Can anything be done to improve meal quality in nursing home?

Babalou, What is CMS? The only ratings I know of are Meicare's and US News and World Report. A rating of "1" would alarm me.

A nurse once told me that staffing ratings can be misleading. A facility may, for example, have three stars for staffing which is apparently based on patient-nurse/etc ratio however they may be more efficient than another facility with a higher rating due to a larger but less efficient staff.

As for hospital discharge people - specifically the social workers I spoke to at the hospital, they knew nothing. They just wanted the patient out. They handed me a paper with a list of nursing homes and let me do the research. I found some of them appalling. The hospital, a very good one, should be ashamed to include these nursing homes on the list. I found the hospital social workers uninformed and unhelpful. Maybe the law restricts what they can say but trying to get some real help at a moment of crisis was impossible.

Houseplant, the detailed information you would like to see is most likely calculated and reviewed by the facility's or the parent corporation's accountants on a regular basis. It would probably be considered proprietary and not available to the public. But I'm certain that it would be the basis for determining service levels and cost.

I would like to see a budgetary breakdown of monthly costs itemized in the areas of nursing care, personal care, meals, laundry and recreational staffing. In a second table I would like to see a breakdown in real-time costs associated with maintenance staffing and equipment, and landscaping costs. Additionally, I would like to see what is spent for overall staffing and executive level leadership. I just think meals really is a leftover thought when it comes to making them attractive and tasty. Meals seem to meet dietary requirements, but not much more. I'm sure this data is buried in a vault in state or and/or federal agencies and carefully shielded from public view. Maybe it would take a media investigation via the Freedom of Information Act to determine how Medicaid dollars get applied to a Medicaid budget. Snfs take in public dollars so some level of transparency should exist. I just haven't seen any information of this nature.

Trevor, after posting the other night, i looked up the facility"s current CMS rating. In all categories, it has fallen to one star, except in staffing, where it has 4 stars ( this is for patient/staff ratio), which is the stat i always look at.

I'm not sure what to make of this. MsMadge, another poster has her mom in
a 5 star memory care place that sounds like a poorly run asylum. My mom is in a one star place getting fabulous care.

Apparently, the ratings don't tell the whole story, which is why you have to visit and see for yourself. When mom first entered here, it was on the recommendation of the discharge folks at the hospital. We said " but their rating..." The nurse, "go see for yourselves".

I have no idea about confessions. Father is on staff and visits each resident who so desires frequently.

Why is your facility only rates three stars when it seems to be five stars?
Just curious....If nuns distribute communion daily, how often does a priest come to hear confessions?

That's a lot for a facility that is rated average.

So, nothing to with meals. My mom ( private pay) is at a three star ( out of 5) NH in Connecticut. She has meals and snacks, staff on call, laundry, sheet and towel service. Chaplain who vists, nuns who distribute communion daily. In room movies, cable TV. Meds prescribed and deliivered by an RN who explains to her what is being given to her. Nurse Practitioner who vists her daily. Vitals taken and recorded. Family called if suspicion of infection or injury. Care conference with all involved stafff every 90 days. Walking protocol inplace--every day a staff member walks mom with walker, gaitbelt up and down hallway and number of steps loged for record. Social activities take place each day. On site beauty salon.
Geriatrician on site who examines mom when needed and advises on treatment and consults with family. Psychiatric APRN who visits and consults on/adjusts mom's antidepressants and antianxiety meds. Wound doctor who visits regularly. Podiatry services. Audiologist, optomotrist and dental hygienist who visit and examinr/ service mom.

Social worker who answers my emails in 24 hours.

Yes, i think this is worth the $12,000 per month mom is paying. She wil run out of funds in three years (she's 93 now. She has been there for almost 3 years). I'm grateful we found a facility that would accept Medicaid after 3 years private pay. She wil run out of funds in 2 years.

Her curent payments offset not just her future costs, but those of current Medicaid residents. Happy to pay it forward.

Surely even at $200 a day there is a good profit, no?

Babalou

It's still profit, that is one top of the profit from room and board.

pamstegma

I'm not surprised. There are seniors who don't want to/ feel like eating so there could be some savings in not feeding them 3 meals a day. Yes, the food is blah and bland,

5 per day times 30 days is 150 dollars per month. Profit margin, even for Private Pay patients is not large

Trevor, the posted rates are not what Medicaid pays. My MIL paid $400 a day, but if she went on Medicaid, the facility got $200 a day. That's why nursing homes love to take private pay residents.

Wow only $5 a day! And they charge over $300 a day!

zythr, Nursing homes get about $5 a day from Medicaid, for all 3 meals. Plus they are required to serve low fat, low salt, low sugar items. Blah!! Yes, the food is tasteless. You would eat better tasting stuff in the county jail.

NH gets a good deal buying food in bulk.

MsMadge, It seems you have a serious problem with your nh. Have you spoken to the food service people?

My mom's memory care has bizarre food especially considering many folks have trouble swallowing plus there's no choice - everyone gets the same thing - they gave polish sausage at least twice a week - yuck

I try to get her takeout from a family diner at least a couple if times a week - I have no idea was they served tonight as menu said chef's choice but mom had tummy trouble and her poor bedridden roommate was vomiting - I had to f fetch a nurse at midnight to help her

Plus a lot of the meals are taken out to "Meals on Wheels" customers.

Thanks for this advice. One of the nurses, a very nice one, said that the meals come in mostly frozen and that there is not much they can do. I don't know. Most residents don't seem to complain or at least they just accept it. I don't see why they can't do better. I will talk to whoever is in charge of food service.

The highlight of the day for nursing home patients can and should be the food!
My step father was recently in a nursing home inside a hospital. It is called a Skilled Nursing Facility...It is a great place. Medicaid was paying for his stay.

He was there for 2 years until his recent passing 3 weeks ago. He enjoyed the food until recently and wanted a change. I talked to the dietitian and found out that he could design his own menu, from the choices she provided, for the next 21 days in a row...all 3 meals. Then it would repeat. And if he didn't see what he wanted on the menu, he could write in what he wanted! The dietitian was helpful to the extreme to try to get him what he wanted. So the key is ... get to the dietitian, find out what is possible, and if that doesn't work, escalate to the next level! Don't just accept the status quo without investigating!

Cost and dietary restrictions are no excuse for producing bad food. Simple food is easy to cook and does not have to be complicated. Do kitchen staff ever taste the food they serve? If it does not taste good to them it will not taste good to the clients. Perhaps the kitchen needs better supervision. Please don't tell me that I don't know what I am talking about. I have cooked in University kitchens serving at least 200 students at a time. The food is always simple and attractive and taste good. If the clients refuse to eat the food, the food is wasted. Add a little love to your cooking, and take pride in what you do. If meals are included in the monthly fee, why should family pay extra to have to food brought in?

At one time I was placed on a gluten and dairy free diet. The only bread I could have was rice bread as none of the gluten-free bread of today was even on the shelves, same with lactose free milk.

The diet was extremely tricky as it was amazing how many food items contain gluten and dairy. Just curious what type of items are you bringing your Mom to make sandwiches or is she making lettuce sandwiches with the lettuce wrapped around the meat or chicken?

My Dad is on a dairy free diet, so I supply his Assisted Living kitchen with his LACTAID® Milk and LACTAID® ice cream. Dad gets his fair share of protein with fish, chicken, eggs, nuts, green peas and beans. Sometimes lactose free yogurt. Dad has a menu style meal, thus sometimes he only orders soup and salad for lunch so he can have his heavier meal at supper.

First, the meals have to meet the health department rules that say low fat and low salt. That alone can make meals seem a bit flat.
Second, special diets have to have written orders from an MD. You can't just ask for a diabetic meal. It has to be ordered by your doctor. Same with gluten free; it has to have a doctor's order. The health department makes the rules, facilities just follow them.

EBeach: The answer is yes. At my mother's NH, she was given a menu to pick from for the weeks' meals. She didn't realize it, though. She didn't like one meal, that was a Mexican dish. I had already been living there for 6 months. I went out to do a quick errand. My brother had arrived for his 7 DAY stint and he said when I got back in the room of the NH "this is cold." I said "it's supposed to be cold; it's salsa!"

We were just talking about this yesterday. My friend wanted to celebrate the Rams first game in LA, so we had a “football” party and brought everyone’s family member from their care facility. The biggest complaint is they dislike the food. I recently obtained my Dental Hygiene Alternative Practice license and will have an opportunity to go into the facilities and see for myself. I have been a cook and know the joy and pleasure a good meal brings. What else to they have? I plan to provide oral hygiene and promote all healthy living. I intend to intervene on the behalf of any patient who needs help. Wish me luck. By the way, I would be kind but approach the administration. I grew up very poor, and cooking on a tight budget is nothing new to me, I have done it.

Wouldn't it be better to complain to the NH first? Document the complaints and if there is no satisfactory response, then go to state authorities?

The State requires balanced meals for residents. My daughter says its really too much for some of her residents. But the facility must provide it even if resident hasn't eaten it. In most places, lunch is the largest meal. I would cpmplain to the state.

Take some photos, date them and show them to the administration. Politely point out that food does nor meet nutritional standards as well as not being appealing. Ask if you can speak to the person in charge of food services. See what results get first. Be polite of course.

GA is absolutely correct, address this with the facility before going outside to the Ombudsman.

But also remember that, simply knowing that there is an Ombudsman and Joint Commision out there is very empowering. At a point when my mom's care was substandard and there didn't seem to be anything anyone could do, asking the administrator why my next call shouldn't be the the Ombudsman and Joint Commision lit a fire like I'd never seen. Just keep it in your pocket.

I'm going to take a somewhat contrary position and propose that management of nursing homes can extend beyond elder and diet specific issues and fall into the realm of good management, period. Restaurants don't survive by serving unappetizing and unhealthy food, nor are they able to tolerate ignoring customer's desires.

They're competitive; nursing homes if run more like a competitive business would be able to see the value of high standards across the board.

The facility I've taken Dad to 3 times for rehab falls in that category. When issues have arisen, I've gone to the DON or the Administrator, if staff isn't able to resolve the problem. I follow the chain of command and with the exception of a few problems last time (which I was unaware of as I wasn't able to visit as often), issues have been resolved satisfactorily.

This favorite rehab facility (also now expanding to long term care) hired a chef from one of the top upscale restaurants in the area. Menus were planned as if they were in fact operating a restaurant, but not at the level of lobster and prime rib offerings. There was a standard alternate menu with a good choice of items.

This facility also offered one free meal to one family member, a nice way to begin a relationship with the family as well as the elder.

Our first experience with rehab was when we were still novices. Food was generally good, always served hot in a manner hospitals use (warmth held into the food by covers, delivered on carts). If Mom didn't like the food, sometimes we supplemented with food from home, but if my recollection is correction the food staff could make accommodations for special diets.


I would first try to discuss the issue with management and find solutions at the facility level. If you go beyond and bring in an Ombudsman, it puts unwanted pressure and embarrassment on the management, which might in fact be willing to work with you and address the problem.

I like the "speak softly and carry a big stick" philosophy.

And remember, staff in these facilities are subject to criticism at perhaps a level seen only in hospitals. If attorneys, repair shops, restaurants and more found themselves explaining to oversight authorities, they might just tell the complaining person on the next visit that they're no longer handling his/her work, or the repair shop is booked for the next several weeks and can't accommodate them, or that the restaurant is already booked to capacity and it's suggested the complainer find another restaurant.