Nutrition, Kitchen Safety

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Nutrition, Kitchen Safety Preparing Meals for
Elder Care ReceiversModule 15
Elder Family Caregiver Education
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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
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Planning Meals Using Dietary Guidelines

• Tailor the Guidelines to the specific Care
  Receiver
• Choosing appropriate Dietary Guidelines
• Physicians/Dietitians guidelines, prescribed
  specifically for the Care Receiver
• Guidelines from organizations for specific
  chronic diseases of the Care Receiver
• http//www.goldencuisinestore.com/home.jsp?navSect
  ionhomepageTitleHome
• 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)  

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New Dietary Guidelines effective 2005

• One size doesn't fit all USDA'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.

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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

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Determine Care Receivers Food Preferences

• Avoid serving foods the person dislikes
• Substitute others to provided needed nutrients
• Adjust recipes for favorite foods to satisfy
  dietary guidelines

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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

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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

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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

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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)

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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 sugar If 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

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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

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Reorganizing the KitchenFor Safety Convenience
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Physical Hazards Assess the Kitchen

• Electrical/fire hazards
• Frayed electrical cords
• Overloaded plugs
• Natural gas leaks

• Tripping/falling hazards
• Slippery or cracked flooring
• Loose tiles
• Throw rugs
• Extension cords
• Clutter

After assessing, make any needed corrections and
repairs
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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!

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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

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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?

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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

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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
  Receivers 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

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

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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

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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

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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

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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

• 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

NEVER, EVER, LEAVE CARE RECEIVER ALONE IN THE
CAR!
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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

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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

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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

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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"
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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

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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

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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) its 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

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Easy-on-the-Caregiver Techniques For Preparing
Meals Examples

• 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

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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

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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

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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

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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

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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 Receivers ability

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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

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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

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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
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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

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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 Receivers 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

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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

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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 physicians 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

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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
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What Assistance is Available through the Area
Agency on Aging (AAA)?
Services for persons age 60 and older

• Caregiver Services

• 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

   Note Not all services are available in all
counties. Call the Area Agency on Aging
for information about a specific community. 
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• Written by Jeanie Crane, 2004, from her book
  Lets 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