the Experts: Creative Solutions for Local Providers
by Local Providers
Food Services to Meet the Needs
of Culturally Diverse Participants
is cultural competence important in food services?
Americans Act Nutrition Programs and other programs providing meals to
older adults are being challenged to meet the needs of their culturally
diverse communities. In 1999, 16.1% of persons 65 years and older were
minorities--8.1% were African-Americans, 2.3% were Asian or Pacific Islander,
and less than 1% were American Indian or Native Alaskan. Persons of Hispanic
origin (who may be of any race) represented 5.3% of the older population.
Minority populations are projected to grow to 25.4% of the elderly population
in 2030 (1). This represents an increase by 219% for older minorities,
including Hispanics (328%), African-Americans (131%), American Indians,
Eskimos, and Aleuts (147%), and Asians and Pacific Islanders (285%)(2).
exist in older adults because of differences in gender, race or ethnicity,
income or education, disability or living in a rural location (1). Substantial
disparities exist among racial and ethnic groups and by gender in mortality
from many causes of death (3). In 1998, 6,498,076 older adults were recipients
of Older American Act (OAA) Title III services. Of these, 19.6% were members
of racial and ethnic minority groups (4,5). African Americans constituted
over half (54%) of the 1998 minority clients served, followed by 30% Hispanic,
11% Asian American or Pacific Islander and 5% American Indian or Native
Alaskan (4). The National Evaluation of the Elderly Nutrition Program
1993-1995 found that 25% of congregate and home-delivered meal participants
were minorities. This percentage is almost twice the national percentage
of minority adults over age 60 (6).
health disparities among older persons and in particular minority individuals,
the Administration on Aging has encouraged the Aging Network to participate
in the U.S. Department of Health and Human Services Healthy People
2010 initiative by using it as both a planning and evaluation tool
for programs and services. The two major goals of Healthy People 2010
are to (1) increase quality and years of healthy life and (2) eliminate
health disparities. Healthy People 2010 builds upon a national
effort initiated over 20 years ago to develop comprehensive health objectives
that can be used to effectively direct health promotion and disease prevention
efforts. The initiative reinforces the concept that improving the health
of the Nation requires the long-term commitment and participation of all
Americans Act encourages outreach to underserved and isolated populations
in greatest social and economic need, to members of ethnic and racial
minority communities and to those over age 85 (4,5,7,9,10). In response
to this call and the increasing members of minority, Programs must change
in order to improve the health of all citizens. To this end, Nutrition
Programs need to provide culturally competent services and staff need
to be culturally sensitive. Providing culturally appropriate, nutritious,
high quality and tasty meals can be an effective outreach effort to bring
in the target population, improve customer satisfaction, promote health
and reduce health disparities.
can Nutrition Programs use to assure cultural competence?
competence is defined as a "set of attitudes, skills, behaviors and
policies that help organizations and staff to work effectively with people
of different cultures" (11). Serving older adults of diverse cultures
requires staff and volunteers to be compassionate, respectful, warm, empathetic
and genuine. It is essential to develop and enhance staff cultural competency
skills in the work environment. The Administration on Aging's Achieving
Cultural Competence: A Guidebook for Providers of Services to Older Americans
and Their Families (12) is a useful resource.
can be defined in several ways. It can refer to the people who live within
a geographic boundary or to a group of people who have similar beliefs,
culture or shared identity and experiences. Getting to know a "community,"
its people, and its resources, will help service providers identify strategies
for service delivery. If a community center or church is an important
local institution, developing partnerships with that organization may
help reach the targeted group.
can Nutrition Programs use to meet the ethnic and cultural food preferences
religious customs are two of the many factors that influence our food
preferences. Understanding the "culture" and its relationship
to food preferences will help Nutrition Programs improve the quality of
their services. Nutrition Programs should embrace their participants'
diversity and focus attention on customer satisfaction. Serving familiar
ethnic foods at congregate meal sites and to the homebound will increase
the likelihood that the meal will be eaten and enjoyed. It may be one
way to increase participation in congregate settings.
menus for the Nutrition Program, the cultural food preferences of all
program participants should be considered. Today, the menu often contains
common ethnic foods like spaghetti and lasagna; chow mien and stir-fry
beef and broccoli; corned beef and cabbage; fried chicken and sweet potatoes.
However, there may be many entrees and side dishes representative of other
cultures that are often overlooked. The good feeling participants have
when served favorite ethnic foods partly comes from the recognition that
their cultural preferences are important and respected.
food preferences of program participants can be challenging. Nonetheless,
making adaptations to menus is essential. The following strategies from
a variety of settings may help:
the environment welcome and attractive, reflecting participants' cultural
background. Decorate dining areas with ethnic memorabilia.
community input when developing programs and planning menus. Target
outreach to specific ethnic, cultural, or religious communities. Many
programs have an advisory or community council with participants of
various ethnicities to assist with menu planning.
Senior Resource Development Agency, Pueblo, Colorado, has a Nutrition
Committee led by the Nutrition Director of Pueblo's Elderly Nutrition
Programs. The majority of committee members are site managers, who
provide feedback from older adults who eat at the congregate sites
and from Meals-On-Wheels drivers, who provide feedback from homebound
Havana Activities and Nutrition Center, Miami, Florida, and their
nutritionist relies on a number of avenues for feedback and assistance
with menu planning for their primarily Cuban-American population.
Homebound participants are surveyed regularly by staff regarding
satisfaction with the menu . Site managers report comments often,
particularly when new items are introduced. An annual food preferences
evaluation is completed and the program's advisory council also
assists with menu planning.
County Aging Services, Tampa, Florida, uses a Customer Satisfaction
Survey to obtain participant feedback regarding satisfaction with
the program and specific menus.
Life Care Alliance, Columbus, Ohio, found all Asians should not
be considered as one group when considering food preferences and
social needs. The Alliance initiated separate meetings with representatives
from the Chinese, Korean, and Vietnamese communities.
a suggestion box to encourage participants to recommend menu ideas.
staff and volunteers who reflect the diversity of the community served.
Use bilingual staff, volunteers and/or interpreters to solicit menu
and program ideas.
Hale Makua Skilled Nursing Facility, Kahului, Maui, Hawaii, staff
provide input on the type of ethnic foods to include on the menus.
Monthly meetings with the Resident Council (similar to a Nutrition
Program's advisory council) are held to discuss which menu items
have been successful and which items need to be discontinued or
Life Care Alliance, Columbus, Ohio, had a Vietnamese faculty member
from a local University help the program meet the nutritional needs
in his community through a better understanding of the culture.
authentic ethnic cuisine.
programs may do their best to provide ethnic meals, providing authentic
ethnic cuisine may be difficult for cooks without such native experience.
Norge Jerome, PhD, suggests having a cook "experienced"
with traditional ethnic cooking be a "guest" cook or use
an ethnic restaurant in the community as a caterer. This is particularly
important during special occasions and holidays to carry on cultural
- Use an
ethnic caterer or restaurant to serve specific ethnic and/or religious
Services of Snohomish County, Mukilteo, Washington, uses different
ethnic restaurants to cater to their Korean, Chinese, and Southeast
Asian groups. The restaurants follow a meal pattern provided by
the nutrition provider and the caterer develops the actual menu
based on the known preferences of the group.
Care Alliance, Columbus, Ohio serves similar groups. However, they
transport Chinese and Vietnamese older adults to different Chinese
and Vietnamese restaurants every Saturday and provide programming
similar to other congregate sites. They transport Korean participants
one Saturday a month to an existing congregate site, where a Korean
restaurant caters the meals. Programming is also provided there.
All meals follow the general meal pattern.
Havana Activities and Nutrition Center, Miami, Florida, uses a Cuban-American
caterer for their congregate and home delivered meals. Ninety-five
percent of the participants are minority (primarily Cuban, African
American, and Caribbean). Although primarily Cuban in design, the
menus are mixed with American and Caribbean foods.
a variety of meals and/or foods from different ethnic groups.
Kautz Osterkamp of the Southern Arizona Health Promotion Network
suggests featuring one ethnic cuisine per week, rotating among the
different cuisines that represent their community members. For example,
the Edgewater Retirement Community, Galveston, Texas, features one
ethnic cuisine per week on a four-week cycle menu plus Italian,
Chinese, Mexican, etc., served one or two times per week.
new foods to coincide with ethnic and religious holidays and nutrition
participants on the origins and historical significance of various
foods and cooking practices, as well as the nutritional contributions
of each food.
cultural food items as side dishes, desserts, or snacks, if not the
entrée on a regular basis.
Hale Makua Skilled Nursing Facility, Kahului, Maui, Hawaii, offers
comfort foods to ethnic groups if they cannot provide a familiar
ethnic entrée. For example, they offer tofu/miso saimin (soup)
as a meal alternate/side dish to Japanese residents and sandwiches
as a meal alternate to Caucasian residents.
Jerome suggests condiment packages that allow individuals to flavor
their foods, as they are accustomed to. A "Mexican pack"
may contain hot sauce and adobe seasoning. A "Chinese pack"
may contain low sodium soy sauce, hot mustard, duck sauce, and chop
sticks. These are the seasonings seen on Mexican or Chinese restaurant
tables and are regularly placed on tables at congregate sites.
What are some of the challenges in meeting the needs of culturally
diverse participants and how can they be overcome?
Programs want to expand food choices and respect cultural preferences.
However, perceived obstacles include increased costs and compliance with
Dietary Reference Intakes (DRIs) and RDAs (13). Limited funding, decreasing
resources, a diminishing volunteer pool, and lack of transportation also
challenge Nutrition Programs. These often overshadow desires to increase
menu choices. Program administrators need to weigh the benefits and drawbacks
of offering more culturally representative menu choices. Consider the
- If a program
provides only one entrée daily, the cycle menu should offer entrees
that are multicultural. Such changes will not increase food costs to
any significant degree.
- If a program
offers a choice of side dishes to reflect the ethnicity of the community,
such changes will not affect food cost significantly.
- If a program
hasn't been offering a monthly "ethnic or culture" theme,
begin now. Build it into nutrition education plans. Collaboration with
participants and their community representatives will go a long way
in establishing good rapport.
Asian, African-American, and other ethnic restaurants and caterers can
provide meals at costs comparable to other establishments, particularly
if individuals in the community assist in negotiations, as was the experience
with the Life Care Alliance in Columbus, OH. The cost of their kosher
meals catered by the Jewish Community Center was reasonable.
- To comply
with the DRIs and RDAs when incorporating new foods, follow a meal pattern
first and know the main ingredients and nutrient content of the food.
A number of nutrient databases contain foods of other regions. Commercial
food purveyors can provide nutrition information about their products.
Compliance with the DRIs may be challenging, but it is not an "excuse"
to avoid menu variety.
- If program
participation is down, attracting minority or culturally diverse participants
may be the key. Consider this: A happy participant (customer) is usually
a repeat customer and one who will spread the word about the fine food
and service available. It is worth spending a little more on a meal
if it means better participation and customer satisfaction.
Cultural Competence: A Guidebook for Providers of Services to Older
Americans and Their Families http://www.aoa.dhhs.gov/minorityaccess/guidbook2001/CC-programs.html.
This web-based document from the federal Administration on Aging outlines
the principles of cultural competence and offers guidance on creating
programs that work.
Everything about ethnic foods and ingredients, holiday food traditions,
religious dietary practices, regional food customs, recipes, fun facts,
& cultural nutrition resources. Also available, Ethnic Foods Nutrient
Composition Guide, with over 700 ethnic, religious, and regional items--
from Ajwain to Zapote-- arranged by food category; indexed alphabetically,
by cultural group, and scientific name. Also available from EatEthnic.com:
International Quantity Foods http://www.eatethnic.com/iqf.htm.
Whether you cater large events, run a restaurant, or do institutional
cooking, you will enjoy International Quantity Foods. Over 150 authentic,
kitchen-tested recipes from 20 different cultural groups. Introductory
material on the cuisine, common ingredients, seasonings, preparation
methods and meal patterns of each nation. Though this 1990 book is out
of print, you can order a spiral-bound, copied black-and-white version
for $32.95 plus S&H.
Community Services Project FLASH (Filipino-American Lifestyle
Assessment for School-lunch and Health). Nutrition
and fitness education materials for Filipino-Americans targeted to the
public, teachers, students, parents, food service supervisors and restaurateurs.
The project aims to reduce risk factors related to heart disease and
stroke. Spiral-bound guides cost $8 each. These well-written materials
are packed with healthy tips and recipes. Phone 619-594-2795 or 619-293-3871
for more information or order forms. You can also write Kalusugan Community
Services, c/o Dr. Ofelia Dirige, 7982-H Mission Center Court, San Diego,
Resource Group: Vegan in Volume. http://www.vrg.org/catalog/volume.htm.
Chef Nancy Berkoff, RD, shares culturally diverse (Asian, Caribbean,
Latin American) quantity recipes. It offers a brief explanation of vegan
nutrition, equipment suggestions, and covers catered events, college
food service, and hospital food service. It can be purchased online
- A Cookbook
of Healthy Vietnamese Recipes: A Collection of Vietnamese Recipes From
the San Francisco Bay Area Vietnamese Community. This cookbook was
made for health promotion within the ethnic community. Contact: UC Regents
Vietnamese Community Health Promotion Project, 44 Montgomery Street,
Suite 850, San Francisco, CA 94104; Phone: 415-476-0557. Cost: $12.50
the dal?: Food and Nutrition Experiences of Ethnic Minority Seniors
in Long-Term Care." This paper examines the dietary options
currently available to ethnic minority seniors in long term care facilities
and how they and their families cope with any shortcomings of the health
system in meeting their needs; the literature on the meanings assigned
to food, particularly as these pertain to immigrants and the elderly;
and make suggestions as to the future directions that dietitians, nutritionists
and health administrators might to take in order to address identified
shortcomings. Submitted March 14, 2001 for the Prevention and Health
Promotion Strategies, Ministry of Health, Victoria, British Columbia,
Canada by Dr. Sharon Koehn, Vancouver, BC. (604) 733-8637, Email: email@example.com.
- The National
Policy and Resource Center on Nutrition and Aging provides a list of
resources under the heading Special Populations.
- US Department
of Health and Human Services. Healthy People 2010: Understanding
and Improving Health. Washington, DC: US Dept Health Human Services,
Government Printing Office. 2000.
on Aging. Profile of Older Americans 2000. Available at: http://www.aoa.dhhs.gov/aoa/stats/profile/default.htm.
Accessed November 6, 2001.
E, Lentzner H, Rooks R, Weeks J, Saydah S. Health and Aging Chartbook.
Health, United States, 1999. Hyattsville, MD: National Center for Health
on Aging. Facts and figures: Statistics on minority aging in the
U.S. Available at: http://www.aoa.gov/minorityaccess/stats.html.
Accessed November 6, 2001.
on Aging. 1998 State Performance Reports. Available at: http://www.aoa.gov/napis/97spr/tables/table3.html.
Accessed November 6,2001.
Policy Research, Inc. Serving Elders at Risk, the Older Americans
Act Nutrition Programs: National Evaluation of the Elderly Nutrition
Program 1993-1995, Volume I: Title III Evaluation Findings. Washington,
DC: US Department of Health and Human Services;1996:103-105, 203.
on Aging. The many faces of agin: Resources to effectively serve
minority older persons: Healthy People 2010. Available at: http://www.aoa.gov/minorityaccess/healthypeople2010.html.
Accessed May 21, 2001.
- US Department
of Health and Human Services. Health People 2010. Available at:
Accessed November 6, 2001.
on Aging. The many faces of aging: Introduction and Welcome.
Available at: http://www.aoa.gov/minorityaccess/intro.html.
Accessed May 21, 2001.
on Aging. The many faces of aging: Promising practices and programs.
Available at: http://www.aoa.gov/minorityaccess/promising-practices.html.
Accessed May 21, 2001.
- US Dept
of Health and Human Services. Health Resources Services Administration.
Cultural Competency: A Journey. Available at: http://www.bphc.hrsa.gov/culturalcompetence/Default.htm.
Accessed June 11, 2001.
on Aging. Achieving Cultural Competence: A Guidebook for Providers
of Services to Older Americans and Their Families. Available at:
Accessed September 7, 2001.
- 13. National
Policy and Resource Center on Nutrition and Aging. Nutrition 2030
Grassroots Survey Report. December 1999. Available at:
Accessed June 11, 2001.
- Judy Arbeiter,
Section Manager, Hillsborough County Aging Services, Senior Citizens
Nutrition and Activity Program, Tampa, FL. firstname.lastname@example.org
Buck, PhD, Nutritionist, Division of Elderly Services, 25 Sigourney
Street, 10th Floor, Hartford, CT 06106-5033. email@example.com
- Rosa Carranza,
MS, RD, Nutritionist, Little Havana Activities and Nutrition Center,
Miami, FL. firstname.lastname@example.org
D. Chan, RD, Hale Makua (Skilled Nursing Facility), Kahului, Maui, HI.
- Peta R.
Dudley, MS, RD, Edgewater Retirement Community, Galveston, TX.
Hamilton, Program Supervisor, Fellowship Dining, Polk County Elderly
Services, Bartow, FL. email@example.com
Herman, Director of Meals on Wheels, Life Care Alliance, Columbus, OH,
(614) 278-3141, ext.261. firstname.lastname@example.org
Kautz Osterkamp, Southern Arizona Health Promotion Network. email@example.com
W. Jerome, PhD, University of Kansas, School of Medicine, Shawnee, KS.
- Dr. Sharon
Koehn, Vancouver, BC. firstname.lastname@example.org
Looney, MSRD, MBA, Senior Resource Development Agency (SRDA), Pueblo,
Peppones, MS, RD, CD, Nutrition Director, Senior Services of Snohomish
County, Mukilteo, WA. email@example.com
- Amy Van
by Stacey Reppas, MS, RD and Lester Rosenzweig, MS, RD, and staff of the
National Policy and Resource Center on Nutrition and Aging, Florida International
University, Miami, FL. Contact: firstname.lastname@example.org
project is supported, in part, by a grant from the Administration on Aging,
Department of Health and Human Services (DHHS). Grantees undertaking projects
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS policy.
Posted on 05/07/2004