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From Oct 5-9, it is Malnutrition Awareness Week. Watch what we are doing to move from awareness to action in this "Nutrition in Action" video featuring Kristen Simonds, Registered Dietitian & Nutrition Manager

Story from Kayla Barett:

Meet Mel!

Mel was diagnosed with Parkinson’s disease many years ago. When I was assessing Mel at lunch, I noticed he was having trouble getting the food from his plate to his mouth due to his hand tremors. Tremors are a symptom that comes with the progression of Parkinson’s disease. Together, with the Occupational Therapist, Taylor, we reviewed his dexterity and found some handy adaptive utensils that significantly improved Mel’s mealtime experience and the amount of food he was able to eat! This is just one of the ways dietitians help to prevent malnutrition in long term care.

Other ways we help prevent malnutrition in long term care include:

• Every time we adjust diet texture, either to allow someone to more easily chewing their food, or to ensure that their food is as palatable as possible, we’re working on reducing malnutrition.
• Every time we work with Occupational Therapists to provide special adaptive cutlery or suggest a lipped plate, we’re increasing independence at meals to help prevent malnutrition.
• Every time we help train staff on safe feeding, we help reduce malnutrition.

Focusing on the whole meal experience is how we action Nutrition

This past year, I joined Aramark’s Bethany Care location as the Resident Experience Manager. It was a position created a few years ago in partnership with the Bethany team. The role is focused on all things that impact the resident experience, working alongside all the operation managers across all Bethany Sites province wide, whether its care from Bethany staff, or Aramark food service, housekeeping or laundry services.

Enriching and Nourishing Lives

During one of my Resident Connect visits, a resident informed me that they had been skipping meals lately, not because of the food quality or choices but because certain food products would not settle well with after eaten. I quickly acted and got our Head Chef, Operations Manager and Dietitian involved to see what we could do so that our resident was getting enough nutrition as well as making sure that meals were more enjoyable. In our initial visit with the Dietitian, we learned that this resident is in fact allergic to many ingredients that were being used in her current meal plan. After further consultation with the Dietitian, our Head Chef took charge and went to meet with the resident to build a custom menu that would cater to the resident's dietary restrictions. In following up with the resident, they were over the moon with joy regarding the menu changes that were implemented and had not skipped a meal since. As the Resident Experience Manager, I was able to enrich the life of this resident.

Paul Houngmany, Executive Chef

• Celebrating the Resident- whether it is a resident's birthday or anniversary, we make them feel right at home.With the Birthday Program, the team presents the resident with a birthday card, cupcake and sing them a song.
• Resident Council – Monthly meetings lead by residents’ and family members at each site where we can address their questions and concerns about meals in addition to how we as a team we can support each resident especially throughout these challenging times.
• I am Resident Connect – Each week the Resident Experience Manager creates customer service tips that focus on improving meal experiences.
• Catering / Groceries / Menu Programs – Working with the Head Chef on a continuous basis to improve our menu choices at all sites including but not limited to; providing residents with day to day groceries and snacks that can be ordered through our supplier. Kick starting menu trials such as our new menu taste testing which allows the input of what residents would like to see on future menus (i.e. favorite dishes, desserts etc.). Catering themed meals to provide residents with menus to look forward to and unite resident’s together facility wide.

Visit the Canadian Malnutrition Task Force website for evidenced-based tools and resources that help prevent, detect and treat malnutrition.

They key to taking action is working together with the care teams and the food service teams to make good nutrition a priority 

Working across several long term care facilities, ensuring Residents eat well and stay nourished during the COVID-19 Pandemic has presented some new and unique challenges.

Visitor restrictions and social isolation has often meant Residents have had to eat alone in their room.

Changing provincial rules meant having to select only one facility to work in. Caring for the residents at the other sites required remotely working with care teams through a lot of virtual communication and monitoring those at risk for malnutrition. As Dietitians, we speak about the consequences of malnutrition often. However, the pandemic has brought to light for many people how poor nutrition can impact those at risk even more. I was fortunate enough to have other RD's to work with, to bounce ideas off of, and to put plans in motion. Having first hand experience of the virus in a facility, I was able to share these experiences with management at my other sites and turn Nutrition Awareness into Action.

1. Keeping hydrated is an important part of health and nutrition. With additional health care aide staff, we implemented additional hydration and snack carts, focusing on those residents at risk for malnutrition and dehydration.

2. It is sometimes hard for residents to eat all the food they need in order to get the right amounts of nutrition to keep them healthy and strong. This is especially important for those who need minced or pureed food. I have been working with the Food Service team to fortify food and beverage recipes.  This means they get more nutrients in smaller portions.  

3. Before COVID-19, our homes did a lot of recreation programs and activities for residents in the dining or recreation rooms. Now, our team brings the fun to the resident’s home units.  We have brought fun theme meals from the dining rooms to the residents.  Working together with the recreation team, we hosted a Greek night. We played Greek music during the Greek featured menu and we decorated the units with Greek themed decorations.

They key to Nutrition in Action is working together with the care teams and the food service teams to make good nutrition a priority.

Visit the Canadian Malnutrition Task Force website for evidenced-based tools and resources that help prevent, detect and treat malnutrition.

Working together with the Resident and their care team, we optimize Nutrition to avoid complications and trips to the Hospital.

As a dietitian in Long Term Care(LTC), I work with the Young Adult unit, the Elderly Fragile unit and the Dementia unit. These residents are in LTC due to the complex needs with diseases such as Alzheimer’s, strokes, Diabetes, Heart Disease, Huntington’s disease, Multiple Sclerosis, Schizophrenia, and Parkinson’s Disease.  My goal is to work with the resident and care team to provide the best possible care to residents.

I monitor resident's nutritional status to prevent or delay a trip to the hospital. As a Dietitian, I develop treatments to help reduce malnutrition, poor food intake, skin wounds, dehydration, unintended weight loss, unintended weigh gain, and poor blood sugar control.

Along with the basic nutritional needs, I work closely with the Resident, and their care team to develop the best way to keep up their nutrition.  Since I am not a constant observer of the residents, the health care staff are able to provide insight into a residents behaviours and responses to different treatment. This includes providing nutrition at the best time, knowing food tolerances and textures, and identifying behavior interventions that work.

I have frequent contact with the resident to acknowledge, include them their treatment, and encourage them to eat.  I also work closely with families to obtain any other information on food likes and dislikes or how they can help. 

In some cases, a resident needs extra nutritional. Nursing staff are of great assistance if nutritional supplements are required. They provide feedback on acceptance and tolerance of supplements to make sure Residents are getting a benefit. 

Along with daily interaction with residents and the health care team, Dietitians work with Food Service Managers in developing therapeutic and special menus for residents. This requires detailed knowledge of therapeutic diets and modified textures. Some examples of this are providing nourishment with other foods tolerated, in various quantities, after certain interventions, such as after medications, at earlier times in the day. 

Working with staff and family are crucial in meeting nutritional needs.

Visit the Canadian Malnutrition Task Force website for evidenced-based tools and resources that help prevent, detect and treat malnutrition.

Assessing feeding and swallowing is an important part of detecting malnutrition

Long term care residents in continuing care homes are some of the most vulnerable people in the geriatric population. The Registered Dietitian (RD), is key to ensuring residents are able to meet their nutrition and hydration needs.

I am responsible for monitoring our residents’ nutritional status to prevent or delay hospitalizations for issues such as malnutrition, skin wounds such as pressure ulcers, dehydration, and unintended weight loss. Some of the more common diseases that affect long-term care residents are strokes, diabetes, heart disease, multiple sclerosis, Parkinson’s disease and Dementia, such as Alzheimer’s.

As the RD, a large part of my job is assessing feeding and swallowing problems. This may result in changing the texture of the resident’s diet to one that is easier to chew and/or swallow. If the resident can’t get enough nutrition orally, nutrition supplements may be ordered to improve intake and weight. In rare cases, when the resident is unable to eat enough food orally, a tube feed may be initiated to achieve optimal nutritional status.

I once had a resident who was a diabetic and on tube feeds throughout most of the day. He wanted to go out of the nursing home to take a course but was unable do so because of the continuous feeds being given. The interdisciplinary team I work with came up with a solution so the resident could leave for a few hours. A small hole was cut into his knapsack for the tube to be placed inside the bag with a portable pump. Although he was unable to take the course, he was able to take walks outside with the portable pump and he was ever so appreciative of being able to see the beautiful sunsets in the evening. This small change made a huge improvement to his quality of life.

RDs work with other healthcare team members such as Physicians, Nurses, Health Care Aides, and other allied healthcare works such as Occupational Therapists, Physiotherapists, Social Workers, Chaplains, and Recreation Therapists.

I am also proud to mention that we work closely with other RDs around the city and the province where we network, educate and solve any nutrition issues that may come up in our long term care practices. The Calgary RD group is called the Southern Alberta Continuing Care Group. My colleagues have been a great source of strength and I very much appreciate them for helping me survive during this pandemic.

RDs are essential for the management and care of the long term residents’ nutritional needs.  Since the pandemic started, RDs have been working very hard to keep everyone nourished and fed safely. This has been a very trying time and one I hope will strengthen all of us going forward."

As a small team, our employees are involved in every aspect of the meal service 

Collingwood General and Marine Hospital (CGMH) has been making moves to improve both the nutrition and meal experience for patients. January 2020 was the launch of Freshflex™, providing fresh, flavorful and nutritious meals to patients at CGMH.

Food is only nourishing if eaten. In healthcare, we all strive to prepare nutritious meals for our patients but giving patients choice elevates the opportunity that meals are not only delivered but eaten and enjoyed as well. We cook and prepare meals on site - use fresh items, cook many meals from scratch and follow the newly updated dietary guidelines.

Our dietary aides play an active role in supporting mealtimes at CGMH. As a small team our employees are involved in every aspect of the meal service – selections, preparations, plating and delivery. Our team understands the value of nutrition to our patients. Daily, our team visit patients at the bedside to give details on the next day's menu options and takes selections patients have made to be served the following day. We provide choice to patients even when therapeutic diets and/or texture modifications are required.

The eye eats first. We take great pride and care in our Freshflex™ menu. Menu items are carefully plated one at a time, based on the patient’s meal selection. We use a variety of dishes that helps to showcase the meal and further exude the restaurant quality that we strive to provide. A meal is more than the food and we aim to cater to all the little details to make the meals enjoyable for patients. We have found that since implementing Freshflex™ our food waste has reduced, and our supplementation needs have decreased as well indicating that our patients are nourished and satisfied. 

The time spent with patients during the menu selections, meal delivery and tray retrieval can also be a bright spot in a patient’s day. It is also a time where we may learn about inquiries or concerns and pass these along to the clinical dietician, whom we work closely with. We provide support in getting packages opened and helping to remove any barriers that may prohibit the enjoyment of the meal. At times, it can even be the attentive eye of our dietary aides that notice when meals are not being consumed allowing action to be taken in addressing any issues.

Mealtimes matter. Supporting the nutrition of our patients not only improves the patient experience but also helps shorten the stay. Food is medicine and we are proud to play our part in supporting the health and wellness of our patients.

Visit the Canadian Malnutrition Task Force website for evidenced-based tools and resources that help prevent, detect and treat malnutrition.