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SUCCESS WITH PREPARED FOODS in LTC Sandra A. Matheson Rosie Maclean Barbara E. Jaques

Success with Prepared Foods The “ Success”  Project for Healthcare Myths and Facts about Prepared Foods 9 Steps to Success in LTC The Future

The “Success” Project OMAFRA - MOH formed an inter-sectorial working group to identify and conduct work that would benefit all stakeholders Needed - healthcare foodservices guide to purchasing and using prepared foods. Project Steering Committee to oversee development - Industry, OHA, DC,OMAFRA Food Systems Consulting engaged to obtain, compile and organize the information – June 1999

The “Success” Team Project Steering Committee – Linda Dietrich, DC; Rae Aust, Private Recipes Food Systems Team – foodies, culinary passion, cook-serve advocate, implementor, theorist. Our clients – Donna Larkin, SSM; Marianne Matichuk, Pioneer; Elaine Robichaud, Alliance, NB; Fran Haley, The TTH. Contributors and Reviewers – listed and unlisted.

© 1999 Dietitians of Canada Information in this Guide is intended to assist healthcare foodservice and nutrition professionals to use prepared foods most effectively. The advice represents the expert opinion of the consultants and reviewers appointed by a steering committee. Information in the Guide does not represent official policy of Dietitians of Canada.

© 1999 Dietitians of Canada The standards included in this Guide are current at the time of publication. Professional judgement is required for application of information in the Guide and Dietitians of Canada disclaims responsibility for application of this information.

Project Terms of Reference Develop a guide or manual to promote the benefits and assist health care food service and nutritional care professionals to use prepared foods most effectively.

Terms of Reference  The guide will serve to: a)   educate healthcare / institutional purchasers b)   promote good purchasing practices, including food safety c)   increase awareness of the availability of sourced prepared foods and systems which support their delivery - such as rethermalizing carts.

Unspoken Terms of Reference The guide provides the documentation to legitimize the use of prepared food in healthcare – hospitals and LTC facilities It is the beginning of a body of knowledge – terminology, techniques, standards of practice to guide use, conversions and planning.

Unspoken Goal It is the basis for an on-going dialogue between industry, operators, the healthcare system and professionals about using food technology, advanced foodservice management systems, IT, and “bright ideas” providing flavourful, colourful, aromatic, healthy and safe foods creating exceptional meal experiences for patients, residents and consumers.

Order Guide from Dietitians of Canada www.dietitians.ca Single copy  $40.00  Discount for Volume Orders

A Prepared Food System …is a foodservice system where more than 70% of menu items are purchased fully cooked, ready to assemble, heat and serve Required menu items are sourced and procured from a variety of qualified suppliers

Enhanced Cook-Serve …is a foodservice system where more than 30% of menu items are purchased fully cooked, ready to assemble, heat and serve Prepared food items items are sourced and procured from a variety of qualified suppliers Many produced items are easy scratch using convenience items like soup bases, mixes and combining prepared components like chicken breasts with convenience sauces.

Myths and Facts about Prepared Foods November 27, 2000 – 1:30pm DC Gerontology Network Fall Workshop 2000

Myths The quality is inferior to on-site cooked food…it’s airline food, TV dinners. There is not enough variety There is no guarantee of availability It costs more.

FACTS - QUALITY Quality is not routinely measured When it is … quality as perceived by consumers can be improved with a prepared food system. ( TTH, 1997; CARA - Nutriflex, 1999) Quality meals require product and process controls…cook-serve and prepared are equally vulnerable to misuse and loss of quality

Food Systems’ Perspective With the best cook-serve system you can get a range of 4/10 -10/10 during the 21 meals served each week With the best prepared food system you can get a consistent 8/10. For short or average length of stay acute care …a consistent 8 is a good standard For LTC…we want some 10’s…suggest the 70% procure / 30% produce…in our model most of the 30% produce is in the resident home unit.

FACTS - VARIETY In a cook-serve system endless variety is possible but it requires funds for culinary talent, good quality, fresh food ingredients and facilities. Funding is not keeping pace with rising consumer expectations and diversity of care requirements, especially in LTC. Low wages for LTC cooks/food handlers, Sup and RD’s means an increasing challenge to fill positions with qualified, committed staff.

FACTS - VARIETY Consumers have higher expectations about meeting special food needs with a wider variety of hot and cold foods and beverages that are familiar, appropriate and appealing. It is becoming cost prohibitive with cook-serve from a food and labour perspective to produce variety and quality of food required.

FACTS - VARIETY More manufacturers are producing prepared foods because of consumer demand for healthy choice HMR products. Variety is increasing annually; product lines being rationalized based upon marketplace response.

FACTS - AVAILABILITY Variety and availability issues are linked in cook-serve and prepared food With prepared food the sources are the federally and provincially inspected food manufacturers, healthcare food production centres, local bakers and suppliers and in-sourcing from on-site retail café or bakery.

FACTS - COST Availability and cost are linked for cook-serve and prepared foods. Food cost for cook-serve is often under estimated by considering only raw ingredient cost - ignoring the cost of supplies, labour, over production/waste, and facilities overheads.

FACTS - COST Many studies demonstrate you can procure food at lower cost than you can make it ….when all costs are considered…this is especially true for new facilities if the capital cost can be avoided. Cook-serve costs are increasing where as volume and competition are driving the cost of prepared foods down or value up.

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Food Systems Projects Food Only       On-site Prepared Hospitals     $5.50-$6.00      Same or Less LTC      $4.38 $5.40- $7.00 Patient or Resident Mealday Costs Hospitals     $20.00      $18.00 LTC      $12-15.00*       $10.00-13.00* Cost of labour dependent

Best Value = quality/cost

To Achieve Best Value Need measurable quality indicators Need food budget that supports quality standards Increasingly more likely achievable with a higher proportion of prepared food, especially when building new or renovating.  For LTC Home Area Kitchens can be freshly preparing  up to 40% of menu requirements.

9 Steps for Success with Prepared Foods in LTC

9 Steps for Success Planning a Prepared Food Menu for LTC (Enhanced Cook-Serve) Determining Resident  Needs & Likes Ensuring Compliance with MOH Stds Assessing Functional Foods Sourcing Prepared Food – Pureed, Minced, Single Portions, Proteins Receiving Prepared Food

9 Steps for Success (… continued) Tempering Prepared Food Heating Prepared Food Using in a Resident Home Kitchen Serving Prepared Food Disposing of Prepared Food Measuring the Results Continuous Improvement / innovation New Design Guidelines Facilities

A Prepared Food System*

Step 1 – Menu Planning Evaluate Current Rethink Options Rethink Service Styles - BLD Integrate with special needs Enhance LTC with finger foods; special occasions; integrated ADL

Step 2 - Sourcing Sourcing is key – suppliers can help Selection process – pre-determined criteria; stakeholder involvement Guide – many helpful product selection templates

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Resident Home Kitchen Concept  The FoodService Planning Group

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Step 6.  Meal Service - Enhancements Benefits with Prepared Foods Frees labour to concentrate on service Move from “back of the house” to “front of the house” Potential for easy scratch or added touches for greater variety and fun for LTC Ease of use of heat and serve approaches Cost control

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Step 7. Disposal Manage food costs through aggressive use of batch preparation, heat and serve Product is left chilled or frozen until just ahead of service Major reduction in food waste Cook-serve “just in case” production tactics result in significant over production and cost Suppliers working on less packaging Emphasis on resealable packaging – packaging on service ware.

Step 8 – Measure Results Diagnostic measurement tools 3rd Party Patient and Resident Satisfaction surveys Plate waste audits Weight gains; clinical indicators

Step 9. Continuous Improvement Pilots Site Visits – Pioneer – New LTCs Supplier User Groups – HFS Networking and Benchmarking Skills Upgrading – digital tools

The Future Resident and family driven changes Private Sector Enterprise More Functional Foods Individualized Menus and Meal Service Palm cardex Web based supplier resources