The Healthcare Continuum: A New Approach to Foodservice in Healthcare Facilities

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Foodservice in retirement homes, long-term-care facilities (LTCs) and acute-care hospitals is a unique beast, beset by challenges and held to standards that its public-domain restaurant counterparts could never fathom. But change is in the wind in this segment, especially as activists raise their voices about the medicinal value of food and the all-powerful baby boom transfers its bulk into its embrace.

In a conversation about how food is planned, prepared and delivered to healthcare facilities, it’s important to make a distinction among the various healthcare providers that undertake the task. Broadly speaking, they can be divided into three categories: retirement homes (or independent-living homes), LTC facilities (or nursing homes) and hospitals.

“I think it’s more of a continuum,” says Brad McKay, CEO at Healthcare Foodservices Inc., an Ottawa-based provider of prepared meals for hospitals and LTC facilities in Canada. “It’s all institutional feeding for patients who aren’t making decisions about the food. There are common threads.”

HOSPITALS
Hospitals are a category unto themselves for their short-term engagement with their “clients” and the exclusively publicly funded model that supports them. Hospital food — the butt of jokes everywhere — suffers a challenging reputation, say those in its defense, mostly because of the financial constraints that check it. Every hospital sets its own food budget, since health ministries don’t give hospitals cost guidelines. The North York General Hospital in Toronto, for example, spent $11.51 for food each day, per patient, in 2014/15.

“Foodservice is the hospital department that gets squeezed first because it’s not thought important to the clinical experience,” says McKay. Too often, hospital food is conceptualized as hospitality rather than medical treatment or an essential for good health. Management attempting to cut dollars from their budgets will often hone in on foodservice.

“The culture of food in institutions is that food is an irritating necessity,” agrees Joshna Maharaj, a chef and food activist from Toronto. “Foodservice is generally lumped in with maintenance and housekeeping. It should be much closer to patient care.” “No one expects food in public institutions to be gourmet,” says the commentary in the Food in Institutional Settings in Ontario: Health Equity Perspectives report, prepared by the Wellesley Institute in July 2017. “However, we should expect it to be nutritionally adequate, socially and culturally acceptable and safe.”

But studies have found patients often eat less than half of the food on their meal trays. “Making improvements to the delivery method and timing of meals, focusing on culturally appropriate food, and to the meal environments, could improve patient dietary intake,” the Toronto-based Wellesley Institute report concludes. But it’s essential, says Maharaj, that funding gets increased to facilitate this. “[The industry]did a ton of work and found paths through in really exciting ways, but everything comes back to whether the ministry would invest, because there’s no way around that. We need money to make any changes in hospital food.”

LONG-TERM CARE HOMES
Excluding Quebec, approximately 143,000 people live in nursing homes in Canada, some 80,000 of them in Ontario. More than 90 per cent of residents are over the age of 65. Still, these people are not sick. They’re well enough to be on their own for extended periods of time; their complex health conditions and support needs aren’t dire enough to require hospitalization, but neither can they be met in the community or at home. Their average stay in an LTC home is three or four years — the last three or four years of their lives. Here, says the Long-Term Care Homes Act, residents get to live in dignity while having their physical, psychological, social, spiritual and cultural needs met. Their dietary needs, one might argue, are another matter. Typically, LTC homes are subsidized by the provincial government. That means residents pay only partly out of pocket. This past summer, Ontario gifted the province’s 77,000 nursing homes a financial injection that bumped the $8.33 daily allowance for residents to $9 (still less than the $9.73 that Ontario inmates get).

“It’s not enough,” says Maharaj. And it’s why lots of LTC homes serve cheaper protein foods and fewer fresh fruits and vegetables — and are still unable to meet residents’ special dietary needs, says the Food in Institutional Settings in Ontario report. That makes frozen and canned vegetables, fruits and meats mainstays at these facilities.

RETIREMENT HOMES
Retirement homes are arguably the most autonomous, well-funded and comfortable of the healthcare foodservice lot. They are also, says Geoff Wilson, a principal with Toronto’s fsStrategy Inc., “the foodservice category where there’s the most evolution, innovation and movement.”

That’s because these institutions are universally privately funded, which means residents foot the entire bill. It’s a tiered system of both quality and expense. Across Canada, monthly fees for retirement-home suites range from $1,453 to $3,204, on average. But some accommodations are much pricier. A one-bedroom independent-living suite in London, Ont., costs $5,800 a month and a two-bedroom in Vancouver is $7,695. The varying fee is a function of lots of things, including the size and location of the accommodations, the number of amenities and the quality of food.

“The retirement-home industry has become extremely competitive and one of the big selling points is the food,” says Wilson. You bet, says Richard Bailey, Business Development manager in healthcare seniors living at Centennial Foodservice, based in Calgary. “Food is everything in these homes — that’s all these seniors talk about. It’s like a cruise ship. You eat, you complain about being stuffed, then you talk about what’s for dinner.”  “A few years ago, retirement living had a reputation in the general marketplace for food that was bland, straightforward and overly pre-prepared,” says John Curtis, national director of Culinary Services at Revera Retirement. “But we’re making great strides in fresh, from-scratch cooking. We’re transitioning [far] away from people’s perceptions.” Hiring top-quality kitchen talent is a big part of that, says Curtis. Many of the culinary professionals at Revera’s 131 cross-Canada residences are Red Seal-certified chefs. It’s the same story at other retirement residences, where the foodservice arm is upping its game by hiring chefs who cut their teeth at luxury private enterprises to man their kitchens. Paul Marshall, the executive chef at Westerleigh Parc in Vancouver, is fresh off a 35-year run in Vancouver’s luxury-hotel kitchens. In 2015 and 2016, he scored the top spot at the Best of the West annual food competition —the sole contestants representing a retirement community. “We must’ve shocked the hell out of the chefs there from all the leading restaurants in the North Shore,” Marshall says.

Shifting their talents to retirement communities is a natural move for career chefs, says Bailey. After years of enduring restaurant hours and forfeiting quality of life, a post with a retirement home looks good. Marshall calls his move to Parc “the most gratifying thing I’ve ever done.” Cooking opportunities at retirement communities are still pretty unexplored, he says, but are evolving. And Marshall’s doing his part. “I know most of the chefs who operate professional cooking schools and this is definitely a career path. You can put retirement communities on the same level as restaurants and hotels.” And this category of chef still gets to innovate. In fact, it’s expected of them. A late-summer meal on the Westerleigh’s dinner menu featured a duck-confit crêpe appetizer, and a choice of an ancho-chili chicken casserole with saffron rice or fresh haddock with a Moroccan-preserved lemon and green-olive vinaigrette.

Another development on the retirement front includes a movement to replace the three daily meals with on-demand eating. The single dining room is being augmented by multiple dining opportunities, including on-site bistros where residents can grab a snack or a beer. “If you’re a resident, we recognize that sometimes it’s nice to eat in a different environment,” says Curtis. Revera’s three new residences set to open in the spring — in Edmonton, Regina and Ajax, Ont. — will feature bistros with grab-and-go counters, outdoor patios and pubs, along with full-service dining rooms. “That’s the retirement community of the future.”

IN-HOUSE VERSUS OUTSOURCED
Foodservice in a healthcare setting is “in transition,” says Michael May, vice-president of Operations at Nutra Services Inc., a large dining and nutritonal services-contracting company focusing on the seniors’ market. “While the ’80s and ’90s were all about making food offsite and operating ‘kitchenless facilities,’ there has recently been more focus on in-house prepared foods.”

According to fs Strategy Inc.’s 2017 Canadian Institutional Foodservice Market Report, Canadian hospitals outsource 30 per cent of their food prep, LTCs outsource 14.2 per cent and 13.1 per cent of retirement homes contract their foodservice out. There are pros and cons to both paths, with the relief that comes with transferred oversight of responsibility being the biggest tick in favour of retaining outsiders. “It can be a very formulaic thing, and these operators are great at cranking out a program,” says Maharaj. “Having someone walk in and offer you a turnkey solution for your food is a gift.”

More than that, says May, outsourcing buys peace of mind around food safety, reduces liability for the home and exposes clients to the collective knowledge of a large company with developed policies and procedures, menus, volume-purchasing opportunities and external corporate support.

But at the end of the day, says McKay, there’s actually scant economic advantage to either option. Surveys his company has conducted show contracted hospitals compared to ones that prepare all food under their roof experience no difference in either performance or patient satisfaction.

Still, Maharaj urges health institutions to do it themselves — and to do it mindfully. “The problem is that foodservice isn’t aligned with the hospital’s organizational values, the commitment to excellence that oversees care and research is not applied to foodservices. What needs to happen is for a hospital to say ‘this is our vision for food, this is the role we believe food plays in nurturing wellness.’ Don’t leave your vision in the hands of a third-party operator.”

And servers and chefs at a residence get to know their clients better this way. “We’re in your home,” Curtis says. “We worry that with outsourcing, you lose that personal touch. Our chefs know how Mr. Curtis likes his eggs and when in the meal to bring him his coffee. That would be hard to duplicate when you outsource.”

Volume 50, Number 7
Written by Laura Pratt

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