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SPEAKER 1: So I'll open it up just for discussion. And I think as an aside to Cheryl is that they've got an interesting organization that does research and publications on the aging field. And you previously were Hyatt, correct? So you come from a hospitality background. Yeah. OK.
So let's throw it out to the group and talk a little bit. This is the theme for this as well as John Rijos's session, which will be next, is around this whole area of senior living and post acute. So, yes?
SPEAKER 2: Hi, so this question is for Michelle. I'm wondering-- just two quick questions. What was the trigger for going more plant-based, more healthy? Was someone kind of from the top pushing this, or is this something you personally wanted to do? Because, obviously, many university settings are not doing this, don't feel compelled to do this.
And then my second question is, you know, sometimes there's this perception that to go more plant-based, to go more healthy is actually more cost prohibitive. And so where are the savings coming from? What can others learn from those savings that are kind of thinking whether they should go down this path?
MICHELLE: Yeah, sure. Thanks for the question. So a couple of things. Sodexo actually just announced last week that they're adding 200 plant-based recipes to their entire program. So I think there are a lot of organizations that are starting to add more plant-based into their portfolio.
We're certainly getting a little bit of a push from our demographic. It certainly has a little bit of a different interest in plant-based.
But also, we joined with Menus of Change, which is a collaborative. And it started it started out of Culinary Institute of America, a partnership with Culinary Institute and Harvard School of Public Health. And the focus was really meant to be on industry, university, campus, campus dining, and then also associations to come together and really start working on providing sustainable and healthy food choices. They go after 24 basic guiding principles. And if you just look up Menus of Change, you can see those principles. And they're focused mostly on serving plant-based foods that are minimally processed and also focus on sodium and so forth.
So we really tried to-- we joined Menus of Change, but then try to incorporate all of those principles into our menus. But it doesn't necessarily translate-- right, back to your point-- to the customer, because a lot of times the customer is saying, "Ew, it's vegan," or, you know, "Where's the meat?" And certainly we found that.
And so we tried to be a little bit more stealth about it and go after more of a stealth health approach, which is why we've added the produce to our meat dishes. So it's not as overt as, you know, Dirt-- I don't know if you guys know Dirt Candy, which is a very popular restaurant in New York City that she just puts unpeeled carrots on the plate and it's very, very vogue. We really are putting those-- you know, we're boosting our pot pies, the traditional foods that you see in institutional food service, we're really just pumping them more with the vegetables.
So, in terms of the cost of goods, we did see an impact in our cost of goods. We saw a great impact because just in one year we reduced our meat purchases by almost 55,000 pounds. So we saw a significant change.
So the challenge is then making that shift and then continuing. So that's why setting those early goals was really important for us. OK, so the first year we reduced by 5%. Do we want to reduce by 5% the following year, or do we want to hold steady with what we did the previous year? Hopefully that answers it.
SPEAKER 3: How's this? OK. Is it Cheryl?
CHERYL: Yes.
SPEAKER 3: All right. Thank you so much. I really deeply appreciated your emphasis on the role of relationships. I don't get to hear that often enough sometimes in these larger forums.
And I just wanted to piggyback on what you shared about the education piece. And I echo that, as an organization that focuses on education and consultation to shift culture in care environments, that one of the things that I would really love to see more in senior living environments are education opportunities for people of all ages that work there. I don't care what their role is. But to learn about community building, to learn how to engage someone in an authentic relationship.
And a big part of that, too, needs to be teaching people about the impacts of ableism and ageism in those environments, because you can be incredibly customer service minded, and behaving in a way-- even if you mean well-- that is incredibly insulting to people of a certain age or somebody living with different abilities than you have. So I just think this is important in all environments where food is being served.
SPEAKER 1: So I'm just curious if any of the acute care systems, like Bob or others-- Jeff-- that are involved at all in the senior living as an extension of your overall health system, have you gotten into looking at any of the dining innovation sides of things?
SPEAKER 4: I can talk loud enough, I think. We have a whole division through Catholic Health Initiatives that is for senior living. And I have to admit, I'm not aware that there's anything going on with food innovation. So I would be remiss if I told you I did know.
SPEAKER 5: Something to look at in the future.
SPEAKER 4: Yeah.
KELLY: One of the things that we're seeing in senior housing is that in order to go here, we had to invest in a very expensive point of sale system. Because now people want to know, they expect to know what's in what they're eating. And the transition that has to occur-- and I kind of call us, we're south of a million, north of what my daughter eats here in the Cornell dining. So I'd like to encourage the cost savings, but you know.
No, I'm kidding about that. So what we had to do-- kind of. But we had to do-- and actually, I'd be a hypocrite if I said that, because one of the ways-- we don't let our teams save money in the food department. Because that is short money, high satisfaction. And so, when you're in a health care setting, where there's a bunch of nurses saying, if you don't do this, the world is falling. So I need to pull money out of food into this budget, then we need to figure out another way to pay for that "if you don't do this the world is falling" from a health care perspective, because food is, like, the interior design of the experience. It's what the resident sees and feels.
So what we had to do, is we just went to Toshiba. We have nine communities, and it was a couple-hundred-thousand-dollar investment. And you put all of your recipes in, and it shoots out what's in the food. So before you can-- it shoots out what's in your recipes.
So before you can start really going here in a kind of quasi-institutional environment, there is that investment that is helpful to be made in a point of sale system, and helps with your inventory, and also to let people know what's in their food. So that's a big difference that we're seeing.
SPEAKER 1: Just out of curiosity, have you seen much-- I know there was an article in Senior Housing News saying that people were beginning to see a little more of the interest in plant-based options. Is that something that any of your residents have been more interested in recently?
KELLY: Well, you know, seniors are, you know, they're older, but they're just as heterogeneous as this room is. If I were to have this many older folks in a room, now that they're not young, you would see as many different options as you would see here. We'd get the same number of people who've ordered the dessert and a Diet Coke as you do with the younger people, or the people that want plant-based food or no nuts and then they eat pumpkin pie, you know. So they're as heterogeneous as we are.
We also have where the adult child or their family wants them to eat gluten-free, and they don't want their families to know they're not eating gluten-free. So it's just it's as heterogeneous as this room is. So we see everything. People that have lived their lives for 80 years and now have a garlic-- and now they say they're allergic to garlic. The family's like, where did that come from? So they're just like us. We're seeing everything that we see here.
SPEAKER 6: So I excuse myself if I am deviating to a subject that perhaps this part of the morning doesn't-- it's not sufficient. So stop me if-- but, Kelly, you get at very important point, which is the cost. And I think this is what many of us consistently have to think about.
My observation in programming new communities for new developers and operators is there is this question about bundle or unbundle in terms of services, and food being one of the drivers, as we all know, of satisfaction.
So at Marriott Senior Living, we did a study in all of our independent living communities, and what was the driver of greatest satisfaction. And consistently in all of our communities for many years it was food. So there is a high correlation, and that's exactly what Kelly was saying.
So the question becomes, how do you deliver an independent living experience where food is so important to the experience by giving people the option not to have food? And once you give them the option not to have food, do they really even need to come to your community? Right? Is it better, more suitable for them to stay at home?
So I'm curious, maybe the conversation with so many operators in the room, is the idea of if you have a meal plan that everybody is required to subscribe to at least to a minimum level, right, like how do you make it such that it becomes so desirable that it's a reason to move in, but not so expensive that it comes cost prohibitive to come?
So I think there's this tension constantly that I see. And I saw one operator doing this tour with this European client. It's called Garden Spot. It's in Pennsylvania. And I was fascinated.
So the community is the CCRC, but they're very mission-oriented. And what they've done is they said, OK, everybody has to subscribe to a minimum of 20 or 30 meals a month. But then you could use your meal card-- if you're not using the meals, you don't lose it. You can give towards a charity. The amount of money that you're not using to eat goes towards a philanthropic organization that they're aligned with that feeds people in the community that they're in, outside the walls of the CCRC.
People feel good about that because the residents are moving to this community because they like this purposeful living. And so the idea of, like, well, if I don't eat, I'm not angry that I'm losing money living here. And I might leave or not refer. But I'm satisfied because the money on investing is going to a higher purpose. So I just throw that out as something this tension that constantly exists in our industry and maybe creative ways to combat it.
SPEAKER 1: Any comments? So I think what I'm going to do is-- I'm sorry, Kelly.
KELLY: Cheryl, I think you mentioned-- or somebody mentioned upcharges. And I think what we're seeing-- and it would be interesting to talk to some of our hospital folks here. You know, is it-- we're going to the concept of off charges. Like, here's what's included. Here's an upcharge. And we call them "big red bus" because I had just investigated meal programs here, right? So people -- we don't call them that in life, but we called them that in our corporate office, because all of us have kids at school, right?
So the idea of applying that, that here's what's included if you're real value-driven but taking away-- what we never want our food service directors to say in their food meeting is, "It's not in my budget." So by saying you can have upcharges-- and we give the example, we had one community, 90 residents, they had a $3,000 a month berry budget, because the residents want berries in the middle of winter.
And so what we said is, you know, if you live in the Andrus house, you get berries with berries are cheap for two reasons, because that's when berries are good. And so what we said was if they want berries in the winter, there's an upcharge for that. And you know it could be $3 for one of those little things of berries retail. So charge them $3 for it. That's fine. But if you're value-oriented, then you won't choose the upcharge on the menu.
So I'd be interested in a more institutional settings like hospitals or other environments, could you-- is food such a small portion of your budget that you can spend more on it? Because people are staying there so-- how are you handling it? Because hospitals now and other health care settings are competing on their food just like college campuses are.
JEFF BOXER: Yeah. Hi, this is Jeff Boxer, New York Presbyterian. Just to comment, certainly on the inpatient setting, obviously that cannot be passed on. A difficulty has been how to do this in a way where we plate and sustain, for thousands of patients, a presentable meal.
We have done this fairly successfully with our employees in really transitioning over to more healthy options, something I'll talk about this afternoon. And we've gone to the blended burgers with Pat LaFrieda meat and a 50-50 mushroom blend that's been a hot seller that we can't keep on the shelves.
But it was not easy. And we saw a real decline, initially, in revenue from our employees who wanted the unhealthy options. You would think that as health care providers we would be the first ones to embrace this, but there was a initial decline in revenue. And now we're starting to see it level out as this becomes more and more of a trend in the neighborhood and there are less and less options.
But what is starting to happen to fill that void of that unhealthy need is you're seeing food trucks coming into the neighborhood, which is serving these unhealthy options and really combating the success that we've had in moving towards more healthy options and that embracement that we saw.
SPEAKER 7: --with Lenox Hill. So I mean, I think every customer walking into every door, especially from an impatient standpoint, people are-- there's a value they're associating with their health care. There's clinical value, experiential value. So the minute we start, there's a value on that food. And people are very quick to say, you know what? This didn't meet my expectation. I'm not paying for it, very quickly out of the gate with what their deductible or copay is.
So one of the things we've done, and I have a few slides on it, is create additional streams of revenue for certain patients to buy amenities and experiences that allow us to raise the bar for everyone else absolutely free. So we don't get into that "do you pay for the berries or not?"
So what we have is we've done a pilot on three of our floors. And people pay a nightly fee. And you get a private room, upgraded amenities. You get room service-- made to order a la carte, glassware, stemware, China, full linen napkins, the whole piece. And you pay for it.
And what we've done is we charge patients for those amenities. Same clinical care, same nurses, same doctors. You pay that. What that then allows us to do is fund room service for the entire hospital absolutely free to the hospital.
So the hospital's not incurring any additional costs. That additional cost that would be for supplies, utilization, FTEs, is being paid for by satisfied patients who are paying for an upgraded experience. So people all want to stay at the Four Seasons. Someone chose the room that's 500, but somebody wants the $2,000 a night suite. And they're happy to pay for it, right? I mean, that customer who wants that million dollar price point is willing to pay for it.
But then what you've done now is create all that extra revenue to then put back in. So we have to get creative with how we make that money when everyone's got a 1.3% percent margin on a good year.
SPEAKER 1: OK. My timer is telling me now it's time for a break. That's a great segue, thanks Joe.
Discussion on dining innovations in senior living and post-acute care settings. Part of the Healthy Futures Roundtable held on October 10th, 2018.
