SPEAKER 1: The next part of our roundtable will focus on John and Frances. So without further ado, all right.
JOHN RIJOS: Hi, guys.
How was breakfast? It's a very tiny aisle there, right?
AUDIENCE: From a design perspective.
JOHN RIJOS: So I'm John Rijos. Let me spend one minute telling you about who we are. I spent 13, 14 years as President of Brookdale, largest senior living company in the world. When I took it over, we were 16 communities. When I retired, we were 650 communities, and it was worth $6 billion. It's not worth $6 billion anymore. It's gone down.
Anyhow, I came up here to Cornell and became executive in residence for a calendar year, decided I wanted to get back to work, although this view is incredible right there, right? So I went back and started my own private equity firm, raised a scrillion dollars, and we've been investing it ever since-- so all in health care, 50% in other forms of health care, dermatology, dental, addiction recovery, veterinary, surgery centers-- but 50% in senior living, which is what I do, and so we've been investing in that. And so in the last three years, I've bought 37, 38 communities, something like that. I'm actually late this morning because I was on the phone with people from 630 this morning on number 38, which I can't talk about yet.
Anyway, so that's what we do. So what I've done over these years is I keep finding the best of the best, and I hire them. I just bring them in, pay them whatever I need to pay them because I want the best of the best in every part of our businesses-- our retirement services, our activities, our dining, our executive directors. I overpay for everybody. Fran would not say I overpay. But I pay top dollar for everybody in all of our businesses because it's worth it. If you buy a building for $50 million, why are you worrying about $10,000 difference on an executive director? It's incredibly stupid.
But anyhow, so this morning, my first-- probably only job is to introduce Fran. Now, Fran, when I brought her into our company a couple of years ago, her name was Fran. I noticed, as our company got bigger, she has more letters in her name. Now, it's Frances, right?
Anyhow, Fran is our national director of dining services at CPF Living and Grace Management. Grace Management is a company that I own. It's our management company for our senior living communities. So it's a vertical situation. Fran is incredible. She's terrific. This whole presentation is really hers. All I did was read it. But she's not shy, and she likes to talk, so let me introduce Fran Showa.
FRANCES SHOWA: And thank you, John, for that. That was really nice. So we're going to talk a little bit about this. And everything you were talking about earlier, if I contradict that, don't hate me. That's all I'm going to say about that. So let's move on.
All right, so our food program. How many of you are familiar with the 2011 initiative called "The Pioneer Network?" Nobody. One hand. One hand. OK. So Pioneer Network started in 2011. Yes, and you're familiar with it as well. Thank you. So it's a multidisciplinary group of bringing people together.
And basically, I'm just going to boil it down to a couple sentences. It's, we treat conditions medically, and we allow residents in our communities to eat what they want to eat. We provide the highest quality we can. And basically, our audience dictates what they will eat, not a lot of therapeutic diets. In our communities, in our assisted livings, we have two. That would be a regular diet and a diabetic diet, which is portion-controlled. And that's basically what it is. It's a very generic diabetic diet.
All right, so our standard. Right here. And this we take exactly from the Pioneer Network standard. It needs to be meaningful, life affirming, humanitarian, and satisfying. Those are our four tenets that, when we're creating menus, we have to always go back to. This is what's important. And the pictures that you're seeing, these slides are actually residents in our dining rooms, which, I think they look really beautiful.
All right, so what this slide's showing here is actually one of our farmer's markets, and I'll talk about it in a minute. But what we found-- and that was through studies and, mostly, because of the Pioneer Network-- is that therapeutic diets don't work for residents in a independence or an assisted living setting. So the data would suggest, in the studies that I've read, after the age of 75, very restrictive diets lead to poor intake, low intake, and that's not what you want in those residents.
And also, there wasn't any real data that said people were living longer, healthier or happy with their low-sodium, no-flavor, cardboard diet, right? And don't get me started on gluten free. Don't get me going there. Just don't. All right? So we don't have a lot of things in our communities. You won't see a lot of sugar free. And why? Why wouldn't you see sugar free? Why wouldn't you do that? Because as you all know, as a group of colleagues here who all get it, when you remove the real good stuff out, the sugar, you have to still put it back with something else. It's still carbohydrate.
So go to the store and actually get a York Peppermint Pattie that is regular and get a York Peppermint Pattie that is sugar free. I challenge you. And you will see that the calories in the sugar free are higher, so is the carbohydrate. So what we found was that when we were giving our residents sugar free, they were having more uncontrollable blood sugars than just giving them a regular portion of the stuff that's really good that's going to actually give them a fabulous satiety level. They're going to be satisfied eating two bites of a regular piece of cake instead of having 100 pieces of the sugar-free cake, where they never get any satisfaction at all, right?
Satisfaction in what we do in food is the most important. And I'm here to tell you that through my 30 years of being in this. I know-- you're like, 30 years? She really been in this business 30 years? I can't believe it, either. But, yeah, I have. And I'm telling you from experience. I was just telling John, you know what our biggest sellers are in our communities? Biggest seller? Take a guess. It's nothing plant based, I'll tell you right now.
AUDIENCE: Mac and cheese.
FRANCES SHOWA: No, mac and cheese, no. It's hot dogs, baby. It's hot dogs. And it's pizza. And the hot dogs, we get these great kosher hot dogs, all beef, and most of the time, I get the comment, why don't we have hot dogs that have pork in them? And it's just like, [INAUDIBLE]. Really? I give you this great hot dog, and they're usually 4 to 1 So if you know anything about food, a 4 to 1 is pretty big. Hot dogs, big seller. Big, big seller.
All right, so what we do. Within our communities, it has to be-- this idea that we have a big dining room and people eat in a regimented time, that's not working anymore. But also, the idea of calling it all-day dining, I think is what it was coined for years, that's a really old title. It's restaurant style.
And that's all it is. It's restaurant style. It's not necessarily a restaurant, but it's a style of one. We open, we close. We allow the residents to eat when they want to eat. However-- and for those of you that are in my industry of senior dining, how many of you understand that you have a group of residents that have to eat at 8:00, 12:00, and 4:00?
And the ones that want to eat anywhere in between that, are the weirdos, right? They're the weird ones. Because the residents that are born that are in our communities now, the true baby boomers, not the ones that are born 1960 to '65, but before that, they love having that regiment. They love it. And they want to eat at a certain time. Now, we're saying, hey, it's restaurant style. Eat when you want. That blows people's minds.
What? Eat when I want? I have to run to the dining room at 8 o'clock or else the biscuits are going to be gone. So we do that. And in our communities-- so we fight that. We go between that. But I think, going forward, we're going to see more of that-- the restaurant style not being such a big deal. And please, stop calling it all-day dining, because that's not what it is. It really isn't.
Oh, these are just some pictures of our communities. So this was a spaghetti night. But you know, I want to show you something. This was spaghetti night, but look, look at the outside. It's all still light, right? So that's dinner, 4 o'clock.
So we had people that started at 4:00, but then we have the ones that stay till 7:00, so it goes all night. I mean, it's a big, big thing. So we have a 4 o'clock meal, an open style, but we still have people that are regimented. But within those communities, we have other choices. So we have dining rooms that are all day. We have bistros that are more like a coffee shop, a Starbucks. We have all day pantries and 24-hour pantries so they can grab food whenever they want, take it back to their apartments, and we have farmer's markets, all right?
So the biggest challenge to having restaurant style is definitely making it interesting. And I think, right now, it's easy. It's easy because this is what our audience wants right now. I think, going forward, when my group retires, which is really quick. We're going to be retiring soon here. And the people behind us are not going to be so happy with the dining room situation that it is. They're going to want to have something more fast and casual, and they're going to leave the big dining room going out to dinner thing to actually leaving the community and going out to dinner.
So bistros. This is something that we're doing now in a lot of our communities. So what we have coined the phrase of "multi-style" is we have multi venues within one venue. And so this particular picture is of a bistro in Tulsa. And, actually, if you walked in, you'd see the news on. You'd probably smell a panini cooking. And the coffee's awesome. They have this great coffee that they roast there. It's not what you would expect walking into the typical independent living community, but what I do love about it is when you walk in, it's the smell of that community.
It's a lot of cinnamon, and a lot of coffee. And that's like a huge, big hug. When you walk into that, isn't that the best part? Even if you don't drink coffee, the best part of a Starbucks or-- I don't know, is Starbucks big here. You're all just looking at me so blankly. What is that? What is that?
The Starbucks maybe has a little burnt roast smell to it. Go into a Coffee Bean and Tea Leaf and that's a good smell. But trust me when I say, smell is so important. Smell is a big part of food, let me tell ya.
All right so, this is in Memphis-- the Memphis bistro, where we do panini, and pizza, and hot dogs-- oh, chili dogs, big deal in Memphis. Now wouldn't you think it would be barbecue? Yeah. Yeah, I would, too. But what do I know? I'm from Vegas. So no, it's actually chili dogs, pizza and panini barbecue-- they want to go out to have their barbecue. They don't have barbecue where they live. They want to be able to grab a hot dog, throw some chili on it, and go play bridge. Look, we gotta get to bridge. OK, so that's what they want to do. Oh, OK, so this is Acacia Springs.
JOHN RIJOS: So can I tell you about that slide?
FRANCES SHOWA: Yeah.
JOHN RIJOS: So at the bottom, you see-- yeah--
FRANCES SHOWA: This one right here.
JOHN RIJOS: That one. That's my favorite. That's in Las Vegas, one of our communities in Las Vegas. That's a wall where we have draft beer built into the wall.
FRANCES SHOWA: And wine.
JOHN RIJOS: And wines.
FRANCES SHOWA: Free pour.
JOHN RIJOS: And so people can drink all they want. And what we find is the more they drink, the happier they are.
FRANCES SHOWA: Well, it's true. So true. Thank you, John. That is a motto in our company. Thank you for that.
JOHN RIJOS: So we have these draft beer walls in our community.
FRANCES SHOWA: We do. And luckily, this is in my hometown in Las Vegas, Nevada, as you can tell, "Welcome to the Raiders" up here. So here's the deal with this. It's fabulous, right? You walk in, we have four kinds of beer on tap, we have free-flow wine going on. But we also have what? We have the beginning of the baby boomer generation in there.
So who gets excited about it? Me and John. Were like, yeah! You get excited. We got beer. We got wine. We can go get whatever we want. Yeah, we get excited. The residents? Not so much. But I do see, we're starting to pick up-- the newer and the younger residents that are coming in, they see that, and they go, whoa, yeah, I've made it. This is the place.
JOHN RIJOS: So one of the things that you'll see in all of our communities-- and I think you see it across the United States, it's like when you stay in a hotel. Everybody likes to have a pool at the hotel. Only 2% of the people ever use it. And so they like it, but they don't use it. In our communities, we have lots of stuff. We don't ever restrict anybody from eating anytime. They can eat 24 hours a day. We have farm-to-table areas in all of our communities.
So I told Franny when she did the farm to table, get big baskets, load them up, keep them full all the time. You know who looks at that? The adult children. They love it. The resident grabs an apple, grabs a banana. Sometimes, they grab the whole basket, and we have to go back and get it.
FRANCES SHOWA: Well, do do that as well.
JOHN RIJOS: But not that often.
FRANCES SHOWA: No, you gotta fight a little hoarding, but that's all right. We can handle that. But what's so interesting about this is that, again we serve so many fabulous things out of this bistro. They make the best potato skins. I'm telling you, hands down, that's the place to go, right? In this community in the middle of Vegas. And see the girls smiling at the pizza? Because they love that pizza. They love it. They love having the little pizza in the little box, and they think it's great.
Now I thought these upscale communities, yay, I've arrived. This is going to be great. I'm going to get to do all the-- I'm going to actually use my culinary degree, and we're going to make some fabulous stuff. Do you think they want that? No. They want the pizza, and they want the hot dogs, and they want the fast stuff. So that's what they want.
AUDIENCE: Fran, can I ask you a question about that?
FRANCES SHOWA: Yeah, please.
AUDIENCE: Yeah, so this continues to come up. But as an organization and an expert in food service, have you ever seen any practice that helps people who are aging change their behaviors and outlook towards food? I do this for my daughter's school. So I say, it's like, you could appeal to the lowest common denominator and continue to give the French fries, the pizza, the hot dogs, and everybody will be happy. Minimal food waste, and I agree with you. But, like, raising the bar is so hard. Have you been successful doing anything to help these people?
FRANCES SHOWA: Well, yeah, I'll show. We do. We have. Yeah, no, it does sound bad, doesn't it?
AUDIENCE: No, it doesn't sound bad--
FRANCES SHOWA: [INAUDIBLE] awesome! Let me move on. Let me explain that. You see have a lot of people, and we're not going to see that. We're not going to see this shift until you guys retire, really. Because, honestly, you're much more savvy about eating healthy than we were when I was a kid and before that. And that's really the truth.
If I came home-- I love this-- if I came home and said to my mom, I'm a vegan today, oh my god. I don't know that I would be standing here today talking to any of you. I come from an Italian family, both sides. And yeah, no. There was no vegan. There was no vegetarian. Are you kidding? That would have been crazy, right?
In one sentence, it's this. This is how I sum up my whole childhood. And the one sentence, it's, oh my god. You're so fat. And then the other sentence, it's, what? You're not eating? You don't like it? So you get it? It's that push-pull thing.
All right, so this a bistro that we have in Tulsa. And they actually-- they have a two-deck pizza oven right there, but they do a lot more of like the fresh-- like a Quiznos more, of that kind of toasted sandwich. And the residents really love that. And those things that just-- these over here that look like just punches or infused water are actually infused waters. They're vitamin waters that are actually pretty tasty, with no aspartame. Because that seems to be the problem is that when you go to those more infused waters, you have that aspartame. And then what? We have more issues with the sweetener.
But, yeah, the thing about this community is they bake fresh cinnamon rolls every morning. So the first thing you smell when a resident gets up and walks to our lobby is a fresh baked cinnamon roll. How do you not love that, right? I really am going to get to the healthy part. I am. I promise. All right. Oh, god, next slide, danish and donuts. Hey, they love it. We give them what they want. They love it.
All right, so this is-- oh, this is our Memphis community and just a few cross sections of our bistro there. And like I said, that's another one. I've tried everything, and it seems that, right now, the big trend is that everybody wants pizza. Everybody wants hot dogs. Everybody wants that kind of thing.
So how do we get any kind of healthy? How do we get anything that's healthy into our residents, right? So I'm going to explain. This is a 24-hour pantry. So we have air-screen refrigerators strategically located in every community. And in there, they put entrees to go which is probably what they've had, they've served that day that were the specials. There's always water.
The residents decide on what kind of drinks they want in there. This particular community wanted the little Shastas. Who wants the little Shastas? They wanted the little Shastas because that was from their childhood, so that's what they wanted. We put desserts in their salad, yogurt, stuff like that. But it's always there.
So why do we do that? Why? Because you know, we have so many people that want to eat dinner at 4:00. And then, at 1 o'clock in the morning, they wake up, and they're hungry, and you wonder why. And so we found that those people that wake up at 1 o'clock, 2:00 in the morning, they go and grab something out of the 24-hour pantry, and they sleep a little bit later in the morning, which is much better for them than being up early and having to get to breakfast. It actually calms their whole system down, which is a good thing, if you ask me.
JOHN RIJOS: One of the things we do in our communities, as I said-- so people obsess about cost of food. $6.92, $6.95. I couldn't care less what it costs. Let's call it $20 a day. That's $600 a month. People are paying $5,000 a month to live there.
And the single thing that they love the most is their food. When they wake up in the morning, they start thinking about breakfast. As soon as they're done with breakfast, they start thinking about lunch. Then, they start thinking about dinner. And then after dinner, they start thinking about breakfast again. So don't worry about $2 or $3 per resident per month or per day. It just doesn't matter.
FRANCES SHOWA: So a little bit of my background, I have a culinary and a nutrition degree, both of them, which sometimes, in my brain, will kind of have a little bit of fighting going on. And so that question that you asked, Meredith, regarding, how do we get anything healthy into our foods, it's very difficult.
So in our restaurants, then, we usually do some kind of comfort food special. Our anytime menu is geared to, usually, local, what's happening in the community and how the person wants to eat. And then we always have what we call a "healthy special," which is usually fish, chicken, something like that, that is minimally seasoned and usually grilled. Because we have charbroilers and things in our kitchens. And we're lucky. We have a lot of great equipment in our kitchens in our communities, which a lot of communities don't have. So we're very lucky.
But if I did away with French-fried potatoes, and fried chicken on Sundays in a lot of our communities, I would be killed. I'm pretty sure I would. I'm positive. They would run me out on a rail. So we hopefully educate. And we educate our residents to make good choices. That's what we do. That's the best thing that we can do. It's not our job to be the food police, but we can educate them and say, maybe this rather than that.
But at the end of the day, I don't know how many of you work directly with seniors, they're not-- you do-- they're not eating enough. Usually-- the usual-- and I'm not talking about the exception to the rule. I'm talking about the everyday person. Their intake never, ever is that it would affect their health usually one way or the other. That's what I've seen.
So my 91-year-old mother who just recently passed away this year went from always 140 pounds to 90 pounds. That was just insidious wasting. There was nothing-- me, of all people, I tried everything. There was nothing I could do to have her do this.
So the only thing I could do, that I realized that I could do, was give her what she wanted at the moment she wanted it. So if my mom wanted gravy and noodles, that's what she got. So that's what we tried to do. There was no stopping that process. But in the meantime, if we can make it so that they're happy, if we're treating the condition medically, and we're allowing residents to eat what they want and we're trying to give them the best quality that there is, which we do.
We have very high quality meats. I know that for a fact because I manage the order guide, so I make sure that we have usually very little select or usually choice are prime meats. And so, yes. Our food costs are high. They are. But it's worth it for our residents. The last thing--
JOHN RIJOS: So one of the things that Fran's done in our communities-- all my communities are big, and they always had really big dining rooms, and that was the only place to eat. And big dining rooms are part of the past, not the future. You want them broken up. So she took big dining rooms and made it half a dining room, and then created a farm-to-table area, where people could just grab food. And it looked interesting, and it was fun to visually see.
And then, we took areas of the lobby and made bistros out of them. So now you have, in the same building, with no difference in cost, really, you have three different venues that feel very different from one another. And not only is it interesting for the residents, it's very interesting for the adult children who help make the decision about where mom lives, right?
I was in one of our communities last-- well, every week I'm in one of my communities-- but maybe two weeks ago I was in the community, and a husband and wife were sitting in the dining room. And the wife was yelling at her husband about what he was eating, because it wasn't healthy. And she said how long, do you plan to live if you're going to eat like that? And he said to her, I don't want to live if I have to eat like you.
FRANCES SHOWA: That is so true. OK, well, thank you, John, for that. Farm to table. OK, so this is amazing to me. We always had fruit in our communities-- always had fruit in our communities. All I did was take it and display it differently. And I can't tell you how many residents said, I can't believe we have fruit now! We have it now! Look at us; we have fruits!
So this is our farmer's market in Sterling Heights, which would be Detroit, Michigan. And OK, this was just for the picture. We normally don't put green beans and red potatoes. We do put cucumbers out, the small ones that are snacking.
But basically, we have farmers markets, and the food is whatever is local to the communities. The initiative is that our food service departments partner with their local produce companies. I think you were talking about it. We get the glut of the market so that we're only eating-- so I don't have that problem. Because our residents know that berries are not-- winter time is not when you get berries, and so we don't have that. And actually, this was a winter-- this is a winter market.
So there's a lot of apples, and I think that's why they filled it up with this. Because that's all you usually get in the winter, is you get apples, some grapefruit, and some grapes. Those are the best winter fruits are. And the thing is the salad bar to the fruit stands are changed seasonally. And it's great. Our food service directors call their produce guy and say, so what's in season? I mean, I offer them calendars. They have that, but they're looking for the stuff that's the glut of the market-- and like your colleague over here stated-- because it's the best time to eat it, so it tastes great.
But what I love is that just by changing the perspective of fruit, the residents think it's something they never had. They always had it. We just weren't displaying it properly. Because fruit in a bowl is not the same as fruit in a cool market, right? And this particular community took an old door they had and built this themselves with crates and doors and decided they wanted that farm look.
This is same thing. Everybody can create their own farmer's market the way they want to do it. This one's in Tulsa. And this was also winter. And so you see it's a lot of the same. It's grapefruit. It's apples and bananas. Bananas, we have to have, even, no matter what-- so even though those usually are not like a locally sourced item.
This is Memphis. And in Memphis, they fill up three of their baskets always with peanuts, raw, shelled peanuts. Yum, right? And that's because the residents take them back to their apartments. And some of them boil them.
Have you ever had a boiled peanut? Oh, come on. You're shaking your head like it's good. You know it's not. That's the worst thing I've ever had. I was driving through South Carolina, kept seeing these stands-- "boiled peanuts, boiled peanuts!" I thought, oh my god. I'm going to die if I don't have a boiled peanut. So I had to stop and get a boiled peanut, and it was one of the worst experiences of my life, just to say.
So our residents take them to the room. They salt them. They roast them. They boil them. They do whatever. And they think it's the greatest thing ever. And it's a great protein source, and I'm really glad that that's something that they really like, and they love it.
OK, so this basically just talks about how we do it. It's the initiative for this. And our directions are that it needs to be local. We want it to be sustainable as possible. We really want to promote that. And then, of course, we are very much big on color, and the mix, and how everything is displayed. So our communities are allowed to do their farm stands any way they want to.
Now this is not where the produce truck comes in and we don't have enough room for, like, onions and sweet potatoes so we throw it on the fruit stand; it's not like that. It's definitely a well-thought-out-- but it's more of a community. It's more drilled down into that community what they actually eat. So they're all different in all are our different communities.
JOHN RIJOS: People's taste in Alabama is different than in Maine. So all of our menus that Fran supervises and all of our auto guides, are all built about regional preferences.
FRANCES SHOWA: Oh, yeah. Maine. Wow. How many of you are from Maine? Oh, a whole lot of you. Wow, yeah. So in Maine, what I love about Maine is that I got this emergency-- emergency email, emergency 9-1-1. Fran, there's no red hot dogs on the order guide. And I thought, who wants a red hot dog? That's disgusting. But in Maine, you have to have the red hot dog. Do you guys even know what I'm talking about, the red hot dog? Yeah, they're red. They're dyed red, and they're full of fat, and they have to squish when you put them in your-- it's kind of like the boiled peanut.
It's one of those things that, yes-- but if they didn't have-- if Maine didn't have that, it was an emergency. I didn't have it on the order guide. And I'm afraid the world was going to end. Maine was going to fall off into the ocean because there was no red hot dog. Because, Meredith, they love them hot dogs. I'm telling you.
FRANCES SHOWA: Oh, I get that all the time. They don't care. They want their red hot dog, do you understand? The red hot dog is the important thing. So we're going to talk a little bit now-- I'm going to kind of segue into two trends. I was just recently-- how many of you are affiliated or know about Direct Supply? Oh, good. You guys are a great crowd, let me tell ya. [RIMSHOT IMITATION] Be here all week.
All right, so Direct Supply is big within our health care, usually for our seniors system. And I was just at a big conference for them. Because with them, at Direct Supply, I'm a big deal so I kind of like Direct Supply. We were talking about trends going forward. Now I don't know how many of you would agree with me, but labor is a problem. Getting servers and our independent communities has been such a problem for all of our communities. And apparently, this is not just a Fran problem at Grace Management. This is a global problem.
So in Japan, because they're genius there, they have now-- they have serving robots. Serving robots. Wait, go back, robot. Come back. And so in this restaurant, the cook actually plates up the tray for the server robot, and the robot actually takes it to your table. How cool is that?
JOHN RIJOS: I was staying in Aloft. You know what an Aloft hotel is? I ordered coffee and toast in the morning. It was delivered to my door of my room by a robot.
FRANCES SHOWA: So cool, right?
JOHN RIJOS: I didn't tip him.
FRANCES SHOWA: He's not coming back. He hates you now, John. How many have you ever had an Amazon drop a package from a drone? Wow. You guys are really killing me. So in Vegas, we're a hub. We're a hub for Amazon. And we can actually get packages dropped by drone there, nothing cooler than waiting and seeing it up there and having it-- but you know what? I guess that's for a whole nother-- because all of you are just looking at me like, oh my god. Get this lady out of here. Wow. That's why I don't like coming this far, John. I'm telling you.
OK, so the future. Fast casual is the way it's going to be. Residents are not going to want to go to a dining room. Like I said, they're going to want to reserve they're going out to dinner by actually leaving the community and going out to dinner. They're going to want to see more of a fast casual with a lot more variety than what we're serving now. Definitely. Definitely going to want to do that.
And I think kitchens are going to become more visible. And I know that's something that we've done in restaurants years-- we started that a long time ago. But I'm thinking that, going forward, we're going to really-- that's going to be very important in the future. And then they've recently done some studies. And that's what I put on this slide here-- is that the 75-year-olds, 65 to 75-year-olds are really demanding that fast-casual kind of thing.
So have any of you younger people ever been in a retirement community and gone to eat? OK, so have your grandparents ever been like, oh my god. The meal is taking too long, and it's been like a few minutes? Like, where are they going? Where? Where are they going? That's what I want to know. So I don't know what happened, but something happened to us.
Maybe you could speak to this, John. What happens, John? Why do we have to get-- why is it we can't wait for our meals to come to us? It's got to be fast. It's got to come right out? What happens to us? So hopefully, maybe we can affect that change, and that won't happen to us, because we wouldn't have to run off to bridge.
All right, so [SIGH], I think that's all I gotta say here about this. I've belabored this issue. I want to thank you all for your time. And if you have any questions, I'll probably be gone, but John'll be here. So thank you.
SPEAKER 1: [INAUDIBLE] questions before we take our mid-morning break. Any questions for Fran or John?
AUDIENCE: Not a question, just a comment. I mean, I'm in health care. I'm in an acute care setting. And I have recently been refocused on seniors and the needs of the senior community because of my mom. And as I look around and I look through the literature, I see where one of the primary issues facing the senior community right now has to do with that will to live.
FRANCES SHOWA: Right.
AUDIENCE: And as I have identified that, I have seen that happen in instances around me so much that it's heart-wrenching to watch. People deciding to go, just because they have no joy, nothing to live for. So I just want to say that it is so refreshing hearing your perspective on giving the seniors what they need to feel alive, to feel valued, to feel happy, however that manifests itself. I heard at the top of your discussion that you manage medically and also using food.
FRANCES SHOWA: Well, we treat conditions medically, and we allow the resident to eat what they want. So we're going to give them-- if they want to have more than the prescribed amount of chocolate cake, then we're going to make sure they get some more insulin. We're not going to stress about that. We're going to treat that condition medically, and we're going to make sure that residents take their blood pressure medication, if they want to have that one ounce of chips. We're not going to say, no. There is no food, I guess is what it is-- there is no food that is taboo.
AUDIENCE: Are you able to share some of your clinical disease management outcomes with us using that model?
FRANCES SHOWA: You know, actually, I can. I was just speaking to the state of Tennessee about this. And we found brittle diabetics. When they went to the generic diabetic diet, where it was portion control and we used-- you know, they were eating things again like butter and sugar, not in huge amounts but in a portion, we saw that we had much more stable blood sugars than when they were eating things all over the board because they were not satisfied.
And that's the thing is that we want to get that resident to that satiety. We want to get that. How does that look to you? And if that's a one ounce bag of potato chips with your sandwich, we're making sure you're [INAUDIBLE]. That's what it is. But I thought it was amazing that we saw these blood sugars stabilized.
And what was so awesome about that is that this doctor that I was working with told me that I was crazy and didn't know what I was talking about. And I said, of course I'm crazy and don't know what I'm talking about, but the blood sugar record log did not lie. What we saw was this great stabilization. And so the beauty of that is, this guy's on board now and said to us, when our residents come in, our assisted living come to our community, they on a regular diet. He's not messing around with any more therapeutic diets. And so that, to me, was a huge victory.
AUDIENCE: OK. All right, thank you.
SPEAKER 1: Yes?
AUDIENCE: So first of all, I just want to say thank you for demonstrating that you acknowledge it's an honor to work in the elders' home, and that you work for them and they're not there to behave and do what you are suggesting they should do. Along those lines, though, I noticed "meaningful" being a part of the values that you outlined at the beginning with graceful dining.
And so I'm kind of curious if that translates into the residents having the opportunity to share recipes, maybe that are near and dear to their hearts, work with your culinary team to bring those into the environment, make it an opportunity for them to become more well known, maybe even bring their culture to life through those kinds of interactions. And I'm also wondering if they love the idea of cooking, if it's a meaningful part of their existence. Do they have the opportunity to help prepare any food?
FRANCES SHOWA: OK, so that's a two-part question. So we use this system called "growth menus." I don't know if any of you are familiar with that. I love growth menus. And, yes, by using this system, a resident can bring me their recipe. I submit it, and then it becomes standardized through the system, and our kitchens can then make it. So we do that lot. We'll have on our menu-- we'll have for a special that day, "Rosemary's Chicken," and "Mr. Smith's Famous Mashed Potatoes--" we do that a lot in all of our communities.
Our residents are allowed as much input as they want to give us into our menus. Nothing is standardized when it comes to food. Because having lived all across the country, I know the difference of how different people eat, where I live as opposed to in Kentucky or in New York, you eat way different than we do in California. So, to me, that's very, very important.
And the reason why we use growth menus-- it's such a wonderful system because it adapts so easily to regions, but also down to just the community level. I have communities that are in the same state that is completely different and have completely different menu sets. These menus also provide to our staff, when they are formulated for however many portions it's going to be-- the nutrition label is always provided. So at any time, I know how much fiber, Vitamin A, salt, anything you want, I know exactly what's in our menus across the board at any time. So another valuable resource and why I love using this system.
Our residents don't cook per se, but we do a lot of demonstration cooking that our residents are involved. They're involved in many committees like that. We encourage them to want to cook in their apartments, but they don't want to. I would say the majority of people don't want to. They want to come to the dining room and know that they're Cornish game hen recipe is being produced. And they love that. So I say, that's how we do that.
JOHN RIJOS: And we put the name of the-- Mrs. Levy's Cornish game hen-- we put "Mrs. Levy's Cornish Game Hen" on the menu. So if people don't like it, they can talk to Mrs. Levy.
FRANCES SHOWA: Exactly. Exactly. Because we don't want any responsibility for that.
AUDIENCE: That's a big misconception about the seniors. Like, the son or daughter will come in, oh, mom's cooking-- mom loves you cook. It's a big thing. Mom is like, I'm so done with cooking.
So what they want to do is cook like apple pie, and dessert, or make some cookies-- like, they want to show stuff and the stuff-- the few things that they really enjoy, and you get-- they have kitchens. And we have kitchens in our communities, and they cook. Their daughter comes in, and they cook.
You know, they love to cook, but they don't want to make dinner every night. So there's ways to do all of that. Yeah. But there's a big misconception. They want to do what they want to do when they want to do it, and they don't want to have to do anything. That's why you pay a million bucks.
FRANCES SHOWA: So I want to be clear. I wasn't generalizing about people. I was actually speaking about individual preferences. And they are a different person to person.
AUDIENCE: I have a comment, Brooke. This is all great, and it's important, the dining experience and how it relates to the residents' experience. But in Des Moines, I'm telling you, I'm seeing more and more from employer to employee. And for example, Facebook. We have big, huge Facebook campuses. And I don't know if you've ever seen a Facebook location, but their dining service is a la carte. They have chefs. They have play rooms. They have couches for naps.
And so we have 20,000 staff, just in Iowa. I'm sure many of you have a lot of staff, too. And there aren't enough of them to go around. So short of buying robots for everything, I would say transcends some of this thinking to the employer to the employee. Because if we don't, then we're not going to be competitive to the new world. And by the way, in New England, it's not "hot dog," it's "aht dog".
FRANCES SHOWA: Oh, my god. You're killing me!
AUDIENCE: Just so you know it's not "hot dog." Right, Sam? It's "aht dog."
SPEAKER 1: Thank you. I want to thank everyone for their participation. Thank you, John and Fran for sharing. And let's take a break. I think we're a little bit over, so let's take a 15 minute break and get back here about 10:25. And we're going to hear from Joe and Odette at that point. So thank you all, and--
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John Rijos, SHA ’75, Operating Partner, Chicago Pacific Founders, American Senior Housing Association (ASHA), and Frances Showa, National Director of Culinary Operations, Grace Management, Inc. speak about the Graceful Dining philosophy and program - incorporating values such as “meaning, humanitarianism, and life affirming” into a dining program in the senior living industry. The talk was part of the Healthy Futures Roundtable held on October 10th, 2018.