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Mike: Welcome back, Cosmonauts, to everyone’s favorite senior living podcast, Cosmic Soup, and more specifically to everyone’s favorite frequent segment F-Tag Friday. Did you hear that? I almost got the alliteration but throwing in the word “segment” totally F’d it all up. Oh, well. I’ll get over it.

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Mike: You should know the drill by now. Every occasional Friday, our superstar VP of Health Services Randi Saeter breaks down those gosh darn federal tags into bite-sized, digestible chunks so you can keep on keeping on and stay out of the federal hot seat. Speaking of Randi, she just happens to be here right now.

Hey, Randi. How are you doing on this fine F-Tag Friday?

Randi: I’m good. How are you today?

Mike: I’m not dead yet.

Randi: [Laughter]

Mike: So, we have some more exciting things to talk about in the amazing world of F-Tags. What are you going to hit us with today?

Randi: Well, today, I have to say this is one of my favorite F-Tags.

Mike: Whoo!

Randi: It’s menus and nutritional adequacy. It’s F803, and I actually really like this tag.

Mike: Menus and what? Something advocacy.

Randi: Nutritional adequacy.

Mike: Oh!

Randi: Yes.

Mike: See, that sounds awesome and right up my alley because I’m a menu guy.

Randi: Mm-hmm.

Mike: Tell us about this F-Tag.

Randi: Well, this one speaks then about the menus that you have in a senior living community. You have to make sure that these menus are developed and prepared to satisfy resident choices, so we have to focus (when we develop these menus) on nutritional, religious, cultural, and ethnic needs. And, at the same time, we have to follow established national guidelines. That’s what it is all about.

Mike: We are talking more or less about (in these cases in the skilled nursing arena) probably cycle menus, correct?

Randi: We’re talking about cycle menus, so what’s common is maybe a four-week menu cycle, a five-week menu cycle. Yes, you have to make sure that these are done right, basically.

Mike: Yeah. Let me tell you. As an executive chef out there in restaurant land (before I got involved in senior living and aging services), I made a lot of menus.

[Laughter]

Mike: I’ve done a lot of stuff, developed a lot of food programs, and when I came on board in this industry, my mind was blown by the amount of thought and regulation that goes into creating some of these menus. I think that for those who are not, I guess, aware of these procedures and protocols, it can be pretty intimidating because it’s not just a matter of, “Oh, hey, look. I got steak on the menu today.” You don’t get a chance necessarily to have things change out that often. You have to have a lot of regulations in place and make sure that you’re hitting all of these bullet points.

Let’s talk about then some of these requirements for these menus.

Randi: Yes. Absolutely. When I say that they have to be developed in accordance with established national guidelines, that just means that we are all familiar, I think, with the food guide pyramid and maybe “My Plate” (is what it’s called now). It just gives you the number of servings you need to meet your nutritional needs on a daily basis. That’s what it ties back to.

For example, the residents need or are required to be offered two cups of dairy in a day, so we need to make sure that the menus then are written to reflect that. Also, these menus have to be prepared in advance. You can’t just write a new menu every day, like you were mentioning. They have to be followed.

Again, like I said, we have to make reasonable efforts to meet the residents’ religious, cultural, and ethnic needs. If you’re in an area—let’s say, for example, you’re in the South—let’s write the menus to then reflect their preferences there. That’s going to be different from having menus in the Pacific Northwest where you may see a little bit more fish on the menu. That needs to be taken into consideration and, at the same time, you need to get some feedback from your residents and resident groups when you design these menus as much as possible.

Mike: I’m glad you brought that up.

Randi: Yeah.

Mike: Real quick, before I let you continue on that—

Randi: Uh-huh.

Mike: –because I’ve got to say, I’ve seen a lot of menus. I’ve been to a lot of places now. It seems to me that there are a lot of folks that either aren’t aware of this particular F-Tag requirement, they just don’t know how to do it, or they just choose to not follow it. I just see a lot of the same stuff over and over and over and over again. I don’t see a lot of cultural elements or a lot of religious elements in a lot of places. Is this something that slips under the radar quite a bit?

Randi: It really does because I think, in a lot of places – not all, of course – they write the menus based on what they feel the residents need.

Mike: Yeah.

Randi: And not the other way around, so absolutely you’re right. It is actually a regulation that you have to get some feedback and that you have to update these menus, too, periodically. If you have a four-week menu cycle, don’t just leave it and never make any changes to it. Make changes if you get feedback from a resident food committee meeting that they absolutely don’t want to see meatloaf on the menu ever again.

Mike: [Laughter]

Randi: Let’s change it now. [Laughter]

Mike: Okay. Truth bomb here, guys – truth bomb. Tuna casserole and Salisbury steak are not cultural dishes.

[Laughter]

Mike: This is stuff that’s carried over from the ’50s that still seems to be kind of hanging around here. Knock it off.

Randi: Yeah.

Mike: But I’ll throw myself under the bus once in a while. As chefs or people in the culinary profession, sometimes you put stuff on a menu that you want to see, but that’s not necessarily (in this avenue) the best way to go. You really do have to take into account the cultural elements, the religious elements, or the desires of the residents.

Also – newsflash – hey, people can watch TV. They’ve seen the Food Network. They know what’s out there. They know people are doing different things, and they want to be a part of that exciting world. I think sometimes ageism and prejudice come into place. People just look at it like, “Eh, you know, they don’t care about that stuff.”

People assume they’re thinking in the best interest of the residents but, really, they’re just so systematically planted into their procedures that a lot of times the employees are just afraid to branch out and make changes or they don’t have the qualified leadership in place to know how to make those changes from the culinary platform. Am I right on that?

Randi: Absolutely so right. I think that the dining services director and the dietitian need to work closely on reviewing the menus, too. The dietitian is ultimately the person that will sign these menus off based on the nutritional adequacy, and then they can also make changes based on feedback.

You’re right. We need to not be afraid to make changes to the menu. Sometimes, too, I think that when we write them – and I’ve written menus before – we just get blind, right? I know you have, too.

Maybe we have repetitious dishes on the menu, so it’s always good then to have a second set of eyes or several sets of eyes to take a look at the menu before you publish. Even then, you can still make changes.

Mike: Yeah.

Randi: Nobody says that they have to be bolted down, printed, and you can never edit them subsequently.

Mike: One of the things that I have noticed going into communities is that a lot of times food service workers that work in, say, the skilled nursing areas, they may not necessarily come from a culinary background. That also includes the leadership that may not come from a culinary background. Sometimes, they’re relying on other people or, say, food contractors or third parties to help develop these items. The employees themselves don’t even really know anything about what it is they’re serving.

I also wanted to point out that I know that there is an emphasis on health and nutrition. I think sometimes people take that so literally, for instance, to say things like, “Oh, well, you know, we can’t have things with cream sauce,” or “We can’t have these modern foods because they don’t meet the dietary requirements.” That’s just not necessarily true.

There’s nothing that says you can’t have certain things. It just means that you have to watch how many times within a frequency period that you’re serving them, right?

Randi: Yeah, exactly. What our company does, too, is we focus on fresh ingredients and high-quality foods all across the board. You’re right. We want to make sure that we pay attention to the presentation and the types of food that they’re getting because we shouldn’t skimp on anything in skilled nursing just because they’re in skilled nursing and because they’re on a mechanically altered diet or therapeutic diet. We can still serve foods with cream sauces (if that’s what they prefer).

Mike: Yeah.

Randi: I totally agree with you there.

Mike: When I think of menus and I think of offerings and trying to keep things fresh, my mind says that menus should be at a base minimum level kind of refreshed seasonally, so I think once a quarter. But let’s say twice a year at the absolute minimum that you should be doing this. What’s your perspective as a dietitian and an administrator? How often should these cycle menus be updated?

Randi: Well, the guideline from the government says at least twice yearly, yes, so it’s the fall/winter, spring/summer menu cycles.

Mike: Okay.

Randi: But yeah, that shouldn’t stop you from making adjustments or even changing the menu more often. That’s just the minimum standard. Then, yeah, feel free to make changes accordingly in between as you please. I think that’s important because, again, like I was mentioning earlier, if they absolutely end up not liking the menu – they thought they would like the menu but they don’t – let’s make the changes now versus waiting.

Mike: I think that’s a good callout because I’ve seen that a lot of times where people just seem to not like certain things, and they’re just kind of force-fed them because people don’t want to make the changes. You can make the changes, more or less, any time you want provided that there is enough notice and that it’s posted in accordance with local regulations, right?

Randi: Exactly. Exactly, and you hit it. The communication is key. If you just notify the residents, “Yes, we’re changing the menu,” we’re posting the changes where we’re supposed to post the weekly menu and then the daily menus too, and so as long as they’re in the know then there’s no problem.

Mike: Okay. Awesome.

Randi: Yeah.

Mike: You touched on (a few minutes ago) in regard to actual regulations. You bought up dairy, for instance.

Randi: Mm-hmm.

Mike: What are some other requirements for menus that people may not be aware of?

Randi: Well, we have the general menu, which is just written for regular diet texture, regular like not restrictions, but then when you have the menu then we need to write also what we call the extensions or the diet spreads. They detail what the residents that are on heart-healthy diets or maybe diabetic-friendly diets are supposed to be getting. They may not be getting bacon for breakfast every day if they are on a heart-healthy diet, and we just need to make modifications to accommodate those types of illnesses and diseases in order to then make sure that they don’t get overloaded with something they’re not supposed to have that can jeopardize their health.

We need to have those, what I say, underneath the menu and, behind the scenes, we write those to accommodate those accommodations. That needs to be in place as well.

Mike: All right. Final thoughts on F803?

Randi: Final thoughts: I would say that, again, always be prepared for an inspector coming in and asking questions. How do you steer away from having any issues with menus? Again, communication, looking at your menus more frequently, asking their residents to give you some feedback, working with the residents to incorporate some of their preferences (overall, with all of them), listening to them, and then you should be golden.

Mike: Yeah. If you’re just at a loss for ideas and ways to move forward, by all means, try a consultant. Give us a call. Give Culinary Coach a call.

Randi: Yes.

Mike: We’ll swoop on in there and give you some feedback. Sometimes having a set of eyes from outside the company can give you a fresh perspective. Don’t be afraid to reach out to somebody else to at least get some ideas and opinions from them.

Randi: Mm-hmm. Any time. Yes.

Mike: All right. Thanks, Randi. We’ll talk to you soon on the next F-Tag Friday.

Randi: Thank you so much as well. Have a great day.

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Mike: How could I not have a great day after that pile of F-Tag awesomeness. To recap:
• Be prepared for inspections.
• Take a look at your menus frequently.
• Ask your residents for feedback.
• And include those religious, cultural, and personal elements.
• Above all else, communicate.

Like I said, if you need a hand with menus, hit us up on the website at culinarycoach.us and we’ll lend a hand. Go make some awesome food, have those epic conversations, and we’ll be back in a few weeks for another F-Tag Friday on Cosmic Soup.

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