastern Illinois UniversitySponsored by:

Sun-Maid Growers of California

COMPELLING KEYNOTE SPEAKERS

Gerry LudwigCorporate Consulting Chef

Gordon Food ServiceSponsored by:

Gordon Food Service

Hot Off the Menu!Absolutely

Everything Counts Sensual Nutrition

Michael DonahuePartner, Chief Brand Offi cer

LYFE Kitchen

LYFE Kitchens: Social Responsibility

ANFP’S “CAN’T MISS” SESSIONWant to respond to today’s biggest food trends? ANFP presents current insights and new analytics only at MenuDirections. Other workshops include:

• Gluten-free Can Be Healthy• Conquer Catering!• Plant-based Menus

ST. JUDE CHILDREN’S RESEARCH HOSPITAL TOURStay to the end of the conference, March 4, and take part in on-site learning when we tour this word-class foodservice program, led by Director of Culinary Operations Miles McMath.

Nowhere else will you fi nd an agenda as timely and thought-provoking...REGISTER NOWContinued Education Units (CEUs) Available

Produced by CSP Business Media, LLC, Leadership Conferences & Events

1911 S. Lindsay Rd. | Mesa, Arizona 85204 | p: 480.337.3400 | CSPBusinessMedia.com

For more information contact William D. Anderson at 630.528.9239 or [email protected]

PEABODY MEMPHIS MARCH 1-4THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE

PUSHING BOUNDARIES, BOOSTING REPUTATIONS

PRESENTED BY:

#MENUDIRECTIONS

Like us! facebook.com/foodservice.director

Follow us!twitter.com/fsdeditor

Follow us! CSP_BUSINESS_MEDIA

REGISTER AT MenuDirections.com

MD15_ANFP Ad_Single-sided_February 2015.indd 1 1/16/15 3:23 PM

Join FoodService Director at MenuDirections for educational workshops, culinary demos and keynote presentations, all designed to help you push the boundaries of your menu

and operations while boosting the reputation of your brand.

Rob BellCertifi ed Speaking

Professional & Business Humorist

Dr. James Painter, R.D.Professor Emeritus

Eastern Illinois UniversitySponsored by:

Sun-Maid Growers of California

COMPELLING KEYNOTE SPEAKERS

Gerry LudwigCorporate Consulting Chef

Gordon Food ServiceSponsored by:

Gordon Food Service

Hot Off the Menu!Absolutely

Everything Counts Sensual Nutrition

Michael DonahuePartner, Chief Brand Offi cer

LYFE Kitchen

LYFE Kitchens: Social Responsibility

ANFP’S “CAN’T MISS” SESSIONWant to respond to today’s biggest food trends? ANFP presents current insights and new analytics only at MenuDirections. Other workshops include:

• Gluten-free Can Be Healthy• Conquer Catering!• Plant-based Menus

ST. JUDE CHILDREN’S RESEARCH HOSPITAL TOURStay to the end of the conference, March 4, and take part in on-site learning when we tour this word-class foodservice program, led by Director of Culinary Operations Miles McMath.

Nowhere else will you fi nd an agenda as timely and thought-provoking...REGISTER NOWContinued Education Units (CEUs) Available

Produced by CSP Business Media, LLC, Leadership Conferences & Events

1911 S. Lindsay Rd. | Mesa, Arizona 85204 | p: 480.337.3400 | CSPBusinessMedia.com

For more information contact William D. Anderson at 630.528.9239 or [email protected]

PEABODY MEMPHIS MARCH 1-4THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE

PUSHING BOUNDARIES, BOOSTING REPUTATIONS

PRESENTED BY:

#MENUDIRECTIONS

Like us! facebook.com/foodservice.director

Follow us!twitter.com/fsdeditor

Follow us! CSP_BUSINESS_MEDIA

REGISTER AT MenuDirections.com

MD15_ANFP Ad_Single-sided_February 2015.indd 1 1/16/15 3:23 PM

Enjoy Education, Exhibits, and Networking at ACE!

2015ANFPAnnualConference&Expo

AUGUST 2 -5 HYATT REGENCY GRAND CYPRESS

BRINGVALUETOTHETABLE

ACE&&OR LA N DO, FL | 2015


NEVER FLY SOLO

LT. Col. Rob “Waldo”

Waldman

KeynoteSpeaker

Lt.Col.Rob“Waldo”Waldman,theWingman,overcame

alifelongbattlewithclaustrophobiaandafearofheights

tobecomeacombatdecoratedAirForcefighterpilotand

highlysuccessfulbusinessman,entrepreneur,andNewYork

Timesbestsellingauthor.HismottoisWinners Never Fly

Solo!Throughhiscaptivatingpersonalstoriesandhigh

energyvideo,learnhowyou,likeafighterpilot,cansuc-

ceedinhighlycompetitiveanddemandingenvironments.Be

inspiredtotaketotheskiesknowingthatyouhavewingmen

tohelpyoufacechallengesandchangewithconfidence,

whilemaximizingyourpotentialinallaspectsofyourlife.

OTHER SESSIONS•FoodserviceDepartmentDesign/

Renovation

•ABCsofSuccessfulSurveys

•CenterofthePlate

•QualityIndicatorSurveySuccess

•NutritionandHydrationApproaches

•PreventionandTreatmentofPressureUlcers

•ValueoftheCDMRole

•Deficiency-FreeJointCommissionSurveys

•SanitationSurveysandTraining

•CurrentMenuTrends

•WorkplaceCommunicationStrategies

•TeamBuilding

REGISTERONLINE www.ANFPonline.org Click“Events”

CAN’T MISS EXPO—AUGUST 4

The Expo is a must-see event where exhibitors showcase how

their products and services can contribute to your operational

effectiveness and bottom line.

Foodservice Operation - The Association of Nutrition ...€¦ · Nutrition & Foodservice Edge®...

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Transcript of Foodservice Operation - The Association of Nutrition ...€¦ · Nutrition & Foodservice Edge®...