Role of Dining Services and Dietary Needs of the Resident, 2014 It is the dining services role to provide quality meals and service to all residents that is as home-like as possible. This will be done in a manner that enhances each resident s dignity and in an environment that provides a pleasurable dining experience.
Objectives of Dining Services Determine the Nutrition Requirements of each of our residents Provide meals that are Healthy and Nutritious Serve food only from approved vendor
Objectives: Nutrition & Hydration Hydration and Liquids House Diets/ Therapeutic Diets Mechanical Altered Diets Dining Room Weekly Menus Feeding Assistance Meal Ticket Substitution List FAR Recording-meals & snacks
Hydration Hydration- consuming the proper amt of fluids. Most adults should drink 7-11 cups/day. Minimum fluid needs for elderly: 30cc/kg Or 1500 cc/day (6 ¼ Cups) (Whichever is greater) Ex: 150 lb person (68 kg * 30=2040 cc/day; 8.5 Cups) Staying hydrated is essential for: Digestion, absorption, circulation, excretion, transporting nutrients to cells, building tissue, maintaining body temperature
Dehydration: Physical Signs Signs and Symptoms of Dehydration: Dry mouth, cracked lips Flushed Skin Sunken Eyes, Dark Circles Rapid Pulse, Decreased blood pressure Dark urine, decrease in urine output Increased confusion, Lethargy Constipation Poor Skin Turgor
Sources of Fluids for our Residents Meals: 6.5 cup min Soups, sauces, stews, fruits, vegetables, ice cream, Jello as well as beverages during meals Snacks at 10 am, 2pm and HS 2pm Catch the Wave cart Bedside water Nutritional Supplements Activities and Social Events Medication Passes Family Member and Visitors Hydration Station in Pathways
Regular Diet Includes variety of foods to meet nutritional requirements and individual preferences. The menu provides: 2000-2200 calories/day 5 servings from fruits/vegetables group 5 servings from bread, cereal, rice, pasta group 6 ounces of protein (meat/meat substitutes) 2 servings of milk
Consistent Carbohydrate Diet Standard meal for people with Diabetes Up to 5 carbohydrate choices at each meal 1-2 carbohydrates at evening snack for Insulin Dependent Diabetics Per the American Diabetes Association Studies have demonstrated that when a diabetic consume a variety of sugars or starches, there is no substantial difference in the [blood sugar response] when the total amount of carbohydrate remains [consistent].
No Added Salt Diet (NAS) 2-4 Gram Sodium (Na + ) NAS = No salt packages with meals 2-4 g Na + for those on CHF Protocol. restricts high Na + foods Ex: hot dogs, deli meats, canned soups, cheeses
Simplified Renal Diet Mildly restricts Na +, K +, phosphorus, and fluid intake Limit milk and milk product to ½ cup/day Limit high phosphorus foods Limit high K + foods to one serving a day
Dysphagia/Mechanically Altered Diets Dysphagia- Difficulty with swallowing; sensation that food is stuck in the throat or esophagus Aspiration- Breathing a foreign object into the lungs, such as food or drinks. Mechanically Altered Diet- Altering the texture of the food &/or liquids to minimize the risk of choking/aspiration. Modification determined by speech therapist
Choking/Aspiration Causes of Choking Not chewing food properly Difficulties with swallowing Eating too fast Health Condition Ex: Parkinson s, Dementia Having dentures Poor posture while eating Signs of Choking Coughing or gagging Clutching throat or pointing to throat Suddenly unable to talk Wheezing Passing out; loss of consciousness Skin, lips or nail turning blue
Mechanically Altered Diet Regular, chopped All food is cut up for ease with self feeding National Dysphagia Diet I (NDD1) Pureed-pudding-like National Dysphagia Diet II (NDD2) Mechanical Soft- moist, soft-textured, ground meats National Dysphagia Diet III (NDD3) Chopped- nearly regular textures, no hard, sticky, or crunchy foods, chopped (bite-size) meats
Altered Liquid Consistencies Purple/Lavender Dot on the nameplate outside of room denotes resident on thickened liquids Honey: H Nectar: N Thicker than honey Other Restrictions No Straw: $ Fluid Restriction: FR Check with nursing for amount of fluid allowed between meals
Dining Rooms Do not serve meal if resident is not in the dining room. Resident must be seated when eating All Dining Rooms: Direct Dining Meals plated in dining room All residents need to be asked for menu selections! Read items by name, not entrée 1, entrée 2 Can mix & match protein/starch/vegetable Unexpressed wishes
Dining Rooms Hummingbird Hut Independent dining room Residents choose from posted menu Sterling Café Café experience for short-term patients Residents choose from posted menu Cardinal Café Residents who need supervision/ assistance Residents can order by filling out weekly menu slips
Weekly Menus Weekly menus are provided for residents who prefer to order ahead of time or need assistance with ordering May be filled out by resident or a family member IMPORTANT: Turn in weekly menus to white baskets at nursing stations or give to dining services staff DO NOT put on food carts!!
Assisting with Feeding Read meal ticket for level needed Setup- Open containers, straws, etc. Verbal Cueing- Encourage resident to pick up utensils, take bites or sips, clock cueing, etc. Variable Supervision- Need for cueing and/or assistance varies by meal, day, etc. Total Assist- Needs partial/full assistance with feeding and/or drinking
Meal Tickets Contains name, room #, eating location, diet, dislikes (this column list any food items the resident is NOT allowed to have), adaptive equipment, level of assistance, and diet modifications. Preferences/Beverages column- these items must be provided. Allergy Dot green *** Make sure to read everything on meal ticket to Dining Room Servers ***
Substitution List Located on front of steam table wall. If a diabetic has reached the allotted carbohydrates always offer a substitute from the list (vegetable, protein) Can not refuse item if resident does not want substitute Always Available items can be requested for residents who are refusing a food item.
FAR Recording CNAs need to be available to complete FAR in dining rooms Fortified foods on ticket must be recorded on FAR (Ex: fortified shakes, soups, etc.) Distribute completed FARs back to appropriate nursing stations for recording in Nursing Stations FAR Binder YOUR WORK IS VERY IMPORTANT TO US!!
SNACKS 10am, 2pm, 7pm orange stickers Record snack acceptance on snack sheet in the ADL books.
How to Contact the Dietitian or Food Service Director Dietitians: Log Book available on Pathways, Red Folder on Station Two and a folder on Station One. Dietitians Ext 558: Dana Lutz, Mikki Prout, Janice Fero Food Service Director Ext 501: Bruce Bilbrey
QUESTIONS?