Last week of Dec 2011
I visited with Dad on Boxing Day. I was not looking forward to it. Dad and I had not been close since Mom died. I had trouble accepting the newest spouse, even the fact that there was one. B/F (driver), knowing I wasn’t eager to spend a long time visiting, dogged the time a bit. We arrived later than planned. To my dismay, they appeared to have been waiting dinner for us. We went directly from the door to dinner, with a brief stop to place our coats in their room.
I noticed first: No table-cloth etc., that had been present at the last visit (when Irma [the second wife] was still alive) There was no table dressing at all. There were salt and pepper shakers and maybe a sugar container. It was very bare.
We queued up for cafeteria style serving. I heard someone whisper “You know there won’t be any turkey or anything like that, today.”
Dinner was: Green Salad, potato salad, jellied fruit and marshmallow type salad, raw fruit in chunks, Maybe something else? Then the main dish was macaroni and tomatoes. There were white buns and margarine. I saw no meat or cheese. They served us, to our tables, thin beef soup with crackers while we were in line.
Plain macaroni is inadequate as a main dish for meal. I saw no protein. It seemed thin on the tomato sauce. There was maybe a tablespoon per cup of macaroni. The serving size was large and readily consumed by the clients/guests.
They offered milk at the table or other beverages on the sideboard, fruit drink from machine, coffee or tea. They offered a serving of chocolate pudding for dessert.
Cookies etc were brought around after the meal. It seemed that they were from another visitor.
The menu for the meal bothered me. I had worked in the Stettler Hospital kitchen years ago, and also know the Alberta Food Guide. The meal just seemed inadequate.
I checked into the regulations and monitoring of food for our senior family members.
There is a provincial government document titled “Supportive Living Accommodation Standards”
It is accompanied by a checklist. The section of that pertaining to nutrition is:
Because it stipulates that the diet conform to the Alberta Food Guide, I went to that to check for serving sizes and recommended daily amounts.
Along the way, I also checked on the ownership and management of the Supportive Living Facility Dad lives in. It is apparently owned by the county and managed by a local individual.
I knew from my previous experience working in care homes how easy it was to have a menu which met the standards. Without a quality check, such as is provided by a staff dietician, it is very easy to make substitutions. For instance, the meal I shared may have originally called for a macaroni dish which included meat, cheese and enough tomato to count as a vegetable serving.
That would have meant, to meet the food guide standards, the macaroni dish should have contained, per serving:
· One cup cooked pasta
· ½ cup lean ground beef
· 1.5 ounces cheese
· ½ cup of canned tomato or equivalent in concentrated product.
Another type of substitution is counting a fruit jello as a fruit serving, or a fruit drink instead of a juice. In this case, a pudding was offered for dessert. They may have counted it as a milk serving. It doesn’t quite work. The serving was about ½ cup. A milk serving is a whole cup. Even counting the whole of the pudding, ignoring the quantity of sugar, cocoa and thickener, it would have been a half serving.
My next question was, what kind of government monitoring and oversight was there, and how would one check on the reputation of the facility? Returning to the legislation and user guides, offered to assist in choosing a facility, one finds quite specific regulations for the licensing of facilities.
“· Supportive Living Accommodation Licensing Act and Supportive Living Accommodation Licensing Regulation” http://www.seniors.alberta.ca/ContinuingCare/SLAS/
On the subject of monitoring and compliance, the Govt site says:
“Alberta Seniors monitors all supportive living and long-term care accommodations for compliance to the accommodation standards, minimally on an annual basis. The purpose of the accommodation standards is to ensure accommodations maintain a high quality of accommodation services (e.g. meals, building maintenance, security and housekeeping) that promote the safety, security, and quality of life of Albertans living in those accommodations.”
Further down the page is this statement:
“Health and Wellness also audits a sample of continuing care accommodations each year, including long-term care accommodations, for compliance with the Continuing Care Health Standards and applicable Infection Prevention and Control Standards. As audits are completed, they will be posted as links in the online Alberta Seniors and Community Supports Accommodation Standards compliance report and on the Alberta Health and Wellness website.”
That “audits a sample” approach is not very reassuring. I wonder how many homes are in their yearly sample, and if each home is eventually re-assessed for compliance. I can see no merit in doing a sampling here, except for the acting government’s statistics. Sampling has no effect on individual compliance.
So, now, after I have worked my way through the documentation, I have two choices.
- Report the diet as a problem.
- Monitor my father’s home and his diet to get a more complete picture, and maybe influence more compliance from the management and staff, by virtue of the presence of witnesses.
Time to get back to being the good daughter, if I want to be able to live with myself.