Stories from the front lines: A careful approach to dining at a new nursing facility

Residents are scheduled to move into the new Murphy Rehabilitation & Nursing facility in Murphy, N.C., the last week of October. The freestanding 69,080-square-foot building, operated by Century Care Management for both short- and long-term-care patients, has 42 private rooms and 78 beds for long-term-care nursing and seven halls with a total of 134 beds. A special Alzheimer’s unit called Cardinal Way has 14 beds with two private rooms.

The new Murphy Rehab/Nursing facility, located less than a mile from the antiquated existing facility attached to Murphy Medical Center, not only has much more spacious rooms with private bathrooms and showers but also communal areas like a chapel, an open-concept activities room, two living rooms with fireplaces, a cinema with an 82-inch television, a beauty shop, a rehab gym and two dining locations operated by management company Culinary Services Group (CSG), a longtime partner of Century Management.

Photo credit: Culinary Services Group

Photo: The Cardinal’s Nest restorative dining area in the new Murphy Rehabilitation & Nursing facility in North Carolina, designed for patients needing extra assistance with dining.

Dining facilities at the new Murphy facility include a main dining hall with a private dining room and a special restorative dining room for patients needing extra help with eating their meals, and Duncan’s Tavern, a casual dining and socialization outlet with fireplace, game table, bar seating and an outlet to a courtyard.

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Obviously, the communal areas will be either closed or severely restricted when the facility opens due to COVID-related mandates, and CSG is planning on a flexible approach that will emphasize in-room meal service for the foreseeable future while keeping congregate dining areas ready for whatever Century Management and the state of North Carolina allow.

CSG Area Manager Tom McGinness spoke to Food Management about how the company plans to approach dining at the new Murphy Rehab/Nursing facility as well as its approach in other similar facilities. Here’s his story:

“In North Carolina, guidelines have recently opened up a little bit with regard to communal dining in the dining room, but it’s on a case-by-case basis based on what the COVID situation is at a particular facility. I do have facilities in North Carolina, including one with Century Care, that did just reopen dining, but it’s all in small doses. For example, one facility that just started this week is lunch only and it’s only 12 people per [seating] so that there’s enough social distancing and things like that.

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First off, any communal dining is going to be the residents’ preference because there might be some residents who feel uncomfortable eating in full settings. That happens even without COVID but particularly now with COVID. At this particular facility [where communal dining is taking place], if they have more than 12 people who want to eat in the dining room, they do it in stages, so they bring in a group of 12 and when that group is done, everything gets re-sanitized and cleaned up before they bring the next group in.

A dish of stuffed jalapenos served by Culinary Services Group at its client locations at Friends House Retirement Community in Sandy Spring, Md., an example of the scratch-cooked fare the company emphasizes at the senior living communities where it operates.

[Group dining] may be different at Murphy because the number of residents dining at one time depends on the size of the dining room, so in some places you may be able to bring in more than 12 at a time while at others it’s less than 12.

[Initially, dining at Murphy will be all in-room.]

We’ll bring the food in insulated food carts to keep the proper temperatures, and it will then get passed one hall at a time. These are all trayed, not in to-go containers or anything like that, with regular silverware. Frankly, residents are served the same way as they would be if there was communal dining, except that it’s in their rooms.

For the ordering process, we have menus posted and we go through asking residents what they want. We take down preferences so that even if there’s a menu item—maybe a dislike for the green beans that are the primary vegetable on the menu that day—we have backups built into the system so that they would get something else that better fits their preferences.

We also have a primary and alternate entrée, and in addition to that, we have what’s called an Always Available menu, so if, for example, they just feel like a hamburger, they can get that—assuming it fits their diet restrictions, of course. Breakfasts are usually pretty well received with few requests for something different, but lunch and dinner are where we utilize that Always Available menu more often.

Photo: Veggie spring rolls served by Culinary Services Group staff at Friends House Retirement Community in Sandy Spring, Md.

Photo credit: Culinary Services Group

We do menus on a 30-day cycle and in those 30 days there are few repeats—and none in any given week. A very rare example of a repeat is that every Wednesday for lunch, it’s fried chicken, which is something that residents really look forward to. For those who can’t have it because they are on a heart-healthy diet, we’ll do baked chicken instead for them. Otherwise, there are almost no repeats and the [selections] run the gamut of all proteins and all vegetables. We try to emphasize the use of seasonal, fresh vegetables and fruit whenever that’s possible. Also, we have a heavy, heavy emphasis on scratch cooking with very little in the way of anything that’s prepared in advance.

The 30-day cycle menus are split into spring/summer and fall/winter menus, but each facility has the ability to amend the menu to accommodate regional preferences. For example, some facilities I have on the coast really enjoy seafood lasagna, so we added that to their cycle menu even though It wasn’t part of the original cycle menu. There are other facilities that are more rural, and they enjoy something called a collard sandwich—basically a collard green sandwich. I’d never heard of it, but it is a hit at this particular facility, so we were able to add that to the menu. We really try to focus on regional preferences and understand that ‘regional’ doesn’t mean the whole state of North Carolina, for instance, because there is a wide variety of preferences across the state. So we keep our ears to the ground and ask for resident feedback, and we speak to the administrative staffs of the facilities and make changes as necessary to ensure that residents are getting food that they want to get. However, every recipe is run through our dietitians to make sure that we are meeting the nutritional standards.

Fortunately, we’d had to make few changes due to COVID as the kitchens where we operate are generally large enough to have social distancing, and we really haven’t had to transition our menus at all, with the exception of early on, when there were some supply chain issues.

We have a vast database of recipes that helps us to do scratch cooking, which I believe helps differentiate us from other management companies and even self-ops. All our kitchens are well appointed, and we get a lot of cooperation from our host facilities to make sure we have the equipment we need to do the scratch cooking. We source the majority of our produce from produce-specific vendors that have a focus on sourcing as local as possible, and we try to get fresh protein instead of frozen where possible. We also order to the menu weekly so that there is no large inventory sitting in the freezer for months.”