By Dale Mayerson and Karen Thompson
Ultimately, the goal in meal service in LTC is to ensure that the food and nutrition team achieves a high level of resident satisfaction within the given resources. Nutrition Managers and Registered Dietitians responsible for food & nutrition services in long-term care homes are faced with the challenge of planning the menu but the quality and accuracy of the food served is directly affected by the quality of the food production processes in a home.
Food production forms a link between menu planning, meal service, pleasurable dining, and nutrition and hydration care. Standardized production practices all originate from a well-planned menu and include purchasing guidelines, production planning, standardized recipes and portion control.
Food purchasing and production control
Achieving accurate and consistent purchasing practices that adhere to a planned menu is the goal. When planning a menu, products are selected considering resident likes and dislikes, nutrient profile, ease of storage/preparation, to reduce waste and cost. How well a food holds during production and service is also important. French fries may be crispy and delicious when prepared in the kitchen but may be quite different by the time they are served to the residents. Optimal product selection can improve food safety, for instance, the use of pasteurized liquid eggs carry less risk of contamination than fresh eggs. Cost is an important consideration in selecting products and is always considered one of the criteria for product selection. The least expensive product is not always the best choice. It is also important to note that some products may not be liked by the residents, even if they meet all of these criteria.
Once product specifications are determined, purchasing requirements should match a home’s needs. A forecasting system is an important part of a standardized food production system and should determine daily requirements for each menu item based on resident popularity and diet distribution. This system provides the information to scale recipes and to determine the appropriate quantities to purchase.
Recipes and portion control
Recipes are designed for ease of use in an institutional kitchen and include the basic information including quantity and type of ingredients, time and temperature for preparing and cooking, number and size of portions. Recipes also include identification of internationally recognized Hazard Analysis Critical Control Points (HACCP), principles of time, temperature management, and sanitation, which is a valuable tool for preparation of safe food.
Recipes are designed and tested for safety, cost effectiveness, nutrient and texture profile, ease of preparation and service in the home setting and most importantly to ensure they are liked by the residents. Accuracy and consistency in preparing food items requires regular oversight, monitoring, communicating and follow up with food production staff.
Standardized portion control is a recurring theme in standardized food production. Identification of the standard portion for each menu item, recipe or purchased ‘ready to use’ product must be identified and communicated throughout the production process. The standard portion clearly influences purchasing, forecasting and recipes; as well it directly impacts residents and staff at point of service in the dining room. Inaccuracies or inconsistencies at any step will affect nutrient intake and cost.
How food production affects nutrition care
Food production processes can have a significant impact on nutrition and hydration care. An organized and well-planned food production process is an important part in ensuring the requirements of the resident population meet Canada’s Food Guide and the Dietary Reference Intakes as part of the planned menu.
Residents have a wide range of food concerns that homes work diligently to accommodate. Many residents in LTC struggle to maintain their body weight or may require increased protein to prevent age related muscle loss intake. How can food production affect these residents? Consider that a smaller than standard portion of entrée was ordered or that the cook made the dessert without adding the required skim milk powder or that the service staff used a smaller scoop size at point of service. Each of these changes results in the resident receiving less calories and protein than they are supposed to, undermining the impact of nutrition strategies that are in place to boost their health and wellbeing.
Individual residents may have specific allergies, hypersensitivities or intolerances to specific foods. In addition there are residents that avoid specific food items for cultural and ethnic observances. The home must have a quality standard food production process to be able to state with certainty that a resident is not receiving any undesirable foods. Cooks must follow standardized recipes and have any suggested changes approved by the Nutrition Manager or Dietitian before implementing. Consistent purchasing standards need to consider all foods served including ingredients lists as they relate to individual dietary requirements. Consider that arrowroot cookies may contain lard and not be suitable for those residents observing Jewish or Muslim eating practices or that Worcestershire sauce may contain anchovies that could cause a significant allergic reaction in certain individuals.
Providing appropriate levels of fibre is a goal for all LTC homes. When it is consistently consumed, the residents and nursing staff will benefit from the decreased use of pharmaceutical laxatives. To achieve this, Homes may be routinely offering multigrain products, prunes, flax flour or bran as additions to hot cereals or as a topping on hot or cold cereal to boost daily fibre intake. In order to be effective, these products need to be available and routinely used according to the menu plan and recipes.
Well-managed food production paves the way for an organized and accurate meal service, pleasurable dining and consistent nutrition and hydration care. Along with careful menu planning, a well-managed food production is critical to having a standardized food service and in managing food costs.
A successful menu and food production system will help to make every bite count.
Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide.”