Senior Living Communities - Where does Mom's rent go ?

Retirement communities seem like a great idea on the surface: like a cruise ship for seniors. Social opportunities, wellness opportunities, fine dining, special holiday functions, maintainence services, housekeeping; some have nurse stations, and some have full time LVN's represent a picture of complete care just waiting to put it's arms around your aging parent.
You and your parent tour a facility. The people are so nice. The place looks like a fine hotel. Everyone is so happy to see you. It must be heaven. Oops, trying to avoid that! But as the last stop on route, except of course for some of you, not a bad place to hang your silk scarf, and support hose.
"That beautiful apartment is how much?" $5,000 dollars a month..."and up!!!!????" You swallow. Subtle, but hard. Your parent imagines friends,fun, privilege, bridge players, and chocolate. So where does your rent go? I will give you a hint: it is not dining services, or housekeeping, or maintenance, or capital improvements of health care, or activities. In many upscale senior living communities, you may be surprised to discover that over 40-50% of the operational dollars go to marketing and not to services that directly benefit your parent.
The reason is simple, senior residents move into these communities when they have an average of 5 years left to live. Sad, but factual. So inherent in all "retirement communities" is alot of resident turnover, even when residents are content within their community. Just imagine the numbers, when the residents are not content.
When a resident dies, an apartment becomes empty, and corporate revenues shrink. Some corporations have silent partners (investors), who do not appreciate declines in occupancy levels. Less occupants, less profits. So a tremendous amount of your rent dollars are spent attracting a continual stream of new residents. 40-50% of the yearly budget at the property level is spent on marketing, and the recruitment of future residents. There is even greater turnover, of course, when the services are so-so. I was given $2.40 per person per meal, based on two meals per day in one such upscale retirement community in La Jolla California, as recently as 2007. Marketing first, nutrition? Somewhere much farther down the list.
The caretaking mission represented by these corporations is really not their mission. Profit, not people, again is the mission. The mission of most of these communities is NOT to keep your parents content with cruise ship five star services, no matter what they say to you, during your "free" marketing tour and lunch. The corporate mission is to keep the building full, create large revenues, make tremendous profits,purchase more properties, turn them in to more goldmines. Oh, the hours spent in departmental leadership meetings, working on the shape of the spin.
Until late 2007, I functioned as the Dietary Director for one such "for-profit" corporation. This Carlsbad company, proudly announced, at the 2006 dietary conference for all dietary directors, that they made a NET profit of $11 million dollars with their 23 properties nationwide. More shocking is the fact that some of their properties went much of the year below full occupancy. You can just imagine the profit at full occupancy. Al ot of profit for a company that on my campus, outside of dining services, had a lot of resident turnover, unhappiness with other services, and four executive director turnovers in two years! It is only about occupancy folks. The rest is marketing.
I am not alone in my understanding of just how senior living communities operate. But, people on the inside of the industry, do not speak up because: they are care-givers, and need these jobs. Some, like me, become disillusioned care-givers, and leave the industry. Find the honest broker on your marketing tour, and call them later for a personal chat. They will tell you. Most workers, and local property leadership in these companies are disillusioned too. Or they have darker motives for staying in silence.
There are many things I discovered in my tenures, that have turned me off to retirement communities as a viable future option for aging adults. I have not even touched on the average direct care-giver to resident ratios of 1 to 20 :at the very best. This ratio is at the very root of the problem. Try caring for twenty parents with two hundred challenges daily per parent, and you will get the picture. The cloth just does not stretch to cover the need.
Higher corporate costs drive operational changes that should concern adult children seeking quality residential solutions to caring for their aging parents. I do not believe that all upscale retirement communities really fulfill their care giving promises: and today there are a lot of other alternatives you should also consider.For this much rent ( and more), similar services, are offered for this inclusive price: you should, and do expect five star level housekeeping, fine dining complete with special holiday programming; wellness programs that focus on fall prevention, strength training, and balance education for your parent; maintainence (toilets do have their problems, so do air conditioners/heaters, elevators). If you are still considering an upscale independent living community of 100 to 500 occupants, consider this: every year, you can expect a cost of living increase of 5-9 % in these communities: whether you like it or not. And trust me, the corporation can always defend the reasons for the increase. You will have only the choice to pay or move.
Are independent living communities really full of independent living seniors? Retirement communities usually bill themselves as housing for independent living residents: those with minimal mobility and functionality issues. But in the last twelve years, I have seen less truly independent residents, and more highly dependent, borderline assisted living or early dementia type residents move in. The corporation is motivated simply by the drive to keep the place full. This creates a great demand on service personnel, often untrained. If your parent is very independent, it can be depressing. Your high functioning parent may be seated in the dining room, at dinner, with someone with incontinence issues. Or worse. So before you sign that rental agreement, remember what I have shared with you : current and future residents are hunted constantly by full time marketing people to keep the building full. We had 140 residents, and two full time marketers: they were each required to make 50 phone call contacts each day to "prospects". Be comfortable but observant, when taking a marketing tour of a community: observe the care giving ratio; study the interaction of the residents with each other, and with department heads, peak into administrative offices, talk with the maintainence director and the dietary director about the challenges of their positions. Call them later to ask about what they didn't say. Find out about the property's budget: anyway you can. Look at the food served; tour the kitchen, look in those walk-ins. Fresh, homemade preparations or commercial preparations? Sit down at lunch with a random group, and not of the marketer's choosing. Always try to take an 'unplanned' tour, to get the most honest insight.
In conclusion, you may get more services, of a better quality, in smaller board and cares, than you will in large retirement communities. Retirement communities do have a huge socialization advantage: a lot more prospective playmates for your parents. But they are not for everybody. Make sure to take an industry savvy professional along with you while you are touring, and examining what you really ARE getting for your rent.

SENIORS: HOW TO BEGIN A WELLNESS PROGRAM

THINK PRIMATIVELY.

·      YOU ARE NOT BEING CHASED BY A TIGER EVERYDAY, OR FORAGING FOR THE ENTIRE DAY FOR NOURISHMENT TO KEEP YOU STRONG ENOUGH TO FORAGE DAY IN AND DAY OUT

·       YOU ARE NOT STRETCHING CONSTANTLY FOR THE ONLY BERRY PRECARIOUSLY HANGING ON THE END OF THAT BRANCH.

·      YOU ARE NOT NAVIGATING YOUR BODY THRU A SMALL CREVICE OF ROCK SO THAT YOU CAN ESCAPE HARM, OR GET TO THE COOL DRINKING WATER.

·      YOU ARE NOT CREATING BALANCE BY USING ALL YOUR LEVERS IN HARMONIOUS COORDINATION EVERYDAY…

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……….SO FIRST ASK YOURSELF: WHAT CAN I DO EVERYDAY, TO TAKE THE PLACE OF THAT ?

 

AFTER ALL, YOUR BODY IS ANCIENT; OPERATES AS IF IT WERE STILL ON THE AFRICAN DESERT, AND DOESN’T CARE THAT YOU HAVE A NEW LAPTOP TO WILE AWAY THE HOURS.  IT ONLY INTERPRETS TWO THINGS; ACTIVITY AND INACTIVITY.  ACTIVITY STIMULATES GROWTH, AND INACTIVITY SIMULATES YOUR BODY AND BRAIN TO SHUT DOWN ALL UNNECCESSARY SYSTEMS.  IF YOU DON’T USE YOUR BODY, LIKE A HUNTER EVERY DAY, YOU ARE TELLING YOUR BODY TO SACRIFICE YOUR MUSCLES, YOUR CONNECTIVE TISSUE, AND YOUR ORGANS UST  TO KEEP YOUR BRAIN ALIVE.  YOUR BODY THINKS THAT YOU DO THINGS ON PURPOSE.  SO WHEN YOU SIT FOR HOURS,DAYS, DECADES, AND ATROPHY INSUES AS A RESULT, YOUR BODY THINKS THAT YOU “WANT” TO LOSE MUSCLES, SHUT DOWN ORGAN FUNCTIONALABILITY, AND  DRASTICALY LOWER YOUR METABOLISM……….IT SIMPLY INTERPRETS THESE SIGNALS AS SIGNS THAT SCARCITY IS ‘REALLY BAD THIS YEAR’.

 

START WALKING AS LONG AND FAR AS POSSIBLE IN BETWEEN BOUTS OF SITTING.  IF YOU HAVE NOT WALKED IN AWHILE, START BAREFOOT AT THE BEACH, TO REMIND YOUR NEURONS OF THE CORRECT POSTURE FOR WALKING.  BELIEVE IT, OR NOT, YOUR BODY CAN FORGET HOW TO WALK CORRECTLY.

 

WALK EVERYDAY. NO EXCUSES. NO EXCEPTIONS.  TAKE WATER. DRINK IT. AND REFILL THAT BOTTLE, INSTEAD OF CREATING MORE PLASTIC FOR THE DUMP.

 

JOIN A GYM.  VISIT THEM. CHECK OUT THE ATMOSPHERE. PICK ONE WHERE YOU FEEL MOST COMFORTABLE.  START WITH A TRAINER, SO THAT YOU DON’T END UP MIMICKING THE PEOPLE WHO MIMICK THE PEOPLE: MOST OF WHOM NEVER REAP THE REWARDS, AND MANY OF WHOM GET INJURED.  SURRENDER DOROTHY: YOU HAVE MADE THE RIGHT CHOICE. BE COMMITTED. DO THE WORK. BE PATIENT. RESULTS WILL COME.  YA DIDN’T GET THAT FAR GONE OVER NIGHT……BUT A FEW MONTHS CAN REVERSE THE DAMAGE YOU HAVE DONE TO YOURSELF OVER DECADES.

 

PICK A TIME. CREATE A HABIT, AND STICK TO IT.  THE LESS DECISION MAKING THE BETTER.  YOU HAVE ALREADY DECIDED: SO DON’T LET THAT BRAIN OF YOURS START BUILDING OBJECTIONS: THE DEBATE SOCIETY WON’T GIVE YOU YOUR LIFE BACK.  THE GYM WILL.

 

DON’T CHOOSE BETWEEN PHYSICAL ACTIVITY AND EATING, DRINKING AND TALKING: YOUR DOG ALWAYS CHOOSES THE BED, NOT THE FLOOR RIGHT ? SO DO YOU IF YOU START SEEING IT THIS WAY……PHYSICAL ACTIVITY, UP TO , AND BEYOND THE MINIMUM STANDARDS IS NOT OPTIONAL, IT IS IMPERATIVE, UNLESS YOU WANT TO LOOSE ALL FUNCTIONING DURING THE LAST THREE DECADES OF YOUR LIFE. TRUST ME, YOU DON’T. NO PRETTY. VERY SAD. A LOT OF DEPRESSED PEOPLE WITH FEW OPTIONS.

MAKE YOURSELF MOVE.  REMEMBER IN THE JUNGLE, IF YOU ARE NOT MOVING, YOU QUICKLY BECOME SOMEONE'S LUNCH.............NOTHING HAS CHANGED.....

SO GET UP. MOVE. STRETCH. GET IN THAT RETIREMENT COMMUNITY POOL. EAT NUTRITIOUS FOOD. LIFT WEIGHTS. AND BY ALL MEANS, RUN CIRCLES AROUND YOUR MIDDLE AGED CHILDREN.......

TAKE BACK YOUR YOUTH...........HELP YOUR FIFTY YEAR OLD CHILDREN TO DO THE SAME.....

SENIORS: CHANGE YOUR WELLNESS LEVEL . GET HELP

There are medical plans with support to make healthy lifestyle choices: the research of Jessie Jones at Cal State Fullerton, validated by tons of current research is conclusive: seniors can dramatically improve their state of health and function by ten years or more.  What are you waiting for ?  Great help is available ! Here are two examples:

·      Secure Horizons Advance to Wellness Program- is individualized. Provides a health coach who helps members set goals, asses progress, and realize the goals. A memory kit is included in the Vitality assessment., home safety assessment with a small rembursement from the plan for modifications, programs to assist in financial wellness.

·      The coach training is co-ordinated with a Health Belief Model ( HBM) which is used to determine someone’s readiness to change.

·      For more information: contact www.securehorizons.com/ourplans/programs.html.

·      Secure Horizons is a 2006 recipient of the International Council on Active Aging’s Innovator’s Award

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TOOLS

·      ACTIVE AGING TOOLKIT WWW.FIRSTSTEPTOACTIVEHEALTH.COMTHIS IS A CUTOMIZALE, COMPREHENSIVE, PROGRESSIVE ACTIVITY PROGRAM FOR ABLE BODIED, YET INACTIVE OLDER ADULTS.

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RETIREMENT COMMUNITIES: ARE THEY ACTIVELY TRANSFORMING THE WAY YOUR PARENTS AGE ?

When first hired, as the Executive Chef, and Dietary Manager in 96’ of a very upscale retirement community, I was instructed to do "whatever it takes" to keep the 340 residents happy. During the next 8 years, my residents enjoyed the highest resident satisfaction in the history of the company's very large portfolio.

  In retirement communities, it is great food that keeps the majority of the residents content, and motivated to continue, and perhaps distracted from thinking about other community issues.

There is little debate among industry professionals regarding the importance of great food.

I took a year off in 2004, to do some travel, remodel aspects of my 85 year old mother's home in West Los Angeles, and pay more attention to my middle age health. Buoyant and re-charged, I returned to the job market, and was immediately hired by another corporation's "flagship property".

As Dietary Director, I was still charged with a similar mission, "Do whatever it takes to keep the residents satisfied". Only this time, my company was for profit; the first senior corporation I worked for was not for profit. In eighteen months, I improved the resident satisfaction 44 %, from 50%, when I began my tenure, to 94% as of September 2007. My residents knew that I was not just a chef, but also a nutritionist, focused on improving their level of wellness. Most residents had no prior knowledge of quinoa, wheat berries, or eating for antioxidant protection: but I considered it my responsibility to not only improve their understanding of nutrition, but to help them understand the impact of nutritional choices on their overall wellness, and more importantly, on their independence. My mission was to actively, purposefully educate.

My experiences of the last ten years, have reversed my initial support for retirement communities as a viable choice for aging parents , and their adult children.

I think that many such communities are really apartment buildings run by corporations with more of an interest in maintaining full occupancy, than in promoting wellness, and the high quality of life for the residents within the building. My corporate supervisor actually instructed me to use commercial high sodium meatballs, because they were "cheaper" than scratch; the same fellow instructed me when I first arrived, that I should not cater to special diets: "we do not cater to special diets". This is the mentality of some "for-profit" corporations engaged in senior care giving. It is all about the profit, not the residents.

There are exceptions:  In 2000, I raised over $20,000 from the community  residents because I believe so strongly in strength training for seniors: the non-profit corporation matched the funds, and this allowed me to hire a personal trainer to oversee the "wellness and balance room". After senior fitness testing of 200 willing residents, strength training has become a norm for this community,improving the daily health, and longevity of the participating residents. This non-profit corporation in Sn Diego,  was authentically interested back then, in 'walking the talk'.

The 'for-profit' community, by comparison,  had excellent equipment(Keiser), but had a Wellness Director with no experience or certifications in senior fitness. To her credit, she put on great functions, and theme parties within a minimal budget. 

Most of these retirement communities struggle with occupancy, because people come in with some serious challenges, and while in residency, usually go quickly downhill. So the corporations that profit from occupancy, spend allot of money on marketing, but much less money on regular programming that benefits existing residents.

To their credit, these companies do attempt to bring in somewhat knowledgeable speakers to help influence the way in which their residents age; but this educational dimension, like the other five dimensions of wellness programming are all grossly under funded.

My last employer made $11 million dollars in profit from 23 retirement communities; they spent $2.40 per resident per meal, based on two meals per day. Dining services had, by far, the largest budget for all the properties within the corporation: that will tell you how little is actually spent on housekeeping, wellness, environmental services, capital expenses. In September of 2007, the management team of my property had to discourage the corporate leadership from spending $250,000 renovating the front of the building for aesthetic reasons (stamped concrete, palms, glamorous entrance, walkways, lighting), when the residents were screaming about the level of noise in their dining room, and the discomfort of their upholstered chairs.

If you care about the way that your parent ages, there are many other better alternatives to these glossy retirement communities.

At the very least, you should understand that the data supports the conclusion that people moving into retirement communities, actually decline faster than they would if they were at home with caregivers.

RESEARCH DRIVES NEW PHYSICAL ACTIVITY RECOMMENDATIONS FOR OLDER ADULTS

 

UPDATED RECOMMENDATIONS FOR THE 16-64 YEAR OLD POPULATION, AND COMPANION RECOMMENDATIONS FOR AGES 65 AND OLDER WERE RELEASED IN AUGUST OF LAST YEAR, 2007 

It is important to remember that these are MINIMUM recommendations: if you or your doctor feel that you have a physical impairment or a functional limitation, it will take more effort, time, and patience on your part to return you to full functionality.  All professionals are in agreement, however, that waiting til you are in residential or long term care, is a HUGE MISTAKE. 

The scientists who put together the recommendations could not be more clearer, when they state that  “regular physical activity, including aerobic activity, and muscle strengthening activity, is essential for healthy aging”.  They went on to use the word “critical” to describe the importance “for healthy aging”.  In addition, “strength training is especially (important) for older adults, as it prevents loss of muscle mass, and bone”.

The new American College of Sports Medicene and American Heart Association guidelines released on August 1, 2007 formally endorse strength training. The guideline is 8-10 types of strength training exercises, 10-15 repetitions, 2-3 sessions per week.

Also confirmed: that 30 minutes of aerobic exercise that you are supposed to be getting every day, can be broken into three ten minute increments. The guidelines recommends for aerobic exercise ( 65 % of maximum heart rate):

1. 5 days, moderate intensity for 30 minute sessions  OR
2. 3 days, intense aerobic for 20 minute sessions.

There is also additional emphasis on flexibility : however a leading researcher Jessie Jones, the co-director of Cal State Fullerton’s Center for Successful Aging, and a pioneer in establishing senior fitness testing data, and guidelines felt that the existing science supports that balance and mobility training should be “part of the core recommendations for everyone”  The recommendations only suggest balance training for individuals at risk of falling: most middle age adults of above average fitness would be shocked to find out just how challenged their balance has become, as a result of muscular disuse. Flexibility work is an everyday investment:  take ten extra minutes to stretch the major muscle groups : spend  10-30 seconds for each stretch. 

There is enough evidence that we must get out walking, strength train, work daily on our flexibility and balance: Jones and others feel very strongly that there has to be a “huge surge in public awareness” about these components”.    “with every increasing decade of age, people become less and less active; but the research proves that with every increasing decade, exercise becomes more important in terms of quality of life, independence, and having a full life”.

The lead author of the recommendations, Miriam Nelson, Phd, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston had this to say “ Americans are not on the right path.

The recommendations strongly suggest that an individual work with a provider to develop an activity plan.  After screening from a physician, an exercise specialist can evaluate health risks, activity limitations, risk of falls, baseline ability and fitness level: then a well developed and personalized plan is implemented for the individual.

 

Retirement Communities: KNOW WHERE YOUR RENT MONEY GOES !!

Retirement communitites seem like a great idea on the surface: like a cruise ship for seniors. Social opportunities, wellness opportunities, fine dining, maintainence services, housekeeping; some have nurse stations, and full time LVN's (most have CNA's, or none at all). The largest budget in these communities ? You may be suprised to discover that over 40-50% of the operational dollars go to marketing, not to real services that your parent would ever directly benefit from. The reason is simple, senior residents move into these communities when they have an average of 5 years left to live. When a resident dies, an apartment becomes empty, and the corporate revenues shrink. And some corporations have silent partners (investors), who do not appreciate declines in occupancy levels. Less occupants, less profits.So, I have come to understand that the mission of most of these communities is NOT to keep your parents well served with cruise ship five star services, no matter what they say to you, during your "free" marketing tour and lunch. The corporate mission is to keep the building full, create large revenues, purchase more properties, turn them in to more goldmines. The for profit company that I mentioned above, proudly announced, at the 2006 dietary conference for the directors, that they made a NET profit of $11 million dollars with their 23 properties nationwide. Some buildings went much of the year below full occupancy. You can just imagine the profit at full occupancy.I am not alone in my understanding of just how senior living communitites operate. But, people on the inside of the industry, do not speak up because: they are care-givers, and need these jobs. Some, like me, become disillusioned care-givers, and leave the industry. I am really shocked that more do not speak about life inside senior living. There are many things I discovered in my tenures, that have turned me off to retirement communitites as a viable future option for aging adults. I have not even touched on the average direct care-giver to resident ratios of 1 to 20 :at the very best. Higher corporate costs drive operational changes that should concern adult children seeking quality residential solutions to caring for their aging parents. I do not believe that all upscale retirement communities really fulfill their care giving promises: and today there are alot of other alternatives you should also consider.For this much rent ( and more), similar services, are offered for this inclusive price: you should, and do expect five star level housekeeping, fine dining complete with special holiday programming; wellness programs that focus on fall prevention, strength training, and balance education for your parent; maintainence (toilets do have their problems, so do air conditioners/heaters,elevators). Every year, you can expect 5-7 % cost of living increases in these communities: whether you like it or not. And trust me, the corporation can always defend the reasons for the increase. You will have only the choice to pay or move.Retirement communities ususally bill themselves as housing for independent living residents: those with minimal mobility and functionality issues. But in the last twelve years, I have seen less truly independent residents, and more highly dependent, borderline assisted living or early dementia type residents move in. The corporation is motivated simply by the drive to keep the place full. This creates a great demand on service personnel, often untrained. If your parent is very independent, it can be depressing. Your high functioning parent may be seated in the dining room, at dinner, with someone with incontinence issues. Or worse. Because of the neediness of some residents brought into independent living communities by marketers attempting to fill the building, and the demanding care giving ratio, and the low budget for services, and the high corporate costs for corporate overhead, you may get more services, of a better quality, in smaller board and cares, than you will in large retirement communities. Retirement communities have a huge socialization advantage: alot more prospective playmates for your parents. But they are not for everybody. Make sure to take an industry savvy professional along with you while you are touring, and examining what you really ARE getting for your rent.

Retirement Communities: The underfunding of Senior Nutrition

If you paid $5,000 a month last month for your parent to live in a very nice, upscale retirement community, would you be shocked to learn that only 3.5 % of this money funds the monthly nutritional wellness of your aging parent ?

Your 85 year old parent may be nourished today in a community boasting a "fine dining program", for $2.40 per meal: this was my budget per resident in an upscale senior independent living community in La Jolla, California in 2007.

Retirement community budgets are drafted at the corporate level: that means that a decision is made to give each community's dining service director a fixed yearly budget from which to feed the resident's of a community: as an outsider to senior living, most people would guess that senior nutritional standards would drive the dollars budgeted for daily meal services. That is not always the case.

While some corporations have a full time registered dietician on staff: other corporations do not. My last employer had an accountant, not a nutritionist, deciding the dollars necessary to provide high quality nutritional food to community residents. Furthermore the corporate leadership was more concerned with feeding the community residents food that was inexpensive to buy, and convenient to produce; rather than high quality whole foods that were nutritional. The nutritional wellness of your cherished parent is not the first priority of these very profitable corporations, though from an ethical perspective it should be.

You would think that with the current explosion in nutritional knowledge that senior retirement corporations would be taking the lead in senior wellness programming, and that the food service programs would be state of the art. There is consensus amongst nutritional professionals, and researchers that , inflammation causes aging, and more critically, contributes to the rate of aging.

I have visited many dietary programs , both owned by my corporation, and by other corporations with several property holdings in California, and nationwide. Most of the food, in my opinion, was aesthetically, and nutritionally ghastly. Bad food is the rule, not the exception.

As if that is not bad enough, poor nutrition for seniors can be deadly. For anyone, as a matter of fact.

Most chefs at these communities are not certified, or formally educated Executive Chefs, and have little or no background in nutrition, let alone nutrition specific to the needs of seniors. These individuals are in these positions primarily because they agree to stay within the budgetary guidelines of their corporations; and because they are inexpensive labor. They are not in these positions because of their credentials or nutritional wisdom: yet they are charged with the responsibility of keeping your parents healthy. Frightening. Really frightening.

Some Chefs and Dietary Directors do have great resumes, and the necessary experience: but rarely are they in complete control of the dietary programming: there is usually a bean counter driving the important decision making: like how much money per resident actually goes toward resident meals.

Keep in mind, that yearly, there are market fluctuations; price increases that are unexpected; last year it was dairy that shot up 14% unpredictably: never think that the corporation absorbs these increases, and merely changes their budgeting mid-year. Your parent is stuck with what the budget year money can buy; no matter what happens in the marketplace. There have been years when meat prices climbed, fish prices doubled: and the smaller the dollars per resident meal, the lower the quality of product that your parent will actually receive.

Do your homework when you tour communitites: ask about specifics: here are some key questions to ask:

1. What did your company budget for resident meals per day ?

2. How many meals are included each day ?

3. What proportion of this money is spent on fresh fish ? fresh produce ?

4. Do you cook from scratch ? what items do you cook from scratch ?

5. What is the educational background in nutrition of your Chef ? Dietary Director ?

6. Do you purchase commercially prepared foods ?

7. Do you make dietary adjustments to your regular menu ? what kind ?

If the marketing directors,chefs, dietary directors cannot answer these questions to your satisfaction, just walk away: your parent will never be happy. Explore other smaller communities with a greater nutritional focus: remember, you are what you eat. And for a senior, what they eat, or can't have access to eating, could kill them.