Connections, a new memory support dining initiative developed by Cura Hospitality, combines a specialized menu with several ways to create a better meal—and quality of life—for those living with memory loss. This includes ‘memory cards’ to spark conversation, creative (and more manageable) finger foods, food-based aromatherapy and innovative ways with purees.
Earlier this year, a task force of Cura managers, chefs and dieticians teamed up with the Alzheimer’s Resource Center in Connecticut to develop the program. The task force set its sites on learning “everything we could about Alzheimer’s Disease (the most common form of dementia),” says Deb Santoro, RD, LDN, SPHR, director of staff development for Cura Hospitality.
“We have a client group with the desire to address the needs of a huge generation with quite a few individuals in need of memory support,” Santoro says. “From a food provider standpoint, we looked at what we need to do differently in terms of customer service for a population with memory loss.”
“This is an all-encompassing program with training programs at each site to quick-start this strategy. We want them to become Alzheimer’s experts,” Santoro says. “It’s a culture change. In the past, staff would stay in the kitchen and prepare 100 meals. Now, we are seeking to create more of a home-like environment.”
That means slowing things down, at times, she adds.
“We live in a world where we are always looking for efficiencies, but this is one case where the most efficient service model is not always optimal,” Santoro says. For example, the initiative specifies a "90 second rule,” in which a resident is given 90 seconds to answer a question like “Would you like fish or chicken?”
Cards Spark Memories
The task force learned about emotional memory, short- and long-term memory, says Josh Crandall, director of partnership development for Cura Hospitality.
“We asked, 'What can we do around meal time that can tap into emotional memory?' If we can tap into emotions," he continues, people will remember a positive experience, if not exactly what they did.
The memory cards (see photo) used in Connections have old black and white photos of things like holidays or vacations on one side, and conversation-starting questions on the other. There are about 30 cards in all, and they are to be used by staff interacting with residents.
“The cards create an environment where conversation can occur,” Crandall says. “Meaningful conversations at mealtime can carry a resident through the rest of the day.”
During the testing phase, where a few select communities tried the cards, they’ve made a difference, Santoro says.
“At first, the nursing staff said, ‘Oh we already do that. We have conversations with the residents.’ But after trying the cards, they said, ‘These cards are really great. They allow us to really have more meaningful conversations with the residents.’”
More Finger Foods Allow for More Independence, Better Nutrition
As another part of the initiative, Cura chefs have been tasked with converting favorite entrees and snack items and turn them into finger foods with dips. A chef challenge is underway to encourage chefs to be creative in the initiative.
The results include more finger food with dipping sauces, like chicken skewers, fruit wedges, and the use of more components like tortilla wraps, puff pastry or even wonton wrappers, Crandall says.
“We also learned that it’s common for residents to get up and walk away during mealtimes,” he adds. “It’s hard for them to focus on a single task, and that’s a risk nutritionally, so foods that are portable will help them get the calories and fluids they need.”
Because finger foods allow residents to feed themselves despite advancing dementia, it's a technique that preserves a sense of dignity, another goal of the initiative.
When the Time Comes for Purees
Santoro calls more appealing purees “a crucial piece” of the Connections initiative.
“For some residents, as the disease takes its effect, puree diets become necessary,” she says. “We’ve achieved ways to deliver pureed food so it resembles the actual items. People become distracted, so the more it looks like food, the more likely they are to eat it.”
This illusion is achieved with molds and piping techniques. A fresh melon cup consists of melons pureed separately, then basically reassembled with thickener added, looking a lot like the original.
The aromas from food can stimulate appetites and make for an overall cozier environment, another piece of the initiative.
In many accounts, a country kitchen setup is possible, allowing good cooking aromas to waft throughout the facility, Santoro says.
But if a facility is not set up for country kitchens, there are tools specifically intended to create an aroma, as simple as a crock pot with herbs in it, Crandall says.
The task force found that flexibility is a key characteristic for any initiative helping residents with dementia.
“In memory work, you must be flexible,” Santoro says. “If you’ve seen one patient with Alzheimer’s, you’ve really only seen one patient with Alzheimer’s. There’s no one right or wrong way of doing things. You have to be able to customize.”