ADVANTAGE – Long Term and Post Acute Care

From exotic cuisine to 24-hour dining, long-term care facilities are changing the way
residents eat.

by Elizabeth Rosto Sitko
Culture change is driving most of the innovations we’re seeing in long-term care dining today.
Rather than cookie cutter meals, residents and their families are looking for updated dining
programs that allow for more choices on a daily basis. “Families want to ensure that their loved
ones are eating first and foremost, but also that they want to eat and enjoy what they are eating,”
said Jeremy T. Manners, CDM, CFPP, FMP, culinary and nutrition director, West Haven Manor,
a 257-bed skilled and personal care facility in Apollo, Pa. Residents who are happy and healthy
will ultimately have better outcomes. If you’re looking for new ways to innovate your dining
program, here’s a glance at some of the latest trends in the long-term care dining landscape.

Honoring Resident Requests
Most people don’t like to eat the same things over and over, so be sure to update your menus
frequently with new items. “Residents easily get bored with the same items all the time, so by
changing it up frequently and adding new items or recipes, they get refreshed,” Manners said.
West Haven Manor’s dining department is seeing a lot more requests for items such as tacos,
pizza and Chinese food, he added. Buena Vida CCRC, a 240-bed facility with a 30-bed assisted
living facility in Brooklyn, N.Y, has a large Hispanic population. So residents are always asking
for Spanish dishes, according to Evelyn Conner, CDM, CFPP, director of food and nutrition

“We have added arroz con pollo, yucca four different ways weekly, white sweet potatoes and
sancocho soup [a nourishing stew popular throughout the Latin World]. Every month we have
menu planning meetings with the residents, which allow them to sample different food items,”
she explained. Recently, they sampled chana masala, an Indian dish of chickpeas with onions,
tomatoes and spice. “These meetings allow the residents to agree on items that they would like to
have added to the menus and enhances their evolvement in their care. I’m constantly looking for
Spanish entrees to add to the menus in order to increase the resident satisfaction with their dining
experience,” Conner said.

‘Round the Clock Service
West Haven Manor added a 24-hour menu and a third shift team member to create a 24-hour
foodservice program. The facility has seen an increase in non-traditional residents, middle aged
residents coming in for rehab after knee or hip surgery, and even younger residents in their 20s
and 30s coming for IV therapy. “Many of these residents lead different lifestyles while at home,
up late at night for example, and while in our care, we don’t expect them to just change their
usual habits. Many of these residents are taking advantage of an empty lounge to play Wii, others
are simply utilizing the WiFi from their room to surf the internet,” Manners said. “At home these
folks would be snacking on something more likely than not, so again, why make them change all
of their habits just because they are temporarily residing in a nursing home?” This service has
been very successful since they started the 24-hour meal program in January of 2012, Manners
said. To balance offering many options but not letting food go to waste, many of the items on the
24-hour menu are quick options that can be kept on hand and are easily prepared. After working
with their foodservice distributor, they selected a pre-cooked burger, pre-grilled chicken breast,
along with other choices like individual slices of stuffed crust pizza. These items are all quickly
prepared in a microwave or countertop pizza oven, Manners explained.

Buffet Stations
With the addition of a buffet table to the main dining room, Manners said, West Haven Manor
can offer a variety of options at meal times based on a par level system-that is, a stocking
quantity is established for each item based on average usage and a target number of days’ supply.
Many of the items already available on the late night menu can be offered here as well with the
addition of special items or seasonal items from time to time.
A Healthcare Team Without Doctors……Really???

by Dr. Steven Fuller
There are 624,434 U.S. physicians (AHRQ, 2010), but only 0.6% of them would ever consider
entering an Assisted Living Community (ALC) to provide on-site care. There are more than
36,000 ALCs in the US caring for over 1 million fragile older adults (ALFA 2011), but you are
literally more likely to be struck by lightning than to ever see a doctor walk through the doors of
any of these communities!

The first ALC began in 1981 to care for the Founder’s mother who was in her early 60s (The
History of Assisted Living, These Communities were
originally promoted to provide a supportive, primarily non-medical living environment to bridge
the gap between independent living and the nursing home. But the landscape for ALCs has
dramatically changed since their inception.

The average age of an ALC resident is now 87 years (Harris-Wallace et al, 2011, Seniors
Housing & Care Journal). Thirty-seven percent of residents receive assistance with 3 or more
activities of daily living (NCAL 2012), greater than half of the residents have 2 or more chronic
medical conditions and are taking multiple medications having a variety of potential side effects,
and 42% have at least some degree of memory impairment or dementia (NCAL 2012).

ALCs are no longer predominantly non-medical communities. They have high acuity residents,
and this will only intensify in the future due to a very competitive market as well as resident
expectations to age in place and experience the progression of chronic medical conditions in one
setting that provides ongoing care and monitoring.

In other words, times have changed. But the problem is…our thinking hasn’t! Our thinking is
stuck back in the 1980s and hasn’t kept pace with the changing demands and expectations
residents impose on ALCs. The healthcare team that provides medical oversight of residents in
ALCs is led either by non-medically trained administrators or by nurses with additional support
from aides and assistants. But there is a glaring omission: WHERE ARE THE DOCTORS???

Just as in the 1980s, we keep hauling our residents off-site all over town to a variety of doctor’s
offices just to get their basic primary care needs met. But this isn’t the 1980s any longer! These
residents are 20 years older, much more fragile on average, and all these off-site trips are
incredibly stressful not only on the residents but also their families as well as the ALCs and their
employees. We can and must do better!

It is no longer appropriate to be thinking as we did in the 1980s and have predominantly off-site
physician care. And it is no longer acceptable to have the supervisory medical team not include a
fully engaged physician who provides on-site care.

ALCs and physicians MUST come together and meet the demand of caring for high acuity
patients in the community setting. The direction of modern healthcare delivery is TOWARD
THE COMMUNITY to proactively keep people as healthy as possible at home and AWAY
FROM HIGH COST INSTITUTIONS that only care for patients reactively after they become ill.
This reversal in the direction of healthcare delivery falls right in the laps of ALCs, and the
pressure to care for higher acuity residents will therefore only increase. This also means that
on-site care by physicians offered to ALL residents should no longer be a luxury but MUST be a

There are a few innovative healthcare models now available that encourage ALCs and physicians
to each put “skin in the game” and come together as PARTNERS
es-why). To meet the new demands that confront this partnership is surprisingly easy and not
intimidating and can happen overnight. The biggest obstacle is in our thinking: WE MUST

If we think differently…if we bring physicians and ALCs together as partners, we will discover


Compression Therapy Equipment Available From Vascular PRN Treats Diabetic Ulcers

Vascular PRN offers compression therapy devices that help promote blood flow to prevent and
heal diabetic ulcers.

Ulcers on the legs and feet are a major complication of diabetes. They occur in 15% of all
diabetes patients. Without prompt and effective treatment, they can leave doctors no alternative
but partial leg amputation. Diabetic ulcers precede 84% of all lower leg amputations.

“Our compression therapy equipment gently compresses the leg to increase the flow of oxygen-
rich blood,” said Greg Grambor, president of Vascular PRN. “Compression therapy is effective,
inexpensive, and completely non-invasive.”

The direct cause of diabetic ulcers is the subject of debate within the medical community, but it
is widely agreed that insufficient blood flow is a dominant contributor to the condition.
Treatments for diabetic ulcers other than compression therapy include topical and internal drugs
and surgery, each of which has a number of potential complications.

Grambor also pointed out the use of compression therapy as a preventive measure.

“Compression therapy is a good option even after a diabetic leg ulcer has healed because it helps
prevent recurrences of the wounds,” Grambor said. “Studies have shown that up to half of all
diabetic ulcers recur within five years of healing.”

The U.S. Centers for Disease Control and Prevention last year released its Diabetes Report Card
2012, the result of a survey of diabetes patients nationwide. That survey showed that just over
two thirds of diabetic adults in the U.S. received their recommended annual foot exam in 2009-

“Patients themselves take an active role in preventing these wounds as well through a regimen of
self-examination and proper cleaning of the feet. When doctors combine compression therapy
with patient education, the ongoing prevention of diabetic foot ulcers can be very manageable for
patients,” added Grambor.

Based in Tampa, Florida, Vascular PRN is a leading national distributor of compression therapy
equipment, serving nursing homes, hospitals, surgery centers and other institutions in all 50