This blog recently covered gluten-free school lunches for children. But what about meals for those at the other end of the age spectrum? Specifically, the elderly who require gluten-free meals in nursing homes?
As an adult child you may be concerned about a parent living in a nursing home who must follow a gluten-free diet. Or, you may be concerned about your own later years and how you will manage if and when you have to enter a nursing home.
So, what can we do to ensure that our parents receive the gluten-free diet they need? And what can we do to plan for our possible future gluten-free needs in a nursing home?
I recently asked Ronni Alicea, MBA, RD, a nutrition consultant who works with health care facilities, including nursing homes and assisted living communities, to weigh-in on this issue. She is the owner of Celinal Foods (www.celinalfoods.com) makers of gluten-free food kits used by food service operations.
Are nursing homes required to provide gluten-free meals for their residents with celiac disease and gluten sensitivity?
Healthcare facilities are required by their license to provide the diet a doctor prescribes. This is called a Therapeutic Diet, meaning the diet is used to treat a medical condition. Menus are planned to provide adequate calories and protein and meet the DRI (Dietary Reference Intake) for vitamins and minerals.
Every state has a person called an Ombudsman that will assist if you feel the facility is not adequately providing good care, this includes diet management. The phone number is required to be posted in plain view at the facility.
When trying to arrange gluten-free meals for a parent or relative, do you recommend starting with the dietitian on staff?
Although hospital admissions are not planned, individuals often select their long term care options. When selecting a nursing home, first discuss the diet with administration. As we know, gluten free diet management impacts every aspect of life.
In addition to receiving properly prepared gluten free meals we need to assure that (1) nursing reviews medications and snacks, (2) the activity department includes gluten free options in their activities, and (3) rehabilitation therapies are aware. It is vital that a person following a gluten-free diet does not isolate themselves because of the fear or perception that the staff does not understand their needs.
The facility administrator will coordinate the interdepartmental education with the guidance of the facility dietitian. Once you are comfortable that the facility is committed to continuing your parent’s gluten free lifestyle, it is time to discuss menu planning with the dietitian.
Are all nursing homes required to have a dietitian on staff… and are dietitians on site every day?
Healthcare facilities are required to have adequate staffing to meet their client’s needs. This includes having a dietitian available. The time a dietitian is available depends on the size of the facility and the complexity of the medical conditions. The food service department will be managed by a manager to assure the therapeutic diets are prepared properly. The dietitian will review the menus and medical condition to monitor that the gluten-free diet order is followed.
What type of medical information should be brought to the nursing home on behalf of a parent or relative with celiac disease or gluten sensitivity?
The medical team at the nursing home will conduct an initial assessment that includes a person’s nutrition state. I strongly encourage an antibody test be done on admission to evaluate that the gluten-free diet prior to moving to the nursing home was followed. We all know that gluten can sneak into diets easily!
During the annual physical, insist that the doctor test antibodies to monitor that the facility continues to provide a gluten-free lifestyle. We know that gluten contamination reactions can mimic other medical conditions. We want to be sure to properly treat the cause of stomach pain, diarrhea, joint pain, or the host of other medical complaints that may be caused by gluten but also may be acid reflux or a virus for example.
What recommendations do you have for educating the kitchen staff to help ensure that food provided is gluten free?
My mantra is “production is as important as procurement,” and compels me to write articles and speak at dietary manager education events. It is fairly easy to plan menus and purchase gluten free food now, but the kitchen staff needs to understand that crumbs count. Properly toasting breads is the biggest hurdle I see in my travels.
Kitchens produce 21 meals weekly and daily snacks with full time and part time employees, each of whom need to understand the principals of cross contamination when making the gluten free diet that the dietitian has planned. Every employee needs to be trained on proper technique to produce safe foods and I recommend having signed competency tests on file to assure no employee is left behind.
What recommendations do you have for individuals to help them plan for their later years and possible stay in a nursing home?
Eat well now to avoid possible medical complications that may require nursing home care. This includes following a well balanced gluten free diet that is heart healthy: low in saturated fat and sodium. If you have diabetes, make sure to keep your blood sugar in a good range. Plan to have enough fiber and calcium every day and eat fruits and vegetables!
I encourage all of us to visit friends and loved ones that need long term care services while we are healthy. If you have time, volunteer to spend a day a month in the activities department. In addition to providing companionship you will gain an appreciation on how facilities operate and better understand how to help staff implement a gluten free diet, just in case.
Thank you Ronni!
There is an article entitled, “The Nursing Home Challenge” by Marjorie W. Rogers, RN available online at www.csaceliacs.org/documents/THENURSINGHOMECHALLENGE.pdf. In addition to helping you feel that you are not alone in your concern over nursing home care, Marjorie includes a listing of helpful resources at the end of the article.
You may want to print out copies of the articles “Food for Thought: Gluten Free Diets, Food Allergies and Food Intolerances” and “Gluten-Free Diets: The Prescription for Celiac Disease” by Ronni Alicea, RD and bring them to the nursing home. These articles are geared towards dietary managers. They are available online at: http://www.dmaonline.org/CE/food_for_thought/2008_spring.shtml and http://www.dmaonline.org/Publications/articles/2006_03_GlutenFree.pdf.
Copyright © by Tricia Thompson, MS, RD
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