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&The Big Six When to Report Symptoms of Employee Illness
Eating Disorders in the Aging Population Intervention Strategies
Time for Tea A Soothing and Satisfying Hydration Option
FEBRUARY 2015
FoodserviceOperation
50 Ways to Improve Your
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Nutrition & Foodservice Edge | February 2015 1
®P U B L I S H E D B Y
CONTENTS FEATURES
16 NutritionandEatingDisordersinthe AgingPopulation by Brenda Richardson, MA, RDN, LD, CD, FAND
Anorexia, bulimia, and other eating disorders prevalent in the aging population are discussed here, along with evidence-based nutritional interventions.
24 50WaystoImproveYour FoodserviceOperation by Wayne Toczek
Fifty tips that can improve your foodservice systems are presented. Pick and choose the tactics that can benefit your operation.
28 TimeforTea by Linda Eck Mills, MBA, RDN, LDN, FADA
Keeping residents hydrated is an important goal in long-term care facilities. Tea is a satisfying and viable option, delivering both hydration and health benefits.
32 NutritionTherapyforWoundHealing by April Irvine, MS and Julie Moreschi, MS, RD, LDN
Pressure ulcers are an unfortunate reality in the elderly nursing home population. Understanding the important role of nutrition in wound healing is key to improving quality of life for those affected.
4 Food File
10 Food Protection Connection
38 ANFP Leadership Spotlight
40 Meet a Member
Nutrition &FoodserviceEdge
DE PA RTMENTS
16
24
28
10
February 2015 / Volume 24 / Issue No. 2
1 HOUR SAN
Nutrition & Foodservice Edge | February 20152
BestofLeaders&Luminaries
Nutrition & Foodservice Edge®isthepremier
resourcefornutritionandfoodservice
professionalsandthoseaspiringtocareers
inthisindustry.Itispublishedbythe
AssociationofNutrition&FoodserviceProfessionals.
Editor . . . . . . . . . . . . . . . . . . . . . . . Diane J. Everett
Senior Writer . . . . . . . . . . . . . . . .Laura E. Vasilion
Advertising Sales . . . . . . . . . . . . . . . . . Paula Fauth
Design . . . . . . . . . . . . . . . . . . . . . . . . . Mercy Ehrler
Nutrition & Foodservice Edge® (ISSN 21649669)
is published monthly except combined issues
in July/August and November/December.
©2015 by the Association of Nutrition &
Foodservice Professionals, 406 Surrey
Woods Drive, St. Charles, IL 60174.
Phone: (630) 587-6336. Fax: (630) 587-6308.
Web site: www.ANFPonline.org
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EditorialPolicyReaders are invited to submit manuscripts for
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editor for specific publishing guidelines. Views
expressed by contributors do not necessarily
reflect the opinion of the association.
Printed in the U.S.A.
LynneEddy,MS, RD,
FAND, CHEAssociate Professor, Business Management, The Culinary Institute
of America,
Hyde Park, NY
RichardHynes
Director, Consultant Services, Hobart Corp.,
Franklin, MA
KevinLoughran
Director of Support Services for Food and Dining, Healthcare
Services Group,
Bensalem, PA
RubyPuckett, MA, FFCSI
Director, Dietary Manager Training, University of Florida Div
of Continuing Ed.,
Gainesville, FL
MartyRothschildPresident, Aladdin Temp-Rite,
Hendersonville, TN
BobSala
Founder and Director at Large, Distribution Market
Advantage,
Hoffman Estates, IL
ReneeZonka, CEC, RD,
MBA, CHE
Dean, School of Culinary Arts, Kendall College,
Chicago, IL
E D ITORIA L A DVISORY BOA RD
®
ALSO
I N
OUR
PAGE S
7 37
More ANFP news, inspiration, and education at www.ANFPonline.org
E DITOR ’S NOTEBOOK
LegislativeReport
Nutrition &FoodserviceEdge
February 2015 / Volume 24 / Issue No. 2
Soundnutritioniscrucialtowellbeing,andseveralfeaturesthis
monthoutlinehowmedicalnutritiontherapycanenhancequality
oflifeforpeoplefacinghealthchallenges.Elderlyindividualswith
eatingdisorders,residentssufferingfromthepainofpressureulcers,
andclientswhorejectwaterbutneedhydrationallrequirenutri-
tioninterventionstoimprovewellness.Checkoutthearticlesinour
pagesaddressingthesetopics.Qualitycareimprovesqualityoflife!
Listsofferagreatvisualreminderofthetasksweneedtotackle.
Thelistonpage24presents50thingsfoodservicemanagerscan
dotoimprovetheiroperationandperformatpeakefficiencyfroma
budgeting,staffing,orqualitystandpoint.Pickandchoosetheinitia-
tivesthatresonatewithyou,orusethisresourceasanideastarter
andcreateacustomizedchecklisttomeettheuniqueneedsofyour
foodserviceprogram.
ThismonthweoutlineTheBigSix—specificpathogensidentified
bytheCentersforDiseaseControlandPreventionastransmissible
throughfoodbyinfectedemployees.Staffmembersfacingthese
illnessesareputtingyourclienteleatrisk—especiallyclientswhoare
elderly,veryyoung,orimmunocompromised.Whatistheemploy-
ee’sandemployer’sresponsibilityinreportingsymptomsordiag-
noses?FindoutinourFoodProtectionConnectioncolumn,andbe
proactiveaboutsafeguardingyourfacility’spopulationfromillness.
Andfinally,thisissuefeaturesa“bestof”compilationofquotesfrom
prominentandinspiringindividualswhohavebeenprofiledinour
Leaders&Luminariescolumnoverthepastthreeyears.Ienjoyedre-
readingtheircollectivewisdom,andIhopeyouwilltoo.
Diane Everett, Editor [email protected]
SESSION TITLES • The First and Last Motivational Guide for Humans in the Workplace!• 2015 Surveys: Are You Prepared?• Creative Food Presentations• Be a Leaner, Stronger, Hungrier Leader • Food Safety: Current Hot Trends• The 8 Steps to Controlling Food Costs• New Pressure Ulcer Guidelines for Nutrition• The Foodservice Department as a Revenue Center• How to Market and Promote Yourself• EXPO
® ® ANFP SPRING REGIONAL MEETINGS Become a leader in the foodservice industry
®
REGISTER ONLINE TODAY | www.ANFPonline.org/Events ®
“The recent ANFP Regional Meeting
provided me with wonderful opportunities
to not only attend a wide variety of
interesting educational sessions that match
my career needs, but also to gain valuable
networking opportunities with like-minded professionals.
Thanks for making such a quality program so easily accessible and affordable.” - Kimmi Campagna, CDM, CFPP
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SIGN uP TODAy FOR ANFP SPRING REGIONAL MEETINGS! ANFP Regional Meetings provide top-notch education at affordable and convenient locations across the nation. Discover new ways to tackle foodservice challenges, strengthen your leadership skills, and learn how you can bring more value to the table.
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Nutrition & Foodservice Edge | February 20154
I
T
FOOD F ILE
IN NOVEMBER AND DECEMBER theOrangeCountyPublicSchoolsFood
andNutritionServices(OCPSFNS)food
truckvisitedCentralFloridamiddleand
highschools,servingthreenewmenu
itemsselectedbystudentvote.
Theentrees—WarmAsianChickenSalad,
GreenBeanChickenCaesarBowland
AsianBeefTeriyaki—weredeveloped
inpartnershipwithfoodvendorUncle
Ben’stoencouragestudentstoeatmore
school-providedmeals.
THE START OF THE NEW YEAR oftenrousesaresolvetoloseweight—
agoalthat’sespeciallyimportantfor
peoplepronetoheartdisease,reports
theJanuary2015HarvardHeartLetter.
Carryingtoomanypoundscanboost
bloodpressure,bloodsugar,andcholes-
terol,allofwhichburdentheheart.
Formanypeople,coachingthattrans-
formseating,exercise,andotherhabits
canmakeadifference.Knownasin-
Food Truck Encourages StudentstoEatSchoolLunch
WeightLossGoesBeyond“Eat Less, Move More”
ORANGE COUNTY PUBLIC SCHOOLS FOOD AND NUTRITION SERVICES
hit the road last fall with its Truck of the Month tour.
“TheTruckoftheMonthtourgivesusa
waytoeducatestudentsonthetasty,
nutritiousmealsbeingservedinourcaf-
eterias,”saidLoraGilbert,seniordirector
ofOCPSFNS.“Weknewwehadtoget
creativetoattractourstudents’atten-
tion—andafoodtruckwasanaturalfit
tocombineourserviceswithaneye-
catchingpopculturetrend.”
Afterpurchasinglunchfromthefood
truck,studentscantakeaniPadsurvey
tosharefeedback.Attheendofthe
tour,themostpopularitemwillbe
addedtocafeteriamenusforthe2015-
2016schoolyear.
Schoolofficialsarealreadyseeingposi-
tiveresultsfromtheprogram.Onaver-
age,afterthefoodtruckvisitsacampus,
46percentofstudentswhopreviously
didnoteat,orateinfrequently,inthe
cafeteriaincreasedtheirparticipationto
threetofivetimesperweek.
“Studentsalwayslookforwardtoeat-
ingfromthefoodtruck,”Gilbertsaid,
addingthatitservesabout400meals
duringeachcampusvisit.“It’sbeena
bighit!”
Infactitwassopopular,anothertouris
settostartinFebruary2015andcon-
cludeattheendoftheschoolyear. E
Forinformation
aboutOCPSFNSvisit
www.ocpsmealapp.com
tensivelifestyleintervention,itinvolves
workingcloselywithoneormoretrained
experts,includingadietitianornutrition-
ist,exerciseprofessional,healtheduca-
tor,andpsychologist.
Agoodgoalistoloseatleast1percent
ofbodyweightaweekforthefirstfour
weeksofsuchaprogram.“Reach-
ingthatgoalrequiresamajorlifestyle
change,andthattakesalotofwork,”
saysDr.GeorgeL.Blackburn,professor
ofnutritionatHarvardMedicalSchool
anddirectoroftheCenterforNutrition
MedicineatBethIsraelDeaconessMedi-
calCenter.
Manymajormedicalcentersthrough-
outthecountryofferintensivelifestyle
coaching.Forexample,aprogramat
Harvard-affiliatedMassachusettsGen-
eralHospital,knownasHealthyHabits
forLife,costs$550andincludes12
groupsupportandeducationsessions,
Nutrition & Foodservice Edge | February 2015 5
Consulting Dietitians, Menu & Meal Card Programs,
and Support for Dining Services in Long Term Care
www.ht-ss.com
Continued on page 6
acustomizedeatingplan,andtwovisits
withapersonaltrainer.Someprograms
alsoincludecounselingbytelephone,
email,ortextmessage.
Lifestylechangesandtipsthatcanhelp
withweightlossinclude:
• Plan ahead. Pickonedayaweekto
devotetoplanning,shopping,and
preppingthecomingweek’smeals
andsnacks.
• Go for convenience.Takeadvantage
oflow-caloriefrozendinnersandsu-
permarketsaladbars.
• Pay attention to portion size.Measure
commonfoodslikecereal,peanutbut-
ter,andsaladdressingtoavoideating
morethanaserving.Usingsmaller
plates,bowls,andevenutensilsalso
helpspeopleeatless.
• Exercise in 10-minute bursts.Burstsof
moderateactivity—briskwalking,bik-
ing,orevenjustmarchinginplaceor
doingjumpingjacks—for10minutes,
threetimesaday,isjustaseffectiveas
exercisingonceadayfor30minutes.
• Keep a food diary.Smartphoneapps
canmakethistaskeasier.Lookfor
auser-friendlyonethathasalarge
databaseoffoods.
• Track daily activity.Pedometersand
digitalfitnessmonitors—whetherworn
aswristbands,clippedontoclothing,
orslippedintoapocket—canhelp.
Basiconesmeasurestepsandcalo-
ries,whileotherscaptureheartrate,
skintemperature,andsleeppatterns.
• Step on the scale. Regularweight
checks,donedailyorweekly,aid
weightloss. E
Readthefull-lengtharticle:“DoYou
NeedWeightLossCoaching?”at
www.health.harvard.edu/heart
Nutrition & Foodservice Edge | February 20156
Continued from page 5
WWITH THE NEW YEAR HERE, resolutionstoeathealthierareonevery-
one’smind.Masonjarsaladsare2015’s
lateston-the-gotrendforahealthyand
quicklunch.SaladspackagedinMason
jarsareportable,easytomake,canbe
preppedinadvance,andofferawideva-
rietyofrecipes.LukeSaunders,founder
ofFarmer’sFridge,anewhealthyvend-
ingkioskconcept,offerstipsonmaking
aMediterraneanMasonJarSaladthat
willstayfreshandcrispintheworkplace
fridgeuntillunchtime.
1) Prepthedressingearly.Startsalad
constructionbycombiningthedress-
ingingredientsthenightbeforeto
allowalltheflavorstomarinateand
meldtogether.TomaketheRedWine
VinaigrettefortheMediterranean
Salad,whisktogetherallingredients
(exceptoil)inamedium-sizedbowl.
Whilewhisking,slowlypourinthe
oliveoil.
Fresh New Lunch TrendfortheNewYear
2)Chooseyourgreens.Insteadofthe
standardromaineoriceberglettuce,
swapoutthegreenswithsomething
new.Experimentwithvarietieslike
arugula,kale,andspinach.Eachtype
ofleafygreenoffersdifferenthealth
benefitsrangingfromimprovingim-
munedefenses,loweringcholesterol,
strengtheningbones,combattingheart
disease,andpromotinghealthyvision.
3)Startthejarwithheartyveggies.
Byreverselayeringsaladingredients
withinthejars,thesaladwillberight
sideupandreadytoeatwhenthe
jarisflipped.BaselayersofMasonjar
saladsshouldincludetheheartierveg-
etablesthatcantaketheweightofthe
otheringredients.Whenthesaladis
flippedontoaplate,thelettucewillbe
onthebottomandothervegetables
willbeontop.
4)Layeritup.Aftertheheavyingredi-
ents,packtherestoftheMasonjar
withgreensandgarnishessuchas
croutons,berries,protein,ornuts.Top
theingredientswithmixedgreensand
pinenuts.Tofinish,storeseparate2
oz.containerofdressingontopofthe
salad,screwonthejar’slid,andthe
saladisreadytogo.
5)Knowhowtostorethesalad.To
preventsoggysalad,packeverything
intothejarastightlyaspossibleto
keepingredientsfrommovingaround.
Leavingthegreensforlastcreatesa
moisturebarriermakingthesaladable
tostayinthefridgeforafewdays.
Saladscanbeenjoyedonaplateorin
abowl,oringredientscanbeshaken
upandthesaladcanbeeatendirectly
fromthejar. E
M E D ITE R R AN E AN MA SO N JAR SAL AD
DRESSING
• 1/2cupRedWineVinegar
• 6Tbsp.Water
• 2Tbsp.OliveOil
• 2tsp.Honey
• 1tsp.DijonMustard
• 1/2tsp.Salt
• 1/4tsp.BlackPepper
• 1tsp.Oregano
• 1/2tsp.Basil
SALAD
• 4quartersArtichokes(canned)
• 2eachGrapeTomatoes(slicedinhalf)
• 1/4cupEnglishCucumbers(quarteredand
thinlysliced)
• 1/4cupCannelliniBeans(canned)
• 1Tbsp.ParmesanCheese(grated)
• 2Tbsp.KalamataOlives(sliced)
• 1-1/2cupsMixedGreens
• 1Tbsp.PineNuts(roasted)
Startbylayeringthequarteredartichokesfollowedbygrapetomatoes,cucumbers,beans,cheese,olives,mixedgreens,
andpinenuts.Tomakethedressing,whisktogethertheredwinevinegar,water,honey,Dijonmustard,salt,pepper,
oregano,andbasilinamediumsizebowl.Whileyouarestillwhisking,slowlypourintheoliveoil.Dressingcanbestoredin
a2ounceportioncupontopofthesalad.
DIRECTIONS
Formoreinformation,visit
farmersfridge.com
Nutrition & Foodservice Edge | February 2015 7
LEADERS & LUMINARIES
CollectiveWisdom
by Laura Vasilion
INSP I RAT ION
FROM LE ADERS
& LUMI N ARIES
When we began this column in January 2012, our goal was to profile inspirational leaders and luminaries in the food industry. We reached that goal many times. With each person we interviewed—peo-ple with a passion for the important role food plays in our daily lives—we learned something.
As we enter this column’s fourth year, we thought it would be a great time to recap some of our favorite insights from these impressive movers and shakers. Their full interviews can be found on the ANFP website in the Nutrition & Foodservice Edge archives under Publications: Magazine Index & Archive section (visit www.anfponline.org/Publications/Dietary_Manager_magazine_articles.shtml).
Here is just a small sampling of their collective wisdom and inspiration. Enjoy!
Continued on page 8
Nutrition & Foodservice Edge | February 20158
On the Challenges and Importance of Leadership
“We, as an organization, must look for ways to make the organization relevant and member-worthy. The give and take of the non-profit world makes it much more important that we do this right. Our programs expect much of us as a membership organization, and my biggest chal-lenge is to get them to understand that we must expect something in return besides dues. We must all understand how high the stakes are—not only locally, but nationally, as well.” —Enid Borden, Then-President and CEO of Meals on Wheels Association of America, Alexandria, Va. (January2012)
“We focus a lot on leadership. It’s important our staff gets to know their employees’ strengths and weaknesses. You do that by pairing them up together on team projects accordingly. When your employees trust you and know you’re not go-ing to be vindictive, they will give you their best. But they have to be assured they’re going to be acknowl-edged for their ideas and that you’re not going to steal them. That is crucial.” —Renee Zonka, CEC, RD, MBA, CHE, Dean of The School of Culinary Arts, Kendall College, Chicago. (April2012)
“I believe everyone should always feel better after meeting with you. Regard-less of whether it was a positive or negative meeting, you should have them leave the room feeling better. And also, sometimes you have to give up things you’re really good at to give others a chance to rise to the occa-sion. So you have to be charismatic, but also able to let things go so mem-bers of your team can really shine.” —Ryan Conklin, Executive Chef, Culi-nary & Nutrition Services, Rex Health-care, Raleigh, N.C. (June2012)
On Following Your Dreams
“When I went to culinary school in the 1990s, there was a certified master chef who was in the Navy in the 1960s. He had all these great sea stories and they stuck in my head. I didn’t think too much about them until I started thinking about career options. After competing and working in restaurants for a while I decided to give the mili-tary a try because I always wanted to serve my country.
The other thing that pushed me toward the Navy was the master chef telling me that the Navy is the only military branch that cooks for the president on the West Wing of the White House. So that was a goal of mine. It is still a goal of mine.” —Derrick Davenport, CEC, CEPC. 2013 Armed Forces Chef of the Year and Ex-ecutive Chef/Enlisted Aide for General Martin Dempsey, Chairman of the Joint Chiefs of Staff in Washington, D.C. (September2013)
“My cousin was working in the (Chi-cago) Bulls front office in basketball operations at the time. She knew I did catering and stuff so she called me one day and asked if I’d like to cook a meal for the team. Unbeliev-able. I did, they liked it, and then the trainer called me back and asked if I wanted to be the team chef. It’s still surreal to me, being in the ‘House of Jordan’ and all.” —Steve Jackson, Personal Chef for the Chicago Bulls, Owner of The Con-venient Chef, Chicago. (March2012)
On Giving Back
“Honestly, finger foods in the industry—what is being served to memory care communities in senior assisted living—are very much like the food you would serve your tod-dler. Fish sticks, French fries, peanut butter and jelly sandwiches, grilled cheese. We thought we could come up with something better. Inde-pendence, dignity, and accessibility. That is what we think of when we are trying to provide a better quality of life for those who have cognitive or physical limitations. Individuals who can’t use their fingers or use utensils anymore.”—Sarah Gorham, Chef, Co-Founder/Co-Owner of Grind Dining, Inc., Atlanta, Ga. (November/December2014)
Continued from page 7
Enid Borden Renee Zonka Ryan Conklin Derrick Davenport
Nutrition & Foodservice Edge | February 2015 9
On Beating the Odds
“Once I entered culinary school, the weight came on in a slow pro-gression. Maybe it was because I wasn’t working it off anymore. But it wasn’t like I sat down at a buffet and kept eating. It was very gradual.
That is when I saw the bad side of food, what it can do to your body. I developed sleep apnea, neuropathy, and hypertension. The airlines wanted me to buy two seats because no one wanted to sit next to me. At the amusement park with my nieces and nephews, I couldn’t go on rides because the harnesses wouldn’t fit me. Twice I almost died because of my weight, but my doc-tor saved me. That’s when I knew I had to do something serious.
When I lost the first 186 pounds, I didn’t need to sleep with a machine anymore. When I went down to 205, my diabetes went away.” —Todd Henri Daigneault, Executive Chef at Overlook Medical Center and Union Medical Centers for Atlantic Health Care Systems of New Jersey. (March2014)
“I’m a huge fan of irony. A chef without a stomach? I totally get, on some level, the dark humor of it.
But I missed being around food so I started walking with my family every day, three meals a day, to the hospital cafeteria. At first they felt really guilty that they were having a meal in front of me. I had two IV poles and tubes coming out of me everywhere. I had no strength, but I would push my way down the halls just to sit in the caf-
eteria and watch them eat. To see food and smell food and sort of eat vicariously through them. But also, because eating is not just about eating, it’s about the ephemeral connection we have to food. It’s so powerful. If you think about certain foods, you remember where you were and who you were with when you were eating it.” —Hans Rueffert, of Jasper, Ga., Chef, Restaurateur, Educator, Motivational Speaker, and Author of “Eat Like There’s No Tomorrow.” (April2013)
Laura Vasilionisaseniorwriterfor
Nutrition & Foodservice Edgemaga-
zine.
Steve Jackson Sarah Gorham Todd Henri Daigneault Hans Rueffert
E
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Nutrition & Foodservice Edge | February 201510
FOOD PROTECT ION CO NNEC T ION
The Big Sixby Melissa Vaccaro, MS, CHO
One of the duties of the Person in Charge (PIC) is to ensure that employees understand and report impor-tant health information in order to protect the health of consumers and employees. This is never a pleasant subject. Both employees and the PIC are often hesitant to discuss illness or symptoms of illnesses. “Oh, and by the way, I have had diarrhea for three days now” is not something that just pops up during the course of the day.
Both the PIC and the employee (or conditional employee who has been made an employment offer) have a respon-
sibility to report when these un-pleasantries happen. The employee has the duty to report illness, exposure to certain illnesses, or certain symptoms of illness to the PIC. The PIC has a duty to contact the regulatory agency should a food employee exhibit certain symptoms or be diag-nosed with one of the ‘Big Six’ diseases.
REPORTABLE SYMPTOMS
The symptoms listed in the Food Code cover the com-mon symptoms experienced by persons suffering from the pathogens identified by the CDC as transmissible through
1 HOUR SAN
Nutrition & Foodservice Edge | February 2015 11
PAT H O G E N S T R A N S M IT T E D
There are numerous pathogens that may cause foodborne illness, but there are six that the Centers for Disease Control and Prevention (CDC) bring to the forefront of conversation when it comes to food safety.
T H E B I G S IX PAT H O G E N S
So why does the FDA Food Code and the CDC single out these six pathogens?
The CDC has designated the six organisms listed in the Food Code as having high infectivity (able to invade at low doses) by contamination of food by infected food employ-ees. These organisms are also virulent (able to produce severe disease).
Following is a summary of the Big Six. (Sources: 19th Edi-tion of Control of Communicable Diseases Manual, the CDC website, and the FDA Bad Bug Book, 2nd Edition.)
N O R OV I R U S
Noroviruses are recognized as the most common cause of epidemic and spo-radic gastroenteritis across all age groups worldwide. Noroviruses are the leading cause of food-borne illness in the United States.
Transmission
Transmission occurs primarily through the fecal-oral route, in-cluding direct person-to-person con-tact and indirect transmission through contaminated food, water, or environ-mental surfaces. Vomitus-oral transmission can also occur through aerosolization followed by direct ingestion or environmental contamination.
Food handler contact with raw or other ready-to-eat foods is the most common means of transmission. Norovirus contamination of produce and shellfish can also occur during production. Secondary household transmission is common.
Noroviruses are environmentally stable, able to survive both freezing and heating (although not thorough cook-
food by infected food employees. A food employee suffer-ing from any of the symptoms listed presents an increased risk of transmitting foodborne illness.
• Vomiting
• Diarrhea
• Jaundice
• Sore throat with fever
• A lesion containing pus on the hands, wrists, or exposed portions of the arms
Continued on page 12
UN D E RSTANDING
THE B I G S IX
PATHOGENS
Nutrition & Foodservice Edge | February 201512
Continued from page 11
ing), are resistant to many common chemical disinfectants, and can persist on surfaces for up to two weeks. Proper hand hygiene and exclusion of food employees exhibiting symptoms of norovirus disease (i.e., diarrhea or vomiting) are critical for norovirus control.
Incubation Period
In volunteer studies, the range is 10 to 50 hours.
Symptoms and Complications
Symptoms include acute-onset of vomiting, watery non-bloody diarrhea, abdominal cramps, and nausea, or a
combination of these issues. Low grade fever and body aches may also be associated. Symptoms
typically last 24 to 72 hours.
Infectivity
Noroviruses are highly contagious, and it is thought that an inoculum of as few as 18 viral particles may be sufficient to infect an individual. Shedding of the virus can continue for three weeks after recovery. Peak
viral loads may be as high as 100 bil-lion viral particles/g feces. That means
that it takes very few virus particles to get the disease, but you shed a lot of virus
particles while ill.
N O N -T Y P H O I DA L S A L M O N E L L A
This disease is caused by serotypes other than S. Typhi and S. Paratyphi A. The 2013 Food Code now requires food employees to report a diagnosis of non-typhoidal Sal-monella (NTS). Nontyphoidal Salmonella (NTS) enterica are bacteria that cause a diarrheal illness called salmonel-losis. NTS are among the most common and important causes of enteric disease. An estimated 1.2 million cases occur annually in the United States. Most infections are thought to be acquired through consumption of con-taminated food. According to studies, NTS are estimated to cause more than one million domestically acquired foodborne illnesses in the United States each year and are the leading cause of hospitalizations and deaths due to foodborne illness in the United States.
Transmission
Salmonella lives in the intestines of animals or humans. It can be found in water, food, soil, or surfaces that have been contaminated with the feces of infected animals or humans. People can become infected with Salmonella by:
• Eating foods contaminated with the bacteria.
• Contacting farm animals or pets, animal feces, or ani-mal environments.
• Touching contaminated surfaces or objects and then touching one’s mouth or putting a contaminated object into one’s mouth.
• Drinking contaminated water.
Incubation Period
Symptoms often begin 12 to 72 hours after being exposed to the bacteria, although it can take up to a week or more for symptoms to develop in some people.
Symptoms
Symptoms of salmonellosis include diarrhea, abdominal cramps, and fever. The illness usually lasts 4 to 7 days. Persons with NTS infections usually recover without treat-ment.
Infectivity
The minimum infectious dose of NTS for humans is gener-ally described as 100 to 1,000 organisms. However, doses of fewer than 10 organisms have caused illness in multiple outbreaks. Shedding of the bacteria can occur 4 to 5 weeks after the onset of the illness, even if symptoms of the ill-ness are gone.
S A L M O N E L L A T Y P H I
Salmonella enterica subspecies enterica serovar Typhi (commonly S. Typhi) causes a systemic bacterial disease, with humans as the only host. This disease is relatively rare in the United States, with fewer than 500 sporadic cases occurring annually in the U.S.
Incubation Period
Generally 1 to 3 weeks, but may be as long as 2 months after exposure.
Nutrition & Foodservice Edge | February 2015 13
Symptoms
Symptoms include high fever, from 103° to 104°F; lethargy; gastrointestinal symptoms, including
abdominal pains and diarrhea or constipation; headache; achi-
ness; loss of appetite. A rash of flat, rose-colored spots
sometimes occurs.
Infectivity
The minimal infectious dose is estimated to be less than 1,000 bacterial
cells. An individual in-fected with S. Typhi is con-
tagious as long as the bacilli appear in the excreta, usually
from the first week throughout the recovery; variable thereafter.
S H I G A TOX I N - P R O D U C I N G E S C H E R I C H I A C O LI
E. coli O157:H7 is the most commonly identified sero-type of Shiga toxin-producing Escherichia coli (STEC) as a cause of foodborne illness in the United States. E. coli O157:H7 is a zoonotic disease derived from cattle and other ruminants. However, E. coli O157:H7 also readily transmits from person-to-person, so contaminated raw ingredients and ill food employees both can be sources of foodborne disease. The Food Code definition of STEC covers all E. coli identified in clinical laboratories that produce Shiga toxins.
Incubation Period
Symptoms usually begin 3 to 4 days after exposure, but the time may range from 1 to 9 days.
Symptoms
Hemorrhagic colitis is characterized by severe cramping (abdominal pain), nausea or vomiting, and diarrhea that initially is watery, but becomes grossly bloody. In some cases, the diarrhea may be extreme, appearing to consist entirely of blood and occurring every 15 to 30 minutes. Fever typi-cally is low grade or absent. Infections from EHEC may range from asymptomatic to mild diarrhea to
severe, life threatening complications (e.g., hemorrhagic colitis, hemolytic uremic syndrome).
Infectivity
The infective dose of E. coli O157:H7 is estimated to be very low, in the range of 10 to 100 cells. Children under 5 years old are most frequently diagnosed with infection and are at greatest risk of developing hemolytic uremic syn-drome (HUS). The elderly also experience a greater risk of complications. The duration of excretion of STEC in the stool is typically 1 week or less in adults, but can be up to 3 weeks or longer in one-third of infected children.
S H I G E L L A S P P.
Shigella spp. causes an acute bacterial disease, known as shigellosis, and primarily occurs in humans, but also occurs in other primates such as monkeys and chimpanzees. An estimated 300,000 cases of shigellosis occur annually in the U.S. Shi-gella spp. are highly infectious and highly virulent.
Transmission
Outbreaks occur in overcrowding conditions where personal hygiene is poor, including institutions such as prisons, mental health facilities, day care centers, and refugee camps. Water and RTE foods contaminated by fe-ces, frequently from food employees’ hands, are common causes of disease transmission.
Incubation Period
The incubation time is 8 to 50 hours.
Symptoms
Abdominal pain, diarrhea, fever, nausea, and sometimes vomiting, toxaemia, and cramps can occur. The stools typi-cally contain blood, pus, or mucus resulting from mucosal ulcerations. The illness is usually self-limited, with an aver-age duration of 5 to 7 days. Infections are also associated
Continued on page 14
Nutrition & Foodservice Edge | February 201514
Continued from page 13
with rectal bleeding, drastic dehydration, and convulsions in young children.
Infectivity
The infectious dose for humans is low, with as few as 10 bacterial cells, depending on age and condition of the host.
H E PATIT I S A V I R U S
Hepatitis A virus (HAV) has been classified as a member of the family Picorna-
viridae. The exact pathogenesis of HAV infection is not understood,
but the virus appears to invade from the intestinal tract and is subsequently transported to the liver. The hepatocytes are the site of viral replication and the virus is thought to be shed via the bile.
Transmission
HAV is most commonly spread by the fecal-oral route through person-
to-person contact. Although numerous means of transmission can take place, a common
source of outbreaks can occur through ingestion of water or food that has fecal contamination.
HAV Immunization
Immune globulin (IG) can be used to provide passive pre-exposure against hepatitis A. Hepatitis A vaccination of food employees has been advocated, but has not been shown to be cost-effective and generally is not recom-mended in the United States, although it may be appropri-ate in some communities.
Melissa Vaccaro, MS, CHOisaFood
ProgramSpecialistforthePADepart-
mentofAgricultureandanExecutive
BoardMemberfortheCentralAtlantic
StatesAssociationofFoodandDrug
Officials(CASA).Sheisco-authorofthe
SURE™CompleteHACCPFoodSafety
Series.
Incubation Period
Incubation averages 28 to 30 days (range 15 to 50 days).
Symptoms
Illness usually begins with symptoms such as nausea/vom-iting, diarrhea, abdominal pain, fever, headache, and/or fatigue. Jaundice, dark urine or light colored stools might be present at onset, or follow illness symptoms within a few days. Jaundice generally occurs 5 to 7 days after the onset of gastrointestinal symptoms. The disease varies in severity from a mild illness to a fulminant hepatitis, rang-ing from 1 to 2 weeks to several months in duration.
Infectivity
The infective dose of HAV is presumed to be low (10 to 100 viral particles), although the exact dose is unknown. The viral particles are excreted in the feces of ill people (symptomatic and asymptomatic) at high densities (106 to 108/gm) and have been demonstrated to be excreted at these levels for up to 36 days post-infection.
CO N C LU S I O N
Keep your residents safe by monitoring employee illness. Discuss with staff reportable symptoms. E
Avoid Survey Deficiencies and Make Sanitation Training Stick
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Registration for ACE is open at www.ANFPonline.org Click “Events”
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Nutrition & Foodservice Edge | February 2015 15
1. WhichofthefollowingisNOToneoftheBigSix
Pathogens?
A. HepatitisA
B.Norovirus
C.HepatitisB
2. TheleadingcauseoffoodborneillnessintheUnited
Statesis/are:
A. Salmonella
B. Noroviruses
C. E.Coli
3. Whichareillnesssymptomsthatanemployeemust
reporttothePIC?
A. Fever,abdominalcramps,vomiting
B. Vomiting,diarrhea,jaundice
C. Vomiting,diarrhea,fever
4. WhichofthefollowingisoneoftheBigSixPathogens?
A. Listeria
B. Campylobacter
C. Shigella
ReadingThe Big Six andsuccessfullycompletingthesequestionsonlinehasbeenap-
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FOOD PROTECTION CONNECTIONReview Questions
1 HOUR SAN
5. Whichfoodbornevirushasavaccination?
A. Norovirus
B. HepatitisA
C. HepatitisC
6. WhichpathogencancauseHUS(hemolyticuremic
syndrome)?
A. E.Coli
B. HepatitisA
C. Botulinum
7. WhenmustaPICcontacttheirregulatoryagency?
A. Ifafoodemployeeexhibitscertainsymptomsoris
diagnosedwithoneofthe‘BigSix’diseases
B. Ifafoodemployeeexhibitscertainsymptomsoris
diagnosedwithanyfoodborneillnessdisease
C. Ifafoodemployeecallsinsick
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Nutrition and
Nutrition & Foodservice Edge | February 201516
As healthcare providers focused on nutritional services, our goal is to help our clients maintain—to the extent possible—acceptable parameters of nutritional status. We are expected to follow “best practice” to include:
• Providing nutritional care and services to each client, consistent with the client’s comprehensive assessment;
• Recognizing, evaluating, and addressing the needs of the client, including—but not limited to—the client at risk or already experiencing impaired nutrition; and
• Providing appropriate medical nutrition therapy that takes into account the client’s clinical condition, and preferences, when there is a nutritional indication.
In the State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care for §483.25(i) Nutrition F325 Nutrition, there is an excellent overview on nutrition and the critical role of nutrients. Nutrients are essential for many critical metabolic processes, the maintenance and repair of cells and organs, and energy to support daily functioning. Nutrition, Food and Dining all emerge into a very complex arena that affects the daily quality of life for each of our clients.
So as we are seeing a very rapid increase in our aging population, we look to improve our nutritional care and services. We continue to learn about the importance of
in the Aging Population
NUTRIT ION CONNECT ION
Eating Disorders
by Brenda Richardson, MA, RDN, LD, CD, FAND
UN D E RSTANDING
E AT I N G
D I SORDERS IN
THE E LDERLY
Nutrition & Foodservice Edge | February 2015 17
E ATI N G D I S O R D E R S I N T H E AG I N G P O P U L ATI O N A R E R E A L
• While often overlooked, when eating disorders occur significant morbidity and mortality result.
In a study published in the Journal of the International Psychogeriatrics (June 2010), a literature search of 48 published cases of eating disorders in people over the age of 50 years was conducted. The study shared that the mean age was 68.9 years, and the majority of the cases were female (88 percent). The majority of the cases had anorexia nervosa and 10 percent had bulimia nervosa. Late onset eating disorders were more com-mon than early onset. Comorbid psychiatric conditions existed in 60 percent, most commonly major depression. The most successful interventions included a combina-tion of behavioral and pharmacologic interventions. Mortality was high (21 percent) secondary to the eating disorder and its complications.
• Up to 24 million of all ages and gender suffer from an eating disorder (anorexia, bulimia and binge eating dis-order) in the United States.
• An estimated 10-15 percent of people with anorexia or bulimia are male.
• The elderly develop eating disorders for a number of reasons. These can range from loss of independence to the death of loved ones and a feeling of isolation. Refus-ing food can be a way of regaining control, or passively ending their own lives. Other reasons might include un-diagnosed depression, unresolved past issues, stress, at-tention seeking, etc. Remission can also occur in elderly people who have previously experienced the disorder.
• Women are more likely than men to develop an eating disorder.
T Y P E S O F E AT I N G D I S O R D E R S
Anorexia Nervosa
Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and exces-sive weight loss.
Continued on page 18
“resident choice” and that each client has the right to be actively involved in their care. We are learning more about decision making and the power of letting clients make decisions. So as we improve at identifying and monitoring weight changes and food issues, do we include consider-ation of the presence or risk our clients may have related to an eating disorder? Is there a need to improve our understanding of eating disorders and appropriate inter-ventions for the elderly? This article presents some key aspects of eating disorders to consider when caring for the aging population.
Nutrition & Foodservice Edge | February 201518
Continued from page 17
Symptoms:
• Inadequate food intake leading to a weight that is clearly too low.
• Intense fear of weight gain, obsession with weight, and persistent behavior to prevent weight gain.
• Self-esteem overly related to body image.
• Inability to appreciate the severity of the situation.
• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.
Warning Signs:
• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohy-drates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
Health Consequences of Anorexia Nervosa:
Anorexia nervosa involves self-starvation. The body is de-nied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:
• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing and in-creasing the risk for heart failure.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
Binge Eating Disorder (BED)
Binge Eating Disorder (BED) is a type of eating disorder that is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.
Symptoms:
• Frequent episodes of consuming a very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
• A feeling of being out of control during the binge eating episodes.
The elderly develop eating disorders for a number of reasons, ranging from loss of independence to the death of loved ones.
Nutrition & Foodservice Edge | February 2015 19
Continued on page 20
• Feelings of strong shame or guilt regarding the binge eating.
• Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.
Health Consequences of Binge Eating Disorder:
The health risks of BED are most commonly those associ-ated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease
• Musculoskeletal problems
About Binge Eating Disorder:
• The prevalence of BED is estimated to be approximately 1-5 percent of the general population.
• Binge eating disorder affects women slightly more often than men. Estimates indicate that about 60 percent of people struggling with binge eating disorder are female, 40 percent are male.
• People who struggle with binge eating disorder can be of normal or heavier than average weight.
• BED is often associated with symptoms of depression.
• People struggling with binge eating disorder often ex-press distress, shame, and guilt over their eating behav-iors.
• People with binge eating disorder report a lower quality of life than those who don’t have the disorder.
Bulimia Nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Symptoms:
• Frequent episodes of consuming a very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
• A feeling of being out of control during the binge-eating episodes.
• Self-esteem overly related to body image.
Warning Signs of Bulimia Nervosa:
• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vom-iting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen-—despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual friends and activities.
• Behaviors and attitudes indicating that weight loss, diet-ing, and control of food are becoming primary concerns.
Health Consequences of Bulimia Nervosa:
Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can damage the entire digestive system, and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.
Some of the health consequences of bulimia nervosa include:
• Electrolyte imbalances that can lead to irregular heart-beats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potas-sium and sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
Nutrition & Foodservice Edge | February 201520
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Gastric rupture is an uncommon but possible side effect of binge eating.
About Bulimia Nervosa:
• Approximately 80 percent of bulimia nervosa patients are female.
• People struggling with bulimia nervosa usually appear to be of average body weight.
• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
OT H E R S P E C I F I E D F E E D I N G O R E AT I N G D I S O R D E R
Other Specified Feeding or Eating Disorder (OSFED) is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.
Examples of OSFED include:
• Atypical anorexia nervosa (weight is not below normal)
• Bulimia nervosa (with less frequent behaviors)
• Binge-eating disorder (with less frequent occurrences)
• Purging disorder (purging without binge eating)
• Night eating syndrome (excessive nighttime food con-sumption)
The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious prob-lems in maintaining quality of life and care.
CO M M O N S I G N S A N D S Y M P TO M S O F E AT I N G D I S O R D E R S
Eating disorders in the elderly may present the same symp-toms as those in younger populations but the causes may appear a little different. Just like the younger population, the elderly may develop eating disorders to feel in control. As they see their bodies becoming frail and experience loss of autonomy, they may turn to their diet as one of the few things they feel they can control.
• Weight changes (significant and insidious)
> Weight loss whether it is voluntary or involuntary is well known to predispose them to muscle wasting, frailty, diminished immunocompetence, depres-sion and increased susceptibility to diseases and disorders, and strongly correlates with consequent morbidity and mortality.
• Depression with loss of appetite (or other anxiety disorders)
• Changes in behavior, such as disappearing right after a meal or using the restroom after eating
• Presence of laxatives, diet pills, or diuretics
• Missing, unused, or unopened food
• Fixation on death
• Chronic dizziness
• History of using one or more compensatory behaviors to influence weight after eating (fasting, dieting, etc.)
• History of using/abusing appetite suppressants, excessive caffeine, diuretics, laxatives, enemas, prescription meds, or a variety of complementary and alternative supplements.
N U T R IT I O N A L I N T E RV E N TI O N S
• Early recognition and timely intervention based on evidence-based and an interdisciplinary team approach (medical, nutritional, and psychological).
• Conduct a comprehensive nutritional assessment to include review of weight changes, anorexia, socioeco-nomic factors, medications, and appropriate labs/tests.
• Remember that clients with eating disorders may not recognize they are ill and they may be reluctant about accepting treatment.
• Always refer to appropriate healthcare providers for ad-ditional services as needed.
• Conduct an assessment for psychiatric risk, including suicidal and self-harm thoughts, plans, and/or intent.
• Liberalize dietary restrictions and adjust the diet to serve more of the foods they like.
• Serve several small meals throughout the day, rather than just a few big meals.
• Use flavor enhancers to improve the smell, appearance, or taste of food.
Continued from page 19
Nutrition & Foodservice Edge | February 2015 21
• Encourage the person to socialize and be active, includ-ing eating with others.
S U G G E S T I O N S FO R O N G O I N G M A N AG E M E N T
• Nutritional rehabilitation, weight restoration and sta-bilization, physiologic restoration, management of any refeeding complications, and interruption of purging/compensatory behaviors should be the immediate goals of treatment.
• Consider additional psychological and other therapeutic goals in parallel when possible.
• Work towards achieving an appropriate healthy weight, which assists in improving the physical, psychological, social, and emotional functioning of the client.
• Ongoing monitoring and support is needed. Distorted body image and eating disorder thoughts may persist after achieving a healthy weight and may require longer therapy.
CO N C LU S I O N
There are many issues underlying the growth of eating disorders in the elderly. As healthcare providers we need to recognize that our clients will benefit from prompt identification and evidence-based interventions. Risk of death from suicide or medical complications is markedly increased for individuals with eating disorders. Remember that eating disorders in older adults can be treated, thus improving a person’s health and hopefully allowing them to live longer with an improved quality of life. Nutrition plays a critical role in successful treatment. E
REFERENCES
Brenda Richardson, MA, RDN, LD,
CD, FANDisalecturer,author,and
consultant.SheworkswithDietary
ConsultantsInc.inbusinessrelations
anddevelopment,andispresident/
ownerofBrendaRichardsonAssoci-
ates,Inc.
iDanielleGagne,AnnVonHolle,KimberlyBrownley,CristinRunfola,SaraHofmeier,KatelandBranch,CynthiaBulik,Eating
DisorderSymptomsandWeightandShapeConcernsinaLargeWeb-BasedConvenienceSampleofWomenAges
50andAbove:ResultsoftheGenderandBodyImageStudy(GABI),InternationalJournalofEatingDisorders,Wiley-
Blackwell,DOI:10.1001/eat.220121
Dudrick,MD,FACS.EatingDisorders’PrevalenceIncreased,Today’sGeriatricMedicine,July/August2013.Pp.18-22.
Dudrick,MD,FACS,OlderClientsandEatingDisorders,Today’sDietitian,Vol.15No.11P.44,Nov.2013.
EatingDisordersStatistics.NationalAssociationofAnorexiaNervosaandAssociatedDisorderswebsite.http://www.
anad.org/get-information/about-eating-disorders/eating-disorders-statistics/.Accessedonline1/3/2015.
Lapid,MI,PromMC,etal.EatingDisordersintheElderly.IntPsychogeriatr.2010Jun;22(4):523-36.
StateOperationsManualAppendixPP-GuidancetoSurveyorsforLong-TermCareFacilities(Rev.127,11-26-14)(Rev.
130,12-12-14).Accessedonline1/2/2015.http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-
Only-Manuals-IOMs-Items/CMS1201984.html
WEBSITES FOR MORE INFORMATION:
http://www.nationaleatingdisorders.org/TheNationalEatingDisordersAssociation(NEDA)
http://www.iaedp.com/TheInternationalAssociationofEatingDisorders
http://www.aedweb.org/web/index.phpTheAcademyforEatingDisorders
http://unceatingdisorders.orgUniversityofNorthCarolinaCenterofExcellenceforEatingDisorders
http://renfrewcenter.com/TheRenfrewCenters
Nutrition & Foodservice Edge | February 201522
1. Oftenoverlooked,eatingdisordersresultin: A. Rulesthatmustbefollowedbythepractitioner B. Significantmorbidityandmortality C. Theneedtohavefoodinlockedcontainers
2. IntheUnitedStates,upto______ofallagessufferfromaneatingdisorder:
A. 10million B. 14million C. 24million
3. Theelderlycandevelopeatingdisordersforanumberofreasonsincluding:
A. Dislikeofchocolateandbananas B. Lossofindependence,togaincontrolorpassivelyend
theirlives C. Lackofavailabilityofunprocessedfoods
4. Typesofeatingdisordersinclude: A. AnorexiaNervosa,BingeEatingDisorder,BulimiaNervosa,
OtherSpecifiedFeedingorEatingDisorder B. Anorexia,Overeating,Fasting,Supplementation C. AnorexiaNeurosis,BingeWasting,EatingDyslexia
ReadingNutrition and Eating Disorders in the Aging Population andsuccessfullycompletingthesequestionsonlinehasbeenapprovedfor1hourofCEforCDM,CFPPs.CEcreditisavailableONLINEONLY.Toearn1CEhour,purchasetheonlineCEquizintheANFPMarketplace.Visitwww.ANFPonline.org/market,select“Publication,”thenselect“CEarticle”atleft,thensearchthetitle“Nutrition and Eating Disorders in the Aging Population”andpurchasethearticle.
NUTRITION CONNECTIONReview Questions
5. Screeningfornutritionalriskshouldbecompletedfor: A. Groupsettingsforthoseatrisk B. Familymembers C. Eachindividualatriskorwithaneatingdisorder
6. Provideindividualizednutritionalinterventionsbasedon: A. Interdisciplinaryteamapproachformedical,nutritional,and
psychologicalneeds B. Idealbodyweightinthepastsixmonths C. Averageofthetotalnutrientsinthemenusoffered
7. Theimmediatetreatmentgoalsforaclientatriskorwithaneatingdisorderinclude:
A. Additionalfluidsandlargeportionsdiet,dietarysupplement(s) B. Nutritionalrehab,weightrestorationandstabilization,
physiologicandcompensatorybehaviorsinterrupted C. Restrictingdietarychoicestoreducesodium,sugar,andfat
M A K E YO U R C E H O U R S AU D I T P R O O FAttentionCDMs!PurchaseyouronlineCEproductsintheANFPMarketplaceandyourcompletedCEhourswillbeautomaticallyreportedinyourcontinuingeducationrecord.ThisincludesallANFPonlinecourses,archivedwebinars,andCEonlinearticles.
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IDEA STARTERS
It’s the first quarter of 2015—a good time to evaluate how you can improve your foodservice operation in the year ahead. Consider the following 50 tips that can stream-line or improve your systems, and may ultimately enhance your resident satisfaction scores and bottom line.
1. Invest in dish racks if you don’t have them or have the wrong kind. Replace broken racks. This is the single best way to protect your investment in china and allow items to air dry properly.
2. Limit garbage cans to the number actually needed and attach lids. Connect lids with cleanable nylon cords.
3. Check cleanliness of the dumpster area. Take or request action as needed. Make this part of your daily routine, not just when preparing for your state survey.
4. Interview applicants periodically even if you’re fully staffed. Having a back-up plan is a great safety net if employee issues arise and you need to hire on short notice.
5. Use your chemical vendor to in-service and orient staff. Establish core points to cover: cleaning and sani-tizing methods, de-liming the dish machine, proper chemical dilution ratios, and more.
to Improve Your Foodservice Operation
50 Ways
by Wayne Toczek
Nutrition & Foodservice Edge | February 2015 25
9. Request a monthly velocity report from your prime ven-dor. Meet monthly and look for purchasing opportunities.
10. Meet with your prime vendor rep quarterly to discuss savings strategies and new products.
11. Keep all recipes for the current menu cycle in both electronic and hard copy format. Look into produc-tion software that can easily expand recipe yields to desired amounts.
12. Commit to a consistent calendar of special events. Plan holiday meals and specific theme days in ad-vance. Example: Every third Thursday of the month is an ice cream social or is Taste of the World Day.
13. Update policies and procedures. Keep them current at all times and inform staff of any changes.
14. Change sanitizer solutions in buckets and sinks ac-cording to a schedule, such as every four hours. In heavy use times, replace more often.
16. Find one item in your kitchen that has not been used in six months and remove it. Reduce clutter daily.
17. Offer beverages in bulk. Save money and time with this practice.
18. Offer a dessert cart every week or every month.
19. Stop worrying about the 14.5 hours between dinner and breakfast by offering continual breakfast begin-ning at 6:30 am. Investigate the possibilities and think outside the box.
6. Download the state or local Food Code and use as your go-to food safety guide.
7. Jot down an agenda for each food show you attend. Target vendors based on specific food and menu items you want to learn about.
8. Monitor your preventive maintenance program. Pre-pare a preventive maintenance schedule if you don’t have a maintenance department. Don’t wait for equip-ment to fail—help avoid breakdowns with a proactive plan.
Continued on page 26
15.Create an opening and closing checklist and use it every day. This allows y our department to always be ready for inspection.
Nutrition & Foodservice Edge | February 201526
21. Purchase a wet vac. Use it to clean out such items as non-drainable steam tables and other types of equipment.
22. Communicate with email, especially work orders. This gives you an electronic “paper trail” should questions arise.
23. Keep a maintenance log. Include every work order and follow-up request.
24. Calculate a return on investment for each piece of equipment you need. Present those figures to your boss with the purchase order.
25. Remove all drawers periodically. These are hiding places for dirt and clutter.
26. Designate specific areas for sanitizer buckets and keep them there.
27. Develop your in-service calendar and stick to it. Add extra programs as needed.
28. Visit 10 percent of your customers every day and document it. This means a different 10 percent until all have been visited; then start over. This is the best way to determine customer satisfaction and create a communication line to your department. Commit to resolving issues promptly and documenting steps.
29. Review the waste in your dish room, document and track it. Determine how it can be reduced.
30. Orient all new employees completely. Follow up and repeat until new staff members are competent. Allow employees to do each job independently before train-ing for another position.
31. Write a department business plan. Address such ques-tions as: How will your services look, feel, or perform differently? What is your timeframe for achieving results/change? What resources do you need to achieve your results – and what are the costs of those resources? How will you measure success? How does your plan support the company’s Mission Statement?
32. Track everything that leaves the department and cost it out. Your food cost is the cost of your meal and all the extra things like cookies for special events. Track staff meals. This analysis allows informed decision-making on budgeting.
33. Keep a log of all leftovers. Develop a game plan to use, and adjust production as needed for the next menu cycle. Add these items to your production sheet to communicate with staff.
34. Establish a par stock shelf for china and stop panic buying when a dozen pieces break all at once. De-velop and follow a formula that includes pattern and supplier for all tableware to avoid mismatched service ware and reduce breakage.
36. Update all signs posted in your kitchen to improve clarity and appearance.
37. Track your invoices every week and assess how you are doing in relation to the budget. Share this infor-mation with staff.
38. Understand what technology can do to make your job easier and make time to learn to use it.
Continued from page 25
20.Get creative with supplements and offer a variety of foods. Other items have similar protein and calories, like health shakes.
35.Keep steam table pans in good condition. Bend pan edges back to normal every week so they lay flat on the steam table. Creating a good seal helps ensure proper temperature retention.
Nutrition & Foodservice Edge | February 2015 27
40. Perform QA audits according to the schedule because it’s the right thing to do. By completing these audits and taking action when indicated you will always be prepared for inspection.
41. Support and encourage your staff to become ServSafe or CDM certified.
42. Make sure everyone in your department can calibrate a thermometer.
43. Mount your thermometer in the warmest spot in your cooler(s). Read internal temperature in freezer and cooler to ensure your foods are not in the danger zone.
44. Update resident preferences six months after admis-sion and every six months thereafter. Requests and preferences change over time.
45. Cable tie any cord or hose up off the floor. This allows for proper cleaning and also avoids food collecting on cords lying on the ground.
46. Learn about functional garnishing and teach your staff. Functional garnishing is a great, cost-effective way to present food. Offer food in a fashion that is function-ally garnished in presentation and with condiments.
47. Take the temperature of food at the beginning, middle, and end of service. The best way to test your temperature retention efforts is to read the thermom-eter in the middle and at the end. This allows you to determine whether your steam tables are staying hot, or if staff is turning steam tables off early to allow for easier cleaning.
48. Develop a program to greet all new residents. Create a plan that allows you to introduce yourself, give them a business card, and tell them about meal times and menus, and establish that direct contact relationship.
49. Make simple enhancements to the dining service for your rehabilitation customers. Enhance your room service trays. Consider keeping the condiments in a small, attractive caddy, instead of laying them on the tray. If feasible, use linen napkins instead of paper napkins to upgrade the appearance of your tray service.
There you have it! Fifty suggestions for a more efficient, effective operation in 2015. Pick and choose the ideas that best meet your unique needs, and brainstorm additional tactics with your staff to make your food service the best it can be! E
Wayne ToczekisCEOofInnovations
Services,Norwalk,Ohio.Contacthim
at(419)663-9300orvisit
www.innovaservices.info.
50.Read four good business books per year. Read magazines such as Edge to learn from your peers and professionals in the industry.
39.Sell your value to your boss every month. Present a report of what you have done and achieved.
Nutrition & Foodservice Edge | February 201528
HYDRAT ION IN LONG-TER M C AR E
TeaHydration is a common concern in long-term care. Drinking more water is often recommended. But why not consider tea as an option? The Food and Nutrition Board of the Institute of Medicine in its most recent refer-ence intakes for water in 2005 states, “caffeinated bever-ages appear to contribute to the daily total water intake similar to that contributed by non-caffeinated beverages.” Studies show no effect on hydration with intakes up to 400 mg of caffeine or the equivalent of 8 cups of tea.
Why is hydration important? The adult body is 50-65 per-cent water and needs a balance of water and electrolytes to properly function. Water controls body temperature, impacts blood pressure, removes waste through urine, and
much more. How much water the body needs varies with health conditions, environment, and exercise. When suf-ficient fluids are not consumed dehydration can cause con-fusion, problems with balance, headaches, faintness. Foods such as soup, yogurt, milk, pudding, ice cream, vegetables, and fruits all contain some amount of fluid. The more variety of fluids consumed, the less likely the individual is to be dehydrated. However, even with all of these options, many seniors become dehydrated because of decreased intake of food and fluids or drinking less to minimize the need to urinate. Tea is one option for variety in fluids that is not often considered.
Time for
by Linda S. Eck Mills, MBA, RDN, LDN, FADA
Nutrition & Foodservice Edge | February 2015 29
ages should really be called by more appropriate names, such as herbal tea, herbal infusions, or tisanes. Tea is not a ready-to-drink powder, a ready-to-drink bottled beverage, or a hyper-caffeinated ‘quick shot.’
There are six classifications of tea—green, yellow, white, oolong, black, and Pu-erh. The classification is determined by the production method.
Green Tea
The leaf retains its green color both dried and in the cup. The best green teas are made in the spring from young tender leaves or buds. Green tea is the specialty of China, Japan, and Korea. The best way to drink green tea is with-out milk or sugar.
Yellow Tea
Most yellow teas are made from fat, juicy spring-plucked tea buds; a few are made from large, leafy basket-fired teas. Yellow tea is made in just a few places in China. Even though yellow tea is included as one of the six classes of tea, it is a rare commodity. The best way to drink yellow tea is without milk or sugar.
White Tea
This is a spring-plucked, bud-only tea. The flavor of true white tea is soft and light, and slightly reminiscent of a light black tea. The best way to drink white tea is without milk or sugar.
Oolong Tea
This variety is a tea enthusiast’s dream. Oolong teas are re-freshing and generally described as lush and floral. Oolong teas are best drunk without milk or sugar.
Black Tea
This is the most popular tea among Western tea drinkers. Black teas are flexible, made to be drunk black, with milk and sugar, or with a squeeze of lemon or honey.
Pu-erh
This is China’s most famous fermented tea and is made exclusively in the tea mountains of the Yunnan Province. It can be sweet and light or strong and toothsome. This tea is the daily tea of millions of people in China.
S T E E P I N G T E A
The goal in preparing a delicious cup of tea is to have the right amount of tea, with the right amount of water, for the right amount of time. For most teas, 2-3 grams of leaf and 6 ounces of water for every 6 ounces of capacity in your teapot or steeping cup is recommended. The amount
T I M E FO R T E A FAC T S
Until the early 1800s, only three countries produced tea. To-day that number has risen to over 41 countries. Tea is both the dried leaves and buds of the Camellia sinensis genus of plants, and the caffeinated beverage made from these leaves and buds. Tea is also all wild-growing and ancient tea trees and generations of indigenous tea bushes and tea trees naturally growing in southwest China, Laos, Burma, Thai-land, and Vietnam.
It’s important to note that tea is not a beverage made from or an infusible dried mixture comprised of roots, stems, flowers, seeds or the fruit of any other plant such as pep-permint, chamomile, lavender, etc. As such, these bever-
OPT I ONS TO
MA I N TAIN
HYD RAT ION
Continued on page 30
Nutrition & Foodservice Edge | February 201530
most consumed types of tea. Green tea studies primarily have been with Asian populations who have a different lifestyle and diet than Americans. Studies of individual ingredients to tea – such as caffeine and flavonoids – may not apply to brewed tea consumed in normal amounts. The type of tea, brewing time, and method can affect amounts of compounds present in a cup of tea. Flavonoids in black and green tea prevent oxidation of LDL “bad” cho-lesterol and reduce blood clotting. Black tea can suppress salivary amylase and reduce the cavity-causing potential of starch. Tea catechins have antibacterial properties. Tea polyphenols enhance bone formation and inhibit bone re-sorption resulting in greater bone strength. Fluoride in tea and water can strengthen bones. Tea catechins and caf-feine stimulate thermogenesis and fat oxidation. Regular ingestion of green, white, and oolong teas increase energy expenditure by 4-5 percent and fat oxidation by 10-16 percent. One gram of instant black tea in 250ml of water significantly lowered plasma glucose levels at 120 minutes compared with caffeinated and control beverages.
So, for hydration and health benefits, consider tea as a deli-cious and viable beverage option for your residents. E
Continued from page 29
of tea in 2-3 grams can vary from 1 teaspoon to 2 table-spoons, depending on the leaf size. The measure will be a greater volume of leaf when the leaf is large than when the leaf is small. Some types of loose-leaf tea can be re-steeped several times, which will increase the number of cups of tea obtained from the same 4 ounce quantity of tea.
Water temperature is a critical factor in extracting the best flavor from the tea leaves. Most tea leaves do not like to be blasted with boiling hot water, and more delicate grades of tea such as green and white teas can easily be scorched. To avoid over-extracting the flavor components of the leaf, it is better to steep the leaves slightly longer at a cooler temperature than with water that is too hot.
The final variable in making good tea is the amount of time that the tea leaf is steeped. Tea that is either under-steeped or over-steeped is disappointing. Each type of tea has a steeping time that it responds to best. Black teas prefer steep times of 3-5 minutes; green, white, and yellow teas prefer short steep times of 1-2 minutes; oolong teas prefer steep times of 2-4 minutes; Pu-erh tea prefers steep times of 3-4 minutes.
T E A R E S E A R C H A N D H E A LT H B E N E F IT S
Many studies are observational or epidemiologic so they don’t necessarily show cause and effect. However, caffeine is one of the most-researched substances in the food sup-ply. Caffeine has a long history of safe use. Most studies have been done on green and black teas since they are the
Linda S. Eck Mills, MBA, RDN, LDN,
FADA isaprofessionalspeaker,aca-
reercoach,andco-authorofthebook
Flavorful Fortified Food – Recipes
to Enrich Life.MillsdirectstheANFP
programatLehighCarbonCommu-
nityCollege(Schnecksville,Pa.),and
worksincorrectionalfoodservice.
TeaTime:CulturalTraditionsandHealthBenefitssessionatAND’s2014FoodandNutritionConferenceandExpo
Teatrekker.com
DietaryReferenceIntakesforWater,Potassium,Sodium,Chloride,andSulfate.InstituteofMedicine,TheNationalAcademies
Press,Washington,DC,2005http://www.nap.edu/openbook.php?isbn=0309091691
REFERENCES
Comfort Foods and Comfort Care
Food Allergies
When is Weight Loss Really Weight Loss?
Fortification vs. Supplementation
For many, the long-term care facility is the final living situation for the elderly. Provid-ing for comfortable living in the “golden years” should be of the utmost importance. Food plays a very important role in the quality of life. Comfort Foods and Com-fort Care allows the CDM to discuss the current trends in providing comfort foods, how to incorporate these foods into the healthcare menu, and to understand the relationship between comfort foods and comfort care in the elderly population.
The concept of “liberalized diets” is now mainstream in long-term care. Standards of Practice for Individualized Diet Approaches outlines the recommenda-tions of the Dining Practice Standards from the Pioneer Network. The Standards help CDMs identify dining requirements, the importance of food selection, and under-stand CMS requirements.
Food allergies have been a “hot topic” in the nutrition literature and seem to be on the rise in the United States. Through this Food Allergies course, the CDM will be able to identify common aller-gens, read labels looking for specific food allergens, and discuss food preparation challenges that may be faced in the food-service setting.
Obesity is now considered a public health crisis and epidemic in the United States. It is interesting, though, that in the healthcare world unintentional weight loss is also a serious condition. When is Weight Loss Really Weight Loss? looks at the obesity epidemic in the U.S. It then discusses the concepts of intentional and unintentional weight loss in health care and how to manage it.
Recently, the concept of “Real Food First” is one that examines the use of real food as a supplement for a client who may be los-ing weight. So what is the role of fortified foods or nutrition supplements in nutrition care? Fortification vs. Supplementa-tion will examine the common terms used for this discussion, and how these foods can be used in patient care in the health-care setting.
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Nutrition & Foodservice Edge | February 201532
Healing
WOUND HEAL ING STRAT EG IES
According to the Centers for Disease Control and Prevention National Nursing Home Survey, 159,000 (11 percent) of US nursing home residents had a wound, of which, pressure ulcers were the most prevalent.1 Wounds can lower overall quality of life, increase length of stay, and increase risk of mortality.2, 3 Therefore, clinical nutrition practice guidelines have been developed as adequate nutri-tion plays a critical role in the wound healing process and contributes to reduced cost of wound care and improved quality of life.4
P R OT E I N FO R WO U N D H E A L I N G
Protein, in particular, plays the most important role in nutrition wound therapy. It is involved in all phases of the healing process and aids in tissue growth and repair. Protein is used in the synthesis of enzymes involved in healing, cell multiplication, and collagen and connective tissue.4 Sufficient caloric intake is required to prevent protein from being utilized as a source of energy.4 Intake of dietary protein is especially important in older adults due to changes in body composition that are associated
Nutrition Therapy for
Woundby April Irvine, MS and Julie Moreschi, MS, RD, LDN
LE A RN MORE . . .
...about pressure ulcers at ANFP’s
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Nutrition & Foodservice Edge | February 2015 33
serum albumin levels to evaluate nutritional status of patients. However, recent research concluded that while serum albumin may be useful to help establish overall prognosis (i.e. morbidity and mortality), it is no longer appropriate to use as a marker of visceral protein status.6, 7 Many non-nutrition related variables affect serum albumin levels including dehydration, acute stress, inflammation, metabolic stress, burns, surgery, and cancer.8
Medical nutrition therapy (MNT) for wound healing in-cludes the following: 9
1. Increase energy requirements to 35 to 40 kcal/kg for wound healing. According to the National Pressure Ul-cer Advisory Panel, adjust calorie level based on weight changes and/or obesity.
2. 1.25-1.5 g protein/kg to achieve positive nitrogen bal-ance. Assess renal function to ensure appropriate pro-tein intake.
3. 30 ml fluid/kg to prevent dehydration. Increase fluid requirements due to heavily drained wounds, fever, vomiting, and sweating.
4. Provide sufficient vitamin and mineral intake through a balanced diet. If dietary intake is poor or deficiencies occur, provide a vitamin and mineral supplement that includes zinc and vitamin C.
• Due to the draining of wounds, zinc deficiency may occur. Include a multi-vitamin and mineral supple-ment with zinc.
• Vitamin C is also important in wound healing because it is needed to make collagen, and repair tendons and ligaments.10
I N E X P E N S I V E WAYS TO I N C R E A S E C A LO R I E S A N D P R OT E I N
It is necessary to individualize nutritional approaches or interventions to ensure that individuals will receive food they like or are willing to eat. While food supplements such as nutritional shakes and drinks may be one method to increase calories and protein, it is often a more expen-sive approach. Try food first, using items already served, and fortify it to increase calories and protein with every bite eaten.
with aging, decreased physical activity levels, and reduced immune function. These changes can lead to impaired wound healing and inability to fight infection.4 Arginine becomes a conditionally essential amino acid in stressed adults. Arginine promotes wound healing by increasing collagen deposition and improved immune function.5
B I O C H E M I C A L A N A LYS I S
Laboratory value analysis is one component of nutrition assessment for wounds. Historically, dietitians have used Continued on page 34
Nutrition & Foodservice Edge | February 201534
April Irvine, MS,registrationeligible,receivedhermas-
ter’sdegreeinNutritionandWellnessfromBenedictine
University,Lisle,Ill.,andherbachelor’sdegreeinCulinary
NutritionfromJohnson&WalesUniversity,DenverColo.
Julie Moreschi, MS, RD, LDNistheDieteticInternship
DirectoratBenedictineUniversityinLisle.Shehasbeen
anRDforover29years,andholdsamaster’sdegreein
NutritionfromRushUniversity,Chicago.
Continued from page 33
• Add peanut butter on bread or apples, blend into milk-shakes, or bake in cookies as a healthful approach to increase calories and protein.
• Coat vegetables with olive oil or butter to increase calories.
• Use sour cream in mashed potatoes or as a dip to increase calories.
• Add skim milk powder to oatmeal or hot cereals, soups, puddings, milkshakes, or other beverages to increase protein.
• Offer additional portions of meat, poultry, fish, eggs, yogurt, and/or cottage cheese to increase protein.
S U M M A RY
Enhancing quality of life for individuals with—or at risk for—pressure ulcers is of the utmost importance. Tap into the resources available to you, several of which are cited here, to learn more about the role of medical nutrition therapy in preventing and treating pressure ulcers. E
REFERENCES
i1.Park-LeeE,CaffreyC.Pressureulcersamongnursinghomeresidents:UnitedStates,2004.NCHSdatabrief,no14.
Hyattsville,MD:NationalCenterforHealthStatistics.2009.
2.BriggsM,CollinsonM,WilsonL,etal.Theprevalenceofpainatpressureareasandpressureulcersinhospitalised
patients.BMCNurs.2013;12(1):19.
3.GoreckiC,LampingDL,BrownJM,MadillA,FirthJ,NixonJ.Developmentofaconceptualframeworkofhealth-related
qualityoflifeinpressureulcers:apatient-focusedapproach.IntJNursStud.2010;47(12):1525-34.
4.DornerB,PosthauerME,ThomasD.Theroleofnutritioninpressureulcerpreventionandtreatment:NationalPressure
UlcerAdvisoryPanelwhitepaper.AdvSkinWoundCare.2009;22(5):212-21.
5.BrownKL,PhillipsTJ.Nutritionandwoundhealing.ClinDermatol.2010;28(4):432-9.
6.WhiteJV,GuenterP,JensenG,etal.ConsensusstatementoftheAcademyofNutritionandDietetics/American
SocietyforParenteralandEnteralNutrition:characteristicsrecommendedfortheidentificationanddocumentationof
adultmalnutrition(undernutrition).JAcadNutrDiet.2012;112(5):730-8.
7.IizakaS,SanadaH,MatsuiY,etal.Serumalbuminlevelisalimitednutritionalmarkerforpredictingwoundhealingin
patientswithpressureulcer:twomulticenterprospectivecohortstudies.ClinNutr.2011;30(6):738-45.
8.MuellerC,CompherC,EllenDM.A.S.P.E.N.clinicalguidelines:Nutritionscreening,assessment,andinterventionin
adults.JPENJParenterEnteralNutr.2011;35(1):16-24.
9.NationalPressureUlcerAdvisoryPanel,EuropeanPressureUlcerAdvisoryPanel.Pressureulcertreatment
recommendations.In:Preventionandtreatmentofpressureulcers:clinicalpracticeguideline.Washington(DC):National
PressureUlcerAdvisoryPanel;2009.p.51-120.
10.InstituteforClinicalSystemsImprovement(ICSI).Pressureulcerpreventionandtreatmentprotocol.Healthcare
protocol.Bloomington(MN):InstituteforClinicalSystemsImprovement(ICSI);2012Jan.88.
Nutrition & Foodservice Edge | February 2015 35
Many doctors’ offices across the country have a resolution for the New Year: switching to a team-based model of care called the patient-centered medi-cal home, reports the January 2015 Harvard Health Letter.
“It’s the highest and best version of primary care, specifically designed to take care of people’s preven-tive needs as well as complex chronic conditions,” says Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Harvard-affiliated Massachusetts General Hospital.
The patient-centered medical home model turns a doctor’s practice into a physician-led team that helps patients meet their health goals by getting to know them, developing long-term treatment plans for them, focusing on prevention, educating them about how
to reach their goals, and coordinating care with other specialists if necessary. The team must be available, at least by telephone, 24 hours a day, seven days a week. Several national accreditation programs hold the team accountable to these high standards.
The patient-centered medical home concept was introduced by the American Academy of Pediatrics in the 1960s and took off in the late 2000s among fam-ily practice and internal medicine doctors. Since then, thousands of doctor’s offices have made the switch. Employers are driving the change because they know this model provides high-quality and efficient care for their workers and reduces care people don’t need. “Also, doctors know it decreases burnout among physi-cians and staff,” says Edgman-Levitan. “They’ve now got a team of people helping them do their job better.” E
Patient-Centered Medical Homesto Increase in 2015
Readthefull-lengtharticle:“NewYear,NewApproachto
HealthCare”at:www.health.harvard.edu/health
i
Nutrition & Foodservice Edge | February 201536
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(confidentially,ifyouprefer).
Dozensofarticlesdesignedtohelpyoubefore,
during,andafteryourjobsearcharealsoavailable
freetoANFPmembers.
New Year, NewCareerOpportunities
Enjoy unlimited access
to the CDM Career Network at no
cost! Visit www.healthecareers.com
Nutrition & Foodservice Edge | February 2015 37
LEGISLAT IVE REPORT
by Craig Brightup
ANFPGovernmentAffairsUpdate
ANFPPresidentandCEOJoyceGilbert,PhD,
RDNcametoWashington,DC,formeetings
Dec.2-3topreparefortheSafeFoodforSe-
niorsActtobereintroducedinthe114thCon-
gress;augmentANFP’spresenceonCapitolHill;
andgeneratemoresynergywiththeAcademy
ofNutritionandDietetics(theAcademy).Se-
curingsupportinthenewCongresswastheba-
sisformeetingswithstaffforSen.BobCorker
(R-TN),amemberoftheSpecialCommitteeon
Aging,andReps.ReidRibble(R-WI)andLynn
Jenkins(R-KS).
Rep.JenkinshadpreviouslycosponsoredH.R.
2181andisontheWaysandMeansCommittee,
whichhasjurisdictionoverthebill.Rep.Tom
Latham(R-IA)hadintroducedH.R.2181inthe
lastCongressbutisretired,soRep.Jenkins’
staffofferedtospeakwithheraboutintroduc-
ingthebillinthisCongress.Thisofferwas
reiteratedbystaffatRep.Jenkins’swearing-in
openhouseonJan.6(thestartofthe114th
Congress),andIexplainedthattheLegisla-
tiveCounsel’sOfficedraftedH.R.2181atRep.
Latham’srequestandthetextisgoodtogoin
thisCongress.
WealsodroppedbytheofficesofSen.Al
Franken(D-MN)andRep.PeterRoskam(R-IL),
whosedistrictincludesANFP’sheadquarters.
JoiningusforallofthesemeetingswasEStreet
PartnerThadHuguley,whoisnowpartofour
Washingtonoffice.Huguleyhadarrangedthe
meetingwithSen.Corker’sofficeandiswell-
positionedtohelpgeneratecosponsorswhen
thebillisreintroduced.
BringingHuguleyonboardispartofANFP’s
advocacyshifttoWashingtontoallowmore
outreachtoCapitolHillandwithorganizations
thatsharemutualinterestswithANFP.The
Academywasoneofsixorganizationsthat
officiallysupportedH.R.2181duringthelast
Congress,andwehadaproductivemeeting
withitsVicePresidentforStrategicPolicyand
Partnerships.WewillworkwiththeAcad-
emyonissuessuchasimplementationofthe
ImpactAct(ImprovingMedicarePost-Acute
CareTransformationActof2014),andlook
forwardtotheAcademy’sactivehelponthe
SafeFoodforSeniorsAct.
Whenreintroduced,theSafeFoodfor
SeniorsActwillgetanewnumberforthis
Congress.IfRep.Jenkinsintroducesthebill,
wewillaskRep.EarlBlumenauer(D-OR)to
againbetheleadcosponsor.Wewillalso
askRep.SanfordBishop,Jr.(D-GA)tobe
acosponsoragain,andmoveaggressively
togeneratemorecosponsorsbyjumpstart-
ingour“Gimme10”grassrootscampaignto
generate10morecosponsors. E
When the 113th Congress ended Dec. 31, 2014, the Safe Food for Seniors Act came to an end,
too, at least insofar as being H.R. 2181. Thus, the first step for ANFP in the 114th Congress is to
get the Safe Food for Seniors Act reintroduced with a new bill number, and preparations to do
so began in December.
Watch for Legislative Updates onANFP’sAdvocacyWebsite
ANFP has a dedicated website devoted
to boosting awareness of the CDM
credential and providing ANFP mem-
bers with a voice in legislative issues
impacting foodservice management
and safety.
Look for progress updates on the bill,
ways to help at the grassroots level, and
more at www.safefoodcdm.org.
Craig Brightupis
ANFP’sgovern-
mentaffairs
consultantin
Washington,DC.
Nutrition & Foodservice Edge | February 201538
ANFP LEADERSHIP SPOTL IG H T
Meet Certifying Board MemberYvonneFoyt
NewsfromtheCertifying Board
Yvonne Foyt, CDM, CFPP
C E R T I F Y I N G B OA R D M E M -
B E R YvonneFoyt,CDM,CFPP,is
DietarySupervisoratParksideLu-
theranNursingHomeinLisbon,N.D.
LikemanyCDMs,herfirstbrushwith
thefoodserviceindustrycameinhigh
school,whenshewaitressedatlocal
restaurantstoearnspendingmoney.
Herbigbreakcamein1980,whenshe
tookajobasacookatCommunity
MemorialHospitalandNursingHome
inLisbon.FellowANFPmemberKristi
Salisbury,RD,CDM,CFPPwasher
supervisoratthetime.
“Kristiwasawonderfulmentor.She
gavemetheopportunitytotakethe
DietaryManagersCoursethroughthe
UniversityofNorthDakota,forwhich
Iwillbeeternallygrateful.Ifinished
thecoursein1988,joinedANFP,and
becameDietarySupervisoratCom-
munityMemorialin1990,”saidFoyt.
OfherjobatParkside,Foytsaysitis
thebestintheworld.Listeningintently
CDM CREDENTIALING EXAM OFFERED YEAR-ROUND
TheCDMcredentialingexamisofferedyearroundatmore
than190approvedcomputertestingcenters.Thismeanscan-
didatescanscheduletheirexamonthedateandatthetesting
locationoftheirchoosingaftertheymeetCBDMrequirements
andreceiveconfirmationfromANFPthattheirapplicationhas
beenapproved.
The CDM Credentialing Exam Candidate Handbook contains
examdetails,includingtheeligibilityrequirementsandapplica-
tion.Downloadtheexamhandbookatwww.ANFPonline.org.
EXAM SCHOLARSHIPS AVAILABLE
TheNutrition&FoodserviceEducationFoundation(NFEF)is
offeringscholarshipstocovertheCDMCredentialingExam
fee.March 1, 2015isthenextdeadlineforapplications.Learn
moreatwww.NFEFoundation.org
toherclientstellthestoriesoftheirlives
isadailyjoy.Inheropinion,thereisno
greaterreward.
“Theyarethemostheartwarmingpeople
Ihaveevermet.Theyhavesomuch
wisdomandinterestinglifestoriesto
share.Everymomentspentwiththemis
special,”shesaid.
Thereare,ofcourse,struggles.There
isthedailychallengeofmeetingthe
dietaryandfoodpreferenceneedsof
peoplewhoareusedtobeingincontrol
oftheirmeals.Thentherearethebud-
get,time,andstaffconcernsthataffect
allfacilities.Todealwiththepressures,
Foytoftenturnstoherpeersforsupport
andurgesanyoneconsideringdietary
managementtodothesame.Building
astrongpeersupportnetworkisoneof
herkeystosuccess.Soisjoiningprofes-
sionalorganizations,likeANFP.
“MymembershipinANFPmeansthe
worldtome.Ithashelpedmegrowmore
confidentinmyprofessionalandper-
sonallifeandshownmethatweare
animportantpieceofthehealthcare
team.ANFPhasgivenmesomany
toolstouseinmywork.Ihaveloved
everyminuteofbeinganANFP
volunteer,”saidFoyt.
Duringheroffhours,Foytlikesto
crochetandreadDanielleSteelro-
mancenovels.Shespendsthebulk
ofherfreetime,though,withtwo
specialpeople:hergranddaughters.
“Ilovespoilingthem,”shesaid. E
The Certifying Board for Dietary Managers (CBDM) announces
news and policy changes of interest to CDMs.
AUDITING OF CE SELF-REPORTING RECORDS BEGINS IN JUNE
CDMsarenowresponsiblefortrackingtheirowncontinuing
education(CE)hours,andsubmittingthemattheendoftheir
three-yearcycle.Withself-reportingnowineffect,auditing
ofCErecordswillbegininJune2015.CDMsshouldsaveall
continuingeducation-relateddocumentation(proofofat-
tendance,certificatesofcompletion,etc.)fortwothree-year
certificationcyclesincaseofaCEaudit.
The CBDM Guide to Maintaining Your CDM, CFPP Credential,
whichcontainsstep-by-stepinstructionsforself-reporting
andincludesCEdocumentationrequirements,isavailable
fordownloadatwww.anfponline.org/Docs/CE_SelfReport-
ing_Guide.pdf.
Nutrition & Foodservice Edge | February 2015 39
NEED CONTINUING EDUCATION HOURS AND NOT SURE ABOUT
YOUR OPTIONS?
ANFPhasanewresourceguideforCDMswhowanttolearnabouttheCE
programs,publications,andcoursesavailabletoyoufromyourprofessional
association.
Optionsandformatsforeducationabound.Whetheryoupreferonline
courses,webinars,PDFdownloads,ortraditionalprintedmaterials,there
areresourcesgearedforyourlearningstyleandschedule.Andeducation
topicsarediverseandcoversubjectsrangingfromleadershiptomedical
nutritiontherapytosanitation&safety.
Meetings Preview2015 ANFP
REGIONAL MEETINGS
ANFPRegionalMeetingsprovidetop-notcheducationat
affordableandconvenientlocationsacrossthenation.
13 CE Hrs. per Regional Meeting
March 12-13: NorthCentralRegionalMeeting,Embassy
SuitesO’Hare,Rosemont(Chicago),IL
April 16-17: NortheastRegionalMeeting,HiltonGardenInn
Downtown,Richmond,VA
May 7-8:WestRegionalMeeting,EmbassySuites,
LasVegas,NV
ANFP IS YOUR PROFESSIONAL PARTNER forcontinuingeducation!ChoosefromRegionalMeetings,theAnnualConference&Expo,and/orChapterMeetingsin2015.
®
ANNUAL CONFERENCE & EXPO
JoinyourfriendsandcolleaguesforANFP’snational
meeting.Enjoyqualityeducationandprogramsthat
buildonthetheme:BringingValuetotheTable.
20 CE Hrs.
August 2-5: HyattRegencyGrandCypress,Orlando,FL
SAV E T H E DAT E S FO R T H E S E A N F P E D U C ATI O N A L & N E T WO R K I N G E V E N T S
L E A R N M O R E AT: w w w. A N F P o n l i n e . o r g C l i c k “ Eve n t s ”
CHAPTER MEETINGSManyANFPstatechaptershostspringandfall
meetings.VisittheANFPwebsiteperiodicallyto
learnaboutchaptermeetingsasdatesandlocations
becomeavailable.
www.ANFPonline.org/Chapters
ACE&&ORLANDO, FL | 2015
AnnualConference & Expo
ANFP’s2015-2016Products & Services Catalog
M A K EYO U R C E H O U R S AU D I T P R O O FAttentionCDMs!PurchaseyouronlineCEproductsintheANFPMarketplaceandyourcompletedCEhourswillbeautomaticallyreportedinyourcontinuingeducationrecord.ThisincludesallANFPonlinecourses,archivedwebinars,andCEonlinearticles.
®
PRODUCTS & SERVICES CATALOG | 2015-2016OFFICIAL RESOURCE GUIDE OF THE CDM® | CFPP®
EARN CE CREDIT / DEVELOP LEADERSHIP SKILLS /
GAIN BEST PRACTICES / NURTURE YOUR CAREER /
IMPROVE QUALITY OF CARE / GAIN MASTER TRACK
KNOWLEDGE / ACCESS IMPORTANT REFERENCES,
TEXTBOOKS, AND ONLINE COURSES / START TODAY!
G O L D S TA N DA R D
CE
C B D M A P P R OV E D
NOW AVAILABLE! Download at www.ANFPonline.org
Nutrition & Foodservice Edge | February 201540
MEET A MEMBER
by Laura Vasilion
PayingHisDues
Laura Vasilionisa
seniorwriterforNu-
trition & Foodservice
Edgemagazine.
SendMeetaMem-
berideasto:
Inaneraofhigh
expenses,lowprofit
margins,andtight
budgets,being
efficientwhilestill
providinghigh-
qualityfoodand
serviceisvery
challenging.
Neil Steuer, CDM, CFPP
NEIL STEUER, CDM, CFPP,ofAthens,
Ga.,isFoodandNutritionDirectorat
AthensRegionalMedicalCenter,a343-
bedacutecarefacility.Previously,hewas
CulinaryDirectorandExecutiveChefat
SuperiorCulinaryCenter,inMilwaukee,
Wisc.
Steuer,whobeganhislongcareerasa
chef,hasworkedinawiderangeoffood
industrysettingsincludingcountryclubs,
hotels,cateringcompanies,andrestau-
rants.Havingtransitionedintohealthcare
foodservicenow,hefacesthesamechal-
lengesalldietarymanagersdo.
“Inaneraofhighexpenses,lowprofit
margins,andtightbudgets,beingeffi-
cientandcosteffectivewhilestillprovid-
inghighqualityfoodandserviceisvery
challenging.Thenthereistheefficient
andcontinualtrainingofstakeholders,
coupledwithfindingtherightpersonnel
withinashrinkingpoolofcandidates,”he
said.
Tobeasuccessinthishighlycompetitive
field,Steuerstressestheimportanceof
goodcommunicationskillsandthecom-
pleteknowledgeofallbusinessaspects
ofhisoperation,fromplanning,pur-
chasing,preparing,costing,selling,and
servicingtomodifieddietplanning,food
safety,scheduling,forecasting,andregu-
latoryreadiness.Theseskills,acquired
overtime,formthecrucialfoundationof
acareerindietarymanagement,Steuer
says.Anyonewhoisconsideringenter-
ingthisfieldshouldbeawareofthistime
spent“payingyourdues,”ashecallsit.
“WhenIapprenticedasachef,thatis
whatIwastold.ThatIwas‘payingmy
dues.’Myadvicetopeopleconsider-
ingthisfieldistogetexperienceinfood
serviceinboththebackofthehouseand
frontofthehouseareaswithasmany
jobdescriptionsaspossible.Thetransi-
tiontomanagementwillbesmoother
whenstaffknowsyouhavebeeninthe
‘trenches.’Learnthebusinessendof
managing—policies,humanresources,
budgets,forecasting,foodsafety,
diets,scheduling,hiringprocedures,
etc.Getcertifiedandgetabachelor’s
degree.Manyyearsago,Ithoughtmy
associate’sdegreeinculinaryartswas
allIneededtomoveuptheladder.
Today,thisisnotpossiblewithoutcre-
dentials,nomatterwhatyourexperi-
ence,”Steuerexplained.
Hisadvicetofuturedietarymanag-
ersalsostressesbeingaparticipant
inprofessionalorganizationsand
networks.Steuerciteshisinvolvement
inANFPasanotherwayhehaspaid
hisdues.
“Thereisnoquestionaboutit.Beinga
memberofANFPisveryimportantto
me.Theforums,thewebsite,andNu-
trition&FoodserviceEdgemagazine
arejustafewwaysthatANFPhelps
usCDMsstaycurrentwithinarapidly
evolvingfield,”saidSteuer.
Withthesamededicationheadminis-
terstohiscareer,Steuerlistsanumber
offreetimepursuits.Besidesculinary
instructing,heenjoysboating,camp-
ing,andisanavidcyclist. E
Join FoodService Director at MenuDirections for educational workshops, culinary demos and keynote presentations, all designed to help you push the boundaries of your menu
and operations while boosting the reputation of your brand.
Rob BellCertifi ed Speaking
Professional & Business Humorist
Dr. James Painter, R.D.Professor Emeritus
Eastern Illinois UniversitySponsored by:
Sun-Maid Growers of California
COMPELLING KEYNOTE SPEAKERS
Gerry LudwigCorporate Consulting Chef
Gordon Food ServiceSponsored by:
Gordon Food Service
Hot Off the Menu!Absolutely
Everything Counts Sensual Nutrition
Michael DonahuePartner, Chief Brand Offi cer
LYFE Kitchen
LYFE Kitchens: Social Responsibility
ANFP’S “CAN’T MISS” SESSIONWant to respond to today’s biggest food trends? ANFP presents current insights and new analytics only at MenuDirections. Other workshops include:
• Gluten-free Can Be Healthy• Conquer Catering!• Plant-based Menus
ST. JUDE CHILDREN’S RESEARCH HOSPITAL TOURStay to the end of the conference, March 4, and take part in on-site learning when we tour this word-class foodservice program, led by Director of Culinary Operations Miles McMath.
Nowhere else will you fi nd an agenda as timely and thought-provoking...REGISTER NOWContinued Education Units (CEUs) Available
Produced by CSP Business Media, LLC, Leadership Conferences & Events
1911 S. Lindsay Rd. | Mesa, Arizona 85204 | p: 480.337.3400 | CSPBusinessMedia.com
For more information contact William D. Anderson at 630.528.9239 or [email protected]
PEABODY MEMPHIS MARCH 1-4THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE
PUSHING BOUNDARIES, BOOSTING REPUTATIONS
PRESENTED BY:
#MENUDIRECTIONS
Like us! facebook.com/foodservice.director
Follow us!twitter.com/fsdeditor
Follow us! CSP_BUSINESS_MEDIA
REGISTER AT MenuDirections.com
MD15_ANFP Ad_Single-sided_February 2015.indd 1 1/16/15 3:23 PM
Join FoodService Director at MenuDirections for educational workshops, culinary demos and keynote presentations, all designed to help you push the boundaries of your menu
and operations while boosting the reputation of your brand.
Rob BellCertifi ed Speaking
Professional & Business Humorist
Dr. James Painter, R.D.Professor Emeritus
Eastern Illinois UniversitySponsored by:
Sun-Maid Growers of California
COMPELLING KEYNOTE SPEAKERS
Gerry LudwigCorporate Consulting Chef
Gordon Food ServiceSponsored by:
Gordon Food Service
Hot Off the Menu!Absolutely
Everything Counts Sensual Nutrition
Michael DonahuePartner, Chief Brand Offi cer
LYFE Kitchen
LYFE Kitchens: Social Responsibility
ANFP’S “CAN’T MISS” SESSIONWant to respond to today’s biggest food trends? ANFP presents current insights and new analytics only at MenuDirections. Other workshops include:
• Gluten-free Can Be Healthy• Conquer Catering!• Plant-based Menus
ST. JUDE CHILDREN’S RESEARCH HOSPITAL TOURStay to the end of the conference, March 4, and take part in on-site learning when we tour this word-class foodservice program, led by Director of Culinary Operations Miles McMath.
Nowhere else will you fi nd an agenda as timely and thought-provoking...REGISTER NOWContinued Education Units (CEUs) Available
Produced by CSP Business Media, LLC, Leadership Conferences & Events
1911 S. Lindsay Rd. | Mesa, Arizona 85204 | p: 480.337.3400 | CSPBusinessMedia.com
For more information contact William D. Anderson at 630.528.9239 or [email protected]
PEABODY MEMPHIS MARCH 1-4THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE THE PREMIER CULINARY EVENT FOR NON-COMMERCIAL FOODSERVICE
PUSHING BOUNDARIES, BOOSTING REPUTATIONS
PRESENTED BY:
#MENUDIRECTIONS
Like us! facebook.com/foodservice.director
Follow us!twitter.com/fsdeditor
Follow us! CSP_BUSINESS_MEDIA
REGISTER AT MenuDirections.com
MD15_ANFP Ad_Single-sided_February 2015.indd 1 1/16/15 3:23 PM
Enjoy Education, Exhibits, and Networking at ACE!
2015ANFPAnnualConference&Expo
AUGUST 2 -5 HYATT REGENCY GRAND CYPRESS
BRINGVALUETOTHETABLE
ACE&&OR LA N DO, FL | 2015
AnnualConference & Expo
NEVER FLY SOLO
LT. Col. Rob “Waldo”
Waldman
KeynoteSpeaker
Lt.Col.Rob“Waldo”Waldman,theWingman,overcame
alifelongbattlewithclaustrophobiaandafearofheights
tobecomeacombatdecoratedAirForcefighterpilotand
highlysuccessfulbusinessman,entrepreneur,andNewYork
Timesbestsellingauthor.HismottoisWinners Never Fly
Solo!Throughhiscaptivatingpersonalstoriesandhigh
energyvideo,learnhowyou,likeafighterpilot,cansuc-
ceedinhighlycompetitiveanddemandingenvironments.Be
inspiredtotaketotheskiesknowingthatyouhavewingmen
tohelpyoufacechallengesandchangewithconfidence,
whilemaximizingyourpotentialinallaspectsofyourlife.
OTHER SESSIONS•FoodserviceDepartmentDesign/
Renovation
•ABCsofSuccessfulSurveys
•CenterofthePlate
•QualityIndicatorSurveySuccess
•NutritionandHydrationApproaches
•PreventionandTreatmentofPressureUlcers
•ValueoftheCDMRole
•Deficiency-FreeJointCommissionSurveys
•SanitationSurveysandTraining
•CurrentMenuTrends
•WorkplaceCommunicationStrategies
•TeamBuilding
REGISTERONLINE www.ANFPonline.org Click“Events”
CAN’T MISS EXPO—AUGUST 4
The Expo is a must-see event where exhibitors showcase how
their products and services can contribute to your operational
effectiveness and bottom line.