Facility Menu Project 1

Facility Menu Project

Hannah Bodenhamer

School of Kinesiology and Nutrition, University of Southern Mississippi

NFS 780: Advanced Practice in Nutrition and Food Systems

Professor Kingston, MS, RD

October 18, 2021

Facility Menu Project 2

Facility Menu Project

Palm Healthcare and Rehabilitation Center is a long term care center rated five-stars

based on quality of care, health inspections, and staffing. The excellent dining features are a

contributing factor to the “much above average” quality of care at this facility (Medicare, n.d.).

Past studies have found that recovery and overall satisfaction is directly impacted by a hospital’s

food service quality (“How Hospital Food Service,” n.d.). Thus, it is important to analyze a

facility’s menu and dining services and attend to the areas of improvement.

Palm uses a 4-week cycle menu for their resident dining services. These menus are

communicated to patients verbally, on whiteboards in the hallway, or on weekly charts posted on

bulletin boards throughout each floor. The Dietetic Services Supervisor (DSS) will visit each

patient upon admission to discuss food likes, dislikes, allergies, and aversions, all of which will

then be input into the Resident Dining System (RDS). The registered dietitian (RD) on staff will

also visit residents for assessments, discussions, and patient education. During these meetings,

the RD will discuss any changes in food preferences that will be updated into the RDS for future

meals. Individuals who have food allergies or strong aversions to the offered menu are able to

order meal alternatives from a menu that is located in each patient room or communicated by

the DSS. Each patient may communicate these alternative choices to the nursing staff or to the

DSS directly via telephone. Additionally, patient families are allowed to bring hot and cold food

items from home which can be stored for up to three days per facility policy. These measures

are in place to ensure resident dining satisfaction and decrease the risk of weight loss due to

poor oral intake.

The menu is created by RDs for Healthcare, Inc located out of San Diego, California.

This company is California’s largest menu services provider due to the cost effectiveness, ease

of preparation, and well-loved recipes. If the facility RD decides a different therapeutic menu

should be offered, he or she may present it to the Director of Nursing (DON) for approval. If

approved, this menu would be added to the therapeutic dietary modification policy. The dietary
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manual used to plan and develop therapeutic diets is Diet Manual for Rehabilitation, Residential,

and Long Term Care by Mary Vester-Toews (2018). The nutrition content of all menus are

assessed through several nutrient analysis software systems including Food and Nutrition

Monitoring and Surveillance (FNMS), Elizabeth Steward Hands and Associates (ESHA), and the

United States Department of Agriculture (USDA). RDs for Healthcare will review and audit the

nutrient analyses provided by these online software programs. The nutrient analysis revealed

that all menus (regular, fortified, 2 gram sodium, no added sodium, 80 gm renal, low fat, and

controlled carbohydrate diets) vary in calories between 2,734 and 1,845 kcals. The regular

menu provides 2,410 calories, 90 grams of protein, 303 grams of carbohydrate, 93 grams of

total fat, 1,360 mcg of vitamin A, 3.05 mg riboflavin, 339 IU of vitamin D, 1,335 mg calcium,

1,564 mg phosphorus, 2,966 mg Potassium, 3,721 mg sodium, and 11.1 mg of zinc. The

fortified diet includes 2,734 calories with significantly increased protein (111 gm), total fat (110

gm), vitamin A RAE (1,485 mcg), riboflavin (3.05 mg) vitamin D (516 IU), calcium (1,995 mg),

phosphorus (1,764 mg), potassium (3,397 mg), and zinc (11.1 gm). The 2 gram sodium diet

offers significantly less calories (1,973 kcal) and sodium (2,086 mg). The no added sodium diet,

however, offers 2,401 calories with 3,121 grams of sodium. The renal diet offers less calories

(1,984), protein (79 gm), fat (60 gm), calcium (559 mg), phosphorus (1,080 mg), potassium

(2,686 mg), and sodium (1,561). The low fat diet is the lowest in calories with 1,845 kcal, as well

as 54 total grams of fat, and 5.25 mg vitamin E. The controlled carbohydrate diet has 1,990

calories and 259 gm carbohydrate which is still high compared to the other diets. All diets have

23 grams of dietary fiber except the renal diet which has 27 gm. Each diet listed meets the

nutritional needs of their respective patient populations though some improvements can be

made. The two-gram sodium diet should be under 2 grams and the controlled carbohydrate diet

could be more restrictive regarding grams of carbohydrate.

Residents who are prescribed therapeutic diets will follow the same menu which is

modified to meet the needs of each patient. These modifications and guidelines are found in the
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recipe book which is available in the kitchen. The kitchen staff receives training on these diets

and have a general knowledge on the types of foods and changes that are appropriate for the

respective requirements. This facility offers five distinct diets including the regular menu, fortified

menu, no added salt menu, renal menu and controlled carbohydrate diabetic menu. These

therapeutic diets are offered because they meet the needs of most disease states seen at Palm

Healthcare including diabetes mellitus, chronic kidney disease, congestive heart failure,

hypertension and hyperlipidemia. With limited production ability, staffing, storage, and budget,

other diets such as the low fat and 2-gram sodium diets are not feasible. However, the recipe

book still contains these modifications and nutrient analyses for evaluation. The most prominent

limitation to the dining services at Palm is the therapeutic diet limitations. The 2-gram sodium

and low fat diets would benefit many residents, such as patient populations with hypertension,

hyperlipidemia, and other cardiovascular diseases. Another limitation is the controlled

carbohydrate menu offered to diabetic patients. Specialty items and highly individualized menu

items are difficult to produce in this facility so this menu may not actually be meeting full patient

needs. For example, patients are given ½ of the regular dessert and a moderate amount of

bread which are carbohydrate-dense food choices. The only true modifications are sugar free

juice, jams, and condiments. Some improvements that would greatly benefit the patient

populations at this facility include modifications to the controlled carbohydrate diet to better meet

patient needs. This would include offering low-glycemic, fresh, whole meals, sugar free

desserts, and more natural sources of carbohydrates such as fruits and vegetables. Another

improvement would be sourcing produce from local growers and choosing seasonal items to

increase freshness and quality. Many patients in this facility have made comments or requests

for more fresh foods, so this modification would improve patient satisfaction and health. Finally,

this facility could improve the menu by sourcing more fresh, quality, and lean cuts of meats

rather than frozen or fatty meats.

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Overall, the menus at Palm Healthcare meet the needs of the patient populations being

served. Several improvements can be made to improve the efficacy of therapeutic diets

including modifications to the controlled carbohydrate diet. Overall, patient satisfaction with

meals is high and meets the facility’s standards of quality.

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Reference:

How hospital food service can improve patient experiences and outcomes - food service.

Healthcare Facilities Today. (n.d.). Retrieved October 19, 2021, from

https://www.healthcarefacilitiestoday.com/posts/How-Hospital-Food-Service-Can-I

mprove-Patient-Experiences-And-Outcomes--23493.

Medicare.gov. (n.d.). Retrieved October 19, 2021, from

https://www.medicare.gov/care-compare/details/nursing-home/555257?id=f675a23

e-d274-4abe-a0dc-c2fd686c7533&city=Laguna+Hills&state=CA&zipcode=92637.

RDS for Healthcare, Inc. - Home. RDs for Healthcare, Inc. - Home. (n.d.). Retrieved

October 22, 2021, from http://www.rdsforhealthcare.com/.

Vester-Toews, M., Nakashima, B., Chynoweth, M., Bishop, N., Trask , D., & Ousey ,

S. (2018). Diet Manual for Rehabilitation, Residential, Long Term Care Facilities .

Dietary Directions Inc.

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Appendix A

Regular Menu

Appendix A. Regular Cycle Menu for Autumn 2021

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Appendix B

Appendix B. Therapeutic Menu Modifications Sunday 9/5, 10/3, 10/31, 11/28

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Appendix C

Appendix C. Therapeutic Menu Modifications Sunday 9/6, 10/4, 11/1, 11/29

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Appendix D

Appendix D. Therapeutic Menu Modifications Sunday 9/7, 10/5, 11/2, 11/30

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Appendix E

Appendix E. Therapeutic Menu Modifications Sunday 9/8, 10/6, 11/3, 12/1

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Appendix F.

Appendix F. Therapeutic Menu Modifications Sunday 9/9, 10/7, 11/4, 12/2

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Appendix G

Appendix G. Therapeutic Menu Modifications Sunday 9/10, 10/8, 11/5, 12/3

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Appendix H

Appendix H. Therapeutic Menu Modifications Sunday 9/11, 10/9, 11/6, 12/4

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Appendix I

Appendix I. Nutrient Analysis Averages for the Week