Visit a loved one in a nursing home at noontime on any given weekday and again during the weekend and you will see two completely different scenes.

On a Wednesday, for instance, patients who are mobile, with walkers or in wheelchairs, are gathered in a large dining room, which is bustling with activity.  They are grouped around tables of various sizes, usually according to their ability to interact socially.  Aides move attentively from table to table encouraging patients to eat, assisting some who need specific prompts and, in some cases, feeding those who are unable to feed themselves.  Various levels of occupational therapy are apparent.  The atmosphere is as bright, cheerful and upbeat as the staffing level and décor will allow.

By contrast, on Sunday patients are in wheelchairs in the hallways, in small “activity” rooms on their floors, or in their own rooms.  Very few staff members are in sight.  A TV, unwatched by anyone, is droning in the background.  The patients can be divided, with a few exceptions, into one of two categories—those who can feed themselves and those who cannot.

Those who can open their meal offerings independently, lift the thermal covers from their plates and teacups, insert straws in their beverages, tear open packets of sugar or butter, and easily lift utensils to their mouths vigorously consume their meals.  These are, invariably, the most mentally alert and least physically handicapped patients.

Scattered among them are others sitting quietly, sometimes slumped in their chairs, in front of unopened trays and untouched meals.  They seem to be uninterested in the food, not hungry, not even aware that it is mealtime.  Some of these are the very same patients, who, with prompts or assistance during the week, have eaten reasonably substantial meals.  Without that kind of attention, they are simply unable to eat on their own.  The pared back weekend staff try to assist as best they can as they move from patient to patient, offering a few spoonfuls here or a little coaxing there, but there isn’t time for everyone to be fed a full meal.  Inevitably, when the kitchen aide responsible for collecting trays at the end of lunchtime makes his rounds, many untouched or barely touched trays return to the kitchen and the food goes into the trash.  My friend Dorothy told me that, during her rehab stay in one nursing home, it broke her heart to see some of her fellow patients sit limply before their trays unable to eat their meals.

Nursing homes employ nutritionists to ensure that patients receive a balanced, healthy diet – in theory.  But the practicality of preparing hundreds of standardized meals three times a day for people with multiple dietary needs makes it extremely difficult to serve fresh, attractive, appetizing food.  Nursing home food, like much hospital food, is usually bland or tasteless and unattractive.  Vegetables are invariably overcooked and fresh fruit is scarce.  Bread is of the “Wonder” variety.   Desserts consist mostly of Jell-O, apple sauce, vanilla ice cream or packaged puddings because they are easy to put quickly on trays, can be eaten without teeth and cleaned up quickly.  Meats are often, of necessity, ground.  Especially if the patient is unable to remember the announced menu, it may be impossible to tell what one is eating.  Even a healthy, alert and strong elder would find it difficult to maintain a balanced, nutritious diet in a nursing home.  Dorothy, who at the time of her respite stay was a vegetarian and who was having difficulty swallowing, found it extremely difficult to piece together a meal that would not leave her feeling hungry. And she had her wits about her and was able, with assistance, to fill out the menu request forms.

How can this be good enough for our elderly?  How can this be acceptable when families or the government pay extremely high costs for nursing home care?  Is this an unsolvable financial and organizational problem?  Am I whining about something trivial when larger issues loom in eldercare?  A contributing factor in the rapid physical decline of elders who are admitted to long-term care in nursing homes is, I believe, poor diet and insufficient nourishment.  Some are slowly starving to death.

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