Monday, September 8, 2014

Remembering a Fork

Celebrity chefs such as Wolfgang Puck, we read, are now offering a gourmet touch to services such as Meals on Wheels and even the Culinary Institute of America is offering classes aimed at the nursing home crowd. The burgeoning of the elderly and the old-old residents requiring nursing home care or assisted living is growing rapidly. This provides a tidy incentive to those corporations serving them.

All well and good, you say, because why shouldn't this group of seniors enjoy the pleasures of fine dining? I agree, but I wonder, too, about the cost of the establishments that are offering this fare. Not everyone has the means to move to a premiere senior residential facility or nursing home. What kind of foods do they receive and who prepares them? The bottom line everywhere is, of course, cost and that will always be the prime motivator.

I once visited an upscale nursing home that offered a glass of wine with Sunday dinner and physicians even ordered one cocktail per day for specific residents. The nurses station kept the booze in a locked cabinet ready for the evening dispensing.

The "chef", aka the cook, at this facility where families pay close to $100K/year or more for a family member, was a woman who was intellectually challenged. She did her best and cooked what she knew, but it was always the same meals with little taste. Of course, it was explained to me that the residents didn't like their food seasoned and it was left to them. But how could they season anything when seasoning is an integral part of food preparation and salt and pepper just don't cut it?

As I read this article regarding the increasing turn to fresh, locally grown vegetables and more exotic foods, I also wondered not only about those who can't afford it, but those who don't recognize it. It took me back to a time a few decades ago when I saw what up close and personal reveals to you about dementia and Alzheimer's. I should mention that one of the chefs is even taking chicken and pureeing it in a blender, then remolding it to look like a chicken and garnishing it with a reduction of some type. Good stuff, you'd agree, I'm sure. But what if you won't recognize it as food?  What if the sight of a "chicken" on your plate frightens you?

Alzheimer's takes away more than just memory, it robs you of the ability to independently make simple decisions like eating. I watched as a woman in a hospital sat staring at her plate. There was no movement and she was urged to eat. The problem was that she didn't know what she was expected to do and she didn't know what the utensils were for. Eating had turned into a trial and anything in front of her, including the utensils, were for eating. In fact, she did pick up a fork and try to eat it. How did they permit it to get to this discouraging point?

One of the amusing aspects of nursing home life, if you can find this amusing, is that the dining room becomes much like a high school cafeteria. There are seats for the assorted cliques and if you attempt to join that table, you are quickly and sometimes sharply told to go elsewhere. Yes, dementia does affect those really important frontal lobes involved in decision making and adhering to social rules.

Staff must be quite diligent in helping new residents to their tables and insuring that they will fit in well with the other established members of that table. The plan is to mix some good talkers in with those who can use verbal stimulation. No one actually measures how well this plan works. Does it encourage or discourage talking or bring up other issues? Interesting things to explore.

Meals may be changing and there may be a lot of media aimed at this effort, but how the residents are helped is equally important. Not all of them are so sanguine about the current changes.

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