RESEARCH Current Research Experts Stress Both Wellness and Amenity Aspects of Food and Nutrition Services in Assisted Living Facilities for Older Adults SHIRLEY Y. CHAO, PhD, RD; JOHANNA T. DWYER, DSc, RD; ROBERT F. HOUSER, PhD; PAUL JACQUES, DSc; SHARON TENNSTEDT, PhD, RN ABSTRACT Objectives There has been no consensus on best practices in food and nutrition services in assisted living facilities for older adults. We documented experts’ views on opti- mal food and nutrition services emphases in assisted living facilities, and factors affecting their views. Methods One hundred thirty-five national experts special- izing in health, aging, nutrition and assisted living facil- ities completed a survey consisting four scenarios (ie, home-style, restaurant/hotel, and health/medical, and a combination of these three) in six food and nutrition services areas: dining room environment, meal services, meal quality, nutrition services, employees’ qualifica- tions, and therapeutic nutrition services. Results Sixty-three percent of experts favored the combi- nation scenario. Dietetics education and experts’ beliefs that assisted living facilities should be health promotion and maintenance facilities were significant predictors of emphases, including wellness considerations. Experts’ personal views exerted a powerful influence. Conclusions Experts chose food and nutrition service qual- ity indicators that emphasized a focus on both wellness and amenities as their ideal scenarios for optimal food and nutrition services in assisted living facilities. J Am Diet Assoc. 2008;108:1654-1661. A ssisted living facilities are popular housing alterna- tives that provide a supportive environment for older Americans who can no longer live indepen- dently and who often have low mobility levels (1,2). Ac- cording to the National Center for Assisted Living Facil- ities, assisted living facility residents needed assistance with 2.3 out of five activities of daily living on average, compared to 3.8 activities of daily living for nursing home residents and 1.6 activities of daily living among those receiving home health services (3). Weight problems, chronic diseases, and frailty increase the prevalence of immobility (4). Optimal food and nutrition care can help to maintain or improve mobility, delay the onset of frailty, and further promote the quality of life of older Americans (5-7). Older adults who reside in assisted living facilities are heterogeneous, and therefore it is not surprising that operators of these facilities differ markedly in their views about optimal care relating to food and nutrition services in these settings (8-10). The conceptual components of these views can be grouped into four descriptive food and nutrition service emphases: home-style, restaurant/hotel, health/medical, and a combination of these three (11). Each reflects a different perspective toward food and nu- trition services in assisted living facilities. Both the home style with its free choice of food, informality, and inde- pendence, and the restaurant/hotel style, which features attractively prepared foods, personalized service, and a congenial dining environment, emphasize amenities. In contrast, the health/medical style-focused services em- phasize menus that are tailored to older adults’ preven- tive or therapeutic nutrition needs, other health issues, and dining safety (5,11,12-18). S. Y. Chao is director of nutrition, Massachusetts Execu- tive Office of Elder Affairs, Boston; at the time of the research, she was a doctoral student at the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. J. T. Dwyer is a professor, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, professor of medi- cine and community health, Tufts University School of Medicine, Boston, MA, director of Frances Stern Nutri- tion Center, New England Medical Center, Boston, MA, and a senior scientist, Nutritional Epidemiology Pro- gram, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA. R. F. Houser is an instructor and research analyst, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston MA. Paul Jacques is a professor, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University, Boston, MA, and director of Nutritional Epidemiology Program and a senior scientist, Jean Mayer USDA Hu- man Nutrition Research Center of Aging, Boston, MA. S. Tennstedt is vice president and director, Institute for Studies on Aging, New England Research Institutes, Watertown, MA. Address correspondence to: Shirley Y. Chao, PhD, RD, Massachusetts Executive Office of Elder Affairs, One Ashburton Place, 5th Fl, Boston MA 02108. E-mail: Shirley.chao@state.ma.us Manuscript accepted: March 7, 2008. Copyright © 2008 by the American Dietetic Association. 0002-8223/08/10810-0005$34.00/0 doi: 10.1016/j.jada.2008.07.013 1654 Journal of the AMERICAN DIETETIC ASSOCIATION © 2008 by the American Dietetic Association