# New to Nursing Home Food Service



## bakingdude (Jan 15, 2014)

Hello,

I've done a search of the forums to see what there was about food service in nursing home and have taken in what I could.

I have a broad range of experience in food service (chef at a small cafe, airline catering, deli, bakery) and have recently been hired by a nursing home. My initial position is a little more entry level but there is a very strong possibility that my role could change to more of a management one in the near future.

So... to anyone currently serving in along term care facility or with significant experience in one... what sort of things should I be keeping and eye out for. The management of the facility is asking me to learn as much as I can about the ins and outs of nursing home food service. Any advice?

thanks


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## fatbob166 (Dec 18, 2014)

Finally had to join the forum so I could chime in on this one. I have been working back in an actual restaurant for  over a year now, but I originally left the job to work in a local nursing home for over 2 years. We had a long term care facility, short term care, as well as a small independent living section. All three received breakfast/ lunch/ and dinner served out of 2 separate kitchens within the facility. It was a good gig for a while, but after a couple years, I gave up on trying to change certain things I did not have the authority to change, and back to the grind I went. As for advice, I have plenty:

1. Find a Mentor- In my case, it was not the actual cooking I needed to learn. It was understanding the how and why I was supposed to be doing things a new way. For my first month I was scheduled working side by side with a woman who had worked in the building for 20+ years. She had her own shortcuts and what not, but she taught me how to do everything the way it needed to be done there. Not just for the sake of the resident's food, but also their well being.

2. Learn from Everyone- I have never had issues doing as I was told, but I always ask why. Not to be defiant, but just to understand why I am doing things the way I am doing them. Where I worked my boss, the dietitian, as well as therapists, nurses, and even the residents themselves were all very helpful. 

3. Follow the Rules- This is not your average restaurant, where small health code violations slide, and your average customer is a healthy middle aged adult. Every dietary rule is in place for a reason, and when the facility has its annual inspection the come down hard on everything. Every item need to be labeled/dated, and thrown away after a set number of days, and that's assuming it is heated and cooled by the book. If a person is on a pureed diet or needs to drink a fluids of a certain consistency, you have no choice but to abide. Yes a poor little old lady may be on honey thick fluids (think snot in a bottle) and if she asks you for water you probably wont be able to help her. She could aspirate and die and you would be the one getting screwed in the end.

4. Slow down- The hustle and bustle of a real kitchen is gone. The atmosphere in these places is exactly as you would expect....laid back. More than likely you will be expected to take your time, and it will be encouraged to stop and interact with the residents. Where I worked I would get my ass chewed out for not talking to Mrs. T for a half hour, about her broken hip. Those interactions are are important to the residents. A lot of them know they are not going anywhere. Some of them have no family left. Treat them all like they are your parents or grand parents, and you could make there day.

5. Take pride in your work- Where I worked this was my biggest issue with the other employees. The crap that they would throw on a plate and call food would straight up piss me off, and was a big factor in my decision to finally leave for good. Essentially every meal these people eat could be their last, and in my opinion they deserve that to show in the food they eat. They don't have much going for them. Sure the have some friends and family visit, and some lame activities the facility plans for them, but other than that there's not much. 3 times a day it's time to eat, and I promise you it can make or break their day. Not just the taste of the food, but how the plate looks, how it smells, the dining room atmosphere. 3 times a day 365 days a year they will eat food prepared by you and the other cooks, and they really do deserve the best you can give them.

Any more questions, let me know. I'll keep an eye on this thread as it hits pretty close to home. All though I had a certain amount of anger and resentment towards certain people and political aspects of the institutionalized setting, I definitely miss a lot of things about it as well...


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## seabeecook (Aug 23, 2008)

I worked as a dietary service supervisor at a California skilled nursing facility over 30 years ago. As @fatbob166 said, SNF food service (and health care in general) is a different world. There are hundreds of rules that must be followed to the letter (in California, most come in the form of Title 22 of the state regulations).

Here are a few areas to pay attention to:

1--Cooking will be the least of your challenges. While you may be able to improve on the quality of the food, you must follow the corporate recipes, especially recipes for special diets. The only opportunity I had to demonstrate our skill was at a few staff parties and the like.

2--Start working on your Dietary Managers Association certification. This was just beginning to come around when I left the hospital (I only stayed one year). I see requirement for certification on the job boards all the time.

3--As the manager/supervisor, you'll be responsible for monitoring patient nutritional care. That includes interviewing patients, carting in their file and consulting with the corporate dietitian frequently, especially when a patient has a diet order for something that's out of the ordinary. It's important to note that you generally won't making a decision on a specific diet for a patient. Diet orders come from the physician. Your role is one of interpretation of the diet, execution and consultation. You and/or the dietitian work with the doctor to fine-tune the diet order.

4--Food, labor, supplies, etc., are budgeted based on per patient per day. This is common in the institutional world. My experience in health care, camps, prisons and the Navy has taught me that each facility has it's breaking point where you can do no wrong budget-wise. At my SNF we had 97 beds. Everything always seemed to fall in place when 90 or more beds were occupied. That doesn't mean you can drop your guard. It just meant less stress from falling budgets.


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## bakingdude (Jan 15, 2014)

fatbob166 and SeabeeCook...

Thank you both very much for you insights. This is very helpful.


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## phaedrus (Dec 23, 2004)

You'll have to be hyper-diligent about the recipes.  Many if not most of the residents will be on special diets.  Sodium, fat, etc...it's all going to be very regimented.  I think you'll find the food will be very very bland compared to restaurant food.  My ex-wife was a dietary cook at a nursing home, FWIW.


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