Menu Assessments: What Do You Do When You Don t Have Much to Work With???

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1 Menu Assessments: What Do You Do When You Don t Have Much to Work With??? Presented by: Lisa Sossen, APD Consultant Dietitian 14 May 2015 DAA Conference - Perth

2 Outline 1.Where do I start? 2.Tools available 3. Reports

3 Starting Point Can you do a menu assessment.. Accreditation is next week and we need one.. Alright, we can squeeze it in And by the way, what is this going to cost us??? Well, it all depends on what we do, however, I strongly recommend an onsite visit and talk with the chef, see what your strengths are and look at the areas you are having most difficulty achieving

4 Starting Point Usually there is not much available to work with. You will definitely have a menu The menu may only have the regular diet texture Will most often be quite vague such as seasonal vegetables or chef s choice

5 Gather information 1.Questionnaire chef to complete before on-site visit. Facility information about the resident and diet texture breakdown. Supplement use and how they make it up. Purchase order info for the week. E.g. how much milk do you buy each week? Amount of meat used in a recipe and no. of serves the recipe makes. 2.Watch a meal time. 3. Ask them to keep a full day of meal for ALL textures and Medium serve. Weigh and photograph the meal.

6 Aussie Toolbox Department of Human Services (Victoria) Nutrition Standards for menu Items in Victorian Hospitals and Residential Aged Care Facilities Specified the use of high energy high protein nutrient mid meals is considered for groups at nutrition risk such as aged care Portion size guide Difficult to use the Band Concept when looking at aged care menus Use the recipe analysis info to help support your questions when enquiring about specific dishes. Accreditation Standards particularly, Standard 2.10 Nutrition & Hydration, 3.9 Choice & Decision Making & 4.8 Catering, Cleaning, and Laundry Standards and Guidelines for Residential Aged Care Services Manual

7 Aussie Toolbox Caryl Nowson. Factors to consider when applying NRV s to menu standards, Planning and assessment. DAA web present. Planners can only control the foods available or offered; they cannot control intake devise a balanced menu based on food groups. Difficult to conduct a FOODWORKS analysis. Acknowledge reasons for low intake and the used of supplements, waste, food temp, taste, selection and menu appropriateness. Nowson, Caryl A ; Sherwin, Alice J ; Mcphee, Joan G ; Wark, John D ; Flicker, Leon. Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia, Asia Pacific journal of Clinical Nutrition, Vol.12(2), pp.172-7

Aussie Toolbox Stewart, Alison June 2000.

for a variety of foods from the core food gr

apple crumble and custard provides ¼ fruit, ¼ grain, ¼ dairy Base my aims on her policy statements Non-restrictive

8 Aussie Toolbox Stewart, Alison June Nutrition Guidelines for Aged Care Facilities (unpublished) Opportunities to receive variety of foods Opportunities for a variety of foods from the core food groups and over the day e.g. apple crumble and custard provides ¼ fruit, ¼ grain, ¼ dairy Base my aims on her policy statements Non-restrictive menu Quality of raw ingredients and preparation methods promote nutrient density rather than just providing energy. Aim for <30% main dishes and dessert high salt and fat. Flavour Maximize fibre Menu should clearly state which foods will be prepared for texture modified meals Serve size guidelines Invoice analysis and purchase guide of raw ingredient

9 Aussie Toolbox Iuliano, Woods & Robbins Consuming additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: a feasibility study. The journal of Nutrition Health and Ageing Vol 17 No 6

10 Aussie Toolbox Bartl & Bunney 2004 Best Practice Food and Nutrition Manual for Care Facilities.

11 Aussie Toolbox Queensland Health Nutrition Standards for Meals and Menus State-wide Foodservices Policy and Planning. Table 3: Residential Aged Care Minimum Choice (page 34-37) States how many serves must be provided on Standard menu and texture Modified Menu Per Day & Per Cycle. ALL MEALS & SNACKS

Aussie Toolbox Menu assessment for aged care facilities Checklist 2006 revised 2007 by Pam Digby APD. www.public.health.wa.gov.

12 Aussie Toolbox Menu assessment for aged care facilities Checklist 2006 revised 2007 by Pam Digby APD. Nutrition Auditing Tool for Aged Care Hospitals and Multipurpose Sites Dietary Guidelines for Older Australians NHMRC March The New Australian Guide to Healthy Eating Commonwealth Department of Health and family Services under the National Food and Nutrition Policy Program.

International Tool box CANADA Audits and More. A Nutrition and Food service Audit Manual. 2008, www.health.gov.bc.ca/library/publications/year/2008/audits_and_more_m anual.pdf UNITED KINGDOM Clay, M.

13 International Tool box CANADA Audits and More. A Nutrition and Food service Audit Manual. 2008, anual.pdf UNITED KINGDOM Clay, M Nutritious, enjoyable food in nursing homes. Nursing standard (Royal College of Nursing (Great Britain) 1987), Vol.15(19), pp.47-53; quiz Caroline Walker Trust. Eating Well for Older People Practical and Nutrition guidelines for food in residential and nursing home and for community meals. Report of an expert Working group. 2 nd edition. Chapter 7 Checklist to assess the quality of food and equipment, Appendix 4 Portion Guide

International Tool box FINLAND Suomin et. Al 2004. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finish Nursing Home.

14 International Tool box FINLAND Suomin et. Al Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finish Nursing Home. Journal of Nutrition, health and Aging Vol 8, Issue 4, P USA Johnson et. Al Nutrient intake of nursing-home residents receiving pureed foods or a regular diet. Journal of American Geriatrics Society. Vol 43. Issue 4 Page

My Evaluation Developed my calculation own tools: 1. Meal distribution in terms of categories (express as a %) e.g. Red meat, Wet/Casseroles dishes, Fish, Egg dishes, chicken dishes, party fare, vegetarian dishes.

If there is a recipe for any food then look at the recipe to get an idea of the nutrients provided per serve, esp. for vegetarian dishes. 5.

15 My Evaluation Developed my calculation own tools: 1. Meal distribution in terms of categories (express as a %) e.g. Red meat, Wet/Casseroles dishes, Fish, Egg dishes, chicken dishes, party fare, vegetarian dishes. 2. Estimation of serves of each food group for the whole menu (by week and overall) and the texture modified diets. 3. Test meal evaluate the test meal and determine the food group serves 4. If there is a recipe for any food then look at the recipe to get an idea of the nutrients provided per serve, esp. for vegetarian dishes. 5. Purchase order information and assess if they are actually providing the serves that are estimated on the menu and for the serve requirements. e.g order of 80L/week milk for 60 residents, they will 1333ml weekly or 190ml daily (which is 0.8 serves per day). 6. Menu design. Colour, texture, repetition

16 Check Lists Bartl & Bunney 2004 Looks at no. of serves per week. Need to make your own judgement esp. with the evening meals being more vegetarian based dishes.

17 Check Lists Bartl & Bunney 2004 Resident Input into menu Resident likes and dislikes Textures and Special Diets Choice & Flexibility Menu cycle Seasonal Menu design features Menu is written with all info expressed in detail Menu reviewed and report written

Assessing the weight of the meal Fat Content of the menu

18 Check Lists Pam Digby 2007 Menu Assessment for Aged Care Facilities Checklist Min weight Food Variety checklist Assessing the weight of the meal Fat Content of the menu Salt content of the menu Dessert Checklist Documentation

19 Your Aim of the Assessment Menu meets the preferences, traditions and ethnic foods for all residents. Menu meets the nutritional needs for all residents. Menu provides adequate variety for food groups. Menu provides a range of dishes and choice available. Menu is suitable for all common diet textures and special diets. Menu uses a combination of cooking methods, ingredients, colours and flavours and avoids repetition. Opportunities are provided for residents to eat and drink nutrition foods as well as have extras/snacks to enable enjoyment of meals and assist with the prevention of unintentional weight loss as a result of inadequate energy and protein provision. Adapted from Alison Stewart 2000

2. Ensure you look at all diet textures. 3. Use food groups and serves as a base to your assessment. 4. A test meal is helpful. 5.

20 Take Home Message 1. Recognise this is a complex activity and time taken to complete task can take along time until you get better at the assessments. 2. Ensure you look at all diet textures. 3. Use food groups and serves as a base to your assessment. 4. A test meal is helpful. 5. Use the toolbox of checklists to assist you when evaluating the menu. 6. Make recommendations clear and easy to understand for the chef and facility. 7. Ensure the recommendations are practical. 8. Use point form for the recommendations.

21 Thank you Lisa Sossen Mobile: Acknowledge free clip art from:

Nutrition Inspection Notebook (Updated April, 2011)

Nutrition Inspection Notebook (Updated April, 2011) Publication code: HCR-0412-049 Name of Care Service: Address: Date of Inspection: Care Homes for Older People This Notebook is a tool to assist the Professional