Edge: Training Staff w/ Nutrition in Mind: Bridging the Gap Between Foodservice & Clinical Nutrition

This Nutrition Connection CE article appeared in the 2025 January/February issue of Nutrition & Foodservice Edge magazine. To view a PDF of this article click HERE.

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Training Staff with Nutrition in Mind: Bridging the Gap Between Food Service and Clinical Nutrition

By: Kathy Murdock, MS, RD, LD

It’s almost time to serve lunch. Karen, a cook, receives a call from a nurse asking for an alternate meal for a resident who hasn’t been eating well. The resident prefers soups and sandwiches. These are not on today’s menu and Karen replies that she cannot accommodate the request due to time constraints. Then Karen recalled a recent training session with the dietitian about weight loss and providing adequate choices for residents. Karen decided the nurse should have called earlier; after all, the policy states any orders for alternates be received an hour prior to service. During meal service, she realizes the resident’s tray card indicates she does not eat beef, and the alternate meal today is burgers. With hesitation, Karen makes the decision to honor the resident’s initial request for soup and sandwich for prevention of weight loss.

The education of staff is essential to increase their understanding of how foodservice department goals relate to nutrition therapy goals. It is not enough to train staff in sanitation practices and tray assembly; we must help them to understand nutritional goals and how they play an integral role in the care of residents. If Karen had not received the training on weight loss, she might have decided to not honor the resident’s preferences. This could result in a decline in the resident’s health, and a subsequent citation if a surveyor’s findings conclude that it is the fault of the facility in prevention of weight loss.

Medical nutrition therapy (MNT) is a comprehensive, evidence-based approach to treating various medical conditions using specific dietary interventions. It involves the assessment, diagnosis, and ongoing monitoring of a patient’s nutritional status and the development of a personalized nutrition care plan to manage or prevent health issues. According to Riddle, et al., MNT can help to reduce morbidity and mortality, reduce hospital readmissions, and improve quality of life for residents. A Position Paper by the Academy of Nutrition and Dietetics explains that providing residents with personal food choices prior to using commercial supplementation can often lead to enhanced quality of life and improved nutritional outcomes. Nutritional goals in the long-term care setting include, but are not limited to, the maintenance of healthy weight and prevention of malnutrition, adequate protein to support healing, and sufficient fluid intakes to prevent dehydration and urinary tract infections.

PLANNING TOPICS FOR STAFF TRAINING

Deciding on topics of focus for staff training can be overwhelming. As a CDM, CFPP, you play an important role on the clinical team. Be vocal and participate in meetings.  Ask the interdisciplinary team for suggestions on how your department can be improved. Have there been complaints about food taste and quality? Serving sizes? Provision of alternate food selections to honor resident preferences? Has there been an increase in weight loss overall? If so, how can you help with this? These are all important questions to ask when planning staff training and can help you decide on topics that would be most beneficial.

The Pioneer Network is also a great resource to use in planning educational topics on resident choice and quality of life in the prevention of malnutrition.

The Pioneer Network focuses on person-centered dining in place of institutionalized dining experiences. Another way to organize staff training is to use the CMS regulatory framework as a guide, specifically F-tags. You will be training staff in providing the best service to residents and increasing their understanding of the regulatory process during surveys. Including staff in training on survey readiness can play an important role in a deficiency-free foodservice department.

A review of the most cited nutrition-related F-tags and examples of training modules that would be beneficial for dietary staff could include the following:

F692: Nutrition/Hydration Status Maintenance – Ensuring residents maintain acceptable parameters of nutritional status. Discuss unintentional weight loss and how it can lead to a decline in resident health. Ways that dietary staff can help to maintain a resident’s nutritional status would be providing adequate serving sizes, offering alternative meals to meet residents’ preferences, and following recipes to ensure that sufficient calories/protein are provided to each individual resident. Every resident should be interviewed to obtain preferences upon admission and on a periodic basis/as needed. Dietary staff should be urged to get to know each resident and their preferences. Foodservice staff should be encouraged to sit in on resident council meetings at times so there is less of a disconnect and to increase their understanding of resident preferences and needs.

F801: Qualified Dietary Staff – Ensuring the foodservice staff includes properly trained and credentialed personnel. Explain to foodservice staff the importance of this regulatory requirement and why training and knowledge are vital to ensuring residents’ needs and preferences are met. Spending adequate time participating in training will help staff to understand their role in supporting residents to meet their nutritional needs.

F803: Menus and Nutritional Adequacy – Aligning menus with resident needs and preferences, and ensuring they meet the recommended dietary allowances (RDAs). CMS State Operations Manual, Appendix PP, notes that interventions for weight loss should consider individual preferences of residents. Dietary staff should familiarize themselves with each resident and their preferences. They should also be familiar with the menu, serving sizes, and recipes. Staff must be trained to follow menus and use recipes to ensure that meals are palatable and meet the needs of residents. Serving sizes should be followed by using proper serving utensils, which are outlined in the menu spreadsheets.

F804 Nutritive Value, Palatable Appearance, and Preferred Temperature. Meals served should be appealing in both taste, texture and color. Overcooking vegetables is an example of this. If greens are overcooked, the texture is mushy, the taste is altered, and the color is dull. Overcooking vegetables also alters nutritional content, losing key nutrients such as vitamin C. Waiting to cook vegetables until closer to serving time can prevent overcooking and result in meals that are nutritious and colorful. Assuring proper temperatures are maintained during meal service also helps with palatability.

F809: Frequency of Meals/Snacks – Providing meals and snacks at appropriate intervals. Training in this standard should include timing of meals. Meals should be planned no longer than 14 hours apart (unless an adequate nighttime snack is provided to all residents). An example of a citation is if the evening meal is served too early at 4:30 pm, and the morning meal is served at 7:00 am. This is longer than 14 hours. The evening meal should be served at 5:00 pm. Check your policy to ensure that you are following the intervals set for your facility and that staff are aware of the requirement. Another example of this regulatory requirement is providing snacks. A variety of nourishing snacks that meet residents’ preferences should be available at appropriate times for residents to help satisfy their needs.

CONCLUSION

Karen made the right decision in honoring the resident’s preferences. After all, everyone, as a part of the interdisciplinary team, must work together to help meet the needs of residents. Teamwork is vital and can help improve quality of life, overall satisfaction, and enjoyment of food— which leads to improved nutritional outcomes. Training and educating staff on nutrition and regulatory framework empowers them to make the right decisions and to be mindful of overall nutritional goals.