Dennis and Christine

Christine Robinson and Dennis Nosko of Boston’s A Fresh Endeavor Personal Chef Service have long focused on creating healthy meals for their Massachusetts clients. That includes working with families living with dementia. As the population ages and diseases like Alzheimer’s, Lewy Body dementia, Vascular dementia, and others are on the rise, personal chefs like Christine and Dennis can provide a foundation for enabling patients to stay healthy and stay home longer, while also helping caregivers, who live with the stress and anxiety of constantly caring for a declining spouse or parent, with nutritious meals and one less responsibility.

We asked Christine and Dennis to share their experience of serving clients with dementia and their advice is spot on.

Over the years we have had several clients with memory impairment. One of the main concerns of the family is generally how to keep a loved one in their own home for as long as possible, as long as the care level is up to par. 

Food and proper nutrition is a huge component in a dementia patient’s quality of life. Balanced meals can allow physical and emotional health to improve. That’s where personal chefs come in. But it is NOT an easy task and it may not be for you. However, for those who feel up to the challenge, you can make a huge difference in the life of a family dealing with dementia. 

When clients contact us to work with their family members with dementia, it is usually the children, hoping to keep their parents in their own home. Many times they’re out of state and this can pose some logistical questions. You need to figure out who is the “point” person and make one source of contact so that there is less confusion. We find that there is usually a family member who has good information about the physical health of the actual client and that is generally the person with whom you want to deal.

We always try to make the food all about the client recipient, following any dietary restrictions but making food they seem to enjoy. Keeping them fed is most important.

Not every job works out. You can have a spouse who does not want the service, or the person with dementia does not want other people around. In these cases, you have to evaluate if you are doing more harm than good. While there is no clear cut answer for every case, you want to err on the side of what will keep the client the happiest, even if it means ending the cooking relationship, recommending someone else, or even cooking at a close relative’s home for them to deliver.

Here’s what we recommend when taking on a family with a member who has dementia:

1) Establish whether another person coming into the home is going to be a benefit or a distraction. In-home meal service can either be a huge help or a stranger in the house can cause the family member with dementia extra stress…find out how they would respond. Many times a new person in the mix doing something different can be a welcome thing…but don’t be afraid to ask up front. Also test the waters to make sure how the other family members living in the house, usually a spouse, are going to feel about more help…the dignity and wishes of both parties are equally important.

2) Conduct a thorough client assessment, hopefully in person, and with a caregiver or family member other than the spouse present. Learn what type of dementia the loved one has–it could be Alzheimer’s, but it could also be any number of other types of dementia, which have different symptoms and progression. You can learn more about them on the Alzheimer’s Association website. Find out about medications and other health conditions that can be helped or exacerbated by certain foods. Cranberry juice, leafy greens, and flaxseed, for instance, do not go well with coumadin and other blood thinners. Make sure that any family members seeking your service are provided with copies of the assessment. Seeds, nuts, gassy vegetables, onions, and acidic foods should be explored on paper and in reality. Repeat favorites and get rid of textures that are not working. As the disease progresses and medications change, you will have to revisit this to make adjustments. 

3) Pay close attention to textures and tastes. Something as simple as a blueberry skin can be a distraction and texture issue for a patient. Have any caregivers/family members keep track of favorite items, but especially items that are not being eaten. Sometimes a switch from a ground meat to a solid piece can make all the difference. Sometimes, as the disease progresses swallowing becomes more difficult and textures become crucial so patients don’t aspirate food. But each person is different. Keep notes and be amenable to changes. This is not a time to be the creative chef, but to listen closely to a client’s needs.

4) Pay attention to the spouse and his/her likes and dislikes. Many times the person without dementia is the lesser focus. They are going through a difficult time seeing the love of their life slip into unknown territory. Ask about their favorites. Make a treat just for them. Talk to them. So much conversation is focused on the patient that the other person can feel left out, especially if the kids are spearheading the need for the personal chef. Everyone counts and should be part of the experience.

5) Expect that these cook dates will probably take extra time. Plan for it and expect to talk. Take advantage of the moments of lucidity and talk to the client about stories and what they may suddenly be remembering. Be prepared for the opposite as well, when they ask the same question repeatedly or talk to you as if you were a family member no longer with them. Ask their caregiver the best way to respond. Often, it’s just to go along with them and their conversation without correcting them.

6) Don’t try to become the savior. At the stage you are entering their lives, there is rarely a turnaround and no special meatloaf or spice combo is going to be the cure all. Enhance for nutrients where you can, and ask the family if there are any holistic things they want to try, such as cooking with coconut oil, or grassfed meats. As long as it does no harm, take their lead.

7) Expect that you will cry after more than one cook date.

8) Expect that you will get some great, funny, wonderful stories when they talk to you.

9) Don’t be offended by anything that the client may say to you. Dementia works in odd ways and people who would never use coarse language can come up with some doozies. It is part of the condition and please realize it is NOT directed at you.

10) Be flexible and compassionate. Anticipate that things can change on a daily basis and you may be making more or less food as needs fluctuate.

This is a hard job, not for everyone. But cooking for these families can be the most rewarding job. You really can make a difference but don’t enter into it without realizing that a part of your heart will forever hold these families as very dear.

Have you been cooking for clients with dementia? What has your experience been?

Not an APPCA member? Now’s the perfect time to join! Go to personalchef.com to learn about all the benefits that come with membership.

And if you are a member and have a special talent to share on this blog, let us know so we can feature you!

 

Lemon chicken2

I’m not a personal chef or a chef of any kind. I’m a food writer and a home cook–and a daughter who is now helping my elderly parents out with preparing meals. My mom is caring for my dad at home here in San Diego. He suffers from two forms of dementia–Alzheimer’s Disease, a memory loss condition with which you may be familiar, and Lewy Body Disease, which is less common, related to Parkinson’s, and causes him to have hallucinations; in our situation it mostly centers around his not recognizing my mom. As you can imagine, this has put a lot of stress on her, and she isn’t in the best health herself. So, I’m a caregiver, too.

And that includes doing some cooking for them so Mom can catch a break and just enjoy a meal herself. Recently, however, she suffered from a bad bout of reflux. So I needed to make two different dinners for them. I became what she had always dissed being in our household growing up: a short-order cook.

Making her dinner was easy. Plain, stripped-down skinless chicken breast baked with some cut up carrots in a little water with a smidge of salt. But I needed to be more creative for my dad, who may have memory issues but has a healthy appetite.

Recently I’ve been making them mustard chicken baked with panko. It’s easy–just slather the chicken pieces with a great mustard and roll in panko. Drizzle with olive oil and bake at 375˚ for about an hour. My folks both love this dish, as do I. The mustard tenderizes and flavors the meat and the panko and olive oil create a fabulous crust. What’s not to love!

But I don’t want him to get tired of it, so I was thinking about other options. I love chicken flavored with lemon juice but I had one last ripe Meyer lemon on my tree and thought it might be interesting to chop it up and cook it with the chicken. And add artichokes. I knew I couldn’t find baby artichokes right now–this would be great with trimmed fresh baby artichokes–but I could buy frozen artichoke hearts. It all started coming together–add some shallots, fresh herbs, some wine. Find another Meyer lemon at the market. And that was it.

The result was a marvelous tangy, yet rich dish. The roasted Meyer lemon pieces contributed to the juices but were also wonderful bites, drenched in chicken juices and wine, since they don’t have the bitterness of conventional lemons. The chicken practically fell off the bone, yet the skin was crisp. And the mellowness of the artichokes and shallots complemented the bright sweet flavors coming from the lemon and wine.

I made basmati rice to accompany the dish, which was perfect because this lemon chicken creates  magnificent juices and you want a grain that will sop it all up.  And there were plenty of leftovers for a couple of days. My dad loved it. The housekeeper loved it. And my mom was rapturous over the heady aroma it produces. This goes in the rotation, especially so Mom can enjoy it later now that she’s feeling better.

Meyer lemons
Lemon Chicken with Artichoke Hearts
Serves 5 to 8

5 whole chicken legs, cut into drumsticks and thighs (trim excess fat)
1, 12-ounce bag of frozen artichoke hearts, defrosted
2 Meyer lemons, washed, cut into pieces, and seeded
3 shallots, peeled and sliced
About 12 sprigs of fresh oregano and thyme
2/3 cup white wine
Salt and pepper to taste
1/4 cup extra virgin olive oil

Preheat oven to 300˚F.

Place chicken pieces skin side down in casserole in a single layer. Sprinkle with salt and pepper. Turn over and season the skin side.

Shallots

In a large bowl, combine the artichoke hearts, lemon pieces, shallots, and herbs. Toss with olive oil and salt and pepper.

Mixed in the bowl
Add to the chicken, tucking into the crevices between the pieces. Keep as much of the chicken uncovered as possible. Pour the wine over the chicken mixture.

Ready for oven

Cover with foil and bake for two hours. Then increase the oven temperature to 425˚F. Remove the foil and roast uncovered for half an hour or until the skin is brown and crispy.

Serve with rice or another grain.

Lemon chicken4

What’s your go-to dish to make for a family? Are you adding caregiving activities to your your life and work? Feel free to share the challenges that brings and how you’re managing them.

Not an APPCA member? Now’s the perfect time to join! Go to personalchef.com to learn about all the benefits that come with membership.

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