Shifting Gears: The Evolution of Healthcare Foodservice

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The healthcare sector isn’t always considered the most progressive when it comes to foodservice trends. But changes are happening in administrators’ efforts to improve patient stays — from acute-care facilities to long-term care.

Healthcare does not change as quickly as the commercial-foodservice side of the equation, says Sandra Matheson, president of Food Systems Consulting Inc. in Mississauga, Ont. “The sector doesn’t respond as directly to changes out there. For hospitals in particular, eating is not a prime focus for patients.”

Matheson says foodservice managers are trying to achieve lighter, fresher and more local-style menus “albeit slowly.” And while older populations tend to prefer traditional comfort food, she says relating to all the different needs of patients is becoming increasingly challenging for foodservice operators.

Brad McKay, CEO of Healthcare Food Services (HFS) in Ottawa, cites three broad trends in healthcare-foodservice operations. Cost and budget pressures is one. “That’s more of an issue in hospitals and long-term-care [facilities] since they are government-run sectors. Retirement homes, for their part, are paid by residents.”

The second is labour shortages and the third is menu diversity. “There’s a range of things happening,” he says. “It’s not like a generation ago, when meat, potatoes and gravy kept everyone happy. Now there are divisions based on age, ethnicity and medical needs.”

This is increasingly evident in long-term care, which has become home to wider age ranges. Facilities now cater to patients as young as 30 who don’t “fit into” regular acute care, as well as the frail and elderly, McKay says. “Broader demands are making it challenging to keep to budgets that have to be held close to, or below, inflation.”

The changes in long-term-care demographics is making it difficult for foodservice to keep pace, confirms Barry Reid, vice-president of Sales and Marketing with Flanagan Foodservice Inc. in Kitchener, Ont. “They aren’t just seniors now. Younger people with disabilities are also going into long-term-care facilities and asking for less-traditional food items. They might want pizza or wraps, for example. On the flip side, seniors going into long-term-care homes are much older. They typically want smaller portions and more familiar foods. So you have changes in demand on both sides.”

OUTSOURCING VS. IN HOUSE
McKay says the diversity of diets today means outsourcing continues to be strong. “You can’t always get the labour or the skill sets to manage all those items, so a lot [of facilities] are opting for pre-produced food. Also, staffing limitations are driving organizations to put what staff they have at the front instead the back-of-the-house.” That said, more institutions are installing smaller kitchens closer to the patients. It’s a trend that has been strong in long-term care for some time and now hospitals are following suit.

“Many people aren’t necessarily hungry at prescribed times,” McKay says. “They want to feel they are more at home, rather than in an institution. Over the last five to 10 years, we’ve seen a growing move for kitchens on each floor to bring food closer to patients.”

Not only do they realize cost savings compared to a centralized kitchen, they’re more efficient and reduce waste significantly, he adds. “Decentralized kitchens are more popular. In many cases you don’t even need a central cooking area at all. At the same time, each hospital ward — such as maternity or pediatrics — can have different types of foods.”

“The standardized central tray-assembly model in hospitals is basically going,” Matheson says. “More work is being done in pods that work on specific preparations, such as texture-modified items, maternity, pediatrics — or being decentralized to patient units.” The same applies to long-term care, she adds. “In both acute and long-term care, decentralized kitchens make it easier to manage procurement and staff training and helps facilities operate more efficiently at less cost.”

Matheson estimates that moving to a point-of-care model can reduce waste by up to 40 per cent. “Equipment for each kitchen would average about $100,000. That might sound like a lot when you consider five kitchens would cost $500,000, for example. But, that’s much less than the $1 million it would cost to equip a large kitchen.”

As Matheson notes, a single-tank dishwashing machine in each kitchen can be repaired by local contractors at far less cost than flight machines, which can run up to $300,000 and require specialized parts. “And, if one of your five systems goes down, you can always divert your dishes to one of the others.”

THE NUTRITION FACTOR
McKay notes that dietary demands vary considerably in each of the three sectors. “Food is not central for patients in hospitals, for example. They just want to get better and are there for medical care. They need healing food to aid recovery.”

Recent studies have shown a strong link between higher-calorie/protein foods and the length of hospital stay, he says. “They demonstrate that you can cut a stay by two to three days with proper nutrition. So, even if you spend an extra $10 a day in food, you save by reducing the stay. Doctors and administrators would love that.”

On the long-term-care side, studies also show that Canada’s Food Guide is inadequate when tending to older populations, McKay adds. “The Food Guide only covers adults up to 55. It does not cover the elderly, where the needs are different. For example, an adult should average 0.8 grams of protein per kg. of body weight per day. Seniors, however, require 1.1 to 1.2 grams per day.”

Reid notes that more long-term-care homes are also trying to return to scratch cooking. “They’re looking for more fresh salads and healthier options.”

As the diversity of patients grows — both in terms of age and ethnicity — there is also a rise in interest in special menus including Halal and vegan, among others.

HAPPY RETIREMENT LIVING
In the healthcare sector, retirement homes stand apart in many respects because they’re not regulated. As such, they have much more latitude in terms of what they can offer residents, Reid notes. “They can charge more per meal and offer a more robust à-la-carte menu in a bistro-style setting. There are more opportunities for chefs to be involved. Residents also have an interest in authentic ethnic foods and are prepared to try them because they have travelled and are knowledgeable about food.”

Dana Schiefer, director of Culinary Services for Shannex in Halifax, says the company manages both long-term care and retirement living — often within the same campus environment. A major difference is the variety of diet types, he explains. “In retirement homes, you may have some gluten-free or diabetic needs.

But overall, more than 99 per cent can order from the regular menu and have everything cooked there. In long-term care you are dealing with a broader range of dietary needs, such as texture-modified food and thickened fluids. “Retirement facilities have traditionally stuck with scratch cooking, although long-term care is now catching up, he adds. “In our long-term-care facilities, about 50 per cent was outsourced and 50 per cent done in house. Now 95 per cent is in house. We even do our own purées and mincing, as well as our own desserts. That allows us to be more adaptive to seniors’ needs.”

Long-term care at Shannex has also transitioned to smaller dining-room settings, with an average size of 25 clients per kitchen, so food can be individualized, he explains.

In retirement living, competition also comes into play, Schiefer says. “Meals and recreation are the two most important aspects for residents. If they don’t like the food, they’ll go to a competitor. I’ve seen people come and go from retirement homes because of the food. In this sector, you’re only as good as your last meal.”

While needs seem varied, there is a common denominator driving foodservice decisions, Reid notes. “Everybody wants lower costs, locally grown if possible and healthy choices. More people are looking for a better variety of snacks and desserts, as well as meat-free, gluten-free and sugar-free alternatives. That said, a lot of older patients prefer meat and potatoes, as well as lighter lunches. But the question always comes down to one thing — does that fit their budget?”

Written by Denise Deveau 

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