The Cheap Comes Out Expensive

I am not a political person, nor is this blog post intended to be so, either. The issues I will discuss concerning our government funded food system from a dietitian’s point of view are non-partisan. Our Constitution states that all men are created equal, but unfortunately, our policies do not reflect that yet. This post is intended to bring awareness and to speak for those who cannot speak for themselves. The three institutions I will address are nursing homes, schools, and prisons.

Staffing seems to be an issue everywhere now. The current U.S. unemployment rate is 6.1%, with many of those on unemployment insurance making over $700 a week. Staffing in an institutional kitchen, whether it be a nursing home, assisted living, school, or prison, is so difficult even during good economic times because the average cook makes less than $12/hour. Turnover is high due to other restaurant opportunities hiring at higher rates, but are also struggling themselves to acquire and retain employees. During the pandemic, many restaurants had to close or drastically reduce hours. Signs were posted on drive-thrus begging customers to be patient due to poor staffing. If staff didn’t show up, some would just close for the day. Institutional kitchens have never had that luxury because their customers often have no other source of nutrition. Due to the low wages, the staff who are willing to work in an institutional setting are often not skilled cooks who could follow a typical recipe. Faced with these challenges alone, the solution has been to buy highly processed food items that are just heat up, put on the steam table, and serve. This food is loaded with salt, fat, and sugar in an attempt to hide its poor quality, even though it may meet the caloric guidelines defined by regulations.

Next, let’s talk institutional food budgets. The nursing homes that I worked for had a dietary budget of $5 per resident per day, though you will find that some assisted living facilities with high amounts of private pay residents may have a food budget up to $8-10/day. Read that again. Not per meal… per day. These amounts are set by individual companies after they consider their reimbursement from Medicare and Medicaid patients. School lunch budgets are around $3.50 per child. Worse even than this are prisons. The State of Ohio just confirmed, this year, a new contract to feed prisoners for $3.95 per day (an improvement), but the neighboring State of Indiana has a dietary budget of less than $2 per prisoner per day. As a registered dietitian, I can tell you that I’ve written numerous menus for nursing homes and it was a struggle for me to stay within budget while providing adequate nutrition; I could not imagine writing a menu for a prison on their disgustingly low budgets.

What’s the result of this?

Michelle Obama identified that feeding our school children low-nutrition food would have both short-term effects on grades and long-term effects on health. She had healthy school lunch initiatives that have already been rolled back by the next administration, citing excessive food waste. Consequently, childhood obesity and chronic illness rises every year, poor eating habits are developed, and adequate nutrition is not being met. In our prisons, inmates are forced to beg their families for commissary money so that they can buy ramen, which is dangerously high in sodium and lacking in protein. In our nursing homes, residents are developing failure-to-thrive and placed on nutritional supplements up to three times a day because they don’t like the food that they are being served.

I cannot emphasize enough that even if you have no children in school, no loved ones in prison, or no parents in a nursing home, this should all matter to you. Why? Because your tax money is footing the bill for all of this food. It’s true that they are keeping costs as low as possible, but this then results in your taxes paying for advanced health care for the individuals affected as a consequence of malnutrition. Here’s what I propose along with many others: Let’s put more money in preventing chronic health issues and lessening the overall burden on our health care system. Let’s treat every human with respect and dignity. Let’s improve the quality of the food that we serve by hiring skilled cooks at a livable wage, who can cook higher quality ingredients from scratch. Where will the money come from? We can choose to pay for delicious, quality food now instead of high-priced healthcare down the road. We can develop better eating habits in our school-aged children, support inmates growing their own gardens and learning how to cook their own meals, and respecting our elderly every day by providing high-quality, appetizing meals. Together, let’s raise awareness and demand creative solutions to promote a healthier, and more perfect Union.

And now that the serious stuff is out of the way, time for the fun stuff!

As I stated previously, I worked in nursing homes as a dietitian for 5 years. I was always pushing for homecooked meals, made from scratch as much as possible. For instance, it was against my rules to ever make mashed potatoes out of a box.

I had one kitchen with two individuals who were dynamite cooks with many years of experience. They had the least amount of food waste, significant weight losses, mortality, and complaints of any other kitchen in the company (I would even argue the state). They continue to serve an elderly population of individuals on Medicaid with severe behavioral health issues. These patients have little to no family involvement, as many have burned every bridge they crossed. And yet, the cooks at this facility are loved so greatly for the care that they put into their meals. One long-term patient comes by every single meal and asks for one cook in particular who has been preparing meals as long as she's lived there, yelling to the back, "Thanks for making me fluffy!"

Below are some snapshots of some meals these talented cooks made while I was working with them.

Ham loaf, peas 'n' pearls, cornbread with pad of butter.

Homemade tv dinners to bring back some nostalgia.

Baked chicken thigh, cheesy spinach, roasted red potatoes, and a homemade cheesy biscuit.

Chocolate and peanut butter brownies, made with a little extra thought and love.

Broccoli cheddar soup served with ham salad on Hawaiian bread and cherry pear cottage cheese salad.

Finally, I want to say a HUGE thank you to those of you who are going the extra mile to improve the quality of food that is being served to those who cannot serve themselves. You are heroes as much as any nurse or doctor and are not thanked enough.