All in the name of good taste

Nursing Homes, March, 2005 by Todd Hutlock

The food services staff at St. Cabrini Nursing Home, a 304-bed skilled nursing facility in Dobbs Ferry, New York, took it upon themselves to venture into uncharted territory: Rather than attend a commercial food show where staff would attempt to estimate what residents would like, they would stage a show on-site with the residents as tasters. The main goal was to boost residents' satisfaction by providing them with the opportunity to taste and give feedback on nearly 200 different foods that were being considered as menu additions, including entrees, desserts, beverages, and breakfast items. But the show ended up providing many more benefits for all parties involved.

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The idea came from Chef Supervisor John Hammer, who comes from a hotel background and has been working with food shows in that industry for the past 30 years or so. "We have a Food Committee in the building, as most nursing homes do, made up of residents and some volunteers and staff," explains Hammer. "We meet once a month and discuss what we can do, what residents like, what they dislike, etc. After attending a few of these meetings, I found that one of the things the committee wanted was more variety. I said to my supervisor, Food Services Director Joe Bisaccia, 'We should do a food show, like they do in the hotel business. I wonder if that's possible.' It was kind of a crazy idea, but I felt we needed to bring items in to let the residents look at and taste them and tell us if they thought we were right on with certain items or off-the-wall with them. Who is a better authority? These are the people who are going to be eating these things!"

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With Bisaccia's blessing, Hammer contacted Sysco Food Services--Albany, St. Cabrini's main food distributor, and began to put a plan in motion. Staff had identified types of food to offer and, under the direction of Chief Clinical Dietitian Gayle Breuilly, selected approximately 70 food tasters from their residents based on each resident's varied dietary needs and communicative abilities.

With the testers chosen, attention turned to the types of foods staff recommended to offer at the show. St. Cabrini's team asked that foods be included that were not traditionally part of the nursing home's menu and would appeal to the culturally diverse population of St. Cabrini. This ended up including pulled pork, fajitas, tabouli, and several vegetarian options.

Hammer also explains that St. Cabrini took a special interest in pureed foods: "We have 60 residents who eat pureed food every day, three times a day--what can we do to make those meals more exciting? We want to work with the clinical staff and find the appropriate textures for the numerous diet consistency modifications required. We don't want it to all just taste like pudding--we want it to taste like real food." This led to foods such as vanilla French toast souffle and cheese pizza souffle (quite a step up from pureed carrots).

The show's positive results were seen almost immediately from all parties involved. The residents relished the opportunity to try some new food options and to have their opinions counted. "Overall, it was a huge success with the residents," says Hammer. "We gave out a comment card to each resident and person that attended--we collected somewhere around 300 of these cards, and not one comment was negative."

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For their part, St. Cabrini staff got the valuable opportunity to observe the residents in this unique situation. "The dietitians and therapy staff appreciated being able to watch the residents eat, seeing how they use their hands, watching for swallowing problems, and figuring out what kinds of foods residents could handle. Their eyes were opened and the experience really taught them some things about our residents and their eating habits," says Hammer. This led to changes in the spices and flavors used in the cooking, pureed foods, desserts, hot entrees, and other ongoing menu changes.

In addition, the show was a huge boon to Hammer and the rest of the food services staff: "There was the whole sensation of looking at something and saying, 'Whoa, I never thought of that!' and then you start thinking of ten other things that never would have occurred to you before. All of a sudden, all of these ideas started popping up. Now we know that we can do a lot of different things that you normally wouldn't think of in a nursing home with the various eating issues that take place."

A new sense of camaraderie also was felt among the staff. "It was a learning experience," Hammer explains. "I was able to take something from the hotel business and get that information and experience from my past work out to the nursing home staff that I work with. Since I started working at St. Cabrini, I have been wondering, 'How do I get this information out?' I thought this was an ideal setting to merge our facility's practices with those of the hospitality industry."

The food vendors also were pleasantly surprised with what they learned from the show. It provided them with the rare opportunity to interact directly with the consumers of their products, providing invaluable firsthand information and spurring creativity. "Some of the vendors were a little hesitant because they had never done anything like this before," states Hammer. "Now, they're running with it because it turns out it's a great sales technique. We got lots of positive feedback from the vendors that came because it opened up more areas of revenue that hadn't occurred to them. They can now take these ideas to their other customers and show them these new innovations for food in nursing homes."