Nursing Home Meals

[JT-PDX]

My grandma has celiac disease and was recently in the hospital - the dietician there was great and after a few mistakes was able to get gluten-free meals for her for a week. Now she's been moved to a nursing home and that dietician just doesn't get it. We've had meetings with him to try and explain what's gluten-free but he just doesn't seem to want to try to understand. Grandma is too confused right now to be watching her meals like she used to and we can't be there 24 hours a day. Any ideas how to handle this? Has anyone run into this situation before? I'm sure this problem will continue as her meals will likely continue be prepared for her in the future. I guess I need some sort of concise packet to handout that covers the essentials...?? Any ideas?

[frenchiemama]

Are there any family members close enough to bring her meals?

[JT-PDX]

Yes, I guess that seems to be our only option. I guess I'm just more angry that the home says they can accomodate all special diets but hasn't made any effort to figure out a gluten-free meal for her.

Thanks for the reply.

[Claire]

My grandma has celiac disease and was recently in the hospital - the dietician there was great and after a few mistakes was able to get gluten-free meals for her for a week.  Now she's been moved to a nursing home and that dietician just doesn't get it.  We've had meetings with him to try and explain what's gluten-free but he just doesn't seem to want to try to understand.  Grandma is too confused right now to be watching her meals like she used to and we can't be there 24 hours a day.  Any ideas how to handle this? Has anyone run into this situation before?  I'm sure this problem will continue as her meals will likely continue be prepared for her in the future.  I guess I need some sort of concise packet to handout that covers the essentials...??  Any ideas?

<{POST_SNAPBACK}>

I was a Rehab Therapist in both Rehab and Long Term Nursing Home care facilities. There probably is an exception somewhere but for the most part you cannot trust a Nursing Home to abide by dietary restrictions. The reasons go far deeper than not caring and are not the subject here. If Grandma must be gluten free then you will have to find a way to have her meals brought in. Or provide prepackaged food for her - this could be kept in the home's refrigerator or better still in a small refrigerator in her own room - if the facility permits it. Another thought is - make a habit of dropping in unannounced - at meal time - at least once a week - different days - so the staff knows you or some other family member may just drop in. This does wonders for the quality of care! Claire

[frenchiemama]

When I was in high school I worked in the kitchen at a nursing home. The only special meals I remember anyone preparing were the pureed foods and thickened liquids. They would not have been able to make gluten-free meals (unless they made gluten-free for everyone) at the place that I worked, we had 2 ladies doing all the cooking for around 200 residents.

I know it stinks, but if that were my granny I would just bring her meals.

[judy05]

My grandma has celiac disease and was recently in the hospital - the dietician there was great and after a few mistakes was able to get gluten-free meals for her for a week.  Now she's been moved to a nursing home and that dietician just doesn't get it.  We've had meetings with him to try and explain what's gluten-free but he just doesn't seem to want to try to understand.  Grandma is too confused right now to be watching her meals like she used to and we can't be there 24 hours a day.  Any ideas how to handle this? Has anyone run into this situation before?  I'm sure this problem will continue as her meals will likely continue be prepared for her in the future.  I guess I need some sort of concise packet to handout that covers the essentials...??  Any ideas?

<{POST_SNAPBACK}>

I was a registered nurse for many years and I worked a lot in long term care. First of all you must have the doctor write an order on the chart ordering gluten-free meals. If they don't accomodate then I would speak to the charge nurse and the Director of Nurses. They can send specific instructions to the Dietary dept which should be written on the card which comes on a tray. Be specific, don't say gluten, you must spell it out, no wheat, rye, oats, or barley. Also include the hidden wheat names such as durum or semolina. If they still don't get it I would report it to the doctor and Ombudsman(every state has one). They will investigate the problem.

Everything you do should be in writing (keep a copy). I would also print a sign above her head and be specific, the caregivers are not as well educated but they don't want to give anyone something that would hurt her. Another tip, your grandmother will get better care if you make surprise visits. There is no reason that they can't accomodate her, they are getting plenty of money. Knowing what I kow I would also make a phone call to the people who do the licensing. They may as well learn this diet because there are a lot of us coming along who will be demanding when we get older.

[tpineo]

I would get a doctor's order for gluten-free foods- they have to comply with a doctor's order.

I would also try to use as many pre-packaged gluten-free foods as possible to reduce cross-contamination.

Tania Greenville, PA

[Roo]

my son went to sleep away camp this summer, and although they were very nice and tried to be accomodating I just felt more comfortable providing the food. It's never as important to anyone else as it is to you and there are so many nuonces (sp?).

I stayed home for an exhausting day cooked 7 different meals maybe 10 in your case, did them each servings for 5 packaged them individually and froze them in the huge camp freezer. At each meal he (my son) defrosted the next one. For breakfast he had eggs from them or cereal from us.

Obviously the day of cooking is tough but then it's all done and the more meals you cook the longer until you have to do it again and the more variety your Grandma will get.

Good luck,

Roo

[marilyn]

I agree that the nursing home needs to comply. You will be doing all the people who come there in the future needing gluten-free meals a favor. Get a Dr. order, ditto to the suggestion to write everything down and keep records of conversations. Nursing homes are inspected and the dietitian will check to see if Dr. orders are followed. If after a period of time they do not I would report them - that is a nursing home's worst nightmare. The Department of Inspections and Appeals will look into the complaint.

That dietitian needs a wake up call! With diagnosis becoming easier and more common we will have more and more gluten-free orders. Figuring out how to provide 100% of the RDA for vitamins and minerals, adequate fat, protein and calories no matter what the diet is his job!

Monitor her weight weekly - while they are solving this problem you do not want her to lose ground - that is hard to recouperate from. If a patient loses weight the state will want to know why and they have to document the reason for significant undesirable weight loss.

There are liquid nutritional supplements that might be a good idea to try in the interum. Have the NH check their formulary - either Ross or Mead Johnson probably. The sales representative will be able to recommend one. We use Resource Plus from Novatis (now Mead Johnson or visa versa). But check with whom ever they purchase these types of items from.

As a dietitian in a small hospital I understand the problems associated with educating the staff and compliance. It seems everytime I need to post the list (and it is extensive), go purchase special foods - but this needs to be done. The Food Service Supervisor also need to take responsibility.

What has helped is to designate a shelf in the freezer and kitchen for gluten-free foods. On the shelf also should be an envelop of common gluten-free foods.

One concern I have it the cross contamination and we have not gotten a separate toaster -yet. The FSS and I are going to sit down and figure out how we can do this - one idea would be to have a Rubbermaid that holds the toaster, pans, spatulas etc.

Good luck.

Marilyn McCall, RD.LD

Anamosa Iowa

319 462 6135 ext. 6353