It's not easy to get good food into people with advanced dementia. Their appetites decrease, and weight loss is a big issue. Some have trouble using a knife and fork. Some eat a few bites, then wander around. Many have some trouble chewing or swallowing.
Facilities that cater to the elderly have often solved these problems by serving unappealing pureed food or food that can be picked up — chicken nuggets, fish sticks, and sweet potato fries — but may be short on nutrition.
The Watermark at Logan Square recently showcased a trend in upscale memory units: healthy finger food. Its proud culinary staff offered guests beef Wellington cupcakes, tilapia wrapped in puff pastry, cheesesteak wrapped in crepes, and little balls made of chef's salad ingredients. The approach, which it has branded Thrive Dining, is based on methods developed by two chefs in Atlanta who have been teaching chefs throughout Watermark's 39 senior communities in 20 states how to grind entrees and turn them into attractive food that residents can eat by hand.
Food might be wrapped in rice paper or shaped into empanadas. Starches such as rice or potatoes do most of the binding. There are pasta wedges to serve with meatballs. Grind Dining created the process for the Arbor Co., which is based in Atlanta and has 32 senior communities, including four in New Jersey. Several other chains have gone through training, and company co-founders Sarah Gorham and Stone Morris are working on a cookbook that home caregivers could use.
"It's very eye-appealing, and every bite is a completely balanced meal," said Rob Bobbitt, Watermark's national director of dining services. There were bite-size fruits and veggies at the Watermark tasting in Philadelphia, but the main courses were mostly meat and cheese.
Unidine, a Boston-based company that provides food and dining management for senior living facilities, has created a "Fresh Bites" finger-food program for memory care as well as "Puree with Purpose," a way of presenting pureed food so that it looks more like the original.
"In the last two years, we've really ramped it up," said Steve Servant, Unidine's vice president for business development. He said many large food service management companies are starting to develop special menus for people with dementia.
This upgrade in dementia dining is part of a broader trend to serve well-heeled seniors who are accustomed to fine food. The goal is to give elders with cognitive or neuromuscular problems more independence while preserving their dignity and improving their nutrition. It is also a selling point for pricey facilities.
"Dining is a point of distinction within every community," Grind Dining's Gorham said.
A spot in the Watermark at Logan Square's 14-bed memory unit costs $6,500 to $6,700 a month. The Tucson, Ariz.-based chain also has local facilities in Blue Bell, Media, and Woodbury.
Servant said there is growing recognition that food is a central pleasure for people with dementia. "Food is very healing in memory care," he said, " and it's very much a part of the interventions."
Neither Unidine nor Grind Dining had strong scientific support for their approaches, but officials said that caregivers tell them residents eat more when offered appetizer-like foods.
Gorham said finger foods may reduce stress on staff. "If more residents are able to eat independently, it allows them to concentrate on those residents that you know need help," she said.
Watermark piloted the Thrive Dining program in three communities in San Francisco and one in Tucson in 2015. The Philadelphia Watermark began rolling it out last fall; it's feeding about six people a day now. Ultimately, dining services director April MacDonald wants to include around 25 residents who need nursing home care or have physical problems such as Parkinson's disease that make eating with utensils difficult.
Grinding the food, Bobbitt said, maintains more texture than pureeing, and the vegetable slices retain some bite. "We all enjoy chewing," he said. He said the entree salads are very popular because salads can be labor-intensive for the elderly to eat. Chefs form the ground meat, cheese, and egg for a chef's salad into small balls that can be served with sliced vegetables.
The chef's salad balls were not the top draw at a recent tasting, which included about 10 Watermark staffers and six outsiders. The meal began, as it does in memory care, with warm hand towels scented with lavender (and detergent) followed by a spoonful of tart lime sorbet, which has been found to stimulate appetite. Angela Espinosa, a speech therapist from Bayada who was a guest, explained that the combination of hot and cold — thermal tactile stimulation — awakens awareness.
Jen Tapner, CEO of Watermark at Logan Square, said she frequently eats the baked eggs, a combination of eggs, sausage and French toast cut into wedges. "That's my favorite," she said. "I just think it tastes really good."
Other tasters were not so high on that one, but liked the meat-based dishes. They were salty and some were pretty greasy for finger food, but they were visually appealing and much better than chicken nuggets. The beef Wellington cupcakes were a little crumbly. The grinding made tenderloin taste like good meat loaf. The tilapia in puff pastry was quite good, but what isn't good in puff pastry?
The cheesesteak crepes, which looked like egg rolls, were a hit with a moist, oozing center and cheese dipping sauce. Carolyn Bailey, director of provider relations for Friends LifeCare, thought it was "more nutritious because you don't have all that bread." Wing Yan Lau, a Watermark dietitian, liked the taste. "I think the cheesesteak actually tastes better than the original one," she said.