Hospitality in American Healthcare:

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Hospitality in American Healthcare Past,
Present, Future
William St. John, President CEO Dietary
Managers Association CEOHealthcare Caterers
International
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9 years before the first moon landing
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DMA founded in 1960
Founded in 1960

• 72 members
• Originally a practice group of the American
  Dietetic Association
• First name was HIEFFS
• New regulations recognized dietary manager gtgt
  standalone status
• Became DMA in 1985

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Healthcare Food Service - Today

• DMA 14,000 members
• US and Guam
• 47 active chapters

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Healthcare Past

• Strong revenues
• Less regulated
• Longer hospital stays
• Smaller long-term care industry
• Paper-based systems
• Cook-to-serve meals from scratch
• More labor-intensive
• Many of todays foodborne illnesses didnt
  exist

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Whats on our plate today

• The industry
• Regulations surveys
• Consumer expectations

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Whats on our plate today

• Financial performance
• Food safety
• Leadership recognition

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Industry food service in US

• Nations 2 employer
• 13.1 million workers
• 558 billion in sales
• 70 billion meals/snacks
• 15 of this is non-commercial

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Industry non-commercial growth
In non-commercial food service, healthcare is
growing CCRCs fastest.
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Industry CCRCs

• CCRC continuing care retirement community
• Offers a full range of services housing,
  residential services, health care
• Most include independent living option, assisted
  living, and skilled nursing care facilities
• Designed to serve older adults as their needs
  change over time

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Industry - the graying of America
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Industry - the graying of America

• 1 in 20 older Americans (over age 65), and 1 in 5
  people over 85 lives in a nursing home
• 1 in 3 Americans aged 65 today will spend some
  time in a nursing home
• Eden Alternative Aging should be a continued
  stage of development and growth, rather than a
  period of decline.

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Industry financial models

• Nursing homes, CCRCs, and hospitals have a
  rapidly growing for-profit segment
• Non-profit healthcare organizations outsource
  food service to for-profit firms

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Industry financial models
CONTRACT MANAGEMENT
SELF-OPERATED

• 25 of non-commercial food service is managed by
  contract
• 75 self-operated

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Regulations Surveys whos watching

• Centers for Medicare Medicaid Services (CMS)
  national standards to ensure quality of care
• State agencies survey facilities based on CMS
• Compliance required for reimbursement
• Standards include nutrition, menus, meal service,
  dining environment, sanitation, documentation,
  and more
• Surveyors interview residents

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Regulations Surveys documentation

• CMS standards include a structured resident
  assessment tool
• Timing standards for completion, submission, and
  follow-up
• HIPAA regulations privacy of data

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Regulations Surveys whos watching long-term
care

• Food safety inspection from CMS surveyors PLUS
• Local health department
• Sanitation standards from the US Food Drug
  Administration are adopted uniquely in each
  health jurisdiction
• Also adopted by CMS rules may not agree 100

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Regulations Surveys
concerns priorities
Surviving surveys is a top networking topic
among DMA members
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Consumer Expectations

• Sound nutrition
• Great taste
• Culinary innovation
• Comfort food
• Green food service a sustainable future

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• Our residents want healthier options, including
  nutrition information on the menus. Portion
  control is also more of an issue, partly because
  they dont want to overeat but also because
  smaller portions give them the opportunity to try
  more foods.
• quoted in FoodService Director magazine

Bob Wilson VP, senior living ARAMARK
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Consumer Expectations informationnursing home
survey reports online
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Consumer Expectations informationsanitation
inspection reports online
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Consumer Expectations dining choice

• Selective menus have replaced no choice in
  nursing homes
• Buffet dining50 of US nursing homes

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Consumer Expectations dining choice

• Room service 22 of US hospitals and now nursing
  homes, too

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• In long-term care, residents are looking for
  multiple points of service, all-day dining,
  upscale casual cafes and coffee bars.
• quoted in FoodService Director magazine

Mitch Possinger President, Cura
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Consumer Expectations culinary
talent

• 1 of every 3 nursing homes employs an
  executive chef (FoodService Director Industry
  Census)
• Sometimes also a certified dietary manager
  (CDM, CFPP)
• Chefs tired of restaurant hours turn to
  healthcare
• Healthy yummy!

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Financial Performance driving the bottom line

• Reimbursement model by diagnostic groupings (not
  actual costs)
• Decreased healthcare revenues
• More hospitals and nursing homes are for-profit
  corporations
• Outsourced food service also for-profitcorporatio
  ns

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Financial Performance increasing food service
revenues to offset operating costs

• Catering services, e.g., for events and outside
  groups
• Profit centers, e.g., cafeterias, coffee shop,
  convenience store
• Cashless payment systems for employees increase
  sales
• Non-patient meals in hospitals 55 of volume

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• I see both acute and long-term care focusing
  more on their retail opportunities in the future.
  An analysis of one of our projects showed a new
  retail area would deliver 6 more per patient day
  in revenue.
• quoted in FoodService Director magazine

George Shockey consultant
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Financial Performance containing costs

• Lean labor force
• Reduce food waste
• Competitive bid for purchasing
• Prime vendor
• Group purchasing
• Technology
• Budget monitoring per patient day
• Benchmarking

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Financial Performance catering managers wear
more hats

• Many oversee multiple departments
• Housekeeping
• Laundry
• Retail stores

MANAGE gt 1 DEPARTMENT
MANAGE 1 DEPARTMENT
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Food Safety emerging challenges

• New germs
• Antibiotic-resistant strains
• New methods of transmission
• New processing packaging techniques
• More recalls
• Large-scale food production distribution

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Food Safety foodborne illness in US

• 76 million illnesses per year
• 325,000 hospitalizations
• 5,000 deaths
• Costs 7 billion/year
• Elderly are 10 X more likely to die from
  foodborne illness

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Food Safety healthcare findingsfrom
inspections by the FDA
6-hour cooling

• Holding time temperature
• lt 41F or gt135F
• 6-hour cooling
• date-mark food

Nursing Homes OK
Nursing Homes Not OK
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Food Safety healthcare findingsfrom
inspections by the FDA
handwashing

• Hygiene
• wash hands
• screen new hires
• exclude workers who are ill

Nursing Homes OK
Nursing Homes Not OK
Nursing Homes Not OK
Nursing Homes OK
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Food Safety whos in charge?

• Food safety compliance performs better where
  there is a trained person in charge (FDA
  research)
• It takes science management skills to keep
  patients safe
• DMA credential Certified Dietary Manager, Food
  Protection Professional is most rigorous in the
  industry

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Leadership Recognition

• Regulatory lobbying to require certification
  uniformly
• Public relations efforts healthcare executives,
  consumers
• Collaboration with related organizations (e.g.,
  American Dietetic Association, consulting
  dietitians, long-term care associations)

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Leadership Recognition

• Restructuring organizations to meet changing
  needs

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Leadership Recognition

• Applying vision, strategy, and collaboration

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Whats Ahead?

• Long-term care market expansion
• Profitability
• Sustainability
• Ensuring a safe food supply, HACCP
• Enhanced technology
• Regulatory updates
• High expectations from consumers
• A diverse workforce
• From managers to leaders

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Healthcare Caterers International

• Similar challenges across the globe

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Healthcare Caterers International

• Share your benchmarking ideas!

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Healthcare Caterers International

• _at_ Hciglobal.org
• Click Newsletter and use the blog

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Healthcare Caterers International
Were better together.