MEAL PLANNING AND PREPARATION

        As a personal caregiver, you may have to purchase food for your client. First, develop a menu of what foods will be prepared. Check the ingredients the care recipient has on hand and make a shopping list. A list will help avoid unnecessary trips to the store for forgotten ingredients. It will also prevent duplicate buying of foods already on hand, and, if grouped by types of food, avoid extra steps in the grocery store. Things to remember when planning a meal:

• Variety – A well-balanced diet consists of getting nutrients from many different kinds of foods. No one food is perfect.
• Texture – Combining crispy foods with smooth, soft ones make each texture seem more interesting. Unless the care recipient is on a special diet where the texture of the food is controlled, try to choose different types of texture within each meal served.
• Flavors – If all foods in the meal have a strong, distinctive taste, they will compete with one another and overwhelm the care recipient’s taste buds. Keep the strong flavored foods as the spotlight with milder tasting foods as the background.
•  Color – Give each meal an appealing look by keeping the colors compatible. A sprig of parsley, radish roses, olives, or carrot curls may make an interesting dash of color to an otherwise drab-looking meal.
•  Cost – Most elders are not free to spend an unlimited amount of money on their food, so plan meals that are within their budgets. Consider foods on sale and use coupons whenever possible.

Shopping

        Occasionally, clients will ask employees to go shopping for them. Check with the office to get approval, unless running errands is written in the Plan of Care.

        Assisting with Shopping:

• Review the Grocery List.
• Inventory items on hand or needed, such as basic food, paper goods, toiletries, and cleaning supplies.
• Familiarize yourself with sale items at the grocery store or review newspaper ads with the client.
• Obtain specific information regarding each Item: size, quantity, color, ripeness, and cost.
• Ask the clients about buying a comparable sale item if it’s cheaper.
• Pick up perishables last stop in the grocery store, especially in hot weather.
• Get groceries home and refrigerate perishables as quickly as possible.
• Don’t leave perishables in the car while you run other errands.
• If you live more than 30 miles from the store, consider using an ice chest.

When you shop, be careful in the selection of perishable foods.

• Make sure that frozen foods are solid and that refrigerated foods feel cold.
• The “sell by” and “use by” dates are printed on many perishable foods.
• Pay attention to expiration dates on sealed, canned, and bottled items.
  • The “sell by” date tells grocer and buyer how long produce should be kept for sale on the shelf.
  • The “use by” date is indicates how long the food will retain top eating quality after purchase.

Money Handling Techniques:

• Count the money in front of the client before leaving the home.
• Place the client’s money, grocery list, coupons, and food stamps in an envelope, zip-lock bag, or separate coin purse.
• Upon return, give the client receipts, return unused coupons, and count the change for the client.
• Whenever possible, use a store that itemizes receipts.

Storage of Items Purchased:

• Follow client instructions.
• Be aware of client limitations:
• Label items.
• Open jars ‘and milk cartons as needed. 
• Store items properly.
  • Re-package items into smaller portions as needed.

        Meal Shopping/Purchasing It is important to READ labels when purchasing packaged food, as the listing of ingredients on these labels is critical for special diets. Those on salt-free diets, for example, must avoid products that list sodium on the labels. Likewise, diets that restrict the use of sugar can avoid sugar by checking the label. People with allergies to certain types of foods or chemicals can use the ingredient panel on a label when planning what to eat. Labels also tell us the amount of food in the container, and, sometimes, the number and amount of servings, as well as the calories per serving. This could be important to those care recipients on a low calorie diet. The label may also list the kind of nutrients in the food and the amounts of the nutrients. In products that contain more than one ingredient, such as spaghetti in meat sauce, all the ingredients must be listed. The ingredients found in the greatest amount will be listed first. The ingredient listed last would have the smallest amount. Convenience foods usually cost more than foods prepared from scratch. You must consider that ingredients might spoil before they are completely used. Deciding what to purchase must be made on an individual basis. Purchasing larger quantities can be cheaper than buying small quantities of an item. If storage is a problem, however, the item may have to be discarded before it is all used. Discuss the amount of ingredients needed with your care recipient before you go to the store. Consider the cost of seasonal foods when purchasing foods. Foods that are in season are usually a good buy.

Here is how to reduce the cost of foods that are high in protein:

• Use poultry when it is cheaper than red meat.
• Consider cuts of meat that may cost more per pound but give more servings per person.
• Learn to prepare less tender cuts of meat in casseroles or pot roasts.
• Serve egg dishes such as omelets. # Substitute dried bean and pea dishes for higher cost meals.
• Use fillers such as breadcrumbs or pasta to make a meat dish serve more.

FOOD HANDLING AND STORAGE

Kitchen Food Safety

        Food Safety Infection Control in the Kitchen

• It is very important for the home care worker to understand how to prepare and store foods in a safe manner.
• Foods can be contaminated (poisoned) in different ways.

Anyone who prepares and/or handles food should follow  these guidelines.

• ALWAYS WASH YOURHANDS BEFORE HANDLING FOODS.
• Keep your hair pulled back or covered. Stray hair is a contaminant.
• Foods like raw meats, fish, and eggs can naturally harbor harmful bacteria or parasites. Cooking these foods thoroughly will solve this problem.
• Other foods are contaminated because of improper handling and storage.
• Avoid letting foods stay at room temperature.
• Keep HOT-foods HOT, and keep COLD-foods COLD.
• Wash all fresh fruits and vegetables.
• Rinse meats before cooking.
• Use disinfectants on surfaces.
• Wash tops of cans before opening.
• Keep surfaces and utensils clean, such as:
• Countertops, cutting boards, can openers, dishes, pots and pans;
• Sponges, dishcloths, dishtowels;
• Trash cans, appliances, and telephones.

WASH HANDS FREQUENTLY.

Nutritious Meal Preparation

        Homemakers are frequently called upon to assist clients with meal planning and preparation. The homemaker needs to be concerned with safe handling of foods (see: Kitchen Safety on previous pages) and the nutritional values of foods for clients. The “Food Guide Pyramid” has been designed as a guide for everyone to use when planning nutritious meals. There are four things to remember about a healthy diet, using the pyramid:

1.    Moderation:

• Moderation refers to the amount of food needed for a health body weight.
• Some food choices contain fat or added sugar and they should be eaten in moderation.

2.    Balance:

• The shape of the pyramid indicates that grains, fruits, and vegetables should make up most of our daily calories. However, no one group is more important than the other groups. We need them all, but in varying amounts.

3.    Variety:

• Variety is important. No one-food group can provide all the nutrients we need.

4.    Focus on Fat:

• Certain foods contain more than the recommended amounts of fats.
• They should be used sparingly.

In Basic Menu-planning for clients, consider the following:

• Client needs, limitations (special diet, soft foods)
• Client preferences -review likes/dislikes, favorite recipes
• Cost of food items
• Ease of preparation, re-serving, and re-heating.
• It is helpful at times to keep a log of client preference.
• Involve your client as much as possible in planning and preparing.
• Review cookbooks, magazines for ideas to present to your client.

Hints for Encouraging Improved Nutrition:

• As a caregiver, encourage proper nutrition. Gently share your knowledge. Recognize your client’s right to make his own decision.
• Be aware that very generous portions can overwhelm an elderly client. Elders do have decreased
• Need for caloric intake. Offer smaller portions of a variety of foods as possible.
• Encourage improved nutrition by updating your client on availability of appealing fresh produce.
• Brainstorm with your client on favorite recipes and foods.
• Read labels -educating yourself and your client.
• Be aware that many processed products contain “hidden” sugars and salt. By rinsing off
• Canned vegetables or fruit, you can remove some of the excess salt or sugar.
• Do not neglect the importance of fluid intake to your client’s health. Encourage your client to drink plenty of juice, milk, and water.
• Consider garnishes: They can add appeal to a meal while adding nutritional value.

Examples of Garnishes:

• Orange or pineapple slices, cut radish, slivers of green pepper, celery, carrots, cucumbers, tomato wedges.

        Preparing the Meal Being aware of the amount of energy you use when preparing foods will save time, money, and your care recipient’s resources if you remember the following:

• Prepare one-dish meals.
•  Make enough food for more than one meal and reheat the remaining servings.
•  Use the correct burner size and correct pan size; a small pan should have a small burner.
•  Do not preheat the oven more than necessary.
•  When using the oven, prepare more than one item at a time.
•  Turn off the heat on an electric range a few minutes before the food is ready.
• If possible, use a small toaster oven for small jobs and the big oven for bigger jobs. Other things to consider when preparing meals include:
•  Wash your hands often during the preparations.
• When using spoons, etc. to taste foods, do NOT use them again without washing them first.
•  Properly store any leftovers as soon as possible.
• Prepare leftovers in proper serving size.
• Thoroughly wash all fresh fruits and vegetables.
•  Clean up as you go along and when you are done.
•  Meats should be defrosted in fridge or microwave. Do NOT let them sit out at room temperature.
•  Use as little water as possible when cooking vegetables.
•  Remember to include fluids in the care recipient’s diet.
•  Follow the menu and recipes.
•  Know food substitutions allowed for a special diet if a food item is not available.

General Food Handling Hints

• Encourage clients not to overstock food that spoils easily.
• Keep refrigerators and freezer units in proper working condition.
• Refrigerator temperatures should be maintained at 36°F to 40°F.
• Freezer temperatures should be maintained at 0°F.
• Use foods by expiration date on package.
• Discard foods that show spoilage.
• Respect Client Rights. Explain the need to avoid use of spoiled food.
• Keep refrigerated foods properly covered or wrapped.
• Dry ingredients like flour, sugar, and pasta should be kept in covered containers.
• Foods purchased most recently should be used last.
• A rotation system should be used for canned goods.
• Foods in the refrigerator, as well as in dry storage, should have space around them for air circulation.
• Check dry storage areas periodically for signs of insects and rodent.

Fish, Poultry, and Other Meats:

• It is necessary to keep meats cold. Store them at 30 to 40 degrees F.
• Poultry, fish, and fresh meat such as roasts, chops, and steaks should be allowed some air.
• Loosen tight coverings. Cover the food and use it within a few days.
• Ground meat and variety meats, especially liver and brains, spoil more quickly than others.
• Store loosely wrapped. Cook within one or two days for best flavor or wrap in freezer paper and freeze.
• Cured and smoked meats, such as ham, frankfurters, bacon, and sausage (smoked and un-smoked)
• May be kept tightly wrapped while they are stored in the refrigerator. They keep longer than fresh
• Meals, although bacon and sausage are likely to change flavor.
• Keep cooked meat, poultry, fish, broth, and gravies covered and in the refrigerator. Use within a few days, or wrap well and freeze.

Storing leftovers:

        Don’t cool leftovers on the kitchen counter. Put them straight into the refrigerator. Divide large portions of meat, macaroni, or potato salads, and large bowls of mashed potatoes or dressing into smaller portions. Small portions cool more quickly to temperatures at which bacteria quits growing.

Cleaning the Refrigerator

• Plan ahead. It can be time-consuming.
• Follow client instructions or posted instructions.
• Turn off the freezer. Note the original setting.
• Remove foods and place together in a bin or cooler to retain coldness.
• Some clients want food wrapped in towels or newspaper for further insulation.
• Place pan under drain inside refrigerator or turn up flip section of tray under freezer.
  • Some clients request towels on the top-shelf inside refrigerator and on the floor in front of the refrigerator.

Defrosting the Refrigerator:

Several methods of defrosting include:

• Melt by steam from pans of boiling water placed inside freezer.
• Un-plug “Defrost Plug”(watch carefully!)
• Use hairdryer – avoid electrocution!
• Do not use a hairdryer with a wet hand or make direct contact with water.
• DO NOT use sharp instruments to pry loose ice buildup.
• Some appliances provide a blunt-ended, soft plastic tool (like a pancake turner) for gentle ice removal.
• Be patient. Ensure all ice has melted.

Wash Interior of Refrigerator and Replace Food

• Wipe interior of refrigerator with 3 tablespoons baking soda mixed in 1 quart of water.
• Turn on freezer unit when completed.
• Replace foods.
• Check for proper coldness setting.

Keep Hot Food Hot

• High food temperatures (165-212F) reached in boiling, baking, frying, and roasting kill most food poisoning bacteria. If you need to delay serving cooked food, you have to keep it at a holding temperature – roughly 140°F to 165°F.
• Steam tables and chafing dishes are designed to maintain holding temperatures.
• They don’t always keep food hot enough. So it’s not wise to
  • Leave hot food out more than 2 hours.
  • When cooked food is left out, unheated, the possibility of bacterial growth is of significant importance.
  • Food temperatures drop quickly to room temperature where food poisons thrive.
  • Follow these rules to serve hot foods safely – particularly meat and poultry that are highly susceptible to food po1sorung.

Cook thoroughly

• Cook meat and poultry to “doneness” temperatures. (Refer to cookbook).
• Make sure that meat and poultry are cooked all the way through.
• Use a meat thermometer. Insert the tip into the thickest part of the meat. Avoid fat or bone.
• For poultry, insert the tip into the thick part of the thigh next to the body.

Don’t interrupt cooking

• Cook meat and poultry completely at one time.
• Partial cooking may encourage bacterial growth before cooking is complete.

Cooking frozen food

• Allow frozen food more time to cook.
• Frozen foods require 1 ½ times the cooking time of non-frozen foods.

Thoroughly reheat leftovers

• Cover leftovers when reheating to retain moisture and guarantee that food will heat all the way through.

Bring gravies to a rolling boil before serving.

NEVER LEAVE FOOD OUT FOR MORE   THAN TWO HOURS!

Keep Cold Food Cold

• The colder food is kept, the less chance bacteria will have to grow. That’s why food keeps so much longer in the freezer than in the refrigerator.
• To ensure the refrigerator and freezer are giving good protection against bacterial growth; check them with an appliance thermometer.
• The refrigerator should register 40°F (5° Celsius) or lower.
• The freezer should register 0°F.

        Here are some tips for keeping meat, poultry, eggs, milk, cheese, and other perishable foods cold:

Refrigerating:

• Since repeated handling can introduce bacteria to meat and poultry, leave products in the store wrap unless the wrappers are torn.
• If torn, to prevent moisture loss, re-wrap meats in wax paper, plastic wrap, or aluminum foil.

Read the labels:

• Refrigerate canned meat – or poultry – or store it in a cool, dry place.

Freezing:

• Although “freezer burn” (white, dried-out patches on the surface of meat) won’t make you sick, it will cause meat to be tough and tasteless. To avoid freezer  burn:
• Wrap meats in heavy freezer paper, plastic wrap, or aluminum foil.
• Place new items to rear of freezer,
• Move old items to front to ensure older items are used first.
• Write date on freezer packages to help you know which items should be used first.

Thawing:

        The safest way to thaw meat and poultry is to take it out of the freezer and leave it in the refrigerator overnight. Normally, it will be ready to use the next day.

For faster thaw:

• Put the frozen package in a watertight plastic bag under cold water. Change the water often.
• The cold-water temperature slows bacteria that might grow in the outer, thawed portions of the meat while the inner areas are still thawing.
• If you have a microwave oven, you can safely thaw meat and poultry in it. Follow manufacturer’s directions.

Caution:

Do not thaw meat and poultry on kitchen counter.Bacteria multiply rapidly at room temperature.