Developing dietitian-approved menus for your residents with D’Jeanne Florence, Executive Director of Nutrition and Dining Services, PruittHealth

In this episode of the Post-Acute POV, our host Amy Wootton, RDN, LDN, Director of Nutrition at MatrixCare, is joined by D’Jeanne Florence, Executive Director of Nutrition and Dining Services at PruittHealth to discuss how a Menu Services tool can simplify the customization of dietitian-approved menus, allowing you to deliver appealing and nutritional meals for your residents.

Join Amy and D’Jeanne as they discuss the importance of dietitian-approved recipes and plans, how technology has impacted menu planning and production, and how Menu Services can increase staff efficiency and assist in meeting regulatory requirements. This episode details the impact of food quality, the challenges in providing nutritious meals, and how a nutrition management solution can help with those challenges.

Topics discussed during today’s episode:

1. [01:04 – 02:30] Amy discusses the importance of providing dietitian-approved menus in post-acute care.
2. [02:57 – 03:45]: Gain an understanding of the regulatory requirements for meeting residents’ nutritional needs.
3. [4:10 – 6:08]: We review the resources needed for evaluating meal plans and how to build and plan menus around certain meal restrictions or inclusions.
4. [6:36 – 7:55]: D’Jeanne details the importance of building a balanced diet and emphasizes correct portion sizes in meal planning for your organization.
5. [8:04 – 12:11]: Amy explains how to use a Menu Services tool to improve meal development, diversity, and cost. 
6. [13:05 – 16:32]: We cover different features that can be used to expedite menu planning.
7. [18:33 – 20:23]: D’Jeanne shares what PruittHealth has gained by using a Menu Services tool and how it has increased productivity.
8. [20:34 – 22:30]: The pair discuss the current dining trends across post-acute care.
9. [23:07- 24:07]: Amy and D’Jeanne detail how a Menu Services tool can help maximize your organization’s food budget and decrease stress.
10. [24:49 – 25:40]: We conclude the episode by reviewing the key ideas covered in the conversation and how to access a Menu Services tool.

Resources

• Get MealTracker here: https://www.matrixcare.com/nutrition-management/
• Find out more about PruittHealth: https://pruitthealth.com/
• Listen to more episodes of the Post-Acute POV

Disclaimer

The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials.

©2023 by MatrixCare

Transcript

Speaker 1

Hi everyone and welcome to the Post-Acute Point of View podcast, our discussion hub for healthcare technology in the out-of-hospital space. Here, we talk about the latest news and views on trends and innovations that can impact the way post-acute care providers work.

We’ll also dive into how technology can make a difference in today’s changing healthcare landscape for home and facility-based workers and the people they care for. Let’s dive in.

Amy Wootton

Thank you for joining me today. We wanted to take this opportunity to offer some guidance and introduce some new features as well as a new offering menu services just in time for the start of your spring menus.

My name is Amy Wootton, I’m the director of nutrition with MatrixCare, and I do have a guest speaker joining me today, D’Jeanne Florence, the Executive director of Nutrition and Dining Services for PruittHealth. Welcome and thank you, D’Jeanne, and I appreciate you taking some time today.

D’Jeanne Florence

Absolutely, Amy.

Amy Wootton

Our agenda today we’ll talk about how to explain the importance of using dietician-prepared menus to customize your meals. We’re going to determine how features will affect menu planning, production details, and resident satisfaction.

We’re going to evaluate trends from our dining survey that went out in 2022, and we will talk about staff efficiency and meeting regulatory requirements.

I know there’s many challenges encountered in providing new nutritious meals while maintaining resident satisfaction. Most of you already see the value of using Meal Tracker and our easy to use platform to create your own menus. Today’s refresher will also introduce some new features.

Food is, obviously, a significant contributor to senior residents’ quality of life, impacting their ability, their mood, and overall health. Without good food, you will see waste.

One study found approximately 50 to 70% of residents are leaving 25% or more of food uneven at meals. And according to the USDA predictions, food cost is going to go up another 8% over 2022. We know the normal aging process impacts quality of life, causing the ability to eat and desire to eat at times also causing malnutrition.

Protein energy malnutrition for resident ranges from 23% to 85%, making it one of the most serious health problems and issues facing post-acute care. It should come to no surprise then [inaudible 00:02:38] regulations require that menus meet nutritional needs.

So the balance of making a menu is often very challenging and very time-consuming for you all and requires expert analysis. And here today, D’Jeanne is going to jump in and help us give some of those expert detail requirements. Thanks D’Jeanne.

D’Jeanne Florence

So we’re going to go over the regulations for meals. And let’s start with a reminder of what the requirements basically are. A balanced diet helps seniors to stabilize their medications, maintain healthy body weight, and further decreases the risk of heart disease, diabetes, high blood pressure, and other ailments.

Calories for males and females are different, so creating menus meeting that 2000 to 2200 at a minimum would be safe. And with the help of Meal Tracker, RDS or dieticians have the ability to see nutrient needs right in the software.

We follow standards of practice, the Dietary Guidelines for Americans, also known as the DGAs, and they provide nutritional guidelines for the general population. The DGAs are used by federal food, nutrition and health policies and programs to help the population consume a healthy and nutritionally adequate diet.

The dietary guidelines translate the National Academies of Sciences, dietary reference intakes, or DRS, for nutrients into food and beverage recommendations. These are the nutrition guidelines and regulations that menus must meet and they serve as a reference for developing therapeutic diets for people with chronic health conditions.

So almost every day, research studies about food and nutrition appear in the headlines. With so many news reports, how do you tell what information is based on strong scientific evidence and what is merely a marketing message?

As your residents are inundated with information from the headlines, it is important to be aware and be that sounding board for proven food facts referring back to reliable sources. Use referenceable resources like these to evaluate your menu, to assist you in understanding these nutrient details, and adjusting the food items that are being served to your population.

The Dietary Guidelines for Americans is one, MyPlate for seniors, and that can be found at myplate.gov, and then of course going through the selections, select the older adult section. Well, those are two very good reference points to use when you’re building menus.

And as you build the healthy menu with inclusion of special diets, operators typically see nutrient needs being met, but they must evaluate the nutrient needs of residents so you are sure to support them. Dietary needs change with aging in several ways.

People become less active, their metabolism slows down. Their energy requirement decreases. All of which means that they need to eat differently. So how they ate in their twenties, they’re no longer able to eat the same way in their sixties or seventies.

The abilities to absorb and utilize many nutrients become less efficient. Their nutrient requirements actually increase. Aging is often accompanied by a loss of appetite and changes in taste and smell, all of which can lead to more limited food choices and lower the intake of helpful foods.

Aging is also often accompanied by general oral health decline and a reduced ability to swallow, which can affect food choice and intake. Many older adults experience mobility constraints, which makes it difficult to shop for their foods or lift heavy jars or open containers just to name a few.

Maintaining a nutrient dense diet is critically important for older adults because of the impact of food intake on health. Seniors needs are recommended either in a daily or weekly amounts from the different food groups or subgroups based on a 2000 calorie diet.

Regulatory agents or surveyors are expecting these recommendations to be followed. General list is presented here, but of course, even more details you could be held accountable if not met.

The vegetables not only need to be a substantial part of the daily meal planning, but also need to be of a specific variety weekly to meet the nutrient needs, such as having dark green vegetables one and a half times a week.

And that can be anything from a leafy green like your broccoli, kale, spinach, bok choy, et cetera. Red and orange vegetables like carrots and sweet potatoes, that has to be five and a half cups weekly. Your beans, peas, lentils, it’s one and a half cups.

Starchy vegetables are about five cups. Grains also need to be a mix of whole grains, about three ounces at least weekly. Protein varieties should include a good mix of meats, poultry, eggs, seafood, nuts, seeds, and soy products.

The other thing that we have to consider are portion sizes when we’re looking at menus. You need to understand the appropriate corresponding portion size of each and take that into consideration. With an elite software like Meal Tracker, you can actually see the exact portion sizes, customize it while building your menu and adjust it in the resident profiles as desired and even show the serving size on the tray ticket if desired.

So for instance, if you have a resident with weight loss and you want to give them double portions, you can actually put that portion size into mail tracker so that they can print on the tray ticket for those that are plating the meals for those residents. And that also carries through to the production reports so that your manager knows the exact amounts that you should be preparing and serving.

Amy Wootton

Thank you so much D’Jeanne. It’s a great reminder of all the details involved. All right, what’s next? Once you’ve completed all those details involved in nutrients and portion allocation, you’re not yet done.

A menu next needs to factor in resident preferences, evaluate what the plate looks like, the color of foods, textures, and each category of food item.

All this while taking into consideration menu costs. With features like Meal Tracker, you see the benefit of those resident preferences flowing all the way through to your menu over to production, and with the ability to also run your cost reports.

Some questions though to consider before rolling out your menu. What diets are you trying to serve? Do you have a list or a formulary that your organization agrees upon?

Maybe you look to a more healthy menu, like the DASH Diet or that Mediterranean style. What culture are you trying to adjust to? This must be addressed and reflective for the general population you serve. Will your serving style be more short order, pre-made, farm fresh?

What trends are you incorporating? More plant-based versus variety of meats? More mixed bowl dishes versus traditional three plate items? Operators generally find that having technology that can manage the special needs of their residents is a top requirement.

Additional factors that you need to consider obviously are this season, what season you’re in, to not only rotate variety but help with the cost of food.

A flexible menu system that can be adjusted quickly using our software that caters to the needs of your facility is ideal. A good balanced menu can be both cost-effective and healthy. At the end of the day, your meals need to be enjoyable and improve your resident satisfaction.

With fewer staff, possibly with lack of some RD expertise, Meal Tracker’s trying to help solve that dilemma by offering comforting, traditional and appealing meals that can also be modified to meet your needs.

We’re now offering a turnkey menu option, hopefully making your life a little bit easier with our subscription based menus. On this slide, we look to our dining survey with more than half of our 2022 survey respondents using Meal Tracker to build their own menus or need to purchase pre-built menus to ensure they meet those resident needs.

One out of three told us that they’re struggling with rising food costs and need to be able to make adjustments easier to their menu. Three out of four told us that having a menu variety that is compliant help keep residents healthy and satisfied. No-brainer, right?

Meal Tracker’s new menu services lets you choose from a library of menus developed by RDs. Once you select a menu, you can modify it as needed and accommodate special diets or consistencies, obviously also accommodating your preferences.

Meal Tracker menus will offer cost neutral menus that can be customized to your facilities, unique culture needs. We can provide various extensions like liberalized diets, therapeutic, gluten-free, vegetarian.

These menus can be easily customized for your budget and preference based on the food that you purchase and include nutritional analysis that take the guesswork out of whether or not you’re being compliant.

Our menu services don’t end there. We now offer individual sessions with our RDs to build your exact menu with your subscription. While it might be taxing on your time and resources to develop dietician approved dining plans in-house, it’s not when you let us do the work for you. Lean on our team.

Our dining plans for seniors are easy to implement. We do all the heavy lifting and provide our client menus with nutrient analysis and matched already to recipes.

For nearly 40 years, yes, it’s been 40 years, Meal Tracker has solved challenges for dining operators in healthcare facilities. We recognize today’s generation of food savvy seniors have high expectations for dining services and our mission is to strive to help you and your community meet those needs.

We now offer these Meal Tracker menus within the product for direct subscription.

All right, so with Meal Tracker, you already have menu development features and they focus around nutrient details, recipes, ingredient details, as well as running your own cost capabilities.

But you also can manage things like allergies, likes, dislikes, being able to group those foods, matching items to your menu to actual recipes you’re using so they can be scaled and nutrient analyzed. All of this is extremely important in order to be compliant and meet regulatory expectations.

And don’t forget, utilizing menu printouts for posting. Your menu should be pre-planned, so it needs to be posted. But understanding the challenges for procurement that’s going on and price challenges weekly that you’re dealing with, you may need to make substitutions that are not planned.

Meal Tracker’s now offering an easier way with a new feature for temporary substitutions. It’s coming up shortly. I’ll explain how that works.

According to our dining survey, managing special needs is of top priority. Managers and dieticians feel their dining program is more successful when they focus on therapeutic restrictions.

To do this, the menu ideally is built across special different diets and consistencies, matching to approved diet lists that you’ve agreed upon that I mentioned earlier, communicate those orders, those diet orders with a medical record through integrations, that’s ideal, and have a select menu option for users to have no question on what to offer. So all of that’s available in features in Meal Tracker.

On the nutrient analysis screen, here’s where Meal Tracker utilizes the USDA Food Data central database and you tap into more than 200,000 food items and over 200 nutrients that you can analyze your menu with.

You can filter and display special nutrients, prioritize ones that you’re looking for, and evaluate nutrient details by special diet by day, by meal, and by consistency. You have tools that are flexible to personalize your menu by the number of weeks, add alternate items if you’re having a main and an alternate, create always offered list items, and even a chef’s choice menu.

Here is where we’ll find our latest feature, in this chef’s choice menu feature. Our latest feature, smart swap menu substitution is the only menu program right now with Meal Tracker on the market that smartly reverts or swaps back to planned menu after a substitution has been made.

It easily advances menu items in periods of short staff or procurement challenges. You have the ability to confirm if the swapped item meets your diet requirements right here on the screen when you’re planning your swap and assigned on that specific day that you need it substituted for.

So if a product didn’t come in and you need to swap it out for another product, you’ll be able to just add your substituted item, assign it to the specific day, make sure it agrees to each one of these diets. And this auto updates all of the tray tickets, select menus, as well as supporting menu reports like you run, week at a glance and master menus.

What it looks like, now adding the ability to advance menu substitutions, is shown here. It solves that challenge of not having that item as needed and able to adjust quickly. Also documenting the fact that you made a substitution, which is also a requirement from regulatory agencies.

It can be configured by user security permissions in settings. So only certain users can be permitted to make swaps or substitutions. And obviously we want to make sure we make appropriate substitutions when we don’t have a product in house or can’t produce it that meal.

So creating a menu goes hand in hand with making selections. Using a tablet or mobile device, you can obtain menu selections from residents or family members, make easy adjustments to their options on the spot or in advance while maintaining their diet compliance from your planned menu.

Shown here is that select menu screen, the available items listed that was on the pre-planned menu, and to the right you see what items were selected. You can send that directly to the printer or save it for when you’re able to go back down to the kitchen and run your tickets later.

Relying on the software can help ease your menu planning, streamline your production, and improve resident satisfaction. Our build and adjust options allow facilities to provide that highest level of person-centered care. At this time, I’d like to bring D’Jeanne back into the conversation and ask her a few questions about her experience.

D’Jeanne Florence

All righty, Amy.

Amy Wootton

Thanks D’Jeanne. What was Pruitt doing to build menus before Meal Tracker worked with you on with our menu services?

D’Jeanne Florence

So prior to working with Meal Tracker, our menus were created manually from scratch by myself with the assistance of a few of my regional dieticians. They were manually extended across the different therapeutic diets and textures and hand calculated to determine what the PPD is for the day.

This required a lot of hours. And that’s completed bi-annually, so we can have a spring summer menu and also a fall winter menu. And if you break it down, there’s typically a 28 day or four week menu cycle, which means you have 56 lunches and 56 dinner choices and that’s not even including breakfast.

And so because there has to be a main and alternate meal choice for lunch and dinner, that’s where the 56 is coming from. So you have to also consider variety and prevent food repetition so that your residents don’t get food fatigue, and doing all of this while still meeting the nutrition, budget, and labor requirements,

Amy Wootton

It’s a big feat. Why did you want to use the software program as your menu system?

D’Jeanne Florence

Well, Amy, it’s a no-brainer. With all the hours that go into that and all the work, we decided to trial on the menu services to reduce the labor hours involved to allow more time to focus on other priorities. Menus are important, but of course we all juggle different projects and things that we have to do.

And during the height of the pandemic, labor hours were very precious, and they had to be utilized wisely and patient care always comes first. So taking this into consideration and still needing to provide a variety of appetizing meals seasonally, it was decided to trial Meal Tracker’s menu services.

Amy Wootton

And how has Meal Tracker’s menu system helped you in your organization?

D’Jeanne Florence

Well, Meal Tracker has helped by reducing the labor hours that’s required to produce this menu and we can be assured also that the nutrition requirements are met and there’s a widely acceptable variety of appetizing meal options available for the residents to choose from with their main choices and their alternate choices throughout the day. And our organization strives to achieve resident meal satisfaction. So it’s helped greatly.

Amy Wootton

Like most, I’m sure, like everyone on this call.

D’Jeanne Florence

Of course.

Amy Wootton

Can you describe having how having us do your menu services allowed you to run your business a little more freely?

D’Jeanne Florence

Of course. So utilizing Meal Tracker for the menu production, it’s allowed us to dedicate a more focused effort on resident satisfaction through increasing the menu changes throughout the year. So let’s say previously we’re doing two menus a year, we’re able to kick that up and do maybe three or four.

So change with the actual seasons instead of having to run one menu for six months because it’s removed the labor aspect that’s associated with creating the menus. So that’s allowed us to prevent menu fatigue and keep the residents interested with what’s coming up next and what they’re going to be served during their meals.

Amy Wootton

Great to help. And then what’s the biggest benefit you’ve experienced since using menus with Meal Tracker?

D’Jeanne Florence

I can say that I do appreciate having a point of contact to adjust menu concerns and adjustments. While it was great having a team or some of my team work with me, there’s difference when you have someone whose focused effort is specifically on menus and that’s what Meal Tracker provided us.

There’s a certain level of comfort that comes with knowing the nutritional and budget parameters have been verified and are consistently met. When all of the features of Meal Tracker bundled together and used in conjunction with the menu, then there’s a seamless flow but that I can truly value.

Amy Wootton

Well thank you D’Jeanne. Great feedback and we value you and appreciate you giving us that opportunity to work with you on this new service too. So thanks so much.

D’Jeanne Florence

Absolutely.

Amy Wootton

So let’s jump into dining trends then. With making menus in the industry, what we’re seeing is focus around customized menus and even branding. Operations are looking at crafting cuisine, embracing that foodie revolution.

All of that’s on the rise. Having unique and popular dining program gives your sales and marketing team another compelling talking point when speaking with prospective residents and loved ones. So maybe brand your program and consider that as part of your marketing and dining approach.

Also making thoughtful dishes, incorporating diets that need special attention, especially with that introduction and adoption of IDDSI. Maybe you want to do a pureed program or a Smart Choice program. Having that thoughtfulness for dishes really has been on the rise as well in what we’re seeing in the industry for trends.

Communities also have shifted to obviously more sustainability with that farm to table offerings. Partnering with local farms, this positively impacts the environment while benefiting from a higher quality food. This too can be part of your branding.

A wellness initiative has been around for a while and it continues to be a strong push for menu trends. It’s a top priority and food plays an integral role in this, obviously, overall wellness. Some people are doing Brain boosting bites, energy shots, smoothies, and shake stops to name a few.

In our 2022 dining survey, we can see here some of the responses and we can tell that dining and nutrition is of utmost importance. Some interesting facts here. 75% of operators are still utilizing a four-week cycle menu.

Pre-Covid, this was significantly less. So it’s interesting that we went back to a four-week cycle as our standard comfort as an industry. 54% serve one main dining room. Obviously with Covid and probably staffing challenges, this is still hindering our customers from going out to offering different dining room options.

44% had no change in their food budget, despite the rising food costs we’ve seen. So that was disappointing and I feel your pain points there. 74% feel many variety is of utmost importance for a success in dining program. D’Jeanne, do you feel these responses reflect what you see and what you’re dealing with, if you don’t mind answering?

D’Jeanne Florence

Absolutely. So I can definitely agree with all of these facts. We’ve seen a lot of impact, the change from pre-Covid to Covid where we are currently. Food budget. Our food budget did actually go up a bit, so we did have a buffer to address that inflation that everyone had to deal with. The menu variety, of course that’s always important.

Like I said before, you have to meet your residents’ needs when it comes to their meals. Because outside of bingo and food, those are their two biggest things they look forward to. So we have to make sure that we’re keeping them engaged and meeting their needs and prevent weight loss, of course.

Amy Wootton

Of course. And great that you’re able to get that increase in food budget. So I’m glad to hear that. And there’s other data from our menu survey results, which we’re going to be releasing in the next month or so. So you’ll see some marketing around that and everyone will get the full report from that survey.

Within the cycle menu feature, don’t forget, in Meal Tracker, you already have the flexibility to maintain your menus and create the right menu for your venue. Some dining styles and options we see on trend and what I see from customers out there are shown here.

They’re expanding their menus, maybe offering diverse styles and even different venues. More flexible hours might be what your customers are expecting. This makes keeping up with the quality of menus that meet regulatory standards often challenging though. So don’t forget all of that and you’re trying to entice them but yet meet regulations, it’s a difficult balance that you’re up against.

We know you’re faced with challenges every day. Our goal is to help you increase staff efficiency and meet regulatory requirements that can improve care and outcomes.

So Meal Tracker’s here to help. Using our menu tools can help improve care through proper nutrition details that we’ve put in place, helping maintain compliance, and now also to allow for time savings with features such as that ready-made Meal Tracker menus that I’m introducing to today, as well as the new feature with menu substitutions. Good luck with your spring menus.

Speaker 1

That concludes the latest episode of the Post-Acute Point of View Podcast. We have a lot of guests and topics coming up that you won’t want to miss, so be sure to subscribe. To learn more about MatrixCare and our solutions and services, visit matrixcare.com. You can also follow us on LinkedIn, Twitter, and Facebook. Thank you for listening. Be well and we’ll see you next time.