By Ronni Alicea, RD MBA
For most people it is a bittersweet decision to consider a residential living facility and for others is a necessity. While the social life, meal service, housekeeping and nursing assistance are key benefits of choosing this lifestyle, for people with celiac disease it can be a stressful decision. Here is a review to help assure your diet and medical care will be managed properly while you enjoy your new friends.
Choosing a Facility:
Ideally there will be a few facilities to interview that offer the services you need. Although the admissions office will encourage you to speak with the dietary manager and the dietitian regarding your gluten-free needs, my advice is to ask to speak with the facility administrator, director of nursing and the activities director as well. Confidence that meals and snacks are prepared correctly is paramount however these other departments need up-to-date information about celiac disease too.
There are times when arrangements have to be made quickly. Even if you are the first gluten-free diet in a facility do not despair! The staff wants to do the right thing. Facilities are in the business of providing the best quality of care possible for people. Facilities have an obligation to provide a gluten-free lifestyle as prescribed by your physician. That includes meals, activities and medical care. All facilities are audited by state and federal agencies and every community has an ombudsman to help.
The following recommendations are for both people seeking long-term living arrangement or short term stays to recuperate. Managing Gluten-Free diets, like other food allergies, depends on facility wide awareness.
For the Administrator
1. Ask if they have experience with providing a gluten-free environment. Whatever the answer, yes or no, express your thanks that they are proactive! A gentle reminder of how many people with Celiac Disease will be looking for facilities that are competent will perk up their ears. One of an Administrators functions is marketing the facility.
2. Administrators have to approve purchases and prepare budgets. Food Service Directors will have to purchase gluten-free foods outside their normal supplier. They will appreciate you reminding their boss why.
3. Ask the Administrator to introduce you to the Director of Nursing, Director of Dietary and the Activities Director. The personal introduction will help underline the importance of a team approach needed to assure a proper gluten free life.
For the Food Service Director and Dietitian
1: Ask if they have recent experience preparing meals for a gluten free diet.
a. Use the term cross-contact when discussing meal preparation. Cross-contamination is a term food service workers have learned to associate with food borne illness like salmonella and E. coli.
b. Prepare gluten-free work area by using a fresh clean cloth, spray cleaner and rinse with clean hot water. Facilities will have a red sanitizing bucket that is refilled several times a day however sanitized crumbs in the bucket are still toxic!
c. The most difficult item for the kitchen to make is gluten-free toast. Cooks should know how to make toast in the oven however a dedicated gluten-free toaster may be appropriate. Request Grilled Sandwiches when possible.
d. Review label reading and the need to read labels each time.
2: Residential facilities have a menu that repeats every three to five weeks. Ask if they need help with their gluten-free diet extension
3. Ask who coordinates the between meal snacks?
4. Many facilities have food delivery once or twice a week. Please check out www.celinalfoods.com for information about this inexpensive way to always have meal essentials available.
Conversation with Director of Nursing and Dietitian (and Doctor)
1. Ask if the facility has recent experience with a gluten-free resident. Ask that resident care staff be given an in-service on gluten-free diets.
2. Remind them that you will always need a gluten-free multivitamin, even if you eat 100% of your meal. Many gluten-free foods are not fortified with the B vitamins and Iron found in wheat containing products.
3. State you will need your tissue transglutaminase antibody titer done annually.
4. Remind them that although most medications are gluten-free they should be checked by the facility pharmacist.
Talk with the Activities Director
The activity director is a very important person for you to know. They are very interested in your well-being at the facility and will want to interview you. Be prepared to discuss:
1. Your favorite foods.
2. Your religious needs.
3. Gluten Free craft supplies. Prepare the activity director now with this resource: www.discountschoolsupply.com.
Attend the Care Planning Meetings and Resident Council
If you find that the facility is just not getting the diet correct and are inflexible to learning please alert your local ombudsman. Every state has trained professionals that will investigate your complaints and be your advocate. Facilities should have the local phone number posted in plain view. Visit www.ltcombudsman.org and jot the number down or call the Ombudsman Resource Center at 202-332-2275, but I sincerely hope you never need it.
In our busy life we can all use more friends. If you have a few hours please consider volunteering in a residential facility. There is always need for someone to call bingo numbers or read to the visually impaired. Maybe they have a resident with Celiac Disease? You will feel great and will learn how to be a better advocate for yourself.