HHS Culinary, an FM Top 50 contract firm specializing in healthcare foodservice, is de-institutionalizing its senior dining operations through the introduction of a “country kitchen" approach in which assisted living and skilled nursing residents sit down and dine together rather than individually off of trays in their rooms. The program has been implemented in all seven of the company’s senior living accounts, says Kevin Svagdis, CEO of HHS Senior Living.
“We don’t have tray lines anywhere anymore,” he explains. “The dining rooms are set with silver and china, just like a restaurant, and we then bring the food up to the unit and serve it up there with the assistance of CNAs (Certified Nursing Assistants). We do the food and plate presentation, and they serve it, then our servers walk around and make sure the residents are doing well and see if they need anything else.”
It is sit-down dining with the servers bringing the different courses in succession and clearing the table from the previous course just like in a restaurant, he adds.
There is also more of a customization component to this platform, with eggs being cooked to order in the morning and sandwiches to order at lunch, “so we’re moving some of the meal preparation up to right in front of the residents,” Svagdis observes.
Controlled and restricted diets are handled on a person-to-person basis in the restaurant-style dining format as the staff know the residents and their needs. Those on pureed diets get the same food as everyone else, except it is pureed.
As for residents who are bedridden or temporarily unable to join in the congregate meal, trays are still available, “but the amazing thing we’re finding is that residents want to come to the dining room now,” Svagdis notes. Before, “a lot of them could make it but they just didn’t want to go.”
Infrastructure changes are minimal. One client site required adding a steam table; however, “in our skilled units where we implemented this, the infrastructure was already there, but the programming was very weak,” Svagdis explains, “so we brought in tablecloths and real china and silverware. We then did a lot of training with the people to do literally restaurant-style cook-to-order with all fresh foods and it made a tremendous impact.”
Most clients have already made the necessary infrastructure changes, Svagdis observes. “What they lack a lot of times is the programmatic piece, the training, follow-up and consistency pieces, and that’s what we do for our current clients.”
The menu underwent significant modification to accommodate the new approach.
“What we did is shift our food philosophy and food standards,” Svagdis says. “When we came into the business, it was a lot of pre-prepared foods, a lot of boxes and cans, and we converted to 100 percent fresh. Fresh meats, not frozen; fresh vegetables in season and we hand make all our desserts. We make fresh stocks for our soups and gravies instead of using paste and powders. It has involved a lot of training with the cooks.”
That is certainly a benefit for the residents, but Svagdis says it also had a major positive impact on the company’s staff as well.
“What happened was a huge transformation, especially in the skilled care environment,” he says. “The pride and satisfaction [of the culinary staff] with the job went through the roof, because the residents were raving about the food, they were eating more and the nurses were happier because the residents were happier, so morale skyrocketed.”
Clients are happy too, because the dining program is now a marketing positive for potential new residents. “When they see this type of dining, the food quality, the freshness and the delivery we’re providing in these dining rooms, it helps them get more residents into their communities,” Svagdis notes.
Though there are variances based on the specific facility, the typical meal group is around 20, he says, “which is great because you can really do personalized service [with a group that size]. It’s enough for the residents to socialize but still give that real special customized service. You can come back around and give an extra cup of coffee and make sure everyone’s doing fine.”
While all-day dining is the general HHS approach in independent living facilities, right now there are set meal times for breakfast, lunch and dinner in the skilled and assisted living facilities where the company operates.
“My next goal would be to get skilled and assisted living into all-day dining as well,” Svagdis says, “but it takes a lot of coordination with nursing and so forth.”
He also notes that a regulatory requirement for skilled/assisted facilities is 14 hours between dinner and breakfast, “so if you’re going to do something that’s really innovative and flexible, you have to make sure that’s managed.”
The good thing, however, he adds, is that the state and federal authorities are starting to become a lot more flexible “because they want [dining] to be more of a home experience and less institutional. They did not like this [restaurant-style] model 10 years ago because it felt like the regulatory piece would fall apart, but now they’re seeing it work.”
The challenge for companies like HHS now is to improve on that even more.