Nutrition, Kitchen Safety & Preparing Meals for Elder Care Receivers Module #15

Elder Family Caregiver Education Nutrition, Kitchen Safety & Preparing Meals for Elder Care ReceiversModule #15

Learning ObjectivesThrough this module you will be able to • Plan meals using Dietary Guidelines • Reorganize the kitchen for safety & convenience • Shop for groceries for best nutrition, economy & safety • Identify safe food handling practices • Know easy meal preparation techniques • Demonstrate techniques to make mealtimes more pleasant for Care Receivers The information is provided to raise awareness Always check with health care providers when planning for & serving meals

Planning Meals Using Dietary Guidelines • Tailor the Guidelines to the specific Care Receiver • Choosing appropriate Dietary Guidelines: • Physician’s/Dietitian’s guidelines, prescribed specifically for the Care Receiver • Guidelines from organizations for specific chronic diseases of the Care Receiver: • http://www.goldencuisinestore.com/home.jsp?navSection=home&pageTitle=Home • www.alz.org • www.diabetes.org • www.stroke.org • www.americanheart.org • www.Parkinson.org • United States Department of Agriculture Guidelines for Americans • www.usda.gov/cnpp or call toll free (888) 878-3256 to purchase ($4.75 in 2004)

One size doesn't fit allUSDA's new MyPyramid symbolizes a personalized approach to healthy eating and physical activity. The symbol has been designed to be simple. It has been developed to remind consumers to make healthy food choices and to be active every day. New Dietary Guidelines effective 2005

Note Any Food Allergies, Food/drug Interactions & All Other “Do Not Serve” Foods • Common allergy-producing foods include eggs, milk products, peanuts, wheat products • Some foods reduce effectiveness of certain drugs • Care Receiver may complain that certain foods cause gastric discomfort

Determine Care Receiver’s Food Preferences Avoid serving foods the person dislikes Substitute others to provided needed nutrients Adjust recipes for favorite foods to satisfy dietary guidelines

From Appropriate Dietary Guidelines & Care Receiver Preferences • Prepare meal planning form, one plan sheet/day • As you plan, remember that good nutrition can come from simple foods, simply prepared • Attach recipes (if any) for that day to the form • You may want to make copies of frequently used recipes; attaching a copy is easier than moving the recipe from form to form • Plan for one to two weeks • Look on the time required to do this planning as an investment in future time-saving & stress reduction

Meal Planning • Shopping • Prepare grocery list from meal plan form & recipes • Become familiar with the specific grocery store you use (& food safety practices) • Prepare grocery shopping list in the order of the aisles as you will shop them • Meal Plans • File meal plans for use & rotating re-use (plan once, use over & over) • File plans in loose-leaf notebook • Use a sheet protector to display the plan-of-the-day & to hold any recipes for the day • Mount meal plans on refrigerator door with magnets

Meal Times Care Receiver may prefer (or may be prescribed) to have several smaller meals, rather than the traditional “three squares” • Breakfast, lunch & dinner, plus mid-morning, mid-afternoon, bedtime snacks • Smaller, more frequent meals help keep blood sugar levels more constant • Mealtimes & snack times can become daily “events” to be anticipated with pleasure

Adjusting Foods Served to Dietary Guidelines – Sodium/Salt Whatever Dietary Guidelines are used to plan and serve the Care Receiver, adjustments are often required for optimum nutrition Some may include: • Reducing sodium (salt): • Remove salt shaker from dining area • Use salt substitutes, lemon juice, herbs (as permitted)

Adjusting Foods Served to Dietary Guidelines - Sugar • Reducing sugar: • At least 18 different names for sugar that may appear on labeling: brown sugar, corn sweetener, corn syrup, dextrose, fructose, fruit juice concentrate, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, raw sugar, sucrose, syrup, table sugarIf any of these ingredients appear first or second on label – or if there are several in the list – the sugar content is deemed “high” • Non-sugar sweeteners (if prescribed or allowed) • Some sweeteners can cause unpleasant, even dangerous side effects • All sweeteners are different, i.e., Aspartame Read the labels

Adjusting Foods Served to Dietary Guidelines – Calories & Other • Use both product labels and a reliable calorie counter to record calories on meal plans • Be aware of serving sizes • Be aware that some Care Receivers may need more calories, not fewer • Other Ingredients as prescribed

Reorganizing the KitchenFor Safety & Convenience

Tripping/falling hazards Slippery or cracked flooring Loose tiles Throw rugs Extension cords Clutter Electrical/fire hazards Frayed electrical cords Overloaded plugs Natural gas leaks Physical Hazards Assess the Kitchen After assessing, make any needed corrections and repairs

Physical Hazards Assess the Kitchen, 2 • Fire Extinguisher • Should be charged and operational • Stress: “If there is smoke or fire – GET OUT!” (Plan and practice exit strategies) • Smoke Alarm/Carbon Monoxide Alarm • Batteries working (change them at least when changing clocks to/from Daylight Savings Time)Again stress “GET OUT!

Assess the Abilities of Care Receivers • Every Care Receiver is unique, with individual strengths and weaknesses • Caregivers need to assess the functional abilities of Care Receivers to identify the best possible care • Consult professionals, as needed

Assess for Kitchen Safety • Assess physical abilities and limitations • How much can s/he safely lift? • How far can s/he comfortably reach? • How much bending can s/he tolerate? • Cognitive/memory abilities • Can s/he understand, remember and follow safety precautions?

Hazardous Materials in the Kitchen • The kitchen does contain hazardous materials • To help keep the kitchen a safe place, • Ask, “What is the worst that could happen if this product were used inappropriately?” • Then develop strategies to avoid this possible outcome • Read labels on all non-food products –especially cleaning products • Store all hazardous products in a separate cabinet away from foods Provide a lock for this cabinet if necessary for safety • Post Poison Control Telephone Number: 1-800-222-1222

Sharing the Kitchen with the Care Receiver - Care Receiver independence is a prime goal for Caregivers • Since Care Receiver and Caregiver may share the kitchen space, duties, equipment and food, reduce conflicts by • Making all changes tactfully and with the Care Receiver’s participation • Making adaptations for mobility equipment such as wheelchairs & walkers • Use this collaboration as an opportunity to “chunk the junk” • De-clutter cabinets, shelves, drawers, pantries • Since this may be a major job, take it one shelf or drawer at a time • Encourage Care Receiver to give away unneeded items to family or friends, give to a charity, or to have a garage sale

Arranging the Kitchen • Place items within easy reach of the Care Receiver • The Caregiver adapts to the kitchen as laid out for the Care Receiver • When the Care Receiver no longer comes into the kitchen as a participant, it can then be arranged for the convenience of the Caregiver • Arrange equipment & food packages by type • “Face” all food packages with labels forward for easy identification • Label cabinets, shelves, and drawers, using address labels and bold markers ”A place for everything and everything in its place” equals a stress reducer for the Caregiver(s), especially if there are two or more Caregivers

Grocery Shoppingfor Nutrition, Economy & SafetyAfter meals are planned, grocery shopping is the next step in providing good nutritional care

Nutrition • Choose fresh fruits & vegetables as often as possible • Less-than-perfect-appearance does not necessarily mean less nutrition – and those items may often be purchased for lower cost • Supplement fresh produce with canned and/or frozen

Read Food Labels • Size of serving (NOTE: serving size noted on labels may differ from serving size noted in Dietary Guidelines; use Dietary Guidelines information) • Nutrients contained (for a quick comparison, use the % of RDA information) • Sell-by date (to avoid buying outdated or almost outdated foods) • Avoid buying “empty calories” (“junk food”) • Even if the Care Receiver needs extra calories, those provided should contribute to good nutrition • Special treats may add to quality of life, so when care is taken to satisfy Dietary Guidelines, they may become a part of the plan

Grocery Shopping For Economy - Most households have food budgets • Careful planning & shopping can help stretch the food dollars available • Shop from the list • Use the food dollars for the foods actually needed • Avoid shopping when hungry; hungry shoppers are prey to impulse buying • Use a calculator to track total cost of items in the basket while shopping • Avoid “Total” shock at the check-out stand • Shop during less crowded times for a more pleasant experience

Grocery Shopping For Economy, 2 • Shop for one or two weeks’ worth of groceries in a single trip Fewer trips to the store = fewer opportunities to over-buy • Use Coupons Wisely • Only use for nutritious foods on your meal plan • Be alert for combinations of store specials + coupons for extra savings • Choose to cook more “from scratch” foods • Initial time spent may be longer, but savings can be great • Use shelf labels to compare price-per-unit for best buys • Quality of lower priced items is often comparable to higher priced ones

Physical Safety; help Care Receivers avoid Wet floors, mops and buckets Produce and other merchandise on floor Wrinkled floor mats Unstable displays and stacked merchandise On-floor advertising decals (which may be perceived as 3-dimensional and cause falls) Carts with protruding merchandise Thoughtless shoppers & running children Grocery Shopping For Safety Being aware of safety concerns while grocery shopping, especially when Care Receivers are shopping with them, can help Caregivers provide better care NEVER, EVER, LEAVE CARE RECEIVER ALONE IN THE CAR!

Food Safety • Shop in an order that will keep food at safe temperatures • Packaged and canned goods • Produce • Frozen foods • Dairy and eggs • Meats, poultry, fish • To avoid long waits at check-out, avoid shopping when store is crowded • Take food directly home after shopping and put it away immediately to keep it safe to eat

Safe Food Handling Practices • Many Care Receivers have weakened immune systems & are vulnerable to food-borne illnesses • Prevention: Avoid infections by following safe food handling practices to avoid infections • Put away all refrigerated and frozen foods as soon as possible: meats, poultry, fish, dairy products • Use a thermometer to check temperature inside refrigerator Temperatures from 40 degrees F to 140 degrees F are in the DANGER ZONE for bacterial growth • Refrigerate all leftovers promptly A two-hour limit is often suggested, but shorter times are safer times

Effective Infection Control – Hand Washing • Wash hands frequently in warm, soapy water for at least 20 seconds each time Singing “Happy Birthday” (silently if you wish!) is suggested as a good “timer” for hand washing • Frequently disinfect countertops, cutting boards and all other surfaces that come into contact with food • Wash surfaces and allow to air dry Use a solution of 1 ounce of bleach to 1 gallon of water, Hypochlorite Solution -US Department of Health & Human Service, Centers for Disease Control & Prevention guidelines

Preparing Food • Avoid cross-contaminating other foods when preparing meats, poultry, fish and eggs Example: Do not use cutting board for chopping vegetables after it has been used for cutting meat –disinfect thoroughly first “To spread the word about the importance of measuring food temperature, the USDA has created a campaign centered around "Thermy"

Safe Food Handling • Damp towels, sponges and dish cloths are breeding grounds for bacteria • Use paper towels or freshly disinfected-and-dried towels each time • Cook eggs, meats and other dishes to safe temperatures • Use meat thermometer and chart showing safe temperatures for “doneness” of various foods • Observe freshness dates on food packaging

REMEMBER: “WHEN IN DOUBT, THROW IT OUT!” • Sickness can be caused by food that still looks, smells and tastes “OK” – and even a tiny taste can cause illness • Once a food has become contaminated with bacteria, it may not be possible to make it safe to eat – by any means

Easy Meal Preparation After all the preliminary work is done (planning meals from appropriate Dietary Guidelines, shopping for groceries, being certain that the kitchen is safe) it’s finally time to prepare meals for the Care Receiver – in ways that are easy on the Caregiver • Remember: good nutrition can come from simple food, simply prepared • Easy-on-the-Caregiver Techniques • Plan ahead • Use very simple recipes • Cook once, serve several times

Example 1 -- BAKED CHICKEN – served as Entrée Sliced in sandwiches Chopped and served as chicken salad Leftovers and bones simmered with vegetables & rice to make soup Example 2 – COOK IN QUANTITY – freeze in portions to serve over time beans (or beans and rice) Stew Soup Pasta and sauce Roast beef Baked turkey Easy-on-the-Caregiver Techniques For Preparing Meals – Examples

Easy-on-the-Caregiver Techniques • Assemble meals and snacks for the entire day; put on trays & refrigerate (as needed) • Use store-heat-and-serve containers • “Assemble” meals from what is available • It is not necessary to “cook” every meal! • Be adventurous and creative in combinations of foods

Making Meal Preparation Easier on the Caregiver • Use prepared foods sometimes from a Deli or Restaurant • When cooking for the rest of the family, prepare and set aside an extra serving for the Care Receiver • Delegate tasks to • The Care Receiver (tailor the tasks to his/her capacities and interests) • Family • Friends

Making Meal Preparation Easier for the Caregiver • Play a CD of favorite music to make kitchen tasks more fun • If Care Receiver is present, choose some favorites of theirs, too • When friends ask what they can do – ask them to bring a meal now and then! • Consider using Meals on Wheels for temporary Caregiver respite

Making Mealtime PleasantFor the Care Receiver • Mealtimes are not just about food • They provide the opportunity for socialization • They mark the times of the day • They can be a meaningful, enjoyable activity to be anticipated with pleasure • For the Care Receiver • As needs change, mealtimes can become uncomfortable, frustrating and unpleasant • Caregivers can help avoid this by making thoughtful and appropriate changes

Making Mealtime PleasantFor the Care Receiver – Food • Serve “favorites” often by adapting recipes to Dietary Guidelines • There may be a detectable difference, but often the Care Receiver will still enjoy the food • Provide choices to provide the Care Receiver with a sense of control • Adjust food consistency, texture and morsel size to the Care Receiver’s ability

Making Mealtime Pleasant For the Care Receiver - Chewing & Swallowing • Serving some pureed foods may help Care Receiver become accustomed to them in case they are limited to that form of food later • Assemble meals that appeal to several senses • Aroma and contrasting colors, even foods of different temperatures, make dining more pleasant

Making Mealtime Pleasant For the Care Receiver - Serving Sizes • Avoid servings that seem too large to the Care Receiver • Being presented with large servings can be discouraging to Care Receivers • For many Care Receivers, having smaller, more frequent meals can provide needed nutrients more pleasantly for them

Place Settings • Use solid-color plates and bowls that provide visual contrast with the food • Patterned china can be frustrating for those with low vision: is it food – or part of the decoration? • Use easily grasped or adaptive utensils, cups and glasses suited to needs • The size and shape of the handles of flatware may be hard to hold; adjust to needs • Some cups may be too heavy or have handles too small for comfort; adjust to needs • Glasses with “waists”, or stemware, may be easier to hold and lift without spilling contents Assess all the place setting items frequently; adapt as needed

Physical Comfort • Adjust chair height, table height, chair-to-table relationship as needed • Having the tabletop at elbow height is usually comfortable • Provide cushions, pillows, footstools as needed • Support of the back makes mealtime more comfortable and relaxing • Some shorter Care Receivers may need a footstool to avoid pain and reduced blood flow to the legs • Brighter light is often welcome • For most people, brighter is more cheerful; for those with reduced vision, it is essential

Social Comfort • Include Care Receiver in family meals whenever possible • But also realize that if s/he feels uncomfortable because of changing needs at the table, s/he may prefer to dine alone, joining the family, perhaps for just a beverage • Adjust to his/her needs • Take care of spills with tact; have a towel nearby but out of sight • Provide “shirt savers” or “dress savers” at every meal if spills are frequent • Do not refer to these as “bibs” – even though the Care Receiver may • Provide them in styles and colors that blend with the Care Receiver’s clothes • Allow enough time for the Care Receiver to eat at his/her own individual pace • This may become increasingly slower, but exhibit (and try to be sincere!) patience

If the Care Receiver Dines Alone • Family photos on or near the dining table can provide a sense of comfort • If possible, see that the photos are large enough to be easily seen by the Care Receiver • A pleasant video or a favorite television show may provide some “company” • Providing a system easily used by the Care Receiver may be challenging • A window view with a bird- or squirrel-feeder right outside can provide mealtime entertainment

Letting Go • Realize that as the end of life nears, systems of the body begin to shut down • Coaxing a Care Receiver who is in this stage to eat and drink only causes them greater discomfort • Follow the physician’s guidelines,and when this time comes,find the strength to let go • Seek other meaningful ways to provide care and comfort for the Care Receiverand solace for yourself

Resources For Caregivers • Call: • 2-1-1 throughout Texas. Provides health and human service information for people of all ages • 1-800-252-9240 to get connected with the Texas Area Agency on Aging for your community • 1-800-677-1116 Elder Care Locator to find help in another part of the state or another state • Online: • www.benefitscheckup.org - Helps determine what benefit programs are available. To find this and other information quickly, go online to: www.familycaregiversonline.net You will find online education, resources, links, FAQs

Caregiver Education and Training Caregiver Respite Caregiver Support Coordination Case Management Transportation Assistance Benefits Counseling Ombudsman - advocacy services for those who live in nursing homes and assisted living facilities Home Delivered Meals Congregate Meals Light Housekeeping What Assistance is Available through the Area Agency on Aging (AAA)? Services for persons age 60 and older Caregiver Services Note: Not all services are available in all counties. Call the Area Agency on Aging for information about a specific community.

Written by Jeanie Crane, 2004, from her book Let’s Eat! Guidelines for Assembling Meals for Older Adults, 2003 This program is one module of a comprehensive caregiver education program provided by the Area Agency on Aging Go to www.familycaregiversonline.net for more information about this and other training programs, internet links, frequently asked caregiver questions, legal forms, phone numbers, and more

Nutrition, Kitchen Safety & Preparing Meals for Elder Care Receivers Module #15