For a large segment of the senior population, getting enough calories and protein is a major hurdle to quality of life. The “old school” nursing home remedy has been supplemental shakes and juices, loaded with chemical additives, and with not a lot of variety—or taste—available. These supplements come in cartons, the sight of which makes Paul Sprowls cringe.
“If you walk into a nursing home anywhere today you’ll probably see a health shake or a nutritional juice…chemically enhanced stuff,” says Sprowls, director of dining services for Cura Hospitality, a member of the Elior North America family of companies, at Westminster Woods at Huntingdon, a CCRC in Pennsylvania.
“For years as an industry, when residents would lose weight, we’d put them on that.” Cura is a unit of Elior North America.
The problem with the drinks is that often seniors wouldn’t drink the whole thing, missing out on precious calories and grams of protein. And sometimes, a resident would receive the supplement as many as four times a day. That means flavor fatigue and ultimately “that you’re going to give up on me,” Sprowls says.
“There were only three flavored shakes—chocolate, vanilla and strawberry—and two juices—apple-cranberry and orange juice,” he says. “So you have five choices for the rest of your natural life.”
Another option was a super-concentrated 2 oz. supplement for seniors who were truly having trouble drinking 6 or 8 oz. of traditional supplement.
“So I was thinking of all of that,” Sprowls continues. “I said, ‘What do I have on my shelf that I can make this?’ I didn’t want to buy protein powders, either. But I want to make real smoothies, shakes and snacks that can give us 200 calories and 5 grams of protein (the same as is in the chemically enhanced supplements).”
Three years ago, Sprowls was director at another Cura-managed CCRC, Windy Hill Village. It was there that he created the pilot program that would become Handcrafted Delights, a program for enriched snacks for senior residents who need nourishment and weight gain.
During the development of the new approach, Sprowls, who has been in the senior dining industry for two decades, posed a challenge to all of the staff—nursing, dining services, administrators and execs, too—to drink the manufactured, chemical-laden supplemental juice.
“I handed them a carton and said, ‘Will you drink it?’ They backed away. ‘No!’ So I said, ‘As a nurse, you do this every single day to your residents. Are we meeting our mission?’” Sprowls recounts.
Handcrafted Delights grew from findings of a long-ranging study on aging and diet by the Pioneer Network, a non-profit focused on the changing culture of aging.
“It’s philosophical in a lot of ways,” Sprowls says. “Food that tastes good, is freshly made and meets the nutritional needs of this population. It’s the quality of life we’re after.”
Sprowls, dietitians and the kitchen team began experimenting. They found that yogurt is the perfect go-to for smoothies with protein. Add fresh fruit, and you’ve got an appealing alternative that checks all the boxes. Adding white beans to snacks like cupcakes makes for an undetectable boost of protein. Cottage cheese, when blended, looks nothing like cottage cheese. Peanut butter is a powerhouse that tastes good, too.
“And then you can add peaches or bananas…whatever you have,” Sprowls says. “I understand that some facilities can’t get a lot of fresh produce; use canned peaches. That’s fine.”
Since the program relies on pantry staples and fresh produce, it’s a cost-saving measure. While more fresh blueberries are being purchased, less money is being spent on the old-school supplements. And the labeling system was often wasteful from a labor standpoint, Sprowls says, adding that the numbers have worked out: overall, costs have gone down thanks to this program.
The majority of the Handcrafted Delights are smoothies and shakes, but some snacks—like the white bean cupcakes and also pudding, black bean brownies and peanut butter cookie sandwiches—are also in the rotation.
The enriched snacks are offered twice every day between meals, at 1 p.m. and at 7 p.m. Seasonal shakes like pumpkin spice shake or green shamrock shake are also fun possibilities, another way to prevent flavor fatigue.
The shakes are just for those residents who need to gain weight (about 40 percent of Westminster Woods’ 64-bed skilled-nursing unit, a figure that fluctuates), but they’re served as a treat on Fridays, Sprowls says.
Flavored water with fruit and mocktails are offered to everyone every day, part of an effort to fight dehydration, which the entire population is always in danger of.
The Handcrafted Delights system is available for any nursing home or CCRC and is especially effective in settings with a “country kitchen” decentralized setup, which might serve a group of 15 residents in one wing of a facility.
“I still go to facilities and see those cartons. Do you see long-term care as an extension of the hospital or an extension of the home?” Sprawls says. “Everyone says ‘It’s an extension of the home.’ But don’t say that and still offer supplemental drinks.”
When Sprowls conducted the experiment of offering staff the old supplemental drinks, he tapped into a recent buzzword in senior care: person-focused or person-directed care/living.
“And all of a sudden, you’re putting yourself in the place of the resident,” he says, recalling staff “choking it down” when they finally did try the supplemental drinks. “It’s not just that the staff has to be educated and involved; it’s that empathy place.”
After staff members choked down the drinks, Sprowls then offered them one of his new Handcrafted Delights.
“Then I told them, ‘I want you to try this pina colada I’ve just made,” he says. “That’s so much better…and you don’t know it’s made with cottage cheese.”