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Food Service Questions


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Food Service Questions
Can I use “leftovers” in my facility?
Any food that is leftover (food that was meant to be served for a meal, but was not all served), should be used as follows: Leftovers should be covered, labled and dated, then stored appropriately (refrigerated or frozen) within 1 hour. Leftovers must be cooled to less than or equal to 40 degrees within 4 hours. All hot leftovers must be reheated to 165 degrees for a minimum of 15 seconds. All unfrozen leftovers must be used within 48 hours or they should be thrown away. No leftovers should be used as pureed food.
 
I have been through numerous websites on the internet and yours is the most informative. However, I am needing something for my cooks (I am a Dietary Manager) showing how much liquid, bread, thickener, etc. to add to meats, vegetables, fruits, etc. Do you have anything like this, or would you know where I can find it?
Our new “It’s Tough to Swallow” manual provides specific recipes and guidelines for dysphagia diets. It can be found on under the "publications" page of this site.
 
I would appreciate any help/advice on what is needed to open a dementia unit. We are in the planning stages and have some input on what we need for this particular building. It will be approx. 110 bed area with 3 separate wards. We are currently utilizing the cook/chill method and have a central kitchen to prepare and serve the food. Are there any special needs we should be considering?
There are special needs when considering a dementia unit. This particular population is easily distracted and generally eat poorly at meal time. A few tips to consider: finger foods are ideal as residents with dementia may forget how to use utensils. Also consider small portion meals with snacks between as a large meal is overwhelming and often refused. Our "Diet Manual" has information on food fortification and recipes, calorie booster ideas, and finger foods which are important in maintaining the nutritional needs of a dementia patient. A resourceful website to contact for information and examples is: www.alzheimers.org.
 
What should the food/beverage temperature be at point of service in LTC?
F364 states that food is "palatable, attractive, and at the proper temperature". The interpretive guidelines state: "Is food served at preferable temperature (hot foods are served hot and cold foods are served cold) as discerned by the resident and customary practice? Not to be confused with the proper holding temperature."
 
I have just started working at a senior citizen center. My goal is to improve quality and senior participation. Do you have any publications that address congregate dining? I am also looking for menus & quantity recipes appropriate for this population.
There are many valuable articles available online that discuss congregate meals and the characteristics associated with providing adequate, nutritionally sound meals to seniors. Simply use the key words "congregate meals" and "congregate menus" for valuable information.
 
I have been asked to redo the policy and procedure manual for clinical nutrition in my facility. Do you have a 'table of contents' or some ideas on what should be on the clinical side of the table of contents?
We have a Policy and Procedure Manual for Extended Care, and an Operations Manual for Assisted Living. You can view the table of contents on our website. Both manuals have a nutrition care section. You might consider purchasing one of these and save yourself a lot of time. The extended care P&P manual can be purchased with a CD ROM for customization--a great time savings!
 
When labeling and dating in most facilities do they use a discard date on items or do they label and date with a open date? We are having a tuff time agreeing on which is the best. Can you give us an idea of what most places do?
In our facilities it seems easier for them to do a "discard by" date for the food so there is no mistake about how long it should be kept. The "opened on" dating system leaves staff having to figure out when the product should be discarded (which may not be the best procedure). Facilities usually create a policy to determine how the dating is done in the foodservice department and that is the way they train the staff. Whatever your facility decides on, be consistent with it and make sure all staff are following the same procedure.
 
When should foodservice workers wear gloves?
Gloves should be worn whenever a worker is directly handling a food item. They need to wash their hands before putting gloves on. Gloves need to be changed after they touch any soiled item, contaminated surface, or after coughing or sneezing.
 
I was looking at an article you did on mechanical soft diets. I'm a home health aide and was looking for some recipes. Would you happen to know any or know where I could get some?
Please go to www.beckydorner.com/publications/mr.php
 
I am searching for information on not allowing ice cream, sherbert, and gelatin for residents on thickened liquids; I reviewed the ADA Manual Dysphagia Diet section and couldn't find any information there; I do have some old (10yr) guidelines by a company called TheraTx that includes these items in the "thin" liquid section. The only other information I have is from a state diet manual that included ice cream and sherbert as a "thick" liquid but then footnoted these items as being unstable liquids that will separate into a thin liquid when placed in the mouth.
The ADA publication, "National Dysphagia Diet: Standardization for Optimal Care" includes the following notation on each diet level:These foods are considered thin liquids and should be avoided if thin liquids are restricted:Frozen malts, milk shakes, frozen yogurt, eggnog, nutritional supplements, ice cream, sherbet, regular or sugar free gelatin, or any foods that become thin liquid at either room (70 degrees F) or body temperature (98 degrees F)." This book can be ordered from ADA by calling 800-877-1600 X5000. It is about 45 pages and I believe the cost is around $35.00. In addition, our book, "It's Tough to Swallow: Nutrition and Dining for Dysphagia," includes information on the national dysphagia diet, thickened liquids, preparation methods and detailed recipes for all levels of consistency alterations.
 
I found out today that our hospital still allows syringe feeding to patients. Is this still allowed?
Syringe feeding is highly discouraged due to the increased risk of choking and aspiration with use of syringes. In long term care we do not allow syringe feeding. Staff must be very well trained on: -how to properly position the patient for feeding, -how to place the syringe, -the amount of liquid or blendarized food to give at one time, -the amount of pressure to put on the bulb of the syringe when forcing the food through the syringe, -what signs to watch for to determine if the patient is having difficulty, -when and how to Heimlich, etc. Even if staff is well trained, and syringe feeding is done very carefully, these are patients that are usually at a high risk for choking and aspiration. Syringe feeding is not a safe method of feeding, and with the number of litigation cases related to choking and aspiration deaths on the rise, I would not recommend it.
 
I was wondering what the consensus is on the use of pureed bread for pureed diets. Our reference diet manual allows sliced bread on the pureed diet, if tolerated. Our current menu cylcle notes that the sliced bread may be served whole, pureed or soaked in milk or slurry. This is the same situation with plain cookies and cake. We like to allow the sliced bread and cake whenever possible in order to improve the appearance of the food on the plate. Since some residents on pureed diets have the diet order due to chewing problems, this is acceptable for them. Of course, some residents who are on the diet due to swallowing problems may not be able to tolerate the regular bread and cake. Our philosophy has been to work with the STs to individualize the diet and provide the appropriate consistency for residents with swallowing problems. Pureed bread is not always a very acceptable product to serve, in my opinion. However, since there is now a puree bread mix that is very good, we are thinking about using it for all of the pureed diets, unless the diet order specifically states that whole bread, cake or cookies can be served.
My recommendation would be to puree all bread and baked goods (cake, cookies, etc.) on a pureed diet. Soaking cake or cookies, etc., in milk creates two different textures-- which is very difficult for a person with dysphagia to handle and may cause choking. Slurries are great if they are done properly, but often times what I observe in facilities is that they do not soak the bread item all the way through which again may create two different textures (one being dry and crumbly and difficult to swallow). The new pureed bread products on the market (Novartis, Hormel, Darlington Farms) appear to be a great alternative if facilities do not want to puree their own bread. Cream of Wheat can also be used as a substitute--as others have suggested you can add other items to it to make it taste better (cinnamon and sugar, margarine and salt, margarine and jelly, etc.) Of course, it is wonderful that you are working closely with the SLP to meet the needs of each individual resident. I'm receiving more frequent phone calls from attorneys all over the country asking me to be an expert witness in cases related to choking deaths. This is a very hot topic, and a potential area for litigation against facilities.
 
I do consulting to four ALF/nursing homes, and maintain a private practice part-time. I have a small facility that has asked me to help them implement a food/paper supply inventory system. Currently they do this by eyeball method. It is a 65 bed facility and they run their own operation (no outside contractor) and are NOT part of a buying consortium by choice. They buy from three suppliers. One supplier has an inventory system but if you buy it you have to purchase everything from this one supplier. I do not want to turn down this business opportunity. They have to do a physical inventory and start somewhere. Can you direct me to a software company or software package that may be useful in this process. Have you ever done this for a facilty?
Most of the facilities that actually implement a system like this are using a program such as Computrition, Geri Menu, etc. It depends on how detailed they want to get as to what type of software might meet your needs. Since it is a smaller facility, my guess is they do not wish to invest a great deal of money. Even a simple Excel spreadsheet might do it for them if they want to keep it simple. You might ask around with some of the smaller software companies like Menu Mizar or Diet Master. Look in any JADA or DMA magazine to find many ads for software companies specializing in Dietary software.
 
When will LTC facilities be required to implement the new food guidance system?
I'm not sure when CMS will expect facilities to implement the new food guide pyramid. It may depend on when they receive training on the new information. Some surveyors may insist upon it right away. The regulations and interpretive guidelines have not changed. The interpretive guidelines mention the food guide pyramid as a standard menu planning guide, however, it is not the only menu planning guide. The interpretive guidelines also note that it is not intended to meet the nutritional needs of all residents and the guide must be adjusted to consider individual differences (age, size, gender, activity level, state of health), and to meet each resident's needs. The biggest change with the new food guide pyramid seems to be the number of servings of vegetables, and this may be a challenge for LTC. We are hoping that they will eventually develop pyramids for different age levels, but in the meantime, we may need to adjust for our population. What we have to remember is that the pyramid was developed for "healthy" people. We do not serve many healthy people in our nursing homes. Therefore, the pyramid must be adjusted for the population we serve.
 
We recently had a unfortunate burn to a resident drinking hot chocolate. What is the safe serving temperature of hot beverages?
As you know, our resident's skin is often fragile, and temperatures that may not burn younger persons can cause severe burns in the elderly. Most coffee makers are set to operate at around 160 degrees which is very hot and may cause serious burns. Of course most residents want their coffee hot and would complain if the temperature was lowered, however many facilities have successfully lowered their coffee makers temperatures to 120 degrees. There is no set temperature for hot beverages, it is what is generally accepted and agreed upon by the majority of the residents at the facility (through resident counsil or food committee) and the facilities that lowered the temps did have a meeting with the residents and explained the rationale to lowering the temps (for safety)which most all residents accepted and agreed to. This was made into a policy and the temps were lowered. If a resident specifically requested hotter coffee the nursing staff was instructed to heat the coffee in the microvave for 30 seconds and then explain to the resident that the coffee was very hot and the possibility of a burn was indeed a risk. Some coffee makers will have to be adjusted by the manufacturer as many institutional coffee makers (BUNN) brew at set temps and the machine has to be serviced to lower the temp for brewing. Was the burn to your resident the result of a self service station or was it coffee on the tray? If self service coffee stations are in use be sure to have policies in place to assure the safety of the resident, including the temperature of the coffee.
 
I have a question about policy regarding use of leftovers. Is there a state/fed reg that does not permit use of leftovers for pureed diets?
There is not a federal guideline which specifically prohibits use of leftovers for use in pureed diets. However, guidelines denote that food must be palatable, served at proper temperature, conserve nutrients, etc. The concern of using leftovers for pureed foods relates to food safety, quality, flavor more than anything else. See F364 in the federal interpretive guidelines: "Food prepared by methods that conserve nutritive value, flavor, and appearance; Food that is palatable, attractive and at the proper temperature". As far as state regulations go, you'd have to check your state guidelines, but I would assume that there is no specific mention of use of leftovers for puree--again it would be the application of quality, flavor, food safety--so it would be under those tags.
 
I am looking for any information on using a therapeutic dining room for residents who need assistance with meals. Have you been successful with seperate dining?
Some of our facilities here in Ohio do use a separate dining room for residents that need extensive assistance at the meal or who are disruptive to the other residents. Many restorative dining programs also use a separate dining room for their programs. This has worked well for the facilities in both cases. In both cases, the dining rooms must be able to provide tables and chairs that accommodate the needs of the resident's with adequate staffing to provide the care. Feeding tables such as circle tables or horse shoe tables were not permitted. Residents were transferred from wheelchairs or Geri-chairs to dining chairs whenever possible. The environment of the area must be pleasant, well-lit, and conducive to enhancing the experience. Once the resident improved to the point of self-feeding with minimal assistance they were moved from the restorative dining room to the main dining areas. Either case can work well with careful consideration for the goals you hope to accomplish, proper staff training, and resident's rights in mind. A resident may refuse to be placed in a different dining area and even may refuse to participate in the restorative dining program.
 
Thanks for your service what a wonderful thing for an independent consultant. I have a question about meal points. One of my facilities needs to know where meal points orginated. Is it based on % of the calories from the meal? For example, on a 10 point scale, 5 for meat, 2 for milk, 1 veg, 1 fruit is what that facility is doing. It may seem like a silly question, but they are very serious about the orgin of the point system.
I'm not sure of the origin of the point system that you are describing. To be honest, we have always used a total meal intake percentage in our facilities (we have a consulting practice that consults to about 100 HCFs). We use this because we think it is a bit easier for staff to learn and use--we have developed videos and inservices with photos for training. Unfortunately, there have been studies on food intake records that indicate the records are inaccurate by as much as 40% (staff estimate higher than what was actually eaten). CMS adapted a basic point system which is described in the Dining and Food Service Investigative Protocol (in their guidance to surveyors). But it is more of a 1 point per food item system--without any weights given for nutritional value. ("Each food item served except for water, coffee, tea, or condiments equals one point") They only use this if the facility does not have an established system.
 
How many Kcal/day do you recommend a nursing home menu provide?
Generally we recommend a menu that provides 1800 to 2200 calories daily (with some needing less and some needing more depending on individual requirements). A range of 80-100 grams of protein for the regular menu is usually adequate. Whatever menu planning guidance youu choose should be well documented if you are creating a menu.
 
I am a chef at a palliative care residence, and we have a max of 9 patient rooms, with a turn over weekly. These patients, are all different in their diet, some with swallowing problems, dryness, change in taste, pain, or loose teeth, many different cases. I change the menu daily and would like an idea, of a week to 9 day menu plan for all different kinds of patients. Also many patients get very bored with the same kind of foods. If you have any ideas, please let me know how I can keep an interesting and appetizing menu for these dying patients.
God bless you in the work you are doing--you are serving a very important population. We have a few resources that might be helpful. We have our diet manual and diet instructions that may have some helpful information for you and for your patients/families. The diet instruction manaul would provide information and copy ready handouts regarding some of the symptoms they experience and how they may be relieved, and the diet manual would provide you with guidance on special diet alterations. These tools can help you to create appropriate menus and provide helpful information for your patients. We also have a quantity cookbook which may be helpful that has servings for as few as 10 people. Other than the tools mentioned above which would help you develop your own menus, we have select 28 day cycle menus but we do not currently have a 7 day select menu ready for sale. For more information on any of these publications, please feel free to visit our website at www.beckydorner.com.
 
Can you direct me toward a dementia center that is using family-style dining in their unit? Looking for procedures and recommendations for a successful program.
There are many facilities across the country using family style dining. I'm not sure where you are located, so it is difficult to make a referral. You might try doing an Internet search on one of the following: Eden Alternative and Green House Project http://www.edenalt.com or www.pioneernetwork.net/index.cfm/fuseaction/Content.Display/Page/Home.cfm or Culture Change Now www.culturechangenow.com. Apple Health Care in the North East (primarily Connecticut) is doing a lot with the Pioneer movement, and they may be able to assist you with resources.
 
I need ideas for tracking fluids for restrictions on new Resident Choice Meal Plan.
Tracking fluids for restrictions would not be any different with the 5 meal/day plan than with any other meal plan. Staff would need to track all fluid consumed during the day at meals and snacks just as they always would. It's best if the dietetics professional or dietary manager works with nursing to determine how many mLs fluid will be given with meals and how many mLs will be provided by nursing (med pass, between meal fluids, etc.). If the Intake & Output (I&O) sheets are not readily available for documentation at the time of observation, STNAs should keep a small spiral notebook in their pockets to jot down all fluid intakes, and then transfer the information to the tracking form.
 
I consult to a building that has a high number of puree diets that need to be liquified since they seem to drink better than eat. Do you have any information on these type of diets? Extensions, recipes?
We have specific guidelines and patterns for full liquid diets which can be nutritionally adequate for calories and protein, but potentially lacking in vitamins/minerals unless fortified supplements are used. Blenderized diets are not included in the National Dysphagia Diets (which are considered current best practice for dysphagia) and they are a bit controversial. However, I do get this question quite often, and there may be a need. We have done Blenderized diets in the past in our facilities by adding warm milk to the hot foods/cold milk or juice to cold foods as appropriate--it's been a long time since we've done that. But it was a certain measurement of milk/juice to a certain measurement of each type of food. We do not promote this practice partly because of the volume required to consume for adequate nutrition, and also the quality of the diet (flavor, lack of consistent thickness level, unknown issues with dysphagia, etc). I would recommend working very closely with the SLP if you decide to do this.
 
I am looking for information on the safety of presenting ice cream that has been thickened to consumers needing thickened liquids. Summer will be here soon and I have consumers with Dysphagia concerns that require changes in their liquids and food. Many have asked for ice cream or milk shakes. I realize these are considered thin liquids but I would appreciate any help you can provide on the preparation of this treat.
I have not tried to develop a recipe for thickened ice cream or milkshakes. I'm sure it can be done, but would require quite a few steps (increasing labor cost and food safety risk). If you are working in an institutional setting, I'd suggest the Hormel Health Labs product called "Magic Cups." It's an ice cream that stays the same consistency even after thawing. Great flavor and texture. They also have a wonderful new sugar free version. In addition, many companies offer thickened shakes (Hormel, Lyons Magnus, Nestle, etc.)
 
One of the staff members maintains that the dementia unit should only receive decaffenated coffee due to concern about caffeine exacerbating behavior issues. I remember hearing of a resident rights type issue on this point with a state surveyor who maintained that one must obtain permission from the resident or responsible party before restricting caffeine. What can you tell me about this?
In my personal opinion, blanket decisions should not be made for all residents. When it comes to caffeine, some people are more sensitive to it then others (I happen to be more sensitive myself;) Some people can drink coffee all day and it has no affect on them. Depending on the brand/type of coffee you use, there can be a major flavor difference between regular and decaf. coffee (and for those who love their coffee, this may be a big concern). I do agree that some people with dementia, especially those with sundowner's syndrome, can be negatively affected by caffeine. If a resident's negative behaviors are definitely associated with elevated caffeine intake, then it makes sense to reduce that person's caffeine intake. But we should treat each person individually and be sure that we are meeting their unique needs.
 
I looked on your website to see if you had any sources of recipes for fortified foods for use in long term care facilities. Do you know of any source or website with this information?
We have a number of fortified recipes available in our book, Healthy Weights. The information on this book can be found on our site.
 
When passing out trays, buttering bread/ jelly, etc, in the dining room should the aides/kitchen staff where gloves since they are touching the resident's food and if so, do they need to switch gloves with each resident? They do wash there hands prior to working in the dining room and a sanitizer is available as well. Also, if we only have a 8-10 residents eating in there rooms are there any regulations about having to use closed food carts (since it would be in the hallway accessible to residents). We would cover each individual cart but are concerned about holding adequate temps as well.
I would recommend that if staff is touching any food to be served directly with their hands that they do need to wear gloves. They only need to switch the gloves if they have contaminated them in any way (touching the resident or themselves, if the resident has eaten from the food that the staff member touched, touching the table, picking something else up with the gloves, sneezing on the gloves, etc.) Any time they change gloves, they should wash their hands. Food carts can be wheeled down the halls and food taken out at the room door. It would be best if food was covered--this will also help retain heat. You can refer to the US Food Code or your state food code (can be found on a web search). We also have a HACCP and Food Safety Book (www.beckydorner.com/dd.php) and Inservices (www.beckydorner.com/tr.php) for staff that might be helpful (saves a great deal of time searching, sifting through all the info and creating tools and inservices).
 
A dementia unit that I consult for wants to involve the dementia residents in preparing part of their family-style meals as a part of their "activities of daily living". While I understand and appreciate giving the residents a sense of purpose, I am uneasy about whether this will be acceptable for sanitation and food safety guidelines. Is there a way to do this and still be acceptable?
There are ways to accomplish this that can help to make it more acceptable. With culture change in full swing, I think we'll be seeing more of this in our facilities. Choose to allow residents to prepare safer foods--foods that are not PHFs, foods that will be cooked, baked, heated to an internal temp of 155-165 degrees F. Baked goods may be a good choice. In addition, trained supervision is important. The supervisors should be sure residents wash hands before beginning and as needed through the process, use sanitized surfaces and utensils as appropriate, gloves if needed, etc. The basic food safety guidelines you would follow in a NF or ALF kitchen. The other concern is patient safety with knives, hot ovens/stovetops, etc. Supervision using trained individuals would be the key.
 
We have buffet dining and at the present doing very well, but our quality indicators are up due to me marking leaves 25% or more of most meals uneaten. When you have little 85 year old women who consume very little or it seems, Weights are stable. Should I be marking the mds differently? With the salad bar it’s nothing for them to take 3 or 4 1/4cup servings of fruit, lettuce salad, cottage cheese, pudding, but then only consuming half portions of meat, potatoes, and other vegetables. With the buffet, it’s so hard to really get an accurate meal intake. Have any suggestions?
I would mark the MDS for "leaves 25% or more uneaten" only if the individual left 25% of the usual amount the individual selects. With buffet dining it is very difficult to get a handle on this, as the individual self-selects at the meal. It would be assumed that the individual is capable of selecting a well-balanced diet prior to being in the buffet dining program. General knowledge of nutrition should be a regular educational offering to the individuals participating in buffet dining so at least they have an idea of what good choices are. A general sense of what the individual normally can consume would need to be determined to get an idea of failing intake. You may need to use professional judgement when marking this section of the MDS if meal intakes continue to be needed for all meals selected. Another option would be to only record intakes of those individuals on the MDS schedule during the 7 day assessment period. Careful weight monitoring and excellent communication between the nursing staff and the RD is needed to determine if intakes are changing significantly when buffet dining is in place.
 
I was todl in the past that serving side dishes uncovered on a tray was acceptable if you are using a closed cart for the tray delivery. A state surveyor (PA) is telling us each food item needs to be covered even if it's transported in a closed cart. What are your thoughts?
Generally, if carts are cleaned and sanitized at least 1-3 times a day, and if foods are not carried any distance from the cart for service (carts are wheeled from room to room for ex.), then it is acceptable not to cover each item in a closed cart system. If the covering helps to maintain temps, then you might want to reconsider for certain hard to hold items.
 
I was wondering if you could give me some ideas on "labeling" residents as Diabetics so staff passing out fluids during meal times (they get their fluids before their tray comes out)and such knows what appropriate diet to give them. We are having difficulty finding a way to let staff know who our diabetics are with out being non compliant w/ the HIPPA laws.
This can be difficult! Some facilities have used a different placemat color or pattern or a different colored napkin at the table if the residents sit at the same place for all the meals to designate to staff that an individual may need extra help, adaptive equipmnet, needs thickened liquids or is a diabetic. All staff will need an in-service to let them know of the color coding system if used. Even wristbands, bracelets, wheelchair IDs have all been tried as a result of this problem! Others have had a covered diet roster on a clipboard at the time of service or in the pantries that the serving staff use to determine who needs thickened liquids or low-sugar beverages. HIPPA does not prevent staff from being provided the information they need to successfully carry out the prescribed diet order so staff is able to have this information as long as they keep it covered and private. The other option is to serve everyone lower sugar beverages (such as Crystal Lite or sugar-free punch) with the exceptions being those on regular diets that want and request regular beverages and soda for example. If your diets are liberalized and the menu reflects water, milk, and juice at the meal for the diabetic individuals you should have no problem providing this at the meal for all diabetics that accept it.
 
I am a Speech Therapist currently working in long term care. I am interested in trying to implement the national dysphagia diet in some of the facilities I work in. I was wondering if you could tell me how to find some good information to present to the administrators and kitchen manager to explain the pros to using it.
Are you planning to go with all four levels? Our book "Dining with Dysphagia" would be an excellent resource for any facility that is trying to implement the NDD. We have found that many facilities struggle with the implementation of the NDD. All diets must be shown on a spreadsheet with all staff educated to understand the levels. Terminology changes are also difficult for them as is the actual preparation of the food. Many small facilities use a simple blender (not a blixer or a robo coup or even a food processor!)and would be fearful of implementting NDD for fear that they could not meet the expectations of the diet. It is hard to get everyone on board as staffing, food costs, production changes, and lack of training for staff are barriers to implementation. I do not know of any local facilities here in Ohio that have successfully implemented all four levels. You may want to consider implementing levels one (dysphagia puree) and dysphagia advanced level three to start with so it does not seem so overwhelming.
 
I work in a LTC facility and would like to know if a vegetable serving
We follow My Pyramid menu planning guidelines and the amounts recommended. Lettuce/greens are a one cup serving, most others are 1/2 cup, but we give no less than 3 vegetable choices and 2 fruit choices daily. If you do not plan your menu following this guide, be sure to be consistant and give your rationalization for the recognized menu planning guidelines you use.
 
I am the infection control nurse in a small hospital. I was recently contacted by a local long term-care facility that had a question regarding food service. They are trying to implement a more home-like environment by using nice china plates and cloth placemats in the dining room. Their question was how often those linen placemats need to be washed? Are there any other concerns with this from an infection control standpoint?
You will need three sets of table linen so you. They must be laundered after every use; the tables must also be sanitized after every use. Be sure to have procedures for food delivery if it is wait style or family style. If the meal is set up on trays and then placed on the tables the servers will need to be trained. Serving staff must have clean or gloved hands, they must wash or sanitize when assisting before going on to the next resident. Staff cannot handle any
 
Is it a HIPPA violation to have table cards with residents diet order and food allergies in front of the residents during meal service in the dining room so the servers get it right!?
There has been some debate over this issue and I’m not sure how to answer your question. I am not a HIPAA expert, but my understanding is that you would want to keep this information as private as possible, while still meeting the needs of your residents. If these place cards are out for meals only and they assist your staff in making sure that residents get the correct diet and avoid any fool allergies or intolerances, I would think that would be acceptable. However, these place cards should not be out all day every day—they should be on the tables only in preparation for a meal and during a meal time.
 
What is the calculation again for food cost per patient day and what is a good number for this?
For Raw Food Cost per meal: Cost of food divided by the # of meals served; Patient Days are the number of residents X the number of days in the month; Food= Cost/Patient Day; Cost per Patient Day is the total patient expense divided by the number of Patient Days; Total Cost= Total Cost/PPD. There is not one good number for this as there are many variables to consider (vendors, menu, does the facility include supplements etc.) In our area (Ohio) many facilities run from $3.35-4.50 at the cost per patient day. The best way to find out is to call other facilities of similar care and bedsize to see what they are running.
 
Are straws restricted on Nectar-thickened fluids as part of the National Dysphagia diet? I thought straws are restricted unless specified by SLT evaluation for better swallow control.
The safety of using straws with thickened liquids should be evaluated by the Speech Pathologist for all diets. The National Dysphagia Diet (Level 1-4) may or may not have thickened liquids ordered with it as with any diet. Straws are not restricted by the National Dysphagia Diet unless the SLP has evaluated and wrote an order for "no straws".
 
When dietary aides have to make a pitcher of thicken liquids ex: honey water, nectar juice. how long can it be held before needing to be discarded?
There are a number of factors involved in your decision on how long it is appropriate to hold a pitcher of thickened liquids. In general, if the thickener maintains the appropriate consistency without thickening further, and the product does not separate or coagulate with the liquid, my opinion would be to hold the liquid no more than 3 days when held under proper refrigeration (less than or equal to 41 degrees F).