Wednesday, May 04, 2011

Canadian prisoners allocated more money per meal than hospital patients?

Further to yesterday's post on just how awful diabetic diets can be in Ontario hospitals, today's post keeps the discussion going. I'll get to prisoners in a second, but first let's talk sodium.

An RD in Alberta left this comment yesterday (edited for a bit of brevity),

"I am an RD in an Alberta hospital and unfortunately that probably is typical.

I know with many hospitals dietitians actually have very little to do with the menu despite what is often the public perception. Menu decisions are often made by untrained food services supervisors or managers with often little or no input from an actual dietitian. A dietitian has to compare the menu to Canada's Food Guide in Alberta to make sure that it meets the minimum servings of each Food Group, but I of course know your opinion on CFG :)

Alberta Health Services is also becoming quite strict in terms of things like sodium, which you would be disgusted to know is very high in hospital diets (even a low sodium in our hospital is allowed to have 3 to 5 grams per day!)
3,000-5,000mg per day is considered a low sodium diet?

Now to prison. Another commenter, a thoughtful nutrition manager from Ontario, pointed this out,
"The problem lies in the amount of money the government provides us to feed each person per day: $7.33. That amount is way less than the $11-$12 given to the criminals in prison."
Can anyone else confirm this? Honestly, while I knew hospital food stunk, I'm not sure I had any idea how bad, nor did I have any idea how hamstrung hospitals may be with costs.

RDs! Health care professionals! Caring public! Please continue to weigh in on this. You can leave anonymous comments and you need not identify your hospitals, but please tell us more about patient food woes.

The first step in fixing a problem is identifying one!

What barriers do you see to patient food reform? Where are the stumbling blocks? Is it hospital administrators? Cost? Logistics? Canada's Food Guide?

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  1. Aren't hospitals a place to heal?

    OK, I know that we are not a big institution here but I feed my family of six on less than 5$/person a day without compromising anyone's nutrition or palate.

    Jamie Oliver has shown how institutionalized foods do not have to be bland, over processed crap in schools in the UK and the US, why couldn't hospitals do the same?

    I can't imagine eating any of that.

  2. I wonder what prison hospital food is like?

  3. abbey8:52 am

    Wow every plate looks the same colour, sure hope they like peas and potatoes!
    makes no sense that dietitians are not invloved in the food served to their patients :S

  4. Anonymous10:31 am

    Our medical schools, medical profession and politicians are tied into drugs, screening tests, surgeries and devices.

    The bottom line is stockholders share, not healthcare.

    You can look at the prescription list of any member of your family, and I'd bet not one drug is essential, does what your doctor claims it does AND has a slew of negative side effects which your doctor will treat with more harmful and unnecessary drugs.

    Physicians, who are supposed to be patient advocates and allies, are allied with industry.

  5. Anonymous10:43 am

    "I feed my family of six on less than $5 a day per person."

    You're American? You stay at home to do this feeding? Factor in all the costs.

    Hospitals have to pay the wages of all the people who handle the food. Then they have to pay institutional rates for food. That's more not less.

    And, the health care system is pouring money onto pharma coffers. They prefer to give you a drug, a surgery, rather than help you to health.

    You have a role to play too. Stop taking those prescriptions. Stop asking for screening tests, and stop thinking your doctor knows anything about the drug they just prescribed ie) didn't just take a saleman's word for it's efficacy, and harm, and accept that your health is inversely proportionate to the number of times you are under a doctor's or hospital's care.

  6. Anonymous2:38 pm

    $7.33 is the cost allocated to each resident per day in long term care in Ontario. This cost is supposed to cover three meals, three snacks, beverages, condiments and nutritional supplements if warranted. It is extremely difficult to provide quality, non-processed foods to the residents on this budget. I don't know what hospitals are allocated for each meal but it can't be much more judging by the descriptions of what they are serving to diabetic patients.

  7. "You're American? You stay at home to do this feeding? Factor in all the costs. "

    No, I'm Canadian. In a Small town where food often costs more.

    Yes, I stay at home and make all of our food from scratch and my husband brings his lunch every day.... I understand that not everyone can/is willing to prepare 3 meals a day/snacks etc from scratch but our health and nutrition is very important to us and with a limited income I have to make it work. I even our allotted think that our 200$/week too high but we like having variety and quality ingredients.

    I hope the prescription/doctor comments weren't directed at me... I didn't even go the hospital to give birth... I just meant that it is hard to imagine someone who is hospitalized trying to recover by eating those kinds of foods.

    I really think that good food is doable but people just don't want to put in the extra time or effort. It is all about convenience instead or health or money.

    Sure a loaf of white "bread" costs way less than a loaf of whole grain to cut costs you go with the cheaper of the two. Right? But what about the third option? Buy flour and yeast and you can make 4 loaves for the price of that cheaper option. Takes more time and more effort but it is way more than money you are saving.

  8. Anonymous10:50 pm

    No the comment was directed at us, universal you.

    What we're talking about is what it costs to deliver food in a hospital setting, and how the government is not willing to spend money on food because their health spending is promised to industry.

  9. Anonymous12:28 am

    Plus, the food in that under $8 a day per person for hospitals, care centres and nursing homes includes salaries for all the chain of food service personnel. Insurance, training, benefits.

    Those people don't work for room and board.

    Even if you factored in one salary to your $5 per day per person food budget, it would triple or quadruple in cost.

  10. Alexie3:53 am

    Anonymous, I know I shouldn't respond to this, but... "they prefer to give you a drug... rather than help you to health". You really believe this? That in a single-pay system like Canada, where every cost has to be justified, the entire medical system is in the pocket of foreign Big Pharma corporations? Maybe that's how Dr Freedhof is financing this lavish website... all that fabulous drug money.

  11. In the hospital where I work there is a blanket order for a cookie cutter diet. The nurse must request a nutritional consult or the Doctor my just put low sodium or low fat or low potassium etc. It's a dietary program that must be driven by the nursing staff or the patient simply orders from 2 choices and it comes to them without regard to their individual needs. The food is pretty good however. I think a good nutritional assessment by a qualified dietition should be a part of the normal admission process. It would help a great deal especially with elderly patients who often come to the hospital with protein deficits and electolyte imbalances. These deficits play havoc with their vital signs and make nutritional intake a necessary part of getting them and keeping them stable. I can't say enough about the importance of good nutrition and health. A nutritional consult has always improved the condition of my patients and I will continue to make it a request with each and every patient I can.

  12. Anonymous12:17 pm

    I don't "believe" it. It's fact. You can do the research yourself. Start with CIHR, which recently brought in a Pfizer VP to their board; Health Canada, which has industry reps on their drug assessments committees, and source funding for medical schools; Health Canada, which takes money from pharma for each drug on the formulary; Health Canada which allows pharma to write the PDRs you doctor uses; CMEs which are not only pharma funded but written.

    One of hundreds which seem to have eluded you:

    Author: Joel Lexchin

  13. Anonymous1:40 pm

    BMJ 2011; 342:d2548 doi: 10.1136/bmj.d2548 (Published 3 May 2011)
    Cite this as: BMJ 2011; 342:d2548


    A new deal on disease definition

    Ray Moynihan, author, journalist, and conjoint lecturer
    1University of Newcastle, Australi

    How do we replace the old panels of conflicted experts? Ray Moynihan investigates

    As this still-fresh century rolls forth, medicine’s imperial project looks on the whole to be in remarkably good health, despite the odd failed campaign. With our new found fondness for preventing disease and premature death we’re redefining more and more of the healthy as sick, and then prescribing our new patients lifelong pharmaceutical solutions to reduce their risks. One recent analysis suggests that the definitions of common conditions have broadened so much that virtually the entire older adult population is now classified as having at least one chronic disease.1

  14. The 7.33 applies to retirement facilities too - for 3 meals + 3 snacks a day (and all their supplemental "nourishments" like Ensure). At the Boys and Girls Clubs though - their food budget is just 17 cents per kid for a minimum "2 food group" snack that HAS to include fruit/veg AND follow the standards set out by the daycare regulations.

  15. I'm currently in the civic recovering from crohns related surgery, and really, they have no idea WTF to feed me. The don't seem to understand when I say no nightshade, no gelatin, no soda, no aspertame, no caffeine. :/ Frustrating that I'm spelling out what I can and cannot eat, and they still don't get it.

  16. I'm currently in the civic recovering from crohns related surgery, and really, they have no idea WTF to feed me. The don't seem to understand when I say no nightshade, no gelatin, no soda, no aspertame, no caffeine. :/ Frustrating that I'm spelling out what I can and cannot eat, and they still don't get it.

  17. Anonymous10:25 am

    UHN in Toronto outsourced it's meal prep a long time ago. The only hospital in the group with a still-functioning kitchen is Mt. Sinai. The kosher and halal foods, along with the low residue meals required for GI patients are prepared in-house. How can they afford it? Those kitchens also cater. The catering revenue subsidizes the kitchens.

  18. Anonymous2:53 pm

    I spent all of last year at Princess Margaret Hospital in Toronto - the supposed best cancer institute in the country - with my husband who was being treated for testicular cancer. This was my first up-close experience with that much hospital time, and with cancer, and I was nothing less than shocked. They serve chemo patients fake, white-sugar-laden apple "drink" and fruit punch + cookies whose first ingredients are bleached white flour, sugar and trans-fats. Like INTENTIONALLY serve this stuff!?! When I needed a snack, my options were Tim Horton's donuts or a Druxy's deli sandwich. One particularly early morning I ordered eggs and stood dumbfounded as they microwaved them... in a plastic bowl. And the in-patient meals were downright not edible, never mind unhealthy. It was actually insulting and upsetting during a time when more upset is the last thing you need. PMH should be embarrassed of this aspect of their "care". I find it hard to believe there isn't a better solution than this joke of a food program.

  19. I am an RD that once was the Senior Nutrition Consultant for Ontario's Ministry of Correctional Services. I retired in 2005 ...ministry has slightly new name. The correctional menus are around 2,800 calories per day as the inmate population is largely male and young (19-24 years old) although yes there are older inmates and some women in provincial correctional centre. It costs more to meet their nutritional needs due to the larger volume of food. Canada's Guide to Healthy Eating and the Dietary Reference Intakes apply to all institutionalized Canadians including inmates. We switched to 100% ww bread, brown rice etc. I always considered healthy food part of the "correction" and inmates by and large did want healthy food. I am not fond of the comparison between LTC funding to feed the elderly and correctional institutions for these reasons.