Long-Term Care Menus: Nutrition Guidelines, Regulations, and More
A positive dining experience starts with the menus.
Menus that fail to incorporate resident choices and needs lead to an unpleasant dining experience, unintended consequences like unplanned weight loss, and survey citations.
This article provides an overview of the nutrition guidelines and regulations that long-term care menus must meet.
Nutrition guidelines for long-term care menus
Long-term care menus must meet the nutritional needs of residents based on national guidelines like the Dietary Guidelines for Americans (1).
The dietary guidelines translate the National Academies of Sciences’ dietary reference intakes (DRIs) for nutrients into food and beverage recommendations (2).
Here is a table of the recommended daily or weekly amounts from the different food groups or subgroups based on a 2,000-calorie diet (3):
| Food Group or Subgroup | Daily Amount |
|---|---|
| Vegetables | 2.5 cups |
| Weekly amounts | |
| Dark-green vegetables (broccoli, kale, spinach, bok choy, etc.) | 1.5 cups |
| Red and orange vegetables (carrots, sweet potatoes, tomatoes, squash, orange peppers, etc.) | 5.5 cups |
| Beans, peas, lentils (black beans, chickpeas, lima beans, pinto beans, green peas, etc.) | 1.5 cups |
| Starchy vegetables (burdock root, cassava, corn, white potatoes, etc.) | 5 cups |
| Other vegetables | 4 cups |
| Fruits (apples, bananas, berries, kiwifruit, peaches, etc.) | 2 cups |
| Grains | 6 ounces |
| Whole grains (amaranth, barley, brown rice, whole grain bread, oatmeal, etc.) | 3 ounces |
| Refined grains (white bread, cream of wheat, masa, refined grain crackers, corn grits, etc.) | 3 ounces |
| Dairy and fortified soy alternatives (yogurt, soy milk, kefir, milk, cheese, etc.) | 3 cups |
| Protein foods | 5.5 ounces |
| Weekly amounts | |
| Meats, poultry, eggs (beef, goat, lamb, poultry, eggs, etc.) | 26 ounces |
| Seafood (anchovy, catfish, cod, salmon, tuna, etc). | 9 ounces |
| Nuts, seeds, soy products (tree nuts, peanuts, pumpkin seeds, nut butters, tofu, etc). | 5 ounces |
| Oils | 27 grams |
The quantity equivalents for each food group are:
| Vegetables, fruits (1 cup equivalent) | 1 cup raw or cooked vegetable or fruit 1 cup vegetable or fruit juice 2 cups leaf salad greens 1/2 cup dried fruit or vegetable |
| Grains (1-ounce equivalent) | 1/2 cup cooked rice, pasta, or cereal 1 ounce dry pasta or rice 1 ounce sliced bread, tortilla, or flatbread 1 ounce of ready-to-eat cereal |
| Dairy (1 cup equivalent) | 1 cup milk, yogurt, or fortified soy milk 1.5 ounces of natural cheese such as cheddar cheese or 2 ounces of processed cheese. |
| Protein foods (1-ounce equivalent) | 1 ounce of lean meat, poultry, or seafood 1 egg 1/4 cup cooked beans or tofu 1 tbsp nut or seed butter 1/2 ounce nuts or seeds |
Calorie needs
Long-term care residents tend to be older adults ages 60 years and older.
Calorie needs vary widely based on gender, body size, activity level, and health status.
Older adult females require about 1,600 – 2,200 calories per day and males require 2,000 – 2,600 calories per day.
While the Dietary Guidelines are not intended to be a clinical guideline for treating chronic diseases like diabetes or heart disease, they can serve as a reference for developing therapeutic diets for residents with chronic conditions.
A registered dietitian is responsible for reviewing the menus to ensure they meet residents’ nutritional needs.
Regulations for long-term care menus and dining
Long-term care menus must not only meet the nutritional needs of residents but also reflect their individual preferences and religious, cultural, and ethnic needs.
This is accomplished by assessing each resident to learn their needs and food preferences upon admission and frequently thereafter to identify changes.
Special care must also be taken to identify any food allergies or intolerances.
For residents with dementia or other barriers to expressing these needs and preferences, steps should be taken to learn what those preferences are, which may involve observing their food intake and habits or talking with their loved ones.
In addition to being prepared based on resident preference and choice, food should be presented in an appealing way.
This would include not presenting food that is pureed or cut into small pieces in piles or mixed together.
To make foods appealing, each plate should include a variety of different food colors, textures, and shapes.
Imagine a mound of mashed potatoes, a chicken breast, cauliflower, and vanilla pudding. These items all share the same bland color and similar textures.
Now, imagine a plate with sliced roast beef, potatoes with gravy, roasted green beans, a dinner roll, and a slice of cherry pie.
Beyond appearance, food should be served at the appropriate temperature.
Other aspects of the dining experience
The menu — despite being a significant contributor — is just one aspect of creating a positive dining experience.
Here are other ways to further elevate your residents’ dining experience:
- Create a home-like environment: Using fine or faux china, table cloths, and avoiding trays can help create a home-like environment. Let the residents define what makes a home feel like a home.
- Liberalize therapeutic diets: Therapeutic diets can limit food choice and take away from a pleasurable dining experience. They may also not align with a resident’s goals for care.
- Try restaurant-style dining: Meals are delivered to each resident while sitting at a dining table with other residents in a more restaurant-style setting.
- Allow flexible meal times: Rigid meal times don’t allow for individual choice. Offer residents who prefer to sleep in the choice of eating later.
These options can reduce meal waste, decrease supplement usage, and increase resident satisfaction.
The bottom line
Food is a significant contributor to long-term care residents’ quality of life.
Regulations require that long-term care menus meet the nutritional needs of residents but also reflect their individual needs and food preferences.
Creating a home-like environment, liberalizing therapeutic diets, and restaurant-style dining, and allowing flexible meal times can enhance the dining experience and increase resident satisfaction.
