communal setting, but if they insist on eat- ing alone, staff should respect their wishes. If residents are unable to articulate their preferences, staff should speak with family members to find out what the resident likes to eat, how, and when.
Special dietary concerns For seniors with health challenges, the goal is to allow as liberal a diet as possible so they can enjoy the same food as everyone else. Less restrictive diets tend to result in greater intake, which gives the resident more vitality and satisfaction and therefore promotes a greater quality of life. When modifications must be made, they
should be done in small increments. “The new thinking in long-term care is that we need to be the least restrictive when it comes to food,” said Patel. “Most [older adults] do not consume enough food to begin with, for several reasons.” Intake can be affected by factors including diseases, mobility issues, cognitive issues, dislike of the food, and some medications that suppress appetite. “I would say probably at least 50 percent of residents don’t eat enough,” Patel added. Restricting their diets further could lead to malnourishment. Rogers said that at Sunrise, residents of skilled nursing have their diets closely mon- itored, while those residing in assisted living are given more liberal options. “In our as- sisted living environment, the residents are free to do as they wish. It’s their home, they should choose what they want to eat and we’re here to provide them with the choices to do that.” At Vi, the culinary staff works in close
coordination with the lifestyles department to plan menus. Eating well is a main com- ponent of the company’s Living Well pro- gram, but “eating well” does not necessarily mean being on a strict diet. “Eating well might mean having a cheeseburger today because you’ve been eating salads all week,” said Sandblom. The inclusion of occasional treats and indulgences in a resident’s diet helps to maintain the enthusiasm and enjoy- ment of food that is so important to overall well-being.
Unidine’s menus are supplemented with
spreadsheets detailing modifications for spe- cial diets such as puréed, calorie control, or carb control. Even so, the renal, carb con- trol, and sodium control diets are not strict. “We generally like to liberalize the diets as much as possible,” said Bouchard. When it comes to evaluating a resident’s
food intake and planning a healthy diet, Patel trains her dietitians to look at many factors that affect nutrition. Those include the med- ications a resident is taking, what their usual diet is like, whether they are eating enough food overall, how much they weigh, and the results of any lab work. “We do take care of everybody on an individual basis,” she said. “That’s very important. There are no generalizations. Everybody is an individual and everybody needs to be treated as such.” Dietitians will further consult with nursing staff and medical providers to create meal plans for residents with significant health challenges (see sidebar on p.46). Some of the more common special diets in senior living and their modifications include: • Diabetic/carb control. Since diet restric- tions don’t often have a strong effect on the progression of diabetes, Patel found that it’s often better to adjust the medica- tion as needed and allow residents to eat a nearly normal diet, especially for those whose lab work is within normal ranges. “We keep their carbohydrates consistent for each meal, and we reduce the foods that are really high-glycemic-index or really high-sugar like fruit juice or des- serts,” Patel said. Residents are advised to eat fresh fruit at breakfast rather than drink fruit juice. It’s also important to educate families to prevent them from bringing excessive amounts of sugary treats and desserts to the resident.
• Low sodium. By cooking meals from scratch and eliminating added salt, communities can ensure that most menu items are acceptable for those on low-so- dium diets. Herbs, spices, and citrus juic- es can be used in place of added salt to enhance flavor.
• Renal diet. As with most medical chal- lenges, the renal diet depends in part on
VEGAN CHOCOLATE MOUSSE
Luc Buisson, pastry chef at Vi at Aventura, shared this recipe for a vegan dessert perfect for those residents who require or seek a dairy-free option.
Yield: 40 Servings INGREDIENTS 1.98 lb.
8.8 oz. 10.6 oz. Pinch
METHOD
• Mix sugar, salt, and garbanzo brine with mixer on high speed for 15 minutes until emulsified (consistency must be dense).
• Gradually add cocoa powder, folding with a spatula.
• Fill up ramequin.
• Reserve three to four hours in cooler before serving.
• At the time of serving, dust with cocoa powder and top with chocolate tuiles.
MAY/JUNE 2018
ARGENTUM.ORG 43
Garbanzo bean brine
Sugar
Cocoa powder Salt
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