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My mom is two weeks into an ALF transition. She cannot chew very well and is a vegetarian. The facility is doing their best but she just hates everything they give her. I have ended up going over every day to prepare one meal that she can enjoy, but that is not sustainable. Is this just about continuing to work with the facility on choices? Has anyone else faced this issue? Any suggestions? If I have to go every day, I might as well have kept her home.

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Learning to eat in ours was a learning curve. We started trying different choices from our regular diet and liked some. ALFs usually have a lot of state requirements, many around required care for residents. I would go the head of the health department (Get a letter from her doctor explaining her dietary needs) and explain that she needs to be provided a nourishing diet for her at the facility. Your doctor may know a nutritionist with suggestions. Our (fancy) place does not have one, which amazes me. But you may have access to one who can make suggestions to you, her doctor, and your facility. You might even consider a, pleasant on your part visit and explanation of what is happening to the chef, and to the executive of the place. Start with being pleasant, honey and flies, you know.
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Did you and your mom have an intake meeting before she moved in? That would've been the time to meet with the heads of different departments. Including nursing and dietary. Since you go everyday, maybe you could set up a meeting and discuss what options are available. Include your mom in these meetings so she can actively participate in her own best interest if she's able. Also, explain to your mom that, although you certainly don't mind coming once in a while-say once a week or once a month-to come see her and bring something special to breakup the daily monotony, you also have your own life and obligations. It's one thing to love your parent and help out ONCE IN A WHILE, it's another thing altogether to let her take advantage of the fact that anytime something goes wrong with the food-and I understand how that can be as I live in a nursing facility and the food is less than appetizing-you'll stop what your doing to go bring her something EVERYDAY. That's not fair to you, to her or to whoever's footing her bill. If she has a microwave and a little freezer or fridge in her room, maybe you could buy her microwavable veg. meals?
But, please have that meeting. In the long run, I think everyone, including your mom, will be happier.
Good Luck.
Colleen P. Pell.
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My aunt was like that in assisted living. She didn’t like anything they made. I started having food delivered, via Instacart, to her from a nearby grocery store. She'd tell me what she wanted and every 2 weeks she'd get it. Some she could do herself (Mt. Dew cans, individual applesauce, peaches, jello, and cottage cheese, cut up fresh fruits, individual bags of chips, etc.) and some they did for her (microwaveable meals, peeling an orange or cutting an apple, opening a pack of pb or cheese crackers, American cheese singles, etc.). She had a small refrigerator in her room. It worked wonderfully well from my phone app in Florida to her ALF in Wisconsin.
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Thanks for the update, I love it when I read that things have improved.
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Msblcb: Voice your concerns with the executive director.
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Msblcb Jun 3, 2022
Thank you! I did. I actually gave the kitchen a list of items that I thought she would enjoy. The facility has been very accommodating and the last two days have included well balanced meals she likes and could chew.

it just took a little time to get the right rhythm. Three weeks into the transition and things are settling down. Thanks for the sound advice.
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It might help to check if there are any staff members who are vegetarian. It’s fairly common these days. A staff member or two might be a big help to talk to the people in the catering section – perhaps even work a couple of shifts there.

Just personal – 40 years ago I went from hospital for a week to a residential ‘Mothers and Babies’ facility, because my two babies were very close together. I hoped that they would help care for the older one and give me a few days with the newborn (of course they all wanted the new baby, waste of time for me). There were two young mothers there who were ‘Orange People’ and vegetarian. Normal meals were meat and two veg. Theirs were vegelink ‘sausages’ with the same two veg. They couldn’t believe it! No-one on staff had ever met a vegetarian before.
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Have you tried Textured Vegetable Protein? Cook it up ahead of time….use it for veggie burgers, anything you might use with cooked hamburger; try canned tuna or salmon; how about eggs? Maybe high protein vegetable soups? Good Hubby and I quit meat and poultry about 15 years ago..also check out Morning Star products. Best wishes,
Jan
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If the food is not being made with love, she'll sense it, and it won't taste very good. If she can't chew very well it's a great opportunity to give her drink blended raw vegetables and fruit smoothies. This is what I do with my dementia clients to help them restore their brain health. Those facilities have no idea what a proper healthy diet looks like, which is what all dementia sufferers actually need to begin restoring their brain health. Vegetarians eat dairy products, and there are many grains which do not provide much nutrition. Both do not help to slow the progression of brain disease. It's still early days, 2 weeks, she needs time to settle in, to adjust. Ask for spiritual support at this stressful time. Prayer gets results, so the science shows. I hope the staff at the facility, actually care.
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Mum is vegetarian, we were told that was no problem they already had others who were vegetarian. I noticed that they serve her the same dinner meal each day even when they serve vegetarian lasagna or some other generic vegetarian food. Fortunately for Mum she was far into AZ before being placed there. 😢
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Anyone who prefers vegetarian meals should look for a Seventh-Day Adventist run facility. They know how to cook good vegetarian choices. There are also a lot of Loma Linda & Tasty Bite packaged foods that need only 90 seconds in the microwave. Those would be easy to have on hand.
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"[S]he hates everything they give her" sounds very familiar to me. Mom never went into ALS (sigh) but we went through this with meals on wheels (only lasted a couple of months with Mom) and also the things we tried to take to her. My sisters and I had thought that we would make larger meals at home and take frozen meal-sized portions to Mom so she could just microwave them. She threw them away because we didn't make them the way she did when we were growing up in the '50's. The only way she would eat things was if they were exactly the same. We don't eat that way anymore and we were unwilling to turn our own meals into the boring stuff we grew up with, so we quit taking things to her house for her to throw in the trash. There may be some of this in your mother's refusal to eat the ALF meals.

However, if she needs soft foods I have never heard of a facility that actually made appetizing soft foods. The normally just take whatever the "normal" eaters are having for a meal and put it in a food processor. What they used to serve to my MIL I can't imagine anyone actually eating unless they had lost all sense of taste and sight. I once made a list of about 30 meals that were soft and delicious, things like mac and cheese, souffles, scrambled egg with cheese, etc., that could easily be available for those needing foods that required little chewing, but there was no willingness on the part of the staff to make that effort. There were normally several choices for meals but those choices usually did not include a soft option. I did go to her residence several times each week and make her things that she loved and could eat, but that was the best I could do for her. At the time my husband and I both worked long hours at high stress jobs. We tried to leave her with some things that she would eat, but she ultimately lost a lot of weight. Bananas and chocolate milk drinks with added vitamins do not constitute a proper diet.

Certainly you can't make it to her residence to fix meals for her on a daily basis, though I would think that there was more to her care than simply fixing meals or you probably would not have put her in residential care--though I certainly understand your frustration. As I age, myself, I am hoping to find ways to care for myself as much as possible to keep my relations with my sons happy and that we are always glad to see each other. Part of that is doing what I can and compromising on what I can no longer do. I hope you can find a way to keep your own life on track and help your mother accept some compromises in her life as well. Best of luck to you.
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Fill her freezer with options she likes. Encourage her to "try the meals" since she is more likely to make friends and socialize in the dining room than eating alone in her room. If need be, make arrangements with the administration for alternative food options.

Personally, I find that most vegetables and vegetable dishes in group facilities are canned and/or usually over-cooked to mush. I find that this is pretty much the same in hospitals where I have worked. Asking for "fresh produce" that is lightly sauteed or slightly steamed may help get food that hasn't been cooked to death.
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One of the "problems" might be, other than this diet has not been "ordered" by her physician, is that each facility has to provide a meal that meets standards. (check your individual State for the code of regulations, it should be available)
If meat is omitted then other sources of protein must be provided that will ensure that the resident gets the proper balance.
Since this is AL not MC or SN she can make a choice as to what she takes or asks for. So while the "proper" balance is offered the facility can not "force" a resident to consume the individual items.
One option if you choose....
If this is AL does she have a small kitchenette in her room? A refrigerator/freezer and a microwave? If so you could make up a weeks worth of meal options for her and leave them in her room. Then if she wishes she can eat one of them. At the end of the week toss out any remaining.

With the number of people that are opting for non meat meals I would be surprised if this will not become more common. Particularly with the fake meat products that are plant based. It might be worth discussing with the Dietitian/Nutritionist on staff and see what accommodations they can make.
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caroli1 Jun 7, 2022
The O.P. has indicated that her mother is not cognitively able to select her food from her frig. Also, in looking down the road for myself, I've learned that ALs frequently do not have microwaves because of safety concerns. Also, how able the AL is to respond may depend partly on her level of vegetarianism. One poster replies with ways they'd used cheese and fish in the mother's diet. There are some vegetarians who do eat dairy and eggs (and many who do not) and even fewer who eat fish, I believe--the latter sounds like a non-meat-eater to me rather than a vegetarian. Msclcb, perhaps it would be easier to spell out specifically what your mother can't and can't eat, although from what you've written, you may already have done so.
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I think the AL facility I picked for my parents, told me what I wanted to hear. The staff to resident ratio? "Oh it's excellent" said the move in coordinator. It wasn't, they pushed the button for assistance and no answer for 20-30 minutes. Maybe they did the same with you regarding food and told you what would work to get your mother placed there.

I will say my mother didn't want to eat anything they made. She didn't even want puddings or snacks I'd bring. My picky dad thought the food was good and even looked forward to certain dishes! I ate there a few times and thought it was pretty good food. They provided salads, veggies and breads if the resident didn't want meat. I hope your mother can start getting some food she likes and wants to eat.
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Even if a different meal is not available, can be requested, perhaps have mom just omit meats but have extra of the vegetables, grains, beans, etc. No one likes to waste food but sometimes just leaving the unwanted type of food on the plate or scraping it off before eating is a strategy if the facility cannot omit these things for her.
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It is always the best plan to work it out with the facility. Make an appointment to meet with the head of
dietary and bring a list of options (not complaints) . Approach it in a “let’s work this out” attitude for the best results.
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In my experience the only way that dietary department of a facility will do any type of special diet or accommodations will be if:
- there are medical orders for it. This means the medical director of the facility - if it’s a MC or NH - writes orders for this and it then goes into the residents chart and over to dietary as well. AL do not usually ever have a medical director as it’s just Assisted Living,
OR
- resident pays for a custom meal plan
OR
- the community that the facility draws residents from are a big enough religious or ethnic group so that menu reflect those preferences. Like if observant Jews then dietary does meal plans tailored for that. Ditto for Halal. Vegetarian if majority of residents are Indian. It is very much as CWillie posted on this.

Are there things you can do to legit get beyond all this? Yes
For my mom, she had scar tissue in her throat from botched surgeries when she was in her 30’s so had swallowing difficulties. She had really good dental work so the whole bite & chew not an issue, but it was more smaller bites and more time to swallow. A lifestyle adaptation to an existing & recorded medical issue. Then Mom in her 90’s goes into a NH then had a fall, shattered a hip and became bedfast @ the NH. NH medical director wrote orders for her meals to be “mechanized” and to allow for hand-held substitutes…. which meant heavy proteins (chix breasts, cutlets type of foods) would go thru a machine (mechanized) that creates pinholes so they can be cut & eaten easier and she often got sandwiches cut into 1/4’s as opposed to everyone else’s hot meal. At moms every 90 days care plan meetings, dietary would be there and we’d discuss what worked and what didn’t & they were very responsive. Now there are medical orders for this so they kinda have to be. Comprende?

Imo the issue for y’all is that being vegetarian is viewed as a choice and that as this is AL - and not a NH - that she is not expected to have any special medical needs for the facility to deal with specifically. You both should have been aware of their meal plans before she ever moved in. That they are even trying to accommodate her shows they are a good facility but realistically only so much they can do for a single resident.

Personally I’d suggest that the next visit she does to her own MD, you make it a point to get her swallowing issues into her health chart (& in detail) and if she has any ANY food sensitivity or allergies or food related issues - Celiac disease- those too need get into her health chart. It will matter for when her care gets beyond AL & goes into a NH or MC

If - and this is a big if - there were 6-8 residents who are vegetarian, then I can totally see a facility being able to do vegetarian meal plan for that group. It would be very tofu, other processed soy products & cauliflower based. Foodservice vegetarian is still quite limited and facilities need this to be foodservice bought to ever keep costs reasonable & be assured of delivery. There likely would be an upcharge to the meal plan for the group. If some actually vegan and not just vegetarian, expect it to cost alot more as kitchen will need extra BOH time to reset equipment & on prep.

or you find NH w/overwhelmingly Indian &/or Balinese residents. Good luck
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Good luck with that - I have asked before on this forum about people who are vegan, halal, kosher, have allergies or food intolerances, even just people who are ethnically different than the dominant culture and I have never received any feedback that makes me believe that they are getting the food they want or need unless they can find a facility that caters to that specific culture.
I think part of the problem is that unless a person has a special diet themselves (or someone in their immediate family) they really truly Do Not Get It. That coupled with the way food is bought and prepared in facilities (mass produced as cheaply as possible) makes anyone with special dietary needs vulnerable; as well meaning as they may be the kitchen staff had neither the time nor the foods or the budget available to make special foods for one resident every day 🤷
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LittleOrchid Jun 3, 2022
I agree with you. I think that part of the problem is that meals represent a small part of each day. For many of the staff the highest priorities center around the physical care of the resident's bodies and the cleanliness of the facility itself and they do not see meals/food as anything of importance beyond basic nutrition. If a meal has the right number of calories and the right number of grams of protein, carbohydrate and fats they deem it a "good" meal.

For many of the residents in care, the opposite is true: meals represent an opportunity to enjoy a bit of life that can still be pleasurable. A meal that is tasty and reminiscent of the joys of the past can be the highlight of an otherwise dreary day. Unfortunately, a facility with a chef that could take the time to make each diner's meal a memorable one would be one that few could afford. Such facilities probably exist, but would probably cost more than 905% of us could pay for--and they wouldn't be sending brochures to my zip code!
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Did you speak with the intake coordinator about your mother's vegetarian diet before you moved her into this ALF? What were you told at that time? All the residents chronically complain about food in managed care, in spite of the various options presented to them during meals.

If you haven't already taken this issue up with the Executive Director, now is the time to do so. Also, fill up her fridge with things she likes and she can have the option to dine in as well as go to the dining room for all of her meals. AL is not perfect, so some compromises have to be made. Stop jumping thru fiery hoops to see that all of her requirements are met; suggest instead that she find other alternatives on the menu at her ALF.

Good luck!
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Msblcb May 28, 2022
I did speak to them and provided a detailed narrative prior to the move in. For some reason, they have not been able to “get it”. She does not have the cognitive ability to serve herself out of the fridge. She is stronger than many in the memory care unit but may be unable to function in ALF. We will see. You guidance is so helpful. Thank you!
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