Mention hospital food and visions of Jell-O and bran muffins come to mind. But according to foodservice experts, healthcare facilities are raising the bar when it comes to the meals they serve, offering patients and residents more options than ever before. “What we’re seeing now is patients advocating more for what they want in foodservice,” says Claudia Prusak, senior director, Contract and Operational Services, Lower Mainland Business Initiatives and Support Services, Vancouver Coastal Health. “They want choice in terms of both what and when they eat.”
This shifting trend is having a huge impact on the country’s $4.1-billion healthcare foodservice industry, which encompasses hospitals, long-term care (LTC) and retirement residences. According to Geoff Wilson, principal with Toronto-based fsStrategy Inc., although there is a push for contemporary menus, the approach and challenges differ across hospitals, LTC and retirement living.
“The trend we’re seeing in hospitals is an increased demand for local and ethnic foods as well as flexibility and personalized service,” says Wilson, noting that many hospitals, including SickKids in Toronto, are moving to spoken menus (just prior to lunch and dinner service, each patient is seen for meal selection) and room-service models. “It’s all about choice,” and patients don’t want to eat at set times, he says. “So hospitals are trying to improve the bedside technology they already have, such as television and Internet access, and use them to order meals.”
Prusak says some of Vancouver Coastal Health’s facilities have moved to the hostess model, which involves staff using iPads to take bedside meal orders twice a day. “We have it up and running in two sites in hopes of increasing choice and patient satisfaction,” she says. “If we can get patients eating better while they’re here, that’s what it’s all about.”
However, for this type of system to work, Brad McKay, CEO of Ottawa-based Healthcare Food Services says operators have to change the way they think about foodservice. “You need to be more focused on the hospitality portion and interaction with the patients,” he says, adding that although labour costs go up “it’s offset by your food cost savings, since when people are able to order what they want when they feel like eating it, there is virtually no food waste. Traditional systems want you to order the day before and I don’t think even a healthy person knows what they want to eat the next day.”
Other initiatives, says Pete Cholewinski, director of Research and Consulting with Chicago-based Technomic, include offering dining facilities on each floor so guests can leave their room to eat.
An important driver, he says, is modernization of hospital facilities. “From what they put on the menu to the look and feel of the foodservice facility itself or even the technology, [hospitals] are looking at ways to improve the overall experience.”
But these improvements cost money. “Right now, the biggest challenges have to do with getting access to capital,” says Prusak. “When we need upgrades or new equipment, it’s really a tight funding mechanism and we’re up against the MRIs and other [necessary] patient-care equipment.”
The other challenge to improving foodservice in hospitals is on-site space availability. “There’s healthy competition for space currently used by foodservice to be used by clinical so it’s always about what is the least amount of footprint we can use,” she says.
Gordon Food Service (GFS) has been supplying meals to Canadian hospitals for almost 30 years, and today, the Milton, Ont.-based company supplies 22 per cent of the healthcare market. Natalie Russell, National Healthcare sales manager at GFS, says she’s seen big changes in what operators want from their suppliers. “Healthcare services want partnerships with their suppliers: help in menu planning, plating and improving flavour profiles while keeping costs down,” she says, adding that consultative approaches will continue to grow in importance in the next five years.
In terms of the food itself, Russell says GFS has seen an increased demand from its customers for ethnic foods, diet-specific meals such as gluten- and lactose-free and the use of local ingredients. “The food trends in hospitals follow restaurant trends quite closely,” she says.
But according to McKay, while hospitals may reflect the general population to some extent, the average patient is typically not the average consumer. “The demographic is generally older females in their 70s, so when we develop our food we tend to target that demographic,” he says.
This group, he says, are traditional eaters. “Meat, potatoes and gravy are still the big sellers. But some are interested in kale, quinoa and lighter fare.”
Interest in vegetarian meals — sometimes religiously driven, sometimes just preferences — has also grown. “[There’s] lots of interest in Halal as well but it’s not growing as fast as vegetarian. We see growth in healthier choices such as low-sodium but generally the profile of the food in a hospital is going to be lagging the profile in a restaurant because of the age profile.”
As people age, their weight starts to decline, even among healthy people. “The challenge [in hospitals and LTC] is to add weight, so I have to produce food that tastes great, for an audience that has lost their taste buds and has a reduced ability to taste food. I have to make this food taste great so they want to eat it but can’t use fat, salt or sugar because it has to be healthy, and make it available for about $8 per day.”
His solution? Produce nutrient-dense foods packed with as many calories/nutrients as possible, in as small a portion possible. “Many older patients get intimidated by large plates of food and won’t touch the meal at all,” he says. “The whole food market is going to have to figure out how to feed 70- to 80-year-olds.”
Another trend is the continued effort to lower costs, says McKay. “Healthcare systems across the country are under economic pressure and anything not absolutely core to the clinical system is often subject to budget cuts,” he says. “Foodservice tends to get its share of cutbacks so we always try to help our customers with efficiencies. We understand labour costs in hospitals are much higher than other service operations so we offer as many labour-saving options, such as pre-portioned items, as we can. This is a trend I see continuing as hospitals look at how they can cut back in ways that don’t affect the quality of the food.”
Although the amount varies from province to province, LTCs, which account for about $1.7 billion of the $4.1-billion healthcare foodservice industry, are partially funded by the government — in Ontario, for example, it’s about a 50/50 split.
A key factor impacting LTC facilities is the age of residents, says Wilson. “[They] are getting older because we’re trying to keep people at home longer and there is a shortage of beds as governments struggle to cover healthcare costs.” The result is an increase in hospital patients who are aging, frail and stuck in hospital beds because they can’t get into LTC facilities.
With a national average food allowance of $22.03 per day, per patient in 2015, LTC operators face a real challenge as they move to improve the quality of food served. “As baby boomers age and start moving into these facilities, they are being more demanding and their expectations are higher,” says Wilson, citing more from-scratch production, healthy choices and reduced salt as some of the new menu trends. “The average age [for LTC] is getting older so diets are getting more complicated — more texture modification, more clinical dietetic support is needed.”
LTC facilities are also experiencing a dramatic increase in the residents born in South Asia, India, China and the Philippines, and whose dietary preferences are different than the average indigenous Canadian. As a result, McKay says many LTC operators are reaching out to suppliers for help catering to different preferences. “Long-term care continues to make a lot of their food from scratch in their facilities but we’re seeing more moving to convenience foods,” he says. “It’s a trend driven by the realization that you get better quality food produced in a more commercial manner without the cost of labour needed to make their own food. They are simply plating and re-therming.”
McKay sees a growing involvement of the private sector in healthcare foodservice, which includes an increased penetration of distributors and the growing involvement of contract caterers. “A lot of facilities feel it’s just as easy to outsource the management of the department to one of those contractors,” he says.
In 2004, Vancouver Coastal Health, which operates acute and residential care facilities, produced a business case for outsourcing. Price was also a factor, but not the only factor, Prusak explains. “We have a mix of populations in our facilities, so trying to customize the foodservice so it works for each of those groups is a real challenge.”
The solution was having different providers at different sites while maintaining in-house operations as needed. “At some smaller facilities we’ve outsourced bundles of services (i.e. food, housekeeping and laundry — integrated service models) while for larger facilities we have main suppliers. We have to make sure that whoever we sign up with has the ability to do large complex sites like Vancouver General (600-plus acute care beds) as well as small, not-so-complex sites.”
A ‘Silver Tsunami’ is coming and retirement residences better be ready, says Russell. “Expectations are higher than ever and retirement residences are actually using their food program as a marketing tool, as a way to differentiate themselves,” she says, noting some locations are even serving duck confit on their menu. “Many chefs are moving from hospitality to the senior-living world; not only is it not as hectic but they’re working better hours and bringing a high level of culinary skills to the retirement sector.”
Retirement residences currently account for $1.4 billion of the overall healthcare foodservice market in Canada and according to Wilson, operators’ focus is on improving service and hospitality in a highly competitive market. Offering greater choice, more flexibility and promoting more made-to-order food using local ingredients are all necessary moves to offer great value proposition on the foodservice side in order to attract new residents.
Technomic’s Cholewinski forecasts nominal and real growth of 6.7 per cent for the senior-living industry — more than double the projected growth for LTC (three per cent). “The people coming into the system aren’t going to be looking for the same kinds of food,” he cautions. “Demand for familiar foods will put pressure on operators to contemporize their menus.”
Foodservice growth in the healthcare industry is really not that dramatic, says Wilson. “It’s growing effectively by inflation.”
That’s not the case for retirement homes, which are often faced with collective agreements resulting in increases that sometimes exceed general inflation. But this group is challenged by the same pressures on food costs that the typical commercial foodservice operators face. “The challenge becomes managing menus in order to keep food costs in line.”
Projected growth in 2015 is estimated at $2.5 billion, according to fsStrategy Inc., representing overall year-over-year growth of 2.6 per cent versus the previous 2013 to 2014 increase of 3.8 per cent. The growth varies across the country, says Cholewinski, noting while there is substantial growth in B.C., Alberta is slowing down (although GFS’s Russell says Calgary and Edmonton are starting to gain traction for her company) and Ontario and Quebec are holding stable. “We’ve seen growth in every province and continue to see investments being made,” says Russell.
When it comes to producing food for the healthcare sector, rigorous safety standards must be maintained. For Gildo Vieira, director of Operations at EggSolutions in Etobicoke, Ont., and his team, that means going above and beyond the standard government regulations. “Our healthcare-related foodservice customers have very specific customer requirements when compared to our retail or other commercial customers,” he says. “Some of these requirements include reduced levels of sodium, potassium and cholesterol, amongst others.”
In order to meet those requirements, EggSolutions made a large investment in equipment, staff and training. “This was also required to achieve our SQF qualification, which has also been a big stepping-stone to obtaining/maintaining our high levels of food safety and quality,” Vieira explains.
Necessary certifications include a GFSI recognized certification [Global Food Safety Initiative) as well as Halal, Kosher and Animal Welfare Certifications. “Many of our customers have religious dietary requirements including those of the Muslim and Jewish faiths. EggSolutions has attained both Halal and Kosher certifications; the Halal Certification dictates what is permissible in foods destined for consumption by Muslims and the Kosher Certification dictates what is fit for consumption by those of the Jewish faith.”
Keeping It Clean
David Kwinter, VP of Innovation and R&D at Etobicoke, Ont.’s Egg Solutions is currently marketing a new ‘clean’ protein product he feels will be a valuable addition to hospital menus. Liquid Muscle, made from egg whites, was introduced to the fitness industry in September but Kwinter quickly recognized the product’s healthcare implications. “We recognized at that time that because it’s such a clean product and it offers a large amount of protein and no fat, sugar or cholesterol, that it would be ideal for healthcare. I see this product being used at the hospital cart level to replace products like Ensure, which have a lot of ingredients and are not as wholesome as Liquid Muscle,” he says.
The benefit, he says, is the product’s limited ingredient list as well as its low fat, low sodium drink format. “For burn patients who need a lot of protein but can’t swallow or eat well or cancer patients who have a high need for protein, egg whites are the cleanest form of protein available. It’s pure protein with no fillers, 100-per-cent bio-available (which means your body absorbs it) and your body uses it for muscle repair and regeneration, for energy and many other aspects of protein consumption.”
Volume 48, Number 10