We liked the hospital but the food was awful

There are many little things that could change to improve our health care experience. So far we have talked about a couple of them – small changes to parking policy and improvements in visiting hours are two excellent examples of how to dramatically improve the experience of patients and family members. All our examples come from what patients tell us about their experience with health care. A growing group of patients, providers and researchers at Patients Canada think about these experiences and work together to discover the very small changes that can improve them.

Food is another example of a problematic area in hospitals. Most satisfaction surveys have found that patients complain about the food far more than they complain about doctors or nurses. And everyone knows that cost constraints have resulted in trying to find more and more efficient ways of producing food for hospitals and long-term care facilities. For many years, hospitals have been working hard to produce less expensive food while maintaining quality. Today, hospitals in Canada spend less than $8.00 per day for food per patient. The quality has been mixed. We noticed that so far hospital food policy has not usually included patients and family members, nor has much of this policy been easily accessible to patients and their families.

In the old days, food could not be brought into the hospital because the hospital provided a scientifically correct diet for patients and interfering with that would slow or even imperil the patient’s recovery. Moreover, the safety standards in hospitals were considered to be significantly more stringent than ones at home, and so a second reason to ban outside food was to avert the risk of poisoning patients.

Even today, many older patients and their families believe that these policies remain in place. Some sneak food in to give to their sick relatives. Others, who are more compliant, do not bring any food at all. One older woman watched her husband lose thirty pounds in a three-week stay in hospital because he said, “I hate hospital food and will not eat it!” However she never considered bringing in food that he did like because she (falsely) assumed that it was not allowed and she was not about to flout hospital rules. Her husband never recovered from his sudden weight loss and died within two years.

Today, most hospitals allow families to bring in food. Often they place restrictions on what can be brought in. Below is a quote from the Mayo Clinic Nutrition-wise blog (Nelson, Zeratsky). Despite the fact that it continues to mention the possibility of “deadly consequences” of not checking if it is safe to feed the patient, it is a pretty good example of current hospital policy about bringing in food.

As much as hospitals try, the food they serve may not meet expectations — especially when people don’t feel well. As a result, you may be tempted to bring a meal or special treat to a loved one in the hospital to show your concern and to help make the person feel better. In your concern, you might not ask if this is safe. It’s important to know that in some circumstances this act of kindness could have unintended and even deadly consequences.

Here are some guidelines that my department has put in place to help people navigate this thorny issue:

• Before you bring food in, check with the nurse, doctor or dietitian. Your loved one may be at risk for infection or may need to follow a very strict diet. In some situations, even normal bacteria in foods (such as uncooked items like fruits or salads) or excess nutrients (such as those containing vitamin K, or unknown substances like gluten or allergens) can be dangerous.
• If you get the OK to bring food in, make sure you prepare food safely. The Department of Agriculture has excellent information on their website about food safety for people who are vulnerable to infection. Throughout the steps of food preparation, it’s important to follow the mantra:
  • Clean. Wash your hands, utensils and cutting boards before and after contact with raw meat, poultry, seafood and eggs.
  • Separate. Keep raw meat, poultry and seafood away from foods that won’t be cooked.
  • Cook. Use a food thermometer — you can’t tell food is cooked safely by how it looks.
  • Chill. Refrigerate foods within 2 hours and keep the fridge at 40 F or below.

• Bring only enough food that can be eaten at one time. Consider single-serve items, such as individual yogurts, packages of crackers and peanut butter, and wrapped cookies. That way there are no leftovers to worry about.
• Don’t store perishable foods in the room. In addition to being unsafe, they can be unappetizing.
• Label all food items. Put the name of your loved one on the food container and the date that the food was prepared. You don’t want your kind intention causing problems for another patient.

This set of policies and the write-up might benefit from a review by patients and their families. Critically, patients and their families should know when food can be brought to recovering patients. Otherwise there might be “deadly consequences” of starving older patients by not feeding them food that they like and are used to eating.

Nelson, J., Zeratsky, K. “Play it safe when taking food to a loved one in the hospital.” Nutrition-wise blog. Mayoclinic.org 28 March 2012. Web. 10 Aug 2014.