Portion Size

The thing that shocked me the most when I first began working with the elderly was the portion size of their meals. Maybe it's because I belong to the super-size-me generation, that portion sizes really were that tiny 60 years ago, or maybe when you get old you just eat less. I suppose the baby boomers and the next aging generations will tell us more, but I suspect it is a combination.

 

The elderly folks (that I work with) don't do much, so their caloric needs are much less than that of an active adult. They get up, they shower, they use their walkers to shuffle to the dining room for breakfast, then to the TV room until lunch, then back to the TV until dinner, maybe a game of scrabble, then to bed. A day in the life of a senior at XYZ assisted living revolves around meal time.

Everything is smaller: appetites, plates, bowls, bagels

The entree plates we use at the old folk's home are not a common size. They are in between the sizes of a small hors d'ourve plate and the (present) standard dinner plate. Paper plate size. The perfect size to make a little portion still fill it up and look like an adequate meal, which it is.

Old people can be very particular. The current ones came from an age where food was not in abundance, where they ate everything on their plates, when they couldn't get any ingredient on the planet like we can today.  Many of them get very overwhelmed by the amount of food I sometimes load onto their plates, so overwhelmed that instead of working away it it and eating what they can, they don't touch it. So my ignorance to their preferred portion size results in their skipping of a meal. Respect their portion control. Use a small plate, give them one scrambled egg for breakfast, half a sandwich for lunch, I know it doesn't seem like much, but it's enough.

I've got a list of my "big eaters" and my "small eaters". The big eaters get a whole sandwich for dinner! The smaller or half-portion eaters get, well, a half sandwich. Even the so-called big or "good" eaters eat much less than your average American these days. It becomes very apparent when I feed the staff- their plates are often 1.5 to 2 times larger than the "good eaters." I'm not saying that all non-seniors eat too much, we are much more active in our youth and have higher metabolisms (especially in Boulder, Colorado), and require more calories.

Their little appetites are another reason seniors should be fed nutritious foods; they are only going to eat so much, so there is a much smaller opportunity for them to get all their required nutrients. It is recommended that seniors take a multivitamin, and most do, in addition to their other numerous pills and medications.
...but that's a topic for another day.

The one thing most of my seniors don't skimp on is dessert. I send out the daily menu and receive half orders for the entree, salad and soup, and double orders of dessert! But I like to believe it's because they love my baking.

Starch

Starch: No meal is complete without it

I always thought my first job in assisted living was the best, revolutionary even. I had the idea that all facilities and homes served pre-made packaged and frozen foods. And most of them do. But Fairhaven Estates was different. They hired real cooks and made foods from scratch. Sure we had white cake mix that we'd use- adding cocoa powder or flavored extracts to change the flavor- frozen fish fillets, and a few other items, but almost everything was handmade. We peeled and diced and boiled the potatoes for mashed potatoes and potato salad, we scrubbed the skins for baked potatoes, we washed the little red guys for herb roasted red potatoes, we sliced them thin for scalloped, julienned for fries...  But all we had were potatoes. Everyday. We might have a great entree, fried chicken (with potatoes), baked ham (with potatoes), pot roast (with potatoes), but always (with potatoes). We had the occasional sweet potato fries, and even mashed sweet potatoes (along with mashed potatoes) for Thanksgiving feasts, but that's it. Potatoes.

I did ask my boss why once, he said most of the residents hated rice and spaghetti (they called any form of pasta spaghetti, regardless of shape). I took it as truth and forgot about it- quickly learning how to prepare potatoes every way, and just as quickly deciding I hated them.

I still believed it, up until my current job. I had almost forgotten about other starches, even ones I prepared at home but that didn't register in my brain for one reason or another. Then I encountered the "starch" box at work. My head chef keeps everything very organized; if you are looking for nuts in dry storage, check the nut box, flour- check the grain box. The potatoes (and sweet potatoes) are in a large box on the bottom shelf. But ah... the starch box. Polenta, long grain white rice, arborio rice, wild rice, brown rice, quinoa, bulgur, barley, millet, wheat berries... the list goes on. Next to the starch box, and closely related, we have the pasta box- filled to the brim with all shapes of noodles- spaghetti, lasagna, couscous, cavatappi, egg noodles, elbow macaroni, shells.... All avaliable to prepare and serve with the entree (or soup, or salad, or even dessert).

And the residents love it. They don't want potatoes all the time either! They are still human beings with the same (though slightly weaker) taste buds! Yes- potatoes can be yummy, and seniors do love them, but not everyday.

I totally understand the distaste for spaghetti (the actual spaghetti, angle hair, capellini, linguine and other long pastas)- the long awkward shapes, hard for trembling hands to swirl onto a fork, that slide too easily down your throat, before chewing, and can be hazardous. I myself have choked on spaghetti more times than I'd like to recall. But there are so many pasta shapes! I really like to use the short, flat, wide egg noodles- they have a unique flavor and are both easy to pick up and to eat- great for Stroganoff and casseroles, plus, I always use them when I make chicken noodle soup.

I think a lot of elderly residents dislike rice for the same reason, not that it's hard to swallow, but that it is harder to pick up with a fork. It also tends to get everywhere, so serving in a bowl might make clean-up easier. Risotto is an option too- it sticks together, making it much easier to pick up, and it's creamy and flavorful.

Of all the many grains, I have had the best luck with polenta. It's thick, creamy, and soft, and can be seasoned many ways. The residents love it; it sticks together, sticks to their utensils, stays on their plates (not the floor), is easy to chew (though not necessary) and easy to swallow, and just plain delicious. I usually stir in hot cream and Parmesan cheese at the end, or sauteed onions, mushrooms and thyme ( also one of my favorite risotto combinations). You can prepare it with water or a flavorful stock- just don't forget the salt!

Whatever starches you choose to accompany your meals,  be sure to use a variety. Be open to new breeds and try new recipes. And don't forget about the potato!

Lettuce Salads

Salads seem to be an uncommon part of the senior diet. Lettuce can be hard to chew and swallow, and it wasn't a common food back in the day when our current old folks were youngin's.(Click for Brief Salad History)

In previous homes I've worked in, dinner salads were unheard of, and the salad bar's lettuce and fresh vegetables would go unnoticed next to canned beets, jello and fruit cocktails.

One of my grandfather's chief complaints about senior food was lack of lettuce. He had quite the palate for an 80-sum year-old.  Other than enjoying a giant cookie and beer that my mother would sneak into his nursing facility, he loved a fresh crisp salad. And I know there are more seniors out there with taste buds like Papa Bob.

At my current place of work, we make entre salads at least once a week and small side salads almost daily, with few complaints.

Several of my residents are missing entire sets of teeth, which make chewing rather difficult. For these residents, and others with chewing and swallowing problems, I chop the lettuce or salad greens up very small. For seniors I chop it up small anyways, but for these special cases I mean really tiny. And then I chop up all the toppings just as little. Presentation is still important though, (you eat with your eyes before you eat with your mouth) so I arrange the confetti of toppings on in an attractive manner.

So don't let a few sour apples spoil salads for everyone.  I have one resident who won't eat lettuce, but she'll eat the rest of the salad, so I make her a special plate without it. If you're working in a community, I urge you to give it a try and see how it goes over. Get feedback. If you're cooking for less, say a parent, grandparent or personal client, ask them how they feel about salads- see what they like and don't like about them. We're here cater to their dietary desires, and it's easy to make a few adjustments.

A note about...
Onions: Lots of people in the general public do not like raw onions. The senior population is no different. Be wary.
Bell Peppers: I've heard complaints from several elderly residents that these wreak havoc on their digestive systems. Use sparingly.
The Foundation: There is so much more variety of amazing greens on which to build your salad than iceberg lettuce. Try spinach, mixed greens, romaine, bib lettuce, and others- they actually all have unique flavors and textures.

Why Seniors?

In a lot of ways, cooking for seniors is like cooking for children; many seniors have the diminished taste buds of already bland and old-fashioned palates.

But just because some old folks don’t like flavor (or texture, or spice) doesn’t mean none of them do. And these preparation factors should not (and can not) be compromised for these old farts- usually the ones that have something to say about it too- especially when cooking for many in a home or senior community.

That’s what I do- I am a cook at an assisted living facility. I am professionally trained in the culinary arts and I choose to use my education, experience and talent to cook for the elderly. Because they deserve it too.