No matter how old you are when you are given a diagnosis of celiac disease or gluten intolerance, living gluten free has its challenges. But as awareness around the problems associated with ingesting gluten, even in tiny amounts, has grown, more restaurants and food service operators are heeding the call to provide gluten-free options to their clients. That includes senior living facilities.
As interest in a gluten-free lifestyle grows, senior lifestyle communities are investing in the tools necessary to service this community. But what does it take to provide gluten-free meals to communities of seniors?
Caring and Knowledgeable Staff is Essential
“To make a gluten-free program successful, you have to care,” said Kate Hays, Director of Dining Services at Wake Robin, a life plan community in Shelburne, Vermont. Hays credits her immediate predecessor with building the infrastructure to serve quality food and relies on long-term relationships with purveyors and smart people in the kitchen to execute a successful GF program. “Working with great people is half the battle,” Hays said.
Wake Robin, which cooks all meals from scratch and has an in-house pastry chef to craft exceptional gluten-free desserts, considers food an essential component in building a successful community. “Unlike a restaurant, where people come in and eat once in a while, we are feeding people for years and years,” said Hays. “Food is comfort and no matter their relationship with that, I want them to feel nourished and comfortable sitting with others at their tables.”
Even a tiny amount of gluten— less than can sit on the end of your pinkie— can exacerbate a celiac sprue sufferer’s system, hanging around causing problems for a long time. Ingredients must always be checked by kitchen staff to ensure their formulations do not suddenly include gluten. Awareness around other “hidden” sources of gluten must be explained to prevent them from coming into the community’s kitchen.
“There is a misunderstanding about celiac disease, as often people don’t exhibit any symptoms,” said Alison Precourt, a clinical dietitian at the University of Vermont Medical Center and Wake Robin consultant, “But gluten is in everything. It takes some investigating and can be very challenging.”
Leon Grundstein, CEO and Founder of GenCare Lifestyle senior living communities in and around Seattle, first made the transition to organic food before committing to a full gluten-free menu with certification from the Gluten Intolerance Group (GIG).
“Since we were re-doing all our menus and recipes, it was a good time to add the gluten-free option,” Grundstein said. “GIG gave us a format to develop our menus, to decide what items are gluten-free, how to store the food separately, how to mark it in dry and cold storage and how to prepare it. We had to learn production from scratch.”
Grundstein said sustaining the program is difficult because of high staff turnover in the culinary department. Not only is it a challenge to educate new staff, but Grundstein retains two people on the culinary team to travel between the GenCare communities and monitor the storage and prep of food to ensure compliance. “We also make sure the culinary director updates the training for the new people,” he said. “We refer to it as ‘repeat the beat.’ You can’t just throw it out there and assume everyone is going to do it.”
To that end, the staff at GenCare Lifestyle maintain a working relationship with GIG who return to test staff each year. “It’s not ‘send a hundred bucks and you are certified,’” Grundstein said, “We have to have our staff pass the test every year.” When one of Grundstein’s buildings did not pass GIG’s test, his eyes were truly opened. “I realized that this is serious. It reinforced that this is not a game and we need to perform,” he said. “We need to make sure staff education about gluten-free living is part of the culture. I’m all for the GIG test because it forces us to stay on our game.”
Know Your Audience
“The really interesting thing is someone who says they are allergic to an ingredient but the nursing staff says it’s ok for them to eat that ingredient,” Hays said. “Sometimes I don’t know if it is a loss of cognitive function or the person simply decided the ingredient is no longer important to them.”
Grundstein encourages his staff to balance client requests with an awareness that you cannot please all the people all the time. He did a little test to check on the success of the gluten-free program with diners who are choosing gluten-free as a lifestyle. “We put out some gluten-free muffins in the bistros and we labeled them gluten-free. Some residents tasted them and immediately declared them terrible. So we did an experiment. We put out some gluten-free muffins but didn’t label them. The same ones who complained the first time said ‘hey these are great.’ We have to shift the mindset that gluten-free is terrible. It speaks to the progress of gluten-free food now. It has progressed a lot.”
Health Concerns are As Important as Taste
Precourt notes changes in geriatric patients that may shift their perception of what they are eating. “I see a lot of chewing and swallowing problems as mucus changes when you get older,” Precourt said. Some of her patients experience delirium or confusion which impacts what they are eating and drinking.
Chronic conditions, such as high blood pressure, are negatively impacted by sodium, yet “residents will automatically reach for the salt shaker as the population here may not have the same ability to taste something as they once did,” Precourt said. As a result, chefs often try to under salt when cooking for seniors. Instead of putting salt on the table, Precourt suggests looking for spices that help boost the flavor of a dish. “Fresh herbs or garlic powder or onion powder, or even put in an acidic-like vinegar, or hot spices like cayenne or paprika can give another flavor without adding sodium,” she said.
Make the Kitchen an Ally for All Residents
Hays works with kitchen staff to provide a kitchen environment without cross-contamination. Never wanting to single someone out for not being able to eat gluten, she seeks alternatives wherever she can, swapping rice flour for wheat flour, for example, to make a breaded item safe for all eaters.
Precourt counsels offering a variety of gluten-free options at every meal. “You can offer rice or potato as a side dish, and keep gluten-free pastas, cereals, and pre-made breads on hand,” she said. “Some people are brand loyal so we offer the resident to purchase and then keep it on hand for them.”
Similarly, the kitchen must be a safe cooking space, ensuring no cross-contamination exists. “If you let in even a tiny bit of gluten, the kitchen can’t be called gluten free,” Hays said. Wake Robin keeps a wrapped set of a purple cutting board, purple knife and purple tongs for each neighborhood’s kitchen gluten-free preparations.
Precourt counsels patients to let her alert the kitchen where they live. It can be a struggle, however, to make it fair to the staff when some need to adhere to a strict gluten-free regimen while other residents may simply be testing out a gluten-free lifestyle. “It can be a fine line between true allergy and a resident’s way of eating at the moment,” Precourt said.
Communicate with the Community
Label every dish with ingredient information, Hays suggested. “Our community will show up early to each meal and want to know exactly what they are going to eat.” In Hays’ kitchen, the menus are marked to identify gluten, dairy, garlic and nuts and will also call out the heart-healthy option. Sodium is a hot button ingredient for the community, as medical needs may dictate how much sodium can be included in a live-in community but not the adjacent independent living community.
While gluten-free foods are often used to replace their gluten-containing equivalents, eating gluten-free can be healthier than a diet that includes foods with gluten. “Add in ancient grains like amaranth and quinoa that are nutrient dense,” said Precourt. Legumes and beans are other great sources of fiber.
Trends Play a Part
Hays noted that, though there are a small number of residents who must eat gluten free, many choose to eat gluten free as a lifestyle choice. “It is a dietary choice instead of a necessity. Eating gluten-free has caught on here, as it did in my previous role,” Hays said.
Great food is Appreciated at all Stages of Life
“People really open up around food,” said Hays, who noted how simple it can be to make someone feel well-taken care of with a freshly prepared gluten-free meal. “We do it because we want everyone to be happy. It is the right thing to do and we try to elevate the experience whenever possible”
To make a gluten-free program successful, “you have to care,” said Hays. Medical necessity or not, it is the staff’s job to make sure the residents are safe. “Sometimes I just need to slow down and make it right. It’s an investment in making someone happy. It is an easy thing – check the list and make it happen.”
Grunstein said that “Maybe 2 to 3 percent of our population uses the gluten-free program exclusively. But it is a big marketing tool for anyone looking for a place as food is a big component in a healthy lifestyle.”