Without significant medical advances, the year 2050 will see the number of people with Alzheimer’s double from today’s level, reaching nearly 14 million. The total number of dementia patients across the globe could triple during that timeframe, hitting 152 million.
And no one agrees how to feed them.
In interviews for a new report from Senior Housing News with memory care operators, chefs, food service providers, dietitians, gerontologists and outside thought leaders, a clear picture emerges: despite developing solid memory care dining methodologies, memory care dining leaders struggle to say with certainty that their program is best, because no definitive, evidence-based industry standard exists.
Still, despite the lack of a singular memory care dining practice, leaders agree on many general strategies, and even some specific dining approaches and menu items. Here are six tips providers can use to build a data-driven memory care dining program.
Make observational assessments of each resident’s needs level
Time and again, interviews and research about the future of memory care dining yield a key concept: the importance of a person-centered approach. Everything can and should be built around the individual as much as possible, including the menu, the dining schedule, the dining space and the equipment. That requires an assessment from an expert who can determine each resident’s dementia journey stage.
Beverly Sanborn of Belmont Village Senior Living is one such expert. A gerontologist and vice president of program development for the Houston-based senior living provider, Sanborn wrote Belmont Village’s memory care program. When she visits a Belmont Village community she always does so at meal time to perform an assessment.
There, she can see what stage residents are at in their dementia journey, based on what they do during mealtime. She can then see the skill level the staff have at delivering prompts, cues and other assistance.
“When people have a (dementing) illness … every skill from holding their glass to knowing what to do with food, knowing how to handle utensils, knowing how to bring their fork with their food to their mouths — each one of those is a complex skill,” Sanborn says. “Gradually, all of those skills begin to fade, and they fade in a patterned way.”
Those patterns inform Sanborn’s assessment of each resident’s dementia stage. From there, the dining program can be built.
Train frontline staff to work with dementia residents
The best memory care dining program won’t work without properly trained frontline staff. These are the employees who sit with residents while they eat, and are the first people to make the basic yet critical observations that Sanborn discusses. They are the people who see how much a resident is eating, what they are eating and how they are interacting with their surroundings.
They are the people who are often the first to see signs of one of the most important metrics in memory care dining: weight fluctuation. A good staff can deliver this information by observing residents and collecting data about their habits and actions.
When Abe’s Garden in Nashville, Tennessee, participated in and co-authored a study in 2018 called “Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living,” one of the eye-openers was that a dining room’s atmosphere only goes so far.
“We put everything in place thinking, ‘How hard will this be?’ — and then people started losing weight,” says Christopher Coelho, Abe’s Garden’s continuous education and quality improvement coordinator and co-author of the study.
“So we started doing observations. And it showed that even if you do all the quote unquote ‘right things,’ staff training and the supervision and the monitoring … is pretty crucial to having people eat the right amount.”
A properly trained staff lays the foundation for a successful dining program. Along with the organizations that develop their own proprietary training programs, here are three popular staff training methodologies.
The CARES® Dementia Basics™ Online Training Program
- Developed by: Alzheimer’s Association
- Length of training: Four modules, one hour apiece
The Teepa Snow Positive Approach to Brain Change™
- Developed by: Nationally recognized dementia educator Teepa Snow
- Length of training: While Snow’s program offers a variety of educational components, the training certification lasts two days
“Alzheimer’s: Activity-Focused Care”
- Developed by: Carly R. Hellen in 1992
- Length of training: This book guides operators to write their own training. Sanborn wrote Belmont Village Senior Living’s memory care staff training based on this book, which she calls “the bible” of memory care training
Make food choice simple
One important observation a properly trained staff member can make is not just how much residents eat, but what they eat. Dementia care dining can be viewed as a series of balancing acts, and offering yet limiting choice in foods is one of the most common.
The independent living offering from Abe’s Garden has a dinner menu with 80 food items, but for someone with dementia, that many choices is overwhelming.
Instead, they typically offer residents two choices per meal: one finger food and one utensil food. If residents don’t want either, Abe’s Garden goes back to their full menu to find something the resident will eat. If that food denial becomes a pattern, Abe’s can then replace one of the original choices with the food item the resident is actually choosing.
The same goes for drinks: They offer two choices and go from there.
Staff training, sensory decline, observation and communication all come into play here, too. Presbyterian SeniorCare Network offers two dining choices, but rather than just telling the resident the choices, their staff plates them and shows them to the resident.
That’s because they’ve found that many residents with dementia are apt to choose whichever food item they hear last. If staff asks if they want chicken or lasagna, they choose lasagna. If they offer lasagna or chicken, they choose chicken.
“When you plate them both, they can point to what they prefer,” says Carrie Chiusano, executive director of the Dementia Care Center of Excellence at the Presbyterian SeniorCare Network in Oakmont, Pennsylvania.
Pay careful attention to the five senses
Eating is a sensory experience, and dementia compounds the natural decline of senses that the aging process sets into motion. Global food services provider Sodexo USA, therefore, stresses the importance of paying careful attention to the five senses when developing a memory care dining program.
The company took a deep dive into the topic in 2017 when The Sodexo Institute for Quality of Life partnered with the University of Ottawa’s Life Research Institute to produce a study called “Sense-Sensitive Environments for Seniors: How and Why the Five Senses Matter for Quality of Life.”
Results show just how much our senses decline as we age, making understanding of the senses an important piece of the dementia puzzle that operators must understand while they build their memory care dining programs.
For example, the number and sensitivity of taste buds begin to decline at age 40 for women and age 50 for men, while the sense of smell starts to decline at 60. Those two facts alone will play a key role in how memory care providers can get dementia residents to eat.
“It sounds so simple, but having a protocol in place for staff to check the boxes on how that sensory experience is created for residents at dining time is so important,” Casillas says.
Use color contrast in dishware and food
Perhaps no aspect of the race for evidence in memory care dining is as telling as the ongoing debate around the color of plates.
Sodexo’s reminder to fully consider the impact dementia has on the five senses comes heavily into play when operators are deciding on the colors to use for tables, tablecloths and place settings. A clear contrast of colors is essential — between the tables and tablecloths, the cloths and the plates, the plates and the food. Without it, residents might not understand where the plate ends and the food begins.
The agreement stops there. Sources for our report provided seven different “optimal” colors for memory care dining plates, with colors spanning the entire rainbow. The best color, Belmont Village’s Sanborn says, is ultimately whatever works for the staff.
“You’ll often find that an atmosphere will work particularly well because of the way the team works,” Sanborn says. “They like it, they’re happy, and they’re going to do nicer work (…). Frankly they could eat on any color. It doesn’t make an iota of difference, if you’ve got the staff trained to give the prompts. But most staffs are not trained.”
Modify your menu based on regional preferences
No matter what kind of food you serve to memory care residents, making regional modification is one crucial piece of the equation that will make your menu person-centered.
Artis Senior Living’s COO Frank Wehr believes in the value of the Mediterranean Diet, for instance, but notes that it is most popular in metropolitan areas, including Boston, Chicago, Philadelphia and Washington, D.C. It is not popular in rural areas, including rural Midwest or central Pennsylvania, whose residents tend to favor a meat and potatoes diet. McLean, Virginia-based Artis operates more than a dozen memory care communities across nine states.
“Here in the Midwest, people love red meats and they love seafood, and I think seafood is much better for them, because it’s soft,” says Chef Jose Luna of Vi at The Glen, a CCRC in suburban Chicago. “Some of them have some more problems chewing, so seafood is always a big thing for them. We always know what is in season and know what we can get.”
The MIND Diet requires similar adjustments. This is an original menu that draws from the Mediterranean Diet and the DASH Diet, an acronym for Dietary Approaches to Stop Hypertension.
It calls for leafy green vegetables, which residents in the South might not be used to eating. So providers can make the move to collard greens or green beans, which are more popular in the region, says the diet’s creator Dr. Martha Clare Morris, director of the Rush Institute for Healthy Aging at Rush University in Chicago.
And yet, these changes then bring their own changes — collard greens, for instance, are traditionally cooked in pork fat, which would fall into the MIND’s list of unhealthy food groups. In this scenario, Morris would recommend cooking the greens in a healthier fat, but making the change gradually so that the changes in taste and texture are not so shocking.
“They have to be cognizant of the cultural diet and look at the cultural diet of whatever region where they are … and then make modifications,” Morris says. “I think especially with an older population, that would be important.”
This article draws from the new report, “The Race for Evidence-based Memory Care Dining.” Click here to access the complete report, which digs deep into the wave of data-driven, evidence-based memory care dining programs that are sweeping the industry.
Written by Jack Silverstein