On a recent Thursday, the staff at Sunny Vista Living Center in Colorado Springs, Colorado, bustled in the kitchen.
The phone rang with a last-minute order as Chris Willard tended to a large pot of Thai-style soup with fresh ginger, vegetables and thin-sliced beef. It was a special meal for a woman of Asian descent who didn’t like any of the dozen choices on the menu.
“You have to be creative,” said Willard, a chef who is the nursing home’s food service director.
Earlier that day, he had received a thumbs-up for his gluten-free pancakes. Sunny Vista is part of a slow but growing trend among the nation’s 15,600 nursing homes to abandon rigid menus and strict meal times in favor of a more individualized approach toward food.
Advocates pushing for the change say it has taken more than three decades to get to this point. Now, the federal government is proposing regulations that would require facilities to create menus that reflect religious, cultural and ethnic needs and preferences, as well. Further, the proposed rules would empower nursing home residents with the “right to make personal dietary choices.”
The government acknowledges that the nation’s 1.4 million nursing home residents are diverse and that “it may be challenging” to meet every preference. But it wants facilities to offer residents “meaningful choices in diets that are nutritionally adequate and satisfying to the individual.”
Regulations aside, Donna Manring, owner of Innovative Dining Solutions, a consulting firm, said aging boomers will put pressure on nursing homes to adapt by offering such menu items as organic vegetables, locally sourced meat and gluten-free or vegetarian options.
“Put your seat belts on because expectations are going to grow greatly,” Manring said.
While Sunny Vista is ahead of the proposed changes, advocates for seniors say many nursing homes are still stuck in time, operating like hospitals and offering a limited number of unsavory meals. The ability to choose what to eat and when to do so is hugely important for seniors’ quality of life, said Amity Overall-Laib, director of the National Long-Term Care Ombudsman Resource Center.
Issues with the quantity, quality and variation of meals rank among the top 10 complaints of nursing home residents and their relatives or friends.
Shannon Gimbel, the lead ombudsman for the Denver region, said the complaints go beyond the chicken being too dry or too tough. She’s stepped in to advocate for seniors who weren’t getting enough food or whose requests for fresh vegetables were ignored for far too long. “There are more options than there have ever been,” Gimbel said. “Do I think it stills needs to be better? Yes, I do.”
Under current regulations, food is supposed to be palatable. But Penny Shaw, a nursing home resident in the Boston area and an advocate for nursing home reform, said she’s been served overcooked vegetables and watery mashed potatoes. “Who would want to eat that?” asked Shaw, 72. Shaw said her nursing home offers menu choices, but they are limited. She’d love to order a soup cooked from scratch, kiwis instead of melon and have an avocado once in a while. But the soups are pre-made, and kiwis and avocados are not offered, she said. “ ‘Person-centered’ implies individualized and I don’t think that’ll ever happen,” Shaw said.
Part of the problem is cost. In fiscal 2014, nursing homes spent a daily average of $20.07 per person on dietary costs, which includes the cost for raw food and kitchen staff, according to the American Health Care Association, which represents nursing homes. But those costs vary widely across the country. In Texas, the average is $14.54, while New York is $23.97.
Janet Burns, chief executive at Sunny Vista, said the cost of fresh food is lower than prepackaged meals, but labor costs are higher. Her dietary costs were $1.08 higher than the nation’s average in 2014. However, she said, higher costs are offset by things like preventing weight loss, a problem experienced by many nursing home residents. For example, she said, medication to increase a resident’s appetite is more expensive than preparing a special meal. Costs aside, Burns said, “it’s the right thing to do.”
Sandra Simmons, a professor at Vanderbilt University who studies quality of care and life in institutional settings, says studies have shown that the daily caloric intake of 50 percent to 70 percent of nursing home residents is below recommended levels. The issue, she argues, isn’t just food choices but low staffing levels. Many nursing home residents need physical help or, if they have dementia, they need cues or encouragement to eat. If staff members are stretched thin, they might not be able to provide that level of care. And that means that even if there are choices, residents might not get them.
Sunny Vista resident Althea Jones said it’s been difficult to express her opinions about food, something ingrained in her since childhood. No one told her she had a right to do so, she said. Now she’s being encouraged to speak up — and her voice is being heard. “I love beans,” said Jones, 85. “I don’t eat cattle or pigs, but I can eat chicken.”