Attitudes about food create opportunities for healthcare operators and manufacturers

Share this content:
Attitudes about food create opportunities for healthcare operators and manufacturers
Attitudes about food create opportunities for healthcare operators and manufacturers

Food obviously plays a major role in everyone's lives. We have our likes and dislikes, and nowhere are there more pronounced opinions than among the mature market. The first question, be it in discussion of a retirement community, healthcare facility, or similar location is, “How's the food?” For the food service operator, that's the million-dollar question.

Food service in the continuing care retirement community setting is changing rapidly to attract the next generation of retirees. This generation has different expectations for the environment in which they'll live, the quality of service they'll receive, and the cuisine they'll be served.

We recently conducted research to analyze the mature market's perceptions of food, the role it plays in well-being and its impact on quality of life. The study examined foodservice in long-term care facilities, acute care hospitals and homecare agencies while identifying opportunities for food manufacturers and operators.


A blended methodology of primary qualitative and secondary quantitative research yielded a well-rounded analysis of the three major healthcare service segments, the opportunities for manufacturers in each role that food plays, and the challenges faced by operators.

A network of key decision-makers was used to gain a comprehensive understanding of each care segment's unique demands related to food service. Participants included executives from major contract food service management companies, corporate chefs, food service directors from a number of healthcare facilities, homecare industry organizations and directors from state and area agencies on aging.

Statistical research added context and historical perspective, and also provided data to forecast the each service segment's population. In addition, Centers for Medicare & Medicaid Services - U.S. Department of Health & Human Services data from 1967 to 2009 were compiled and analyzed with statistics from the Aging Integrated Database State Program Reports 2000-2008 and the National Association of State Units on Aging.

Long-term care

Trends in long-term care were found to be divided along generational lines and reflected in the service segment currently caring for the various generations. The Hero Generation (those born before 1925) is being served, in large part, by assisted living. To them, familiarity means everything and comfort food is king: simple foods with simple names and fewer ingredients.

This generation is also cost-conscious and would like its food to be sourced and prepared with frugality in mind; in other words, substance and value without frills. Introducing new menu items — particularly those with complex or foreign-sounding names — is generally a very tough sell, while health concerns are, for the most part, limited to monitoring sodium intake.

The Silent Generation (born 1925 to 1945) is being served in large part by independent living facilities, although some are transitioning into AL. As a whole, this generation had a higher income and is better traveled — factors that contribute to an adventurous palate, preferences for exotic food, higher-end cuisine and trendier food choices. They expect to be catered to and demand a higher level of service than the previous generation. Additionally, the Silent Generation is proactively heath-conscious, viewing food as a wellness tool, seeking out whole grains, herbs and natural products for the benefits associated with them.

Both generations look at food as a means to feeling good. Overall, the Hero Generation is seeking comfort from warm, familiar food, and the Silent Generation is seeking wellness and illness prevention.

The growth of the long-term care segment is tied to the increase in the aging population. In 1990, 8,937 facilities served 638,000 Medicare recipients; in 2009, 15,727 facilities served 1,841,000 Medicare recipients.

Acute Care

In acute care settings, satisfaction ratings are driving the implementation of fully-integrated room service — a comprehensive system that mimics room service in high-end hotels. Here, “clients” can have what they want, when they want it, just by picking up the phone. Food offerings are extensive, as in a full-service restaurant, and plates are delivered immediately after they are finished, ensuring optimal quality and temperature.

In hospitals providing room service, customer satisfaction rates are well above 90%, and recovery seems to be positively impacted. In these settings, food is being recognized for its role in the healing process and connected to a shortened length of stay by many operators.

Approximately 30% of hospitals are equipped to provide room service at present, with larger hospitals being first adopters. However, by 2014, more than 60% of hospitals are expected to offer fully integrated room service.

The acute care market has been relatively stable from 1990 to 2009, serving 1,105,000 and 930,000 Medicare enrollees, respectively.


On the homecare front, patients are being discharged “quicker and sicker” from acute care with the understanding that homecare services are available to address areas of need. Fully 62% of Medicare beneficiaries who begin receiving home care have been hospitalized or receiving skilled nursing services in the 15 days prior.

Homecare providers, 79% of whom are nurses, have a broad range of responsibilities that often include meal preparation. With nursing experience understandably trumping culinary expertise, a significant opportunity exists for food manufacturers — as well as facilities and agencies — to develop and market home-delivered meals to seniors receiving homecare. Texture-modified meals, in particular, are challenging for even the most talented chefs; tasking nurses with making them palatable and appealing is unfair; and achieving such an outcome is unlikely.

Homecare has shown consistent, sustained growth since 1967, due in large part to its cost-effectiveness. The segment has experienced only one period of plateau, which is associated with changes to Medicare's policy on reimbursement. In 1990, 5,730 home health agencies served 1,978,000 Medicare recipients; in 2009, 9,407 home health agencies served 3,319,000 Medicare recipients – an addition of 1,341,000 seniors served (60% increase).

Five key themes emerged:

Environment is everything

Current assisted living facilities were built for the Hero Generation but are now being remodeled and/or replaced with “pod communities” in an attempt to appeal to the Silent Generation, and eventually to Boomers. The institutional environment is being replaced with neighborhood settings where individuality and privacy are the focus.

Food service, while still organized centrally, is being executed and presented in a very decentralized way. The bulk of food preparation is done in one large commercial kitchen, which shuttles the unfinished food to the residential-style kitchen in each pod for customization, finishing and plating. Food committees in each pod dictate the menu and how the kitchen (which is accessible 24/7) is stocked, based on preferences, and making rigid service times obsolete.

Freestanding restaurants, upscale casual dining environments and bars are being built to attract the more culinary-focused, socially driven Silent Generation. Al fresco action stations are replacing institutional dining halls. Winemaker's dinners, meet-the-producer meals and craft beer pairing events are making it easy to confuse these facilities with resorts and boutique restaurants. Clients are beginning to expect a dining experience — not just food. The dining atmosphere is key to providing this experience.

“Hilton” hospitality

Contract food service management is recruiting from Hilton and other luxury hotel chains in an attempt to develop and maintain standards that will appeal to the Silent Generation in both independent and assisted living settings. Flexibility in service hours, fresh menus and higher-end cuisine are becoming the standard. Operators realize that the residents have many dining options and aren't a captive audience, so they've started referring to them not as “residents” but as “clients.”

Aging palates prefer familiarity

As aging advances and/or health decline occurs, there is a strong tendency to revert to familiar comfort foods. Although those in the Silent Generation will likely never lose their adventurous spirit, they will begin to select their food, based on its comforting qualities rather than it trendiness. They will look to food to make them feel good and warm.

Options aren't optional

Clients and clients expect options such as: specialty breads, flavored mayonnaise, grilled sandwiches, local produce, farmstead cheeses and other artisan products. Clients want the standard products to be “fancied up” in a way that they've become accustomed to in fine, casual and fast casual dining restaurants. Clients are also looking for special features and theme nights centered on food; these events and the associated food offerings are reassurances to clients that they aren't missing out on anything and are enjoying the same quality and variety of food that their friends and family living at home have access to. One-size-fits-all corporate menus are unacceptable; customization through mix-and-match options is becoming the standard.

Operators need to please

Success for operators is measured by feedback, whether through Press Ganey in acute care settings, comment cards, third-party surveys, and/or food committee interaction with the operator. In many contract situations, cash incentives are paid for meeting or exceeding a predetermined rating; cash penalties may be paid to a client for failing to meet that rating.


Significant opportunities exist for familiar brands in healthcare food service. They are appealing to operators because they're associated with consistency and to clients because they're associated with quality. The extent to which those products are identified by their brand to the consumer is dependent upon how they're used, the dining format and the quality of on-site materials provided.

Through this research, we learned that food trends often differ by generation, and how they're being realized in each segment of care. Operators are balancing those often-competing demands of different generations. In addition, we gained a deeper understanding of food service operators' decision-making processes, their perspective on branded products and the qualities that make a product appealing or unusable.

The author is director of client services for Varsity, a national branding and research agency focused on the mature market.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.