Liberalized Diets & The Dining Experience Presentation

The Challenge

  • Ensure that individuals maintain weight and nutritional status
  • Provide food that looks, smells, and tastes good

Risk Factors for Weight Loss

  • M-medications
  • E-emotional problems
  • A-anorexia
  • L-late-life paranoia
  • S-swallowing disorders
  • O-oral Problems
  • N-nosocomial infections
  • W-wandering
  • H-hyperthyroidism
  • E-enteric problems
  • E-eating problems
  • L-low salt, low cholesterol diets
  • S-social problems

What Restrictive Diets Do

  • Limit familiar foods
  • Eliminate or modify seasonings in food
  • Contribute to:
    • Poor appetite
    • Decreased food intake
    • risk of illness and weight loss

Diabetic Diets

A regular diet is appropriate for most geriatric individuals who have diabetes

  • Consistent meal times
  • Consistent calories, carbohydrates, and protein
  • Standardized portion sizes
  • Improves quality of life

Cardiac/Cholesterol Diets

  • Medications for heart disease can suppress appetite
  • The importance of cholesterol in reducing mortality rates after age 65 is questionable
  • The risk of causing malnutrition is a greater risk after age 65

Low Sodium Diets

  • People who are elderly do not tolerate low sodium diets well
  • Contribute to:
    • Loss of appetite
    • Hyponatremia
    • Increased confusion

Renal Diets

  • individuals with renal failure are especially susceptible to malnutrition
  • Preventing malnutrition may require liberalizing diet restrictions

Prevention of Weight Loss

  • Individual Interventions
    • Facilitate increased food consumption
    • Provide feeding assistance
  • Dining
    • Enhance the dining experience
      • Favorite food, comfort food, ethnic food
      • Accessibility: when hungry or longing for specific foods
      • Food first, then supplements
  • Family support
  • Nutritional therapy
    • Fortified foods, Snacks, Finger Foods
    • Liquid nutritional supplements

The Culture Change Movement

The culture change movement aims to take the ‘institution’ out of the home.

It involves transforming nursing homes from a traditional model to a person-centered and person-directed model.

* Source: NY State Office for the Aging,

Culture Change

  • Menus and Nutritional Adequacy:
    • Use resident council meetings to discuss menus and meal service
    • Who makes up the “community” culturally?
    • Use regional menus and include ethnic favorites
  • Food Preparation and Meal Service
    • Respect individual preferences and habits regarding meal consumption
    • Train staff on cooking methods that enhance appearance and palatability
    • Observe meal service:
      • Environment
      • Assistance
      • Meal Frequency
      • Different styles of meal service

Dining Alternatives

  • Five meal plan vs. 3 meals plus snack
  • Restaurant-style dining
  • Buffet-style dining
  • Family dining
  • Select menu
  • Extended hours


  • Honor individuals preferences and habits regarding fluid consumption
  • Document person’s fluid preferences in care plans
  • Provide a variety of beverages with meals and snacks
  • Provide beverage stations with easy access or hydration carts
  • Soups, smoothies, lemonade, popsicles, watermelon
  • Room pitchers within reach

Culture Change & Regulations

  • No significant barriers have been identified by Regulatory Services for implementing culture change.
  • Nursing homes can actually reduce their deficiencies by:
    • Seeking positive person-centered outcomes.
    • Care planning according to a person’s wishes.
  • Food and dining requirements are core components of quality of life and quality of care

What it means…

  • Care provided is consistent with the comprehensive assessment
  • Diet is determined by individual’s informed choices and preferences
  • Goals and prognosis refer to personal and clinical outcomes

Impact to Providers

  • Changes in meal time and impact on nursing and caregiving schedules
  • Changes in attitudes about textures and diet liberalization
  • Costs
  • Increased occupancy

DADS Culture Change Initiative

For help regarding:

  • Questions on Culture Change topics
  • Stories on Culture Change successes in Texas nursing homes
  • Questions for DADS experts

Contact DADS Center for Policy and Innovation

Quality Monitoring Program

Providing Positive Partnerships with Providers

Regional Staff:

  • Includes dietitians, nurses and pharmacists
  • Serve as a resource to develop and communicate evidence-based best practices and innovations for improvement of outcomes
  • Available for in-services on a variety of topics.