Observations on Institutional Food

I’m long overdue for a new entry -- since my last post I’ve been at WIC, at a local advocacy organization for people with gluten intolerance diseases, a school district where the school lunch revolution has already been underway for a while, and I spent a week with a university professor learning about what it takes to teach at the college level. Lots of great experiences that I will not unfortunately have time to recount here. I do have something to say about my last rotation, though…

I spent a few weeks in a long-term care facility doing both food service and clinical work. Long-term care is something I’ve thought about as a career because it seems to be a field that requires a balance between clinical knowledge and people skills, and there is an opportunity to develop relationships with patients, unlike hospital dietetics.

This rotation gave me three different perspectives on food service production in a large facility. I learned how to turn out large amounts of food efficiently and cheaply as part of the kitchen staff. I learned how to develop a week’s menu in the role of the dietitian, trying to achieve the mean feat of balancing nutrition, flavor and appearance while giving the people what they want (by “people” I don’t just mean the residents – there were money-crunchers to satisfy as well). Lastly, I saw the food as the residents saw it and tasted what they tasted.

There were some good things: alternatives to the main menu were available, like veggie burgers, non-dairy milks and gluten-free products, and fresh fruit and green salad were always offered. Some dishes were made from scratch. Most dishes came out of a can or box with a list of ingredients that defied even the most literate reader, vegetables were often overcooked, and the meat was so dry and tough that an able-bodied young person would have a hard time slicing and chewing it, let alone an arthritic, palsied, or dentured senior. Most striking was the contrast of oversalted processed foods with the completely unseasoned vegetables (in compliance with the facility’s no-added salt dietary protocol which, oddly, doesn't prohibit the facility from purchasing high-sodium processed foods).

I was surprised, though I shouldn’t have been, to find out that for the most part this is what the seniors were asking for. When this particular facility offered homemade soup, the residents wanted their Campbell’s brand soup back! Remember, the current population in nursing homes is made up of the generation that saw the advent of convenience foods. Packaged foods and TV dinners were a revelation to them (and I loved them as a child, too). It’s no wonder that these seniors in their convalescence are craving the nostalgic flavors and textures of Krusteaz pancakes, Jell-O, and Campbell’s tomato soup.

I was also surprised to have a conference with a 60-something resident of the facility (one of the younger generation there) towards the end of the rotation who was asking for more beans on the menu, more whole grains, more choices with the salad, a wider variety of foods, more dishes made from scratch. When she heard I was from Bastyr, her eyes widened and she pointed at me and said, “Then you know…!”

In defense of the dietitian who plans the menu there, I explained to the resident that there were conflicting desires from the different generations at the facility, and budget requirements that made it hard to get past the processed food mentality, but I also told her that I thought change was a-comin’ because of her generation. I encouraged her to keep asking for what she wanted, and told her that I thought it would soon behoove facilities like this one to proactively plan for incoming residents who are more sophisticated (purely because of greater access to information) about nutrition, whole foods and healthy food choices.

Earlier in my internship, I accompanied a dietitian who is an expert on gluten intolerance diseases on a consult with a different long-term care facility. This facility had a prospective resident asking about their ability to accommodate a gluten-intolerant individual and they were inquiring about how to get gluten-free certification for their kitchens. That was a revelation to me, that a single inquiry could prompt such a change, but clearly these are businesses that will have to work to gain an edge in the burgeoning assisted living market.

What a great opportunity for nationwide food reform! If these incoming generations of seniors manage to bring about enough change in assisted living facilities, a nursing home might look good by the time I’m ready for one.