Creative snack and supplement programs for long-term care

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hat’s to eat? Who’s hungry? Do you like to snack between meals? I know I do, and so do many of the older adults in our care. And snacks are a great way to provide some of the extra calories, protein, and other nutrients that many of our residents need. Do you have a resident who is losing weight? Someone with a pressure ulcer? It’s time to get creative!
       About 15 years ago, Larry, the administrator of a 120-bed skilled nursing facility to which I consulted, came to me about our “supplement situation.” To put it kindly, he was mad. “Becky, why are our supplement costs so high? What is going on here? We need to get these costs down!” Being the dutiful dietitian that I was at the time, I did an investigative study. What I found was shocking. Over time, as a team of dedicated, well-meaning professionals (registered dietitian, dietetic technician, certified dietary manager, nursing staff, and physicians), in our effort to combat weight loss, malnutrition, and pressure ulcers, we had requested and/or ordered enough supplements to feed half of China. That’s a bit of an exaggeration, but it was pretty extreme. We had residents on supplements 3, 4, 5, and sometimes 6 times a day. And what was happening to those supplements? Many of them were literally going down the drain. It was time to make some major changes.
       If you can relate to this story, I’d like to share some great ideas to help you be more effective and jazz things up for your residents.

Make Eating an Experience to Look Forward to
       Eating is an experience—hopefully an enjoyable experience—that you have while surrounded by friends and/or family, people with whom you enjoy spending time and talking, etc. It involves emotional decisions—choosing the food you really feel like eating at the time.
       We need to make snack and supplement time a time to look forward to: a social time, time for fun and gathering with friends.

Focus on Food First
       As always, focus on food first. The first choice is to offer real food, appealing food that residents enjoy, and foods that help to meet the nutrient needs of each individual.
       Make snack time less institutionalized: less scheduled and mundane. This can be achieved through offering a variety of choices in snacks. Allow residents to choose what they feel like eating at the time: “Hmmm…do I want chocolate, a peanut butter sandwich, or maybe a bit of both?”
       It can also be accomplished by enhancing the foods that residents like most. How about trying a program that includes things like:
• Super cereal for breakfast
• Fortified soup or high calorie/protein casseroles at lunch or dinner
• Power pudding for dessert or snack.
       Instead of adding extra foods and supplements, enhance the foods you are already serving. Choose the foods that residents enjoy most and find ways to add calories and protein to those foods. It’s easy to add calories with items like margarine, mayonnaise, sour cream, or whipped cream. Protein can be added with cream, milk, cheese, peanut butter, yogurt, cottage cheese, or powdered milk.

Snack Carts
       Remember when you were a child and you looked forward to the ice cream man coming down your street every evening? Or when you were in the hospital and the candy striper came by with the cart full of goodies (snacks, magazines, newspapers, etc.)? Why not create a similar event for your residents?
       Decorate a cart with a canopy or an umbrella to make it look festive. Make a big deal out of passing snacks by playing music and having positive energy and a smile on your face. Make it an event that residents look forward to everyday. Do you sometimes like to read when you eat? Add newsletters, newspapers, activity or event announcements, or information fact sheets as part of the event. And just like the ice cream man or the candy striper, why not offer candy bars or ice cream novelties once in a while? These are foods we enjoy everyday—our residents will enjoy them too.

Snack Kitchens
       Edna Cox, RD, president of Carolina Nutrition Consultants, Inc., offers these suggestions on the use of snack kitchens: “Snack kitchens should be easily accessible to residents, families, and staff. A possible location might be across from the nurse’s station. Dietary should stock the kitchen with fresh and varied choices of foods and beverages daily.” The concept of snack kitchens is popular for a number of reasons:
• For nursing staff, the items are readily available, and residents do not have to wait on delivery from dietary or call the kitchen when a snack is needed.
• Residents who are able can visit the area independently to have a snack between meals, at bedtime, or whenever they want it, and they do not have to wait for someone to get it for them.
• Residents can go to the snack kitchen rather than use the vending machines and have healthier snacks available.
• Snacks can include items that would be appropriate for most diets including low-sugar or carbohydrate-controlled diets (fresh fruit, applesauce, pretzels, crackers and peanut butter, cereal and milk, sugar-free and Vitamin C-fortified beverages).
       Edna says, “We had concerns at first for the special diets, but it works well. We have actually seen weight gain in some of our problem eaters.” This sounds like a winning idea to me!

Follow the Holiday
       Vicki Redovian, MA, RD, LD, of Becky Dorner & Associates, recommends some creative approaches to snack time using seasons, celebrations, or themes, such as the following:
• Fall: Cider and doughnuts; S’mores and hot chocolate
• Winter: Tea and scones; traditional holiday cookies and milk; valentines or shamrock cookies
• Spring: Hot dogs and “near beer” for baseball season (or real beer for those who can have it)
• Summer: Ice cream social; rootbeer floats; fruit smoothies
• Anytime: Pizza night; candy time (e.g., Reese’s® Peanut Butter Cups and milk); milk and cereal
• Resident choice snacks: Let residents choose by answering the question, “What’s your favorite snack?”

Define Responsibilities
       If you decide to have a snack kitchen, answer the following questions:
• Who will stock the kitchen?
• What will the stocking rotation of foods be?
• Who will keep the kitchen clean and monitor for safe food handling?
If you plan to develop a snack cart program, determine:
• Who can order specific snacks for those residents with special needs (e.g., weight loss, malnutrition, or special diets)?
• Who will pass the snacks and supplements and at what times?
• How will acceptance be communicated with nursing and dietary?
• How can residents on special diets adhere to special diets while choosing their snacks?
       If you’d like to have healthier, happier residents, satisfied families, reduced weight loss, and fewer complications, use a variety of the ideas presented here and let your residents have a snackin’ good time!

Acknowledgement
       This article is excerpted from Diet Plus: High Calorie/Protein Tips and Recipes (copyright 2004 Becky Dorner & Associates).