Nursing Home Food

Puppypants · #1 (**permalink**) 10-11-2008, 07:16 AM

My dad, a Type II, was recently hospitalized, and now had been placed in a nursing home for rehab to regain his strength in order to return home. Last night, his dinner consisted of elbow macaroni with a red meat sauce, a piece of garlic bread, a huge mound of peas, skim milk, a cookie, and coffee with real sugar.

When my sister and I questioned the nursing supervisor, she said this is what they feed all the diabetics in the home. Their dietician gives them an 1800 calorie per day diet, and says it does not matter where the calories come from! Can this be right? My dad has always had good control, following a restricted carb diet. I fear that his sugars will go up, and hinder him from recovering quickly from the cellulitis that put him in the hospital.

Are we right to worry about this kind of diet? It is supposed to be a short term stay, but who knows? Any advise would be really appreciated!

art · #2 (**permalink**) 10-11-2008, 07:26 AM

Get your car.
Drive to the nursing home
Get your Dad out of there today!!

Art

kmac · #3 (**permalink**) 10-11-2008, 07:34 AM

Wow! My heart goes out to you. I would be very, very worried. I will be watching to see suggestions for how to get around this problem. One of my fears is that I will end up in hospital for some reason and they will feed me like that. I know the dietician at the diabetes education classes had similar ideas, although even she did not advocate quite that much carb. A diabetic meal in hospital can be much more carb rich than I usually eat.

Do they let him monitor his blood sugar? Can you smuggle him in appropriate foods? Is he able to keep up a little activity to help burn some carbs? Maybe his doctor will write a letter requesting a diet adjustment??????

I think you are right to worry. Even for those who advocate eating more carbs, it cannot seem right to become inactive with illness and suddenly start eating more carbs, can it?

Your dad needs an advocate to help him work this out and he is lucky to have you!

Hang in there.

Kathi

Puppypants · #4 (**permalink**) 10-11-2008, 09:07 AM

Thanks Kathi - we are going to meet with the dietician on Monday, and figure out how she change his diet. Apparently, the nursing home doesn't do much in the way of customized menus, but if we have to, we will bring his food in.

He is so weak from the celluitis, he cannot walk or do much of anything right now. The rehab is supposed to get him back to his pre-celluitis activity level - he rides his bike every day, takes care of his house, does all his own banking, shopping, bill paying, etc. All of this inactivity is not helping his bg levels at all. Poor guy, he is so miserable, and confused, he's not able or willing to speak up for himself. I think we will have to be the tough guys with this dietician and the home til we can get him home.

mortis505 · #5 (**permalink**) 10-11-2008, 09:17 AM

The dietician is probably using the old ADA diet that promotes carbs. This hasnt been updated in a long time. Ask this dietician if they understand how the body treats carbs by turning them into glucose which is VERY bad for a diabetic.

notme · #6 (**permalink**) 10-11-2008, 09:22 AM

I just recently brought my Mother home from a rehab facility. I was also concerned about the diet they were feeding her. My Mom is not diabetic, but she is on restricted salt diet for her heart and high blood pressure. The food in the nursing home was appalling. Breakfasts were bacon and eggs, lunches were actually their main meal and dinners were small because many of the residents went to bed early and they didn't want them sleeping on a heavy meal.

One afternoon I went in to see my Mom and she had her plate in front of her that consisted of corned beef and cabbage, potatoes and milk. I called for the dietitian who was a total ditz. I questioned her about my Mother's "low salt" corned beef and she apologized saying that my Mom got the wrong meal. I talked to her for awhile and eventually I asked her what type of schooling you needed to be a dietitian at a nursing facility. Her credentials seemed adequate. I asked her what they fed a patient with diabetes and she told me the EXACT same thing you just said. The watched calories. I was flabbergasted. She said they would cut down their calories a bit and gave them sugar free desserts. They ate low fat. She said they would get pasta or low fat meats and fat free milk. I couldn't believe what I was hearing.

My Mom recently broke her leg.....last Tuesday to be exact. She will be non weight bearing for six weeks, so that means a wheelchair for her as crutches are out. She cried because she thought she had to go back to the rehab place. We couldn't do it to her this time. We are bringing her home and getting 24 hour care.

I so feel for you puppypants. This is such a hard time for you and your family. The care at the rehab facilities is minimal and the knowledge of what to feed patients on special diets is nil.

My suggestion? Get together with family members and make a schedule to cook him his main meal. Talk to the nutritionists about low carb for his other meals and hope for the best.

kmac · #7 (**permalink**) 10-11-2008, 09:31 AM

Sounds like you have a good plan in place. You may have to be the "bad guy" in the situation, but it is for the best with your dad. If you have to bring in food, so be it, I guess. Seems strange to me that they cannot provide appropriate food, but your dad needs his usual low carb diet.

Hang in there and advocate for him. I guess the goal is to get him out of there as soon as possible. I have to say that when I read Art's post, I thought "yeah, right on. He has it right." But that is not always practical. If your dad needs the other supports provided by the home, then you will have to work out a plan to work with them. I would investigate what other treatments they are doing, though. If that's what they do for diabetes, I would wonder about what else they do!

Hang in there and stay strong!

Kathi

Kanga · #8 (**permalink**) 10-11-2008, 02:48 PM

I am so sorry, you are in a catch 22 as he needs the rehab facility. Is it possbile for you to take him home and for him to be a day patient? your dad is lucky to have you to advocate for him.

Puppypants · #9 (**permalink**) 10-11-2008, 03:21 PM

Art, I really wanted to take your suggestion and get him the heck out of there - the nursing supervisor told me today that we could try my "old-fashioned" way of eating instead of their new way. There's just no way to talk to these people and have them understand.

This has been hard on us, but most of all, hard on my dad. He is a very active and sharp 85 year old retired iron worker, and it is very difficult for him to not to be able to do the things he likes to do. We are going to give it a week here, bring him his dinner, get tough with the dietitian (maybe I should direct her to this place to learn a little!), and then arrange for some home care in the meantime. He lives in a one story ranch, and would probably do much better at home with some home therapy and care.

Thanks all for caring, and your kind words - it means alot to me!

bcarroll · #10 (**permalink**) 10-11-2008, 06:20 PM

I am a nurse practitioner (and a Type 2), who has worked in nursing homes as an RN.* I'm a little surprised by the response of the nursing supervisor.* Even if the diabetics are given a diet rich with carbs, the most uninformed staff should hesitate to give real sugar with coffee to a diabetic.* (Most staff would know that's not a good option even if they didn't know that peas are full of carbs.)However, it might be an eye opener for you to know that in most nursing homes, there is no dietician working.* The head of the dietary department is usually a dietary manager who typically begins her career as a dietary worker, then receives extra training to become a dietary manager.* In most nursing homes, a dietician is available only as a consultant who comes in monthly, but may only see every patient every 3 months.* The dietician should see every new patient within a few days of their admission, but that doesn't always happen.I agree with the others who say to give it a few days, and if things don't improve, consider other options for your dad.* If there is someone to care for him at home (with meals, personal hygiene, transportation, etc.) you could always elect to take him home and request outpatient therapy or home health therapy.

EeyoreButterfly · #11 (**permalink**) 10-11-2008, 06:51 PM

You might also want to have your father's physician call them and explain to them exactly what kind of diet your father needs. It will be much harder for them to argue with an actual doctor than a patient's family.

David_S · #12 (**permalink**) 10-11-2008, 09:03 PM

Wow. I never even considered this.. what could happen in a facilty where the diet is .. well whatever they decide it is. Can you move him?

Puppypants · #13 (**permalink**) 10-12-2008, 06:57 AM

David, we are thinking of setting round the clock care for him at his home. We will have to turn his den into a bedroom, but that can be done easily enough. We just have to find out the resources available for him. It may take a week or so, but we are going to bring hin dinner every night so we know at least one meal is good.

If my sister or I could, we would quit our jobs and care for him, but is just not an option for either of us. He does need the physical therapy they give (which has been outstanding!) so he can get walking again. So, for, now, he will stay, and we will stay on the dietian to improve his menus.

Funnygrl · #14 (**permalink**) 10-12-2008, 07:12 AM

It's pretty much standard of care and typical to base diabetes diets just on calories while restricting obvious sources of sugar in hospitals and nursing homes. The usual diabetic in a nursing home is one who has simply worn out their pancreas with old age. These people often do respond adequately to such a diet. I'm not justifying it, but it's not atypical or surprising to me either.

You shouldn't have to "smuggle" in food. Most facilities are more than happy to allow meals to be brought from home.

notme · #15 (**permalink**) 10-12-2008, 09:47 AM

Puppypants, this is EXACTLY what we are doing this time. My Mother's care at the nursing home really was substandard. This is not to say that the one your Father is in is the same. We can't find a nursing care facility around here that we feel is good enough to care for my Mom's needs. She is non weight bearing now for six to eight weeks. It is really important that there is no mistakes as her bones are soft and the doctor says there is no backup plan if she breaks the bone around the screws they put in. We are afraid of taking her back to the nursing home. Not to mention she cried when she fell, not because she was in pain, but because she didn't want to to back again. She was terrified. The care was pitiful.

We are bringing Mom home this time from the hospital. We have in home care where we can monitor her for bed sores. She got them at the nursing home last time as she was not turned enough. We can monitor her diet and make sure she isn't on her foot at all. This is going to be tough on us, but much easier on her. I can't stand the thought of her becoming depressed again in the nursing home.

We HAVE to do something about the care people receive in nursing care facilities. Anyone who has never been to one, needs to take a tour. Then we all need to figure out what to do with our elderly that are counting on us for their care. Right now, what we have available is very very sad.