Download HS 12-002 - County of Simcoe

COUNTY OF SIMCOE
ITEM FOR:
HUMAN SERVICES COMMITTEE
SECTION:
Long Term Care
ITEM NO.
HS 12-002
MEETING DATE:
April 10, 2012
SUBJECT:
Food Provision for Long Term Care
RECOMMENDATION:
THAT Item HS 12-002, regarding Food Provision for the County’s four (4) Long Term Care
Homes, be received for information.
BACKGROUND:
Further to Item HS 10-106 (June, 2010), staff has continued to investigate procuring increased
amounts of food that is grown locally in Simcoe County, as well as Ontario grown local food, for
use in the County’s day-to-day operations. The previous report provided information on local food
use within the cafeteria’s operation at the Administration Centre, meeting room and event catering,
banquet services, and Long Term Care Resident meals. This Item will focus specifically on Long
Term Care food procurement and the information gathered to date with regard to opportunities and
challenges faced when attempting to integrate more “locally” grown food into Long Term Care
menus.
Food and Long Term Care
Food and nutrition play an essential role in the health and well being of Residents in our Homes.
The importance and benefits of a safe, reliable supply of a variety of high quality food cannot be
stressed enough in the provision of the excellent nutritional care and appetizing meals they expect
and deserve, and that meet their health and quality of life needs. Caregivers recognize that food,
beverages and pleasurable dining influence a Residents’ psychological and social well-being as
well as their physical well-being. Providing a pleasant and supportive environment with tasty and
attractive meals encourages Residents to eat better and remain well nourished. However, for
today’s frailer Residents with increasingly complex needs, the provision of food is not just a matter
of ensuring high quality food for the dollars spent - there are many other aspects to consider when it
comes to procuring food.
Menu PlanningLong Term Care Homes in Ontario will receive $7.46 per Resident, per day, for raw food until June
30, 2012 of which approximately $5.90 is for breakfast, lunch and dinner, $0.75 is for
snacks/beverages and the remaining $0.75 is for nutritional supplements and/or interventions
required by the Resident. Effective July 1, 2012, this amount will be reduced to $7.33 per Resident,
per day.
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Human Services Committee HS 12-002
Page 2
With this funding, Long Term Care Homes must follow the regulations as outlined in the Nutrition
Care and Hydration Program as set out in the Long Term Care Homes Act, 2007. Menu planning
must be done in consultation with Residents, family members, substitute decision-makers and any
other appropriate team members.
Menus must provide appetizing, nutritionally balanced, cost effective meals and beverages. They
must offer variety and choice to all Residents, and be adapted to meet the Resident’s individual
documented nutrition care needs. The menu cycle must be a minimum of 21 days in duration and
be reviewed and updated annually. It must include the following while remaining within our
budgeted raw food cost per diem:
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three (3) meals daily; a between-meal beverage in the morning, afternoon and in the
evening after dinner, and a snack in the afternoon and evening
menus for regular, therapeutic, and texture-modified diets for both meals and snacks
all nutritional supplements and interventions required for Resident health, personal
needs and quality of life
alternative choices of entrees, vegetables, desserts, and beverages at each meal
adequate nutrients, fibre and energy for the Residents based on the current Dietary
Reference Intakes (DRIs)
a variety of foods, including fresh seasonal foods, each day, from all food groups in
keeping with Canada’s Food Guide
individualized menus for Residents whose needs cannot be met through the home’s
menu cycle
In order to meet these stringent menu requirements with limited funding, procuring high quality
food at the best price is mandatory. To facilitate this goal, currently the County has a contract with
Complete Purchasing whose main food services provider is Sysco.
Food Provided versus Food Wasted
Possibly one of the largest challenges in Long Term Care Food provision rests with the imbalance
between the standards as set out in the Long Term Care Homes Act and the reality of what
Residents consume. As shown above, our menus must meet the nutrient guidelines as set out by the
Dietary Reference Intakes for seniors, which is between 2000-2400 calories daily. This involves
offering and having available for each Resident, specified portion sizes for each meal item. Many
of our Residents find these portion sizes much too large, but we are still obliged to prepare the food
and offer it to our Residents. These larger portion sizes are not eaten by the Residents, creating
substantial waste and utilizing funds that could otherwise be used to improve the menu elsewhere
or to buy more costly or specialty foods. In a study done by Wright and Piche (2011), it was noted
that the majority of Long Term Care Residents consumed only 82% of their meals, therefore
wasting 18% of their prepared meals.
County of Simcoe Food and Agriculture Charter
The County of Simcoe has created a coalition of partners to come together to oversee the process of
creating a “Made In Simcoe County” Food and Agriculture Charter. The purpose of this Food and
Agriculture Charter is to outline the values and beliefs about the food and agricultural system in our
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Human Services Committee HS 12-002
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community or region. When complete, it will act as a guiding document in the development of
local food and agriculture policies, food security programs and an overall local sustainable food
system. It is the Steering Committee’s intent to produce a finished Charter by the end of 2012 that
will help protect and secure the future of food and agriculture in our community. The goal of the
Long Term Care Homes in Simcoe County is to support this initiative and increase, where possible,
the amount of local content in the fresh, frozen and prepared food we provide to our Residents.
Challenges and Opportunities
As staff has examined the current Long Term Care food supply chain in an effort to increase the
local food component, a number of challenges and opportunities have been identified that staff are
working through and wish to summarize for Council at this time:
Defining Local: Determining what is considered “local food” is one of the challenges faced when
attempting to satisfy the general request for “more local food” in our Long Term Care Homes.
Living in Canada, our seasons greatly affect what food is available at various times of the year in
certain geographic areas. This makes it challenging to maintain a firm definition of “local” all year
round, as seasons change. At certain times of year, certain items are widely available in Simcoe
County, at other times they are only available in adjacent regions (for example, within 300
kilometres), at other times only within the Province of Ontario, and, in the mid winter, perhaps only
from more temperate regions in Canada. Many items are only available from outside Canada at all
times of the year.
Is food considered local based on distance alone or is country of origin more important? For
example in January, apples from Orlando, Florida are 1400 kilometres closer to Simcoe County
than apples grown in Kelowna, British Columbia. By some definitions, country of origin is key, as
buying local is meant to stimulate the country’s economy and support Canadian businesses. By
other definitions, distance is key, as greenhouse gas produced by the transportation of the product is
the main consideration. Others are focused only on the providers within a region such as the
County of Simcoe, and believe that all providers outside that region should not be considered local.
As such, institutions, governments, distributors and growers will be challenged to agree on a clear
definition of “local” for some time to come. As previously approved by Council in Item HS 10-106
(June), the County of Simcoe is defining “local” as food that is grown in the County of Simcoe and
other regions in Ontario. We have communicated our definition of local food to our largest Long
Term Care food provider Sysco, and pressured them to increase the amounts of local food they
procure and offer to us, the customer. We have also asked them to focus their efforts on foods
grown within the County of Simcoe.
Connecting to Simcoe County farmers: As outlined in Item HS 10-106 (June, 2010), efforts are
underway to link the growers in Simcoe County with the distributors who supply Sysco for
example, educating them on what the requirements are for a grower to qualify as a supplier to their
particular supply chain. Sysco has developed a program entitled “Good Agricultural Practices”
(GAP), that all of their suppliers are required to comply with if they wish to supply Sysco with their
products. The GAP program encompasses food safety and sanitation, water analysis, fertilizer use
and land use. Sysco also requires their suppliers to abide by the Sysco Supplier Code of Conduct,
addressing ethics and work practices. Sysco has expressed interest in working with the Simcoe
County Farm Fresh Association and related local food suppliers within the County of Simcoe and
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Human Services Committee HS 12-002
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the Province of Ontario to increase the supply of local food to their organization and therefore to
the County of Simcoe. Attached as Schedule 1 is just one example of the information Sysco sends
their customers informing them of new local food options that arise.
Staff are in regular contact with Sysco and are hoping they will make a presentation to Council in
the near future, outlining their successes to date in this area. Staff have attended workshops within
the County on local food, networking with other government agencies, institutions, distributors and
growers from Simcoe County, all in an effort to increase the amount of Simcoe County local food
in our supply chain. The next event is scheduled for April 2, 2012.
Local Food Identification: With the public’s recent focus on local food and food supply
sustainability, the County is among many government organizations pressuring the industry’s
leading suppliers to increase the amount of local food in their product offerings. Many institutional
and retail customers are also requesting local food from these same large suppliers and as such the
industry is working to satisfy the market; this will take time however. Sysco advises that in some
cases they are already providing local food to their customers however, it is not being labeled as
such by Sysco, the original growers, or by the middle distributors along the supply chain.
Developing and implementing a new mandatory labeling scheme through the supply chain is being
discussed in the industry but will be a lengthy and costly project to implement, with many players
who must agree to participate.
Although Foodland Ontario markets and labels Ontario-grown produce, in many cases a finer
identification is being requested, for example, identifying the County or Region where the food has
come from, or even the individual farm. Staff have asked our suppliers to keep us apprised of
progress in this area. Staff have also asked suppliers to clearly identify the local foods they are
aware of on their order forms so we can make comparisons between local and non-local food when
ordering, in particular with regard to price. At certain times of year, best total value is achieved by
buying local, while at other times of year, buying local may simply not be conducive to budget
restrictions.
When discussing this identification system for customers, a further challenge faced by the large
suppliers was noted in that most are using legacy computer systems that simply do not have the
technical ability to easily “show” local foods to the customer placing the order on the computer.
This is a costly hurdle to overcome, i.e. replacing/updating large and integral computer systems, but
we are advised that that the industry is working on it. Schedule 2 provides an example of progress
made in identifying local foods to the customer in Sysco’s computer system.
Other Considerations
Often the question arises, if the large providers have these fundamental systemic barriers to easily
providing and identifying local food, why do we simply not buy our food directly from the local
providers? Some of the considerations in answer to this question are outlined below:
Food Tracing/Tracking: Lack of food tracing/tracking systems is a key reason that buying direct
would be difficult and come with risk to the County and our Long Term Care Residents. The food
that is provided to the County by Sysco must be rigorously tracked starting in the field it is grown,
through all the people that handle it by picking and packing, through the washing process, through
processing and packaging, transportation and delivery. This ensures that any type of illness that
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appears later, that could be connected to food intake can be easily traced back down the food chain,
allowing all who may have been exposed to be advised, and all who may have that” lot” of food in
their establishments, to identify it and dispose of it immediately. There are regular media reports
where food is recalled and lot numbers are used to identify the problem items to the public; these
systems save lives every day. As such, and as noted above, in order to provide food to a large
company like Sysco, that provides food to vulnerable populations in hospitals and Long Term Care,
smaller growers and suppliers must maintain their own quality control tracking systems (such as
those encouraged in GAP) to meet safety and tracking requirements. Sysco cannot begin to do
business with a supplier until they are confident the proper procedures are in place and they audit
their suppliers to ensure compliance. They maintain this level of quality control using hundreds of
trained personnel, equipment, and systems, they act as a point of contact or “filter” between the
consumers and the producers, bearing the risk associated with distributing foods from multiple
sources and allowing their customers to be confident in the safety of the supply, keeping our
Residents as safe as possible when it comes to food borne illness.
Delivery of Goods: Many of the local growers and producers do not have their own delivery
service and rely on the purchaser to pick up their products. The County is not resourced in terms of
staff or vehicles to co-ordinate, pick up, deliver or unload procured food to our Long Term Care
Homes. Refrigerated transport truck equipment is used for this work and presumably would have
to be contracted out and co-ordinated by someone at the County in addition to the food we would
continue to buy via Sysco. Working to increase the amount of local foods in Sysco’s supply chain
so the County can increase our procurement of local food and continue using existing delivery
processes seems to be the most logical approach.
Reliability of Supply: The supply of a large variety of foods in large quantities into the Long Term
Homes is a process that has evolved over many, many years, with staff at the County working with
our suppliers extensively to perfect the process, achieving the best quality and variety at the lowest
cost, all in an effort to meet the complex Ministry menu requirements noted earlier. A large
provider with multiple sources of supply for any one product ensures that rarely is an item not
available, and rarely are our menus adversely affected by a shortage; the supply is very reliable.
Staff believe that working to increase the amount of locally-grown produce in Sysco’s supply chain
will allow the best of both worlds, i.e. local product would be available for us to choose from and
other supplies would also be available should the local supplier be unable to meet the demand, or
perhaps due to price, another option would make better sense.
Menu and Order Planning Using Supplier Systems: The supply of food to the Long Term Care
Homes occurs like clockwork each week. Behind this seemingly simple process is a complex web
of menu preparation and staff analysis using computerized menu systems designed to meet Ministry
requirements, linked into Sysco’s computerized ordering system; this results in food orders
containing generally what the menu calls for that week; we do not buy any more or less than what
we need do not carry a lot of inventory.
The integration of the County’s food procurement process with the computerized systems of our
suppliers has been extensively evolving over the past 10 years and has provided us with huge
planning benefits and efficiencies when it comes to staff resources. It is difficult to imagine the
amount of staff and time that would be needed to provide 505 Residents with weekly menus that
meet Ministry guidelines, plus order and arrange delivery for all that food without the help of the
systems and resources provided by our key supplier. To separate out any part of that food order, for
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example to decide to buy all tomatoes directly from a local supplier in July and August, as opposed
to from that same local supplier via Sysco, would undoubtedly result in additional processes that
would impact staff. It seems logical therefore to continue encouraging our local growers to become
qualified to supply Sysco and other large institutional suppliers, and then ensure those large
suppliers are clearly presenting those local food options to the staff ordering food for Long Term
Care.
Food Cost: Many locally grown foods (e.g. carrots) can be low in cost at certain times of year, but
they are quite often higher in cost compared to the same foods purchased through large distributors.
Sysco has the benefit of bulk buying and passing those savings onto their customers. The County
takes advantage of this and our food buying processes in Long Term Care have been historically
based on the pricing we receive from this supply chain. Once Sysco does clearly identify the local
foods they can provide to their customers, there will be some times when the price is low, but not
likely lower than other choices available. Under the current procurement philosophy, staff would
buy the highest quality carrots at the lowest price, and this may not be the local food item. Council
may wish to re-examine the food procurement philosophy of Long Term Care and sanction
increased spending/budgets in this area in order to increase the amounts of local food procured. In
the meantime, staff will continue to buy local food when it represents the best total acquisition
value.
Food Preparation Labour Cost: While purchasing fresh (versus prepared) foods is generally
associated with improved quality, it would result in a substantial increase in labour hours for Food
Service Workers in Long Term Care. While serving fresh corn on the cob for our Residents or
serving fresh peaches or strawberries is obviously pleasurable and beneficial to Residents, it must
be recognized that it takes much more time to husk and prepare the corn, peel and slice the peaches
or hull the strawberries than to use canned or frozen produce that arguably has the same nutritional
content. Many of our Residents require specific textures of foods be provided just so they can
consume them, for example pureed corn or corn taken off the cob, as opposed to corn on the cob
that requires strong teeth to consume. Those foods now arrive in that processed form, ready for the
Resident to eat. This work would all have to be done by staff in advance of meal time if we decide
to buy only fresh produce. We need to balance food preparation from scratch (some foods cost less
as compared to processed foods, but are more labour intensive) with the purchase of prepared foods
(prepared foods cost more but are less labour intensive). Our current budgetary and operational
models are built on the latter formula, and changing this would involve a substantial cost benefit
analysis.
Procurement Labour Cost: As noted in Item HS 10-106 (June, 2010), the County holds a
competitive process on a regular basis and contracts with a large procurement services provider
specializing in all Long Term Care supplies including food. At this time that provider is Complete
Purchasing whose main food service provider is Sysco. Complete Purchasing and Sysco have
dozens of procurement and delivery staff working to manage hundreds of contracts for thousands of
procured items within that supply chain. That effort allows the County to have one Procurement
Professional oversee the Long Term Care food procurement process, which is managed day-to-day
by the Manager, Quality and Development for Long Term Care. Should the County decide to
procure food for over 500 Residents directly from multiple providers, we would be taking on
dozens of new vendors and contracts for hundreds of items, each with their own particular contract
issues to manage, most of which would not be reliable suppliers all year round and therefore
requiring us to manage multiple redundant contracts for each item or deal with Sysco when our
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local supply became out of season. When the large amount of procurement resources required to
procure food directly for Long Term Care are considered, it seems most logical to continue
pressuring our large suppliers to incorporate more Simcoe County local providers into their supply
chain, and gain the benefit of those changes through existing systems.
Summary:
Including more local and fresh food into our Long Term Care Homes’ meal planning will not only
benefit our Residents, it will also assist our community in building a sustainable food and
agriculture system. In order to increase the amount of local food included in Resident meal
planning, staff will continue to work with our existing suppliers to include more local sources of
supply into their offerings and to provide better identification of local foods in both their ordering
systems and reporting to the County. This will allow us to better monitor and increase our
procurement of local food procured, in particular Simcoe County local food, eventually being able
to measure and set quantitative targets in this regard.
The good news is that high level estimates suggest that 49% or $864,000 of the approximate $1.76
million Long Term Care spends on food with Complete Purchasing is comprised of local food, i.e.
food that is produced in Simcoe County or the Province of Ontario. Schedule 3 breaks this spend
down by category and product type.
To achieve our goal of supporting the Simcoe County Food and Agriculture Charter, staff will have
further discussions with our suppliers on the challenges described above, as well as opportunities
that may assist the County in moving forward with this initiative. Recognizing the increased needs
of our Residents, as well as the increased demands of Ministry regulations balanced by budget and
resource constraints, we need to find creative ways to use our resources effectively to safely meet
the food and nutrition needs of our Residents.
FINANCIAL ANALYSIS:
There are no financial implications to this Item.
SCHEDULES:
There following Schedules are attached and form part of this Item:
Schedule 1- Local Food Flyer
Schedule 1 - Local
Food Flyer.pdf
Schedule 2 – Identification of Local Foods by Sysco
Schedule 2 Identification of Local Foods by Sysco.pdf
Schedule 3 - Local Food Spend
Schedule 3 - Local
Food Spend Breakdown.pdf
April 10, 2012
PREPARED BY:
APPROVALS:
Human Services Committee HS 12-002
Page 8
Pat Miller, Manager, Quality and Development
Laurie Gaudet, Procurement Professional
Dawn Hipwell, Director, Procurement, Fleet and Property
Date:
Jane Sinclair, General Manager, Health and Emergency Services
Lealand Sibbick, Deputy Treasurer
Mark Aitken, Chief Administrative Officer
March 27, 2012
April 3, 2012
April 3, 2012