Boomers reaching senior years raise bar for foodservice in healthcare

Hospital and extended care facility food has long been the butt of jokes. It is routinely offered up as the lowest common denominator in its category but patient dissatisfaction is leading to some innovative changes in the healthcare foodservice industry. Health concerns on the part of an aging population and the more voluble culinary demands of baby boomers have given the movement widespread appeal and impact.

In addition, the World Health Organization in 2005 suggested that a healthy diet, regular physical activity and avoidance of tobacco could reduce premature heart disease, stroke and Type 2 Diabetes by at least 80 per cent and cancer by at least 40 per cent. Obviously there is a huge incentive and opportunity to influence the diet portion of that equation through healthcare facilities.

Within the healthcare sector, Sodexho has 300 contracts in 750 locations across Canada. They provide services in hospitals and long-term care homes and retirement facilities. Sodexho has developed a healthy eating program for its healthcare retail sites known as Your Health, Your Way. All menu items offer sensible nutrition levels and healthful cooking techniques, says Jon Kristjanson, vice-president marketing, communications and community relations.

In the U.S. at least 70 per cent of hospitals are considering or have already implemented new menus to keep pace with current dining trends, according to registered dietitian Phyllis Filgate, president of the American Society for Healthcare Food Service Administrators.

“The hospitality end of healthcare has become extremely important,” states Filgate.

This past summer, for example, Florida Hospital in Orlando introduced 10 new bite-sized desserts patterned after the current trend of serving much smaller desserts in order to deliver flavour intensity but lessen the high calorie impact. While Florida Hospital’s desserts aren’t all fat free, low-fat milk is used instead of cream and minimally processed flours and grains are highlighted.

Kristjanson of Sodexho says that residents’ preference for freshly prepared foods continues to rise, as does increased interest in ethnic cuisine. Sodexho’s nod to outside dining influences is called At Your Request (AYR) Patient Room Service Dining, which is on the 24-hour hotel room service model. Freshly prepared comfort food is promised within 45 minutes from time of order. They offer the program in 185 hospitals in North America.

“Future food service trends within healthcare will be driven by increased recognition around healthy eating habits along with the heightened customer expectations of the baby boomer generation,” says Kristjanson. “There will be increasing pressure on our industry to ensure that support services within the healthcare sector are more patient/resident centric while offering greater individual control.”

Jayne Harvey, CEO and owner of FCS International, a healthcare consulting and training company, agrees that healthcare recipients are demanding more from their foodservice experience. She calls restaurant-style menu systems a “brilliant option” since they meet the criteria of diversity, place autonomy and control in the hands of the patient, enable more efficient production and minimize waste.

“The retirement sector has understood the draw of fine dining to the aging consumer,” says Harvey. She adds that in retirement homes meals are social occasions.

However, that sociability tends to get sidelined in long-term care facilities
where there is much more emphasis on the “healthy” side of food and on dietary restrictions.

Functional foods

Functional food is a very hot trend in the healthcare world. As defined by Health Canada, functional foods are those that may be consumed as part of a typical diet but provide benefits beyond basic nutrition. They are thought to produce physiological benefits and reduce the risk of disease.

At the GFTC 2006 Strategic Symposium, presented by the Guelph Food Technology Centre in partnership at the with Deloitte, NPI Center, ACNielsen and Food In Canada, market analysts predicted that growth in functional food will continue and could top out at $167 billion globally by 2010. Dave Hamilton,

national sales and business development for Winnipeg-based Prairie Orchard Farms Inc., knows all about functional foods. His company’s Omega-3 and selenium-enriched pork products are the first on the North American market to have received approval from the Canadian Food Inspection Agency and the U.S. Department of Agriculture. Prairie Orchard Farms president Willy Hoffmann devised a feed formula that allows Omega-3 to be absorbed by a pig through its diet. For this he was recently awarded a Canadian Agri-Food Award for Excellence.

Many of the diseases against which Omega-3 and selenium offer some protection are more prevalent in older people, for example, heart disease, stroke, cancer, osteoporosis and arthritis. This is significant since, according to Agriculture and Agrifood Canada, by 2020 nearly one in five Canadians will be 65 or older and 75 per cent will have at least one chronic disease.
Fruit juice and drink manufacturer Lassonde is at the forefront of functional foods. Over the last three years, the company pioneered the development of functional beverages with its Oasis Health Break brand.

“Today’s consumer is more savvy and clearly more health conscious. As they retire, they will bring with them their consumption habits,” says Jean-Marc Desnoyers, national marketing director, food service, Lassonde. “They will want to have the same products [in healthcare facilities] that they can buy in grocery stores.”

One of the biggest stars on the functional food scene is the common blueberry. In one study done at the University of Prince Edward Island, researchers found that after a stroke was induced in experimental animals, the group fed a blueberry-supplemented diet for six weeks had significantly less brain damage than the control group.

Ruth Lowenberg, RD, of the British Columbia Blueberry Council says the “blueberry health halo” is shining very brightly these days. She comments that the appeal extends far beyond the high antioxidant benefit of the blue fruit. There is virtually zero labour involved in preparing blueberries; they are available fresh, frozen and dried; they taste good; they’re available year round; and they are a beneficial addition to diabetics’ diets.

“For the operator, customer popularity, ease of use and menu versatility are key,” she says.

With trans fats increasingly being banned or restricted—the federal health minister has set a 2009 deadline for the Canadian food industry to drastically limit their industrial use—sunflower oil is taking up some of the slack. According to the National Sunflower Association, NuSun, a mid-oleic sunflower oil that is the best seller in its category in Canada, has greater stability than many oils so it lasts longer in a fryer and in products such as salad dressing.
A 2005 study published in the Journal of the American Dietetic Association showed that a diet that included sunflower oil lowered blood cholesterol better than an equivalent amount of olive oil.

Unique healthcare variables

A healthcare or extended care facility has unique challenges. Dangerous staph infections are on the rise, and cross contamination and foodborne illness are key problems, especially in settings involving older patients who have more compromised immune systems. Uncontrollable situations such as power outages can render a facility vulnerable to microbial contamination. In most situations sanitation and hygiene situations can be controlled to an extent, and new products are being introduced that make the process much easier.
Georgia-Pacific Food Service Solutions offers disposable Dixie Stoneware® for this purpose. A line of single-use tableware that includes plates, bowls and a kettle, Dixie Stoneware, is made from a blend of polypropylene resin and minerals. It is durable and up to 20 times lighter than permanent ware, according to Sharon Tett, foodservice segment manager with Atlanta-based Georgia-Pacific. It is cut resistant, tolerant of high temperatures, soak-proof and leak resistant. Because it is single use, dishwashing labour costs are eliminated, which saves time and money.

As healthcare patients and residents are now living longer, more and more chronic disease cases are being encountered. For example, the burgeoning increase in diabetes is something that hospitals and long-term care facilities have had to adjust to very quickly.

Sandra McCormick is national director, food services for Retirement Residences Group, which operates about 100 retirement residences in BC, Alberta, Saskatchewan, Manitoba, Ontario and Quebec and 100 long-term care homes, some in the U.S. She says there is a substantial increase in celiac disease and renal failure. Such ailments can involve highly individualized and complicated diets.

As well, there is a public perception that foodservice costs for retirement and long-term care facilities are very much alike. As McCormick points out, long-term care homes are mandated by the Ministry of Health and Long Term Care to provide specific dietary programs and are publicly funded. Retirement residences are funded solely by the residents who live there.

“The public hears about $11 a day food budgets for prisons and compares [that with LTC homes and retirement residences]. What the public doesn’t understand is that the menu for a 30-year-old man will be very different than that for an 80-year-old woman. As a result, the budgets will be very different,” says McCormick.

A healthcare foodservice setting is heavily dependent upon equipment. Hobart FEG Canada supplies dishwashers and food prep equipment to the sector. Doug McKinnon, director of marketing, explains that the equipment varies according to the setting. A long-term care facility, for example, prepares food on-site and requires food processors, slicers, mixers and ovens in addition to dishwashers. A hospital, however, requires very little food prep equipment, as food is generally re-thermed in bulk. Hospitals do need large dishwashing systems, however.

McKinnon says that energy efficiency and water consumption is top of mind with operators. Products that are ecologically friendly and sustainable as well as safe are also desirable.

Campbell’s Foodservice recently conducted a survey of healthcare foodservice operators. Topping their list of what was most important from suppliers were availability of product through the distribution network, a variety of products that deliver sound nutrition, and ease of use. According to Helen Ann Dillon, RD, MSc, director, non-commercial foodservice, Campbell Company of Canada, the company’s Power to Cook Pro program answers all of these needs. The program features more than 150 texture-modified recipes created by a Red Seal chef that require no more than four steps with minimal labour.

In hospitals, Campbell offers branded soup stations for staff and visitors and a portfolio of soups, and texture-modified foods and entrees for patients and long-term care residents. The company was recently awarded a Certificate of Excellence from Blood Pressure Canada for sodium reduction in its consumer soups.

Trends

The industry is becoming greener and healthier, patients and residents are both older and more isolated, and labour continues to be a huge challenge.
Toronto foodservice consultant and speaker Marvin Greenberg says there has been a tremendous rise in cold plating and a decrease in scratch cooking because of the labour crisis. But there still remains the problem that, even given very good products, for example, mashed potatoes that require only the addition of milk, if they’re not prepared properly and held properly, they will taste terrible.

“Sometimes it’s easier for an institution to give Ensure [to residents] than to take the time to cook properly. And [Ensure is] not cheap,” he says.
Two other problems identified by Greenberg are adequate training and security issues. Proper training of personnel can lead to a lot of productivity and reduction of waste, while inventory that’s not being managed well can produce huge losses.

“I’ve been through many hospitals and I see less security than I’d like. For example, cases of Ensure should be under lock and key and are not. It’s a pretty open situation in back of house,” he adds.

Sandra Matheson is president, Marek Hospitality Inc. and Food Systems Consulting Inc. Marek operates retail foodservice for six healthcare clients, while Food Systems provides management advisory services to hospitals and long-term care facilities. Matheson agrees that recruitment of staff and high turnover is an enormous challenge. She is now working with Corbrook to facilitate the employment of the disabled and is using a new HR development tool to assist with training unit managers to retain good employees.

In addition, Matheson has launched a Getting Greener Promotions calendar for the year. Each month she identifies for clients and managers ways to reduce, reuse, recycle, buy local, buy greener and adopt new enviro-friendly habits. Her program includes a green audit done by district managers to assess equipment and facilities.

She notes that the demographics of long-term care are changing. “In LTC, residents are both older and less able but declining mental health is more frequently the cause for loss of independent living. Younger patients with chronic disabling conditions are becoming a larger proportion of care residents. And patients of all ages who do not have the benefit of a supportive family to provide care are also being seen in greater numbers.”

Sharon McDonald, president of Morrison, a division of Compass Group Canada, is responsible for foodservice in more than 135 locations across Canada. Compass is focusing on talent management to stay ahead of the labour curve. Their Balanced Choices program and Trans Fat Action Plan are providing customers with healthier food selections while regular resident surveys and attendance at family council meetings provide feedback for menus. All menus are entered into software that allows planning for many therapeutic diet variations as well as nutrient analysis.

Many successful retirement home operators are integrating the whole notion of wellness and health into their model by ensuring they offer spa services, health classes, more exercise and a variety of activities, and foodservice offerings play an integral part, says Brian Emmerton, vice-president, operations for Complete Purchasing Services Inc. CPS offers a broad range of day-to-day products and services for senior living and healthcare facilities across Canada.

Emmerton adds that the average age of employees working in healthcare, including foodservice, is continuing to climb and absentee costs are going up dramatically. This puts pressure on operators to deal daily with staff shortages and do continuous retraining. The average age of clients entering long-term care has risen 10 years in the last decade, which means that residents and patients are now much older, have more health issues and need more attention paid to their diet.

“A disturbing trend is also the mix of people entering care facilities. It is estimated that 20 per cent of Canadian psychiatric beds have closed in the last three to four years and these people often end up in long-term care facilities as there is no other option,” he adds.

Maximizing profit

Profit margins in the healthcare industry are largely dependent upon management, service issues and food wastage. Operators are given a relatively small allotment (increased in September to seven dollars day in Ontario for raw food costs) and must be scrupulous with their management.
Food costs can be predicted to a certain extent through suppliers and menu development, says Harvey of FCS International. But the highest item for wastage in long-term care is beverages. She explains that this is because standards state that each resident should be offered three glasses per meal. Since fluids are generally pre-poured before the meal, a resident receives a tray with a meal and three glasses, of which much is wasted since few people will drink three glasses in succession.

“Best practices abound but are not generally shared. More often than not it will come down to how you hire, train staff and serve your product. Perhaps if we provided a monetary bonus to being creative on how we get clients to take the recommended fluids, we might just get there,” Harvey suggests. Mozzarella cheese blended with soya is a good way to cut costs, according to Rick Greenwood, director, business development for Bromont. It is very popular with the foodservice industry as it tastes like Mozzarella but is approximately 25 per cent cheaper, he says. The company’s soya topping is currently used on a whole wheat thin crust pizza at St. Michael’s Hospital in Toronto.

Greenwood says that the elderly can be narrow minded and very particular about their food. He tells the story of an elderly man he encountered at a retirement facility who told him he wanted Old Cheddar. When Greenwood asked what his cholesterol levels were, he replied, “Who cares? I’m not here for long and I damned well want to enjoy it.”

Alasko Frozen Foods Inc. has found that frozen vegetable and fruit sales have been increasing by double digits year over year. Recently the company introduced some new interesting blends of non-traditional vegetables such as yellow carrots, the romanesco flower and grilled vegetables. Lynda Shamie, director of marketing, says that consumers are tired of peas and carrots and are willing to invest in something more interesting. She adds that products that are fully cooked, cut, pre-washed and portioned all help reduce labour and energy costs and thus increase profits in the long run.

Elaine McFadden is corporate dietitian and central territory manager for Nature’s Path Foods, which offers organic cereals and bars. She knows foodservice directors who have had to make a special trip to a Whole Foods organic grocery for a patient who would not eat anything but organic. Consequently, she suggests that operators can tap into this customer base that they may not be currently reaching.

It is the human touch above all that marks effective healthcare, whether in the foodservice arena or beyond. Sandra Matheson of Marek recalls a situation at a large downtown teaching hospital during the busy noon hour rush when one of her cooks took the time to help a nearly blind elderly lady get to the cash station with her tray. The cashier then asked the lineup of people if they’d mind waiting while she left her station to help the lady to her table.

“We all need to remember that we are in the hospitality industry and that mealtimes are one of the few refreshment breaks and restorative moments that we have in our busy work days,” she says. “Let’s try to make mealtimes as pleasant as we can for everyone and especially to make the elderly feel they are still welcome in our busy world.”

Never underestimate the ability of food to make or break the mood of the moment or the day, says Harvey of FCS International. “A great meal and great service is better than any medicine out there!”