Monday, January 13, 2014

Invalid food

That's IN-val-id food, although the reason I am writing is that I have had a lot of in-VAL-id food in the last few weeks as I made the progress from hospital to rehab to home.

Hospital food was okay.  By the evening of my surgery I was ready to eat something, and there was something to eat.  Given Kaiser's reputation, though, I was a little surprised that most of the vegetarian entrees were Amy's frozen meals.  They are produced locally - but they are frozen, and many are too high in salt for me.  I've tried Amy's foods from time to time, hoping they might be an occasional easy alternative - but they seem to be either high in sodium or bland.

Home food has been pretty good.  Before surgery I tucked a few treats in the freezer (small persimmon cakes and pumpkin breads - that sort of seasonal dessert) and also froze some soups and pasta dish starters (tomato and beans from the summer garden, for example).  Niece Pam was here, and made a big winter squash stew (with the other sisters included) the day I got home.  She also wanted to learn to make mushroom pate, so we dragged out the Deborah Madison and worked through that recipe - somewhat tedious, but a wonderful savory treat, and something to serve friends who dropped by.  Getting back to my usual breakfast rotation was good, too.

But it took several days to pull out of the gloom induced by the rehab food.  Even 50s school lunch seemed good by comparison.  I tried explaining that I was an ecotarian, but would be a dairy vegetarian for their purposes, but I was there four days before I saw anyone from nutritional services.  It said on my menu slip that came with each meal that I as a vegetarian who liked whole grains and plenty of fresh fruits and vegetables. Each tray had canned fruit on it.  It was five days before someone found a banana for the breakfast tray. Oatmeal was gummy, but I gagged it down.  Most days there was some other kind of hot cereal with scum on the top.  Dinners alternated between lightly sauteed tofu and the worst reheated vegetable burgers I have ever seen, mostly canned veg and white rice on the side.  Bread was "wheat" squishy. The only fat on the trays was margarine.  One day I had frozen veg sauteed with garlic.  One lunch I had something quesadilla like.  These two were the highlights. Occasionally I had a meal that was just what everyone else had - minus the meat and dessert.

I would be so ashamed to be serving such crappy food in a sustainable food center like Sebastopol!  But I realized that my first clue should have been the logo on the promotional materials for the rehab facility.  It was a red delicious apple - not the variety we think of when we go local about food in Sonoma County. Somebody is paying no attention to context.

My question, repeated to many staff members in my eight days of food misery, was "Why do you serve such pitiful food and then give everybody a daily laxative?"

I became a supplier while there.  Thanks to the friends who heard my cries, I had pounds and pounds of tangerines and other fruit which I shared with staff.  "Won't you have one of my tangerines?"   I learned that some staff members bring very healthful meals from home.  Others go to the nearby McDonald's.  One talked about her home food garden, which she and her husband and two young children tend.  I feasted on asking the CNA's what they were having for holiday dinners, and asked them why there were no tamales on our Christmas trays!

Meal times got rather prolonged for me, because when my trays arrived I produced the box of decent tea bags a friend brought, and the loaf of whole grain bread, and my prunes or tangerines, and had my CNA fetch my cheese from the refrigerator.  There wasn't much I could do about fresh, seasonal cooked vegetables.

On reflection, I asked myself why this food was so bad.  Several strands contribute to it, I am sure. One is outdated nutritional guidelines, some enshrined in government regulations, because so many patients are on some sort of government funded health program.  (I saw maybe 2 or 3 people on the rehab wing who were younger. That means most of us were on some version of medicare.)  Parallel problems exist with government guidelines for school meals, of course.   A second is budgeting. One way to cut corners is with food. Never mind that a decent and tasty diet is a part of healing.  It's a place to save money, and then rationalize the action by opining that everyone would complain about the food anyway.  A third is that with some older patients, particularly those on the skilled nursing wing, the challenge is to get calories into them, so why not lowest common denominator foods which are familiar?  But as a colleague who does a lot of hospital and skilled nursing visiting points out, the boomers are coming, and we left coast boomers do not want hot dogs and white bread and canned fruit and vegetables. We want our calories to count for something (better nutrition) and stimulate our taste buds.

Before I left rehab I gave some thought to what might be done about this deplorable situation.  I am, after all, a member of the Sonoma County Food System Alliance, and we do have a working group called Farm to Institution.

I don't think the answer is doing is going to be meet your farmer programs such as our F2I group has done for school lunch leaders.  Getting everybody together to talk solutions may be edifying, but it is the laudable actions of particular institutions which, when reported publically, move the agenda forward.

In the best of all worlds, what I would do is to seek out a rehab/skilled nursing facility which would like to become a model of what is possible, growing into an institution which features healthful food, sustainably sourced.  And I don't think I'd focus on the nutrition and kitchen staff, but bring together representatives of various departments and skill levels who care about good food, including those nutrition and cooking people who are capable of envisioning new approaches.  Who knows - the maintenance worker may have an organic vegetable garden, a nursing assistant may come from a long line of good cooks, a nurse may see things and wonder about how patients' food choices and medications work together - or don't.  And all of the staff receive feedback about the meals - it's just a natural topic for conversation when people are confined without a lot of external diversions. Good food must be seen as integral to a healing system.

Our Food System Alliance could work with such an institution, connecting the resources need to make it a showplace of wholesome, local food.

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