TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER c: LONG-TERM CARE FACILITIES
PART 225 ALZHEIMER'S DISEASE MANAGEMENT CENTER DEMONSTRATION PROGRAM CODE
SECTION 225.6010 MEAL PLANNING
Section 225.6010 Meal Planning
Each resident shall be served food to meet the resident's needs and to meet physician's orders. The facility shall use this Section to plan menus and purchase food in accordance with the following and the Dietary Guidelines for Americans of the U.S. Department of Agriculture:
a) Milk and Milk Products Group: 16 ounces or more of Grade A whole or low fat pasteurized milk where milk is used for fluid consumption. Calcium equivalents for eight ounces of milk:
1) 1½ ounces natural cheese;
2) 2 ounces processed cheese;
3) 1 cup yogurt, or one cup frozen yogurt;
4) 1 cup cottage cheese; or
5) 1½ cups ice cream or ice milk.
b) Meat Group: A total of 6 ounces (by weight) of good quality protein to provide 38 to 42 grams of protein daily. To ensure variety, food items repeated within the same day shall not be counted as meeting a required serving. The following are examples of one serving:
1) 3 ounces (excluding bone, fat and breading) of any cooked meat such as whole or ground beef, veal, pork or lamb; poultry; organ meats such as liver, heart, kidney; prepared luncheon meats.
2) 3 ounces (excluding skin and breading) of cooked fish or shell fish or ½ cup canned fish.
3) 3 ounces of natural or processed cheese or ¾ cup cottage cheese.
4) 3 eggs (minimum weight 21 ounces per dozen, considered a medium egg).
AGENCY NOTE: If one egg is served at a meal, a protein food of good quality may be reduced from 6 to 5 ounces for the remaining meals. If 2 eggs are served at a meal, a minimum of 2 ounces of good quality protein shall be served at each of the remaining meals.
5) 1½ cups cooked dried peas or beans, 6 tablespoons of peanut butter, or 1 cup nuts, not more than twice a week and provided that eggs, milk or lean meat is served at the same meal.
6) 3 ounces of soy protein containing not less than 21 grams of protein or in combination with other sources of quality protein to equal 21 grams of protein, provided that it is acceptable to the resident population.
7) Combinations of all above examples are acceptable, provided that the minimum standard of 6 ounces of a good quality protein food is served daily and provided that the combinations do not conflict with eye appeal or palatability.
8) The content of meat alternative products shall be listed on the menu.
c) Vegetable and Fruit Group: 5 or more servings of fruits or vegetables.
1) A serving consists of:
A) ½ cup chopped raw, cooked, canned or frozen fruit or vegetables;
B) ¾ cup fruit or vegetable juice; or
C) 1 cup raw leafy vegetable.
2) The 5 or more servings shall consist of:
A) Sources of vitamin C
i) 1 serving of a good source of vitamin C (containing at least 60 mg of vitamin C); or
ii) 2 servings of a fair source of vitamin C. This may be more than one food item and shall contain a total of at least 50-100 mg of vitamin C.
B) 1 serving of a good source of vitamin A at least 3 times a week supplying at least 1000 micrograms retinol equivalent (RE) of vitamin A.
C) Other fruits and vegetables, including potatoes, which may be served in ⅓ cup or larger portions.
3) To ensure variety, food items repeated within the same day shall not be counted as meeting a required serving.
d) Bread, Cereal, Rice and Pasta Group: 6 or more servings of whole grain, enriched or restored products. One serving equals:
1) 1 slice of bread;
2) ½ cup of cooked cereal, rice, pasta, noodles, or grain product;
3) ¾ cup of dry, ready-to-eat cereal;
4) ½ hamburger or hotdog bun, bagel or English muffin;
5) 1 4-inch diameter pancake;
6) 1 tortilla;
7) 3 to 4 plain crackers (small);
8) ½ croissant (large), doughnut or danish (medium);
9) 1/16 cake;
10) 2 cookies; or
11) 1/12 pie (2-crust, 8").
e) Butter or Margarine: To be used as a spread and in cooking.
f) Any orders for a change in salt usage in food preparation shall define the gram total. The normal salt intake shall be 10 grams.
g) Other foods shall be served to round out meals, satisfy individual appetites, improve flavor, and meet the individual's nutritional and caloric needs.
h) Meals for the day shall be planned to provide a variety of foods, variety in texture and good color balance. The following meal patterns shall be used.
1) Three meals a day plan:
A) Breakfast: Fruit or juice, cereal, meat (optional, but 3 to 4 times per week preferable), bread, butter or margarine, milk, and choice of additional beverage.
B) Main Meal (may be served noon or evening): Soup or juice (optional), entree (quality protein), potato or potato substitute, vegetable or salad, dessert (preferably fruit unless fruit is served as a salad or will be served at another meal), bread, butter or margarine, and choice of beverage.
C) Lunch or Supper: Soup or juice (optional), entree (quality protein), potato or potato substitute (optional if served at main meal), vegetable or salad, dessert, bread, butter or margarine, milk, and choice of additional beverage.
2) Other meal plans may be used if the facility is able to meet residents' needs using such plans.