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Mike: Hey, everybody. Welcome to F-Tag Friday on Cosmic Soup. Yes, you heard me right. This is our brand new segment coming to you every so often on a Friday of our choosing where we discuss those pesky little federal regulations that can cause you and your community some major problems if they’re not followed to the letter.

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Mike: We figured who better to break down those nasty F-Tags into easily digestible bite-sized chunks than our own VP of Health Services Randi Saeter. Hey, Randi. Welcome back to the show, and thanks for hosting the new F-Tag Friday segments with me.

Randi: Oh, thank you so much for having me today. I’m excited to be here.

Mike: I am excited for you to be here, too, because you know what? This is our first ever F-Tag Friday, and we’re excited to announce this new segment. We’re going to be talking about this twice a month.

I know from everything that I’ve read and heard that F-Tags are just about the most exciting thing in the world. Am I wrong?

Randi: Oh, that is the truth. Absolutely.

[Laughter]

Mike: Before we dig into the meat and potatoes of these amazing F-Tags, since it’s been a while since we’ve had you on, let’s get a refresh. Tell the Cosmic Soup listeners a little bit about yourself and your background.

Randi: Absolutely, yes. I joined our company here back in April of this year. Prior to that, I spent many, many years – more than I want to remember, probably – in different senior living communities as a registered dietitian first. Then I decided that I wanted to pursue a career in administration, so actually, I became a nursing home administrator and worked again over a decade in two different communities as a nursing home administrator. Then we decided to move to Texas from Washington state, and I worked briefly then as an ED (executive director) for Brookdale Assisted Living before I joined 3rdThird and 3rdPlus.

Mike: Yeah. I was really excited when you came on board because you and I had worked together in some capacity (virtually) as we were putting together menus and having some approvals. You helped us a lot with that to make sure that our stuff was on track and that we were following all those nice little rules that we have to follow to make sure that all of the nutritious elements are in place for our delicious food that we love to send out to the universe.

Randi: Yes, that’s right. That was very exciting for me because, of course, a dietitian always I will remain, so I got to—

[laughter]

Randi: Yeah, just stay connected to what I really enjoy doing, too, so that was a fun time for sure.

Mike: Yeah. Well, now it’s a brand new time, a brand new, I guess, time for the company, new things that we’re engaging in, and some exciting new stuff on the horizon. Let’s talk about F-Tags.

Now, when I think of F-Tag, to me it sounds like a bad word, right? It’s the F-word. I was not familiar with these up until recently because my roles that I have performed in have not really required me to dig into that element of the business.

Let’s define—for those out there that may be new to this—what is an F-Tag. What purpose do they serve?

Randi: Yes. You know F-Tag, it just stands for Federal Tag. It refers back to the code of federal regulation, and this is very specific to skilled nursing communities. It’s basically kind of a guide of requirements that they have to meet in order to stay then in compliance in terms of serving their residents, making sure that the residents are receiving the care and services that they’re entitled to. Again, this is something that the government has come up with to guide communities in providing care for everyone in a safe manner.

Mike: Got it. It’s The Man. The Man is regulating this, is what I’m hearing.

Randi: Yes, that’s exactly it.

Mike: If I understand it correctly, there are approximately 357 million F-Tags that we all have to follow, but we’re going to focus on a narrowed down scope of that that really kind of encompasses (more or less) the culinary side of things. Correct?

Randi: That is very true. We’re going to focus on food and nutrition services today.

Mike: See. See, guys!

Randi: Yeah.

Mike: F-Tags are exciting. Come on!

Randi: [Laughter]

Mike: Well, what F-Tag are we going to start with today?

Randi: We’re going to go all the way to the 800s, basically. Under food and nutrition services, we go from F800 through F814. Today, we’re going to discuss F800.

Mike: Nice.

Randi: Yes.

Mike: What is F800?

Randi: F800 is the one that outlines how communities can provide diets that meet each individual residents’ needs from pretty much every aspect.

Mike: Oh, sounds fun and complicated.

Randi: Yes. [Laughter] But actually, it’s not that complicated. It’s just that they, again, have outlined the basic requirements that we have to meet, which we should be, right? It should be pretty common sense. But again, we have to put it in writing so we can make sure that all these areas are covered.

F800 requires the communities. All of these regulations are very specific. They have very specific language, so let me just throw it out there. It says that each community needs to provide each resident with a nourishing, palatable, well-balanced diet that meets the resident’s daily and nutritional needs, special dietary needs, and then, at the same time, takes into consideration each resident’s preference. That’s about. That was a mouthful.

Mike: Yeah. What I’m hoping I heard out of that is, give people healthy food that’s delicious. The word palatable kind of makes me chuckle because having something that you need physiologically and having something that is delicious is not necessarily the same thing.

But you and I have talked about this a million times. We’ll go down this rabbit hole again another day. I think this is an issue in skilled nursing and in assisted living in a lot of places where food is put out there for requirement sake and not really made to be culinarily amazing.

Randi: Yeah.

Mike: But for the sake of this F-Tag, we’re just talking specifically about compliance. Go ahead and break that down a little further for us.

Randi: Absolutely. You hit it. We have to (in these communities) not just focus on what compliance is, although that’s super important. We want to make sure that the food is eye-appealing and attractive to the residents, and that also, now, there has been put a more focus on their choice.

Before, it was like, “Here you go. Here’s the food we have prepared for you. Now you just eat it.”

Now, the choice is more on what we call resident-centered care. We want to make sure that they’re very involved in the decision in regard to what they’re eating on a daily basis, if needed. Choice is key. What the communities then have to do is honor those (within reason).

I know that we want probably steak and lobster on a weekly basis – if not more often. But we know that’s not reasonable, so we then go ahead and make those accommodations within reason.

Once in a blue moon, of course, if there’s a favorite food, we want to provide that. But we’re not required to provide every little single thing that they want on a daily basis because we just don’t have the manpower, we don’t have the budgets to accommodate that. But again, let’s work with the residents to make sure that they get what they need and what they would like (within reason). Then at the same time, let’s focus on the food looking great, tasting great, and being of a higher quality.

Mike: I want to bring up something as well because, as a dietitian, one of the things that I know that you’ve seen is those cases where, for instance, maybe there are mechanical diets involved, textured diets, or some of the more technically skilled diets that some folks are eating. Just because it is a modified diet doesn’t necessarily mean that it can’t still look good and taste good. Do you find that there are a lot of people that just decide, “Well, this is an altered diet anyway, so I don’t have to put forth those same efforts”?

Randi: Yeah, I totally agree. That’s very common, and I’ve seen that in so many communities and so many situations. I think it’s so sad because I think, when we’re sick and we need something that’s modified like that, we should go to the extent of providing even a better-looking quality food than when it’s mechanically altered because probably their appetite is not as good as it used to be anyway (to begin with), so let’s do better at presenting these mechanically altered diets that are more attractive and more eye appealing. So, I totally agree with you. That is key.

Mike: When we get into the minutia of interpreting some of these F-Tags and how they’re regulated, it’s very difficult to sometimes gauge where a requirement comes into play versus where an opinion comes into play. For instance, what is palatable? What is eye-appealing? How do we regulate that?

Randi: You know that is a great question. How we regulate that or how we find that out is when surveyors, inspectors come in (on an annual or more frequent basis) to these communities. They will interview residents and ask them, “How do you feel about the food? How was the quality from your perspective?”

A lot of times it is individual, but they will look at, then, “Okay, globally, what is the impression we’re getting from these residents? Are the communities listening to them and trying to then make changes to meet what they’re requesting or what needs to be presented better?” and so on. So, that’s how they define it.

There’s not a true guideline (black on white) on how to do that. But again, what looks good to you and me is going to look good to the residents too.

Mike: Mm-hmm. What would be an example of a violation of F800, if you can think of one off the top of your head?

Randi: Yeah, it would be that, for example, there’s a resident who would like a fruit cup for breakfast every day because that’s what they’re used to, that’s what they would like, and they have requested it. Let’s say it’s on their meal ticket, and they consistently are not getting it. That is a violation. That would probably be cited by a surveyor, unfortunately, because we’re not honoring the resident’s request.

Then also, again, let’s say that they come in and interview ten residents. They all say that the food just not look good. It just looks like they don’t put any pride in the presentation of the food. Then the surveyor will observe some meals, and also then have the same impression. That can also be a citation at that time.

Mike: What does a citation involve? Is this like a monetary fine? Is this just simply like a “Hey, get your S together,” kind of a thing?

Randi: [Laughter]

Mike: What is the ramification of getting an F-Tag citation?

Randi: It could be mild to severe. Let’s say that it’s widespread and everybody is saying the same thing that, “Oh, my god. The dining services department, they just don’t listen to us whatsoever, and they’re serving food that is just not appealing at all (all the time).” That could be a pretty severe citation with a monetary fine.

But let’s say it’s just the one resident with the fruit cup who is not consistently getting it. It could be a milder citation. That could just be a slap-on-the-hand kind of thing.

It just depends on the level of severity and also if something is causing residents to lose weight because they don’t want to eat the food because it doesn’t look good, it doesn’t taste good. That is a very severe violation and, again, then that can cause the community to be fined very, very extensively. It could be under even monitoring by the state that they’re in for a length of time until the survey agency feels that they’re back in that compliance. Yeah.

Mike: Yeah, and you know that’s a thing I think a lot of people don’t think about. It’s not just a matter of, “Oh, I don’t want to follow this code, follow that code, or meet this person’s request.” In the skilled nursing arena specifically, people eating or not eating their food has an immediate response on their bodies. If they suffer nutritionally for it, that’s a very big deal.

Randi: Mm-hmm. Absolutely, so that’s why it’s so important to listen to the residents. Listen to family members who can give you a history of what they used to eat, what they enjoy, and what they love because it’s easier, right? If you just know their background and you communicate, then you can serve the food that they enjoy. But also, you can also then help improve your food quality if you’re getting a lot of feedback that it’s not up to par.

Mike: Yeah. Awesome.

Randi: Yeah.

Mike: What else do we need to know about F-Tag F800?

Randi: Well, just the last little tidbit. What we recommend, what I would personally recommend, and this is what I also used to do in communities is to make sure that you hold monthly meetings, that you document conversations, and that you just provide an opportunity for feedback from residents. Yes, it’s not supposed to be a venue where you come in and just complain, complain, complain, but it also gives you an opportunity to take information about what they would like to see on the menu, what do they enjoy, can we make some changes here. You kind of work as a team with your residents to make sure you serve; you actually have a great dining services program with excellent food.

Mike: Okay. Awesome. Well, thank you, Randi, for breaking us in on the first-ever F-Tag Friday. I’d say that was pretty painless. We’re going to keep these quick and to the point, guys, so that we don’t bore you to tears. But this is important information, and we want to make sure that we get it delivered to you in a fun and different fashion.

Make sure to join us again on our next episode of F-Tag Friday. It’s going to be awesome. Randi, thank you so much, again, and we’ll talk to you very soon.

Randi: Thank you so much, too.

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Mike: Thanks, as always, to all of you out there in radio and podcast land for hanging out with us and for making this show such a blast to do.

But wait! There’s more! Mark your calendars because if you act now, you can have the rest of these F-Tag episodes (and all the other amazing Cosmic Soup content) absolutely free, delivered to your favorite streaming platform as soon as they hit the airwaves. Just hit that subscribe button and you’re all set.

No need to thank us. Just doing our job.

Until next time, have fun, stay safe, and we’ll talk to you soon on Cosmic Soup.

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