Good Eats For All
Taoists believe all things in life hinge on a natural balance between opposing forces, and that dualism connects everything in the world. Maybe that’s why kids and the elderly have always shared a bond. That unity of opposites — the yin and yang — is common to the young and the old, the inquisitive and the wise, the beginning and the end.
The good news for the elderly is that end is much prolonged these days. With advances in medicine, and the knowledge that eating nutritious foods can increase life expectancy, people are living longer. At the same time, children are more aware of the benefits of a balanced diet and the positive effect it can have on their lives. That places great importance on the role of institutional foodservice. They’re expected to feed and teach the young to one day care for themselves, as well as feed and care for those who can no longer manage it alone. But they must do it on a budget, with a focus on healthy, nutritious foods that taste great, and do it in a profitable way. Without a solid game plan, that’s a recipe for disaster.
HOME AT LONG LAST
Long-term care is arguably the toughest sector in the foodservice industry to manage. It requires a team of knowledgeable dietitians, foodservice managers, cooks and caregivers to get the job done, and even then it’s still a work in progress, with room for improvement.
One issue is the lack of federal standards governing the feeding of long-term care residents. Since healthcare is a provincial responsibility, it differs in each province. And while Ontario’s long-term care homes are generally regarded as having the best foodservices in the nation, others are lagging.
“In Ontario there are high standards around menu planning and nutritional support for seniors in long-tem care homes,” says Sharon McDonald, president of Morrison Health Care Services, a division of Mississauga-based Compass Group Canada. “Residents in long-term care homes eat in a home-like environment and they get a choice [of dishes].” New facilities include smaller dining rooms in which residents can eat, giving them an opportunity to socialize.
“We actually don’t call them facilities, we call them homes, because we want to make them less institutional,” says Sharon Armstrong, operations support specialist at Aramark Senior Living Services Canada. “Patients are referred to as residents. And when you walk into a long-term care home, it isn’t as institutional as it was 15 years ago.”
A registered dietitian, Armstrong says long-term care residents in Ontario have more menu options than ever before. When the menu she designs gets to the homes, it’s not implemented until a foodservice manager sits down with the resident food committee and they review it together. “It is resident focused — whatever they don’t like on the menu, they can take off,” she says. But changes must still be healthy, meeting both nutritional and hydration requirements, the later especially important to the elderly. “Residents let me know, through the foodservice manager, if they really like a new item,” says Armstrong. “But they’ll also tell me if they don’t.”
For example, when a new dish called Red Dragon Pie was introduced — residents balked, especially since they couldn’t figure out what it was. “It was a vegetarian shepherd’s pie,” says Armstrong. “They told me, ‘Why don’t you just call it that?’”
Aramark also caters to residents by displaying sample plates before meals are served. For example, if dinner includes a beef dish and a chicken dish with different vegetables, potatoes or pasta, residents see them plated before they make a choice. “There are always two options at lunch or dinner, but in each of our homes, the foodservice manager will have a third as a back up, in case a resident doesn’t want either,” Armstrong says.
With more options to prepare and many different dietary restrictions to consider, it’s difficult to keep everyone happy. Over the past few years there’s also been a dramatic increase in the number of long-term care residents, which is only going to intensify as baby boomers get older. “With an increasing aging population, we have to be more flexible in providing a variety of meals to address the many therapeutic dietary requirements the elderly have,” says McDonald.
Many residents are on special diets because of pre-existing medical conditions, like diabetes. Some are on specialized renal diets because of kidney disease, or they could be on restricted fat, cholesterol and sodium diets because of heart disease. That creates a huge challenge, because while some residents are restricted in what they can eat, others want to eat whatever they crave.
Morrison’s long-term care homes usually have a three or four week menu. “But it is a little different from province to province,” says McDonald. “In Ontario, we provide a selective menu, and the residents get a choice. A master menu is developed, and from the master menu, we develop therapeutic variations. For example, if we have a grilled chicken breast on the menu for the regular diets, we would also have chicken in a different form for the special diets, if it needs to be modified, cooked without seasoning or maybe minced.”
Armstrong admits balancing the specific dietary needs of ill residents with those who have no restrictions is hard. But when there are different diets, especially with residents sitting at the same table — say if one is on a regular diet, and one is eating only puréed foods — Aramark will purée exactly what’s on the menu. “If you choose a hamburger, you are going to get a puréed hamburger. It won’t be a puréed product that is beef and frozen bread,” says Armstrong. “We also educate them about the reasons for the texture change, which is to guard against choking.”
Both McDonald and Armstrong say their companies do not use cold-tray rethermalization, which is notorious for producing bland, flavourless food. Nearly all the meals prepared are done by cooks in onsite kitchens, an important departure from the dark days of institutional feeding.
Unfortunately, long-term care residents across Canada are not guaranteed the same standards as those in Ontario. One big reason for the discrepancy is budgetary. On Sept. 1, the raw food cost funding for long-term care homes in Ontario increased to $7 a day per resident, higher than in most provinces. Incredibly, that’s up from just $4 a few years ago. When you consider that food costs have gone up and there are yearly inflationary costs, the increase is welcome news. “In long-term care, because the residents are living longer, they have a lot more specialized dietary needs,” says McDonald. “The increase will help us meet those needs.”
In other provinces, for the time being, foodservice providers are often forced to make due with less than $7. In B.C., McDonald says the raw food cost budgets vary, depending on the facility. “In B.C., we still have to meet Canada’s Food Guide, but the standards are not quite the same as they are in Ontario. They are not as stringent.” Many places offer one main course meal with an alternate available should the resident not want it. But the province does not mandate a selective menu as in Ontario.
That begs the question — should raw food costs be controlled on a federal level? “I think it would be a good idea,” says Armstrong. “There are dietitians involved across the country with long-term care in every province, and as an association we are constantly working on best practices.”
Nevertheless, McDonald says because of regional differences, the key is to focus on the outcomes and not budgetary constraints. “When we feed the elderly, the goal has to be the same, regardless of what part of Canada we are looking at — to improve and maintain the nutritional health and quality of life, and to prevent or treat nutrition-related problems associated with aging.”
Lunch gets a new look
Ensuring Canadian students have access to nutritious food has challenges of its own. One constant struggle is balancing the sale of healthy food items with traditional best sellers, especially when the target customer is notoriously fickle.
For years, high-school students have been chomping on french fries at lunch, but thanks to the efforts of foodservice providers, more kids are now opting for healthier choices. “We’ve seen a shift in student purchasing behaviour,” says Tina Horsley, director of Wellness and Sustainability, at Aramark Canada. “In terms of french fry volume, there has been a reduction at a number of school boards.”
Horsley says each school board is different, but on average, there has been a reduction of 30 to 50 per cent in french fry volume/sales over the past year, since the implementation of healthier menus, strategic promotions and pricing.
“We have seen decreased sales of those items,” agrees Ross Munro, president of Chartwells, a sector of Compass Group Canada that manages foodservice schools. “The [student] consumer is more educated today than in my generation. They’re savvy about authenticity and value what they put in their bodies.”
That’s great news for parents, but not necessarily for vendors of french fries, where revenues from high schools are decreasing. But according to Horsley, some of Aramark’s partners are dedicated to working through the transition, looking at new product innovation and maybe one day introducing potato alternatives. “Everyone understands we’re in this together.”
Companies are also boosting the sale of nutritious foods by subsidizing prices and rearranging where healthy items are displayed in the servery. Horsley says Aramark increased the number of specials with foods that are lower in fat, adding more whole grains, fruits and vegetables and lower-fat milk products. “But you also need to reduce the availability of the other foods, because that can sometimes take away some of the great things you are doing,” she cautions.
That means getting creative in marketing new programs to students. For example, having fry-free days and not making burgers available every day is one successful strategy. Working alongside student groups, Horsley says a new overarching strategy called “Fuel” was developed. The messaging encourages students to fuel their mind, their body and their mood through food choices. But more importantly, the decision was made to reach students with relevant information.
“You can tell students about heart disease, diabetes and osteoporosis, but a lot of those things don’t hit home for them,” says Horsley. “The messaging we created addressed how food and lifestyle choices affect mental and physical performance, how you feel, what it does to your hair and skin — which are more relevant to students.”
Chartwells’ marketing strategy encourages students to choose combos with healthy foods rather than fries and pop. “If you look at our combo boards, they read ‘Make Mine a Combo,’ and picture a salad, soup and water,” says Munro. “The other items are available, but you have much greater choice today than you ever did.”
But no matter how creative you get, it’s still a struggle. “We don’t live in an environment where students are on lockdown,” says Horsley. “Sometimes you see a sort of mass exodus. A lot of fast-food restaurants are strategically placed near schools.”
Munro agrees, stating, “When you mandate against something with students, many will rebel. Some schools have taken out chocolate bars, and kids are selling them out of their lockers. Our approach is about education and enticing healthy choices, more than mandating them.”
To that end, Chartwells came up with its Balanced Choices program, which is built on the premise that nothing is wrong with any food item in moderation. “At all of our facilities you can get a sandwich made on whole wheat bread with low fat mayonnaise, a piece of lean ham and some lettuce, which is a very nutritious lunch, and the next day you can have a slice of pizza.”
Chartwells is also encouraging kids to make healthier choices through a strategy used by marketers of everything from jeans to soda to music — the cool factor. “You eat with your eyes,” says Munro. “So we are trying to make healthy food cool. We offer a fruit stick as opposed to only an apple. Years ago, sandwiches were sitting in a brand name Cellophane behind a glass window — today you have ham on multi grain, in a nice bag, sitting in a cooler, where you can actually see the sandwich.”
Eating well is a key to good health, whether you’re in Grade 9 or 99. Institutional foodservice providers are adapting to the changing needs of their customers, but there’s still room for improvement. With continued efforts, they’ll help people live longer, better lives.