NUTRITION CARE FOR THE ELDERLY Presented by Clara L. Gerwick, R. D. of C.L. Gerwick & Associates 6600 ft. 101 Terrace Overland Park, Kansas 66212 FOR THE SPECtAL STUDIES SUB COMMITTEE of the Committee on Government Operations Friday, May 12, 1972 Kansas City, Missouri I am Clara Gerwick, a registered dietitian of the American Dietetic Association. I have been involved with and re sponsible for the nutrition of geriatric residents for over ten years. For the past six years my own firm, C. L. Gerwick & Associates, have and are providing professional registered dietary consulting services to Health Care facilities in Missouri and Kansas. We serve over 25 facilities of which 13 are nursing homes which have an aggregate bed capacity of 1300. My interest in geriatric feeding originated with a federally funded project through the State of Kansas Public Health in 1960. The project was to determine what a registered dieti tian could do to improve the nutritional status of residents in r^irsing homes. I surveyed the food service departments in all skilled care homes and a number of personal care homes in the Wichita, Kansas district. Among the most common problems identified were that planned menus, if available, were rarely followed; inadequate servings of meat, fruits and vegetables? poor sanitation procedures? and many government commodity foods available to institutions were generally not being utilized. The vast majority of homes were receptive
to professional help. I organized a series of Seminars which covered basic principles in improving the operation of their food service departments. The classes were given in strategic locations throughout the district and were very well attended. Implementation of these principles was becoming evident in the homes upon my follow-u visits to the participating homes but, as is often the case, the federal funds were exhausted and the program was curtailed. This did not deter me? it only made me determined to continue consulting on a full-time basis and assist others in becoming aware of the nutritional needs, and developing on-going programs for the improvement of the nutritional well-being of the geriatric resident. Unfortunately, nutrition has had little front-page attention by the news media until the White House Conference on Nutrition For the Aging. A well balanced diet providing all of the essential nutrients daily is just as important when one is 90 years of age as when one is 40. When adequate nutrition is evident in geriatric care, my observations have been the elderly are happier, more alert, have less skin problems, and have a generally bright outlook on life. Through these years of experience, I find that certain "myths" held by some people has been my greatest deterrent. The most prevalent ones have been? "Salt isn't good for old people"; "grind all meat because they can't chew it"; 2
"they can't eat lettuce and fresh vegetatbieis"; toe can't serve food family style tna^'jre too messy"; pre-pbrtioned servings of meat are too expensive"! "our people don't like milk"? "we dah't pay that high a salary to a qualified cook because we don't have the income"; "they waste fresh fruit"; and "these people can't eat Ham! N Beans". These have not only come from unskilled institutional employees but from the professional and skilled personnel. Some of these same remarks have been made directly to me by personnel from state and federal agencies as well. My reply to such statements is that there is much valid evi dence based oh current research to the contrary* At the present time one of our major concerns is providing adequate nutrition to the geriatric resident with the minimal funds available especially in the area of protein intake. We are working with ADM Milling at this time because their protein supplement products can be of great help to insti tutions especially those caring for the elderly indigent resident. These products will not sacrifice nutrition or palatability. We do find that proper training with the facility in how to use such products is very important. Without training in the production of palatable foods, these products will be discarded or wasted. * It took me five years to find someone genuinely interested in the development of a Meals-on-Wheels program here in Kansas City. I found them Brothers of Mercy Extended Care Facility and the Swope Park Mission Coalition Group. -3-
This is a concept of providing a distribution system for hot meals delivered directly to the home of our elderly citizens. The local plan includes those on modified diets as well as those on normal diets. I am pleased to have had the opportunity to develop the menus to assure adequate nutrition as well as sanitation guidelines to insure safety. The present program is by subscription only* With the advent of the "Food Stamp Program" in our area, I strongly recommend that these stamps be allowed to be used for a Hot Meal for our elder citizens. This very program cah make it possible for this citizen to live in his own hom$ longer at significantly less cost. In addition, tney will remain much happiero My observation has been the general nutritional intake of the elderly living alone for a long period of time deteriorates. When they become residents of the nursing home, we see various forms of malnourishment in a very high percentage of the cases. Upon receiving nutritious, palatable food they begin to look and act like a different person. Our very latest endeavor to reach out in the community is a pilot project of the "Frozen Meals Program" for an elderly diabetic patient from one of our local hospitals. Again, I was privileged to develop the menu and sanitation guidelines for the production, packaging and delivery of all meals for each day of the week, 365 days a year. This plan has been successful due to a tremendous team cooperation -4-
to achieve the objectives A diabetic patient has received the proper diet and is well controlled. This has alleviated continued institutional care which, prior to this program, completely exhausted the patient's life savings and placed her on the welfare rolls. My experience has revealed to me, as I hope this hearing will reveal to this committee, that there is much that can be done to improve the nutritional Well being of our senior citizens. The professional assistance of a qualified Dietitian can be amplified by progressive Health Care Facilities. By the same token, it bah be neutralized by a lack of interetet in self-imprbvemeht within the facility, particularly if this is reflected by administrative attitudes. ~ 3""*