Food is important for everybody. Food is nourishment, but it’s so much more. Food is about celebration. Food is about tradition, culture. Food is love,” says Sarah Gorham.
Together with fellow chef Stone Morris, Sarah founded Grind Dining, a food-service consultancy firm, to restore dignity and the enjoyment of food for individuals who have cognitive, neuromuscular, and chewing disorders.
I interviewed Sarah about her work, and she shared her insight into how shifting the dining experience in memory care and skilled nursing enhances residents’ function, independence, and quality of life. “Food affects a person’s mindset and emotional well-being,” she said. “With the right adjustments, residents can eat more, be healthier, and feel satisfied.”

What is Grind Dining?

Grind Dining is a dining solution and program that Stone and I designed for individuals with cognitive or physical limitations who can no longer use utensils to eat. With the Grind Dining Solution, we’ll take the cooked protein, carbohydrate, and vegetable that’s on the regular menu in senior living, grind it, and present it in bite-sized portions that can be easily eaten with fingers.
This provides a nutritious, appetizing solution to the “finger foods” approach that usually involves a lot of fried options. Our solution assists the resident in the sense that they aren’t marginalized because they have cognitive or physical limitations. They’re the same as everyone else in the dining room. Our food is the same food presented and prepared differently, but it’s the same food. It’s all about inclusion.
Then we have a dining program that really engages memory care residents. Engages their senses in terms of aromatherapy, the smell of the room, the feel of a warm washcloth. The taste sensations, the feel, the look of the table, the tablecloth, those sorts of things.
So it’s a whole program and dining solution. We provide training at the communities on the Grind Dining technique and service standards. We also provide management tools to help support the dining initiative to make it a sustainable program. The idea is for residents to be able to eat on their own—to create that independence for them.

What inspired you to create this new way of preparing food for people with physical or cognitive challenges?
We were contracted in early 2013 by the Arbor Company to develop a dining program for their memory care communities. They really found memory care dining to be an area that was under-served and they wanted to provide better nutritional variety and meet all the needs of all the residents regardless of where the residents were at.
This is where the VP of Operations said “We really want to concentrate on finger foods.”
Stone and I think of finger foods as you would in catering, as hors d'oeuvres. So we went out and researched and put all these things together and Stone developed a list of 100 different foods we can do. And during this, she got the inspiration. What really triggered it was the memory of her great-grandmother on Friday evenings preparing for the Sabbath. Getting a fish, putting it in their bathtub, and then preparing gefilte fish from that.
What that is is poached, ground fish that you can pick up with your fingers, and it’s very soft—that was the inspiration. So Stone went out and got an electric meat grinder attachment, three chickens, some vegetables and rice, and we went to work and prepared a buffet table of foods. The VP of Operations said, “You know, you have something. Let’s go with this.” And that was the green light. That’s where we developed the program to combine nutritional proteins, carbohydrates, and vegetables into bites that give people a dining experience that promotes independence, dignity, and accessibility.
That leads to the name of your blog, the Eating With IDA Blog. Can you explain the significance of the acronym for each of you?
The idea of IDA is what we do: provide a dining experience that promotes independence, dignity, and accessibility. For me, my grandmother’s name was Ida. She was very influential in my life. Very much—I remember how she baked. She was German and she baked breads. I really have to attribute some of my desire to be a cook or a chef—I'm not a baker, but a cook or a chef—to the memories I have of being with my grandmother in the kitchen.
For Stone, she had an aunt named Ida, who was cognitively challenged. And that period of time in the late 60s, early 70s was such a different time and experience for individuals with cognitive challenges.
For both of us, these things make us speak from our hearts when it comes to what we do. The grinder on our website’s homepage belonged to my mother, who later in her life lived with dementia.
What impact do you think food, inclusion, and independence have on people’s physical and emotional health? 
Food is important for everybody. In senior living, dining programs are very important.
Organizations see that this can be a point of distinction for them. And when you really get down to it, for the residents, it’s about quality of life. The residents live there, they have three meals a day, seven days a week, and they look forward to that.
When someone starts losing their independence, that’s where they start feeling like they’re in their second childhood. They start getting depressed. They think of things that they did and they can no longer do. That’s where our program brings opportunity, impact, and change for residents. That’s where it all ties in. Food is nourishment, but it’s so much more. Food is about celebration. Food is about tradition, culture. Food is love. So really being able to provide a quality dining program will engage a resident and give them a better quality of life.
With baby boomers aging (and rising conditions such as early-onset dementia), do you see a trend in facilities needing to adapt to different tastes and standards? 
I think more companies are looking at this seriously. Baby boomers are what they’re calling the “silver tsunami.” It’s going to happen, it’s going to come real quick, and we better be prepared.
I’m a baby boomer myself. We have different expectations, and the industry is trying to shift and find “How can we provide for this market when it comes and it hits hard?”


That’s where we’re looking at baby boomers as far as fewer processed foods, fewer additives. More organic, fresh, quality ingredients. Those are the expectations because that’s the lifestyle. That’s who you are as a baby boomer. That’s what you want. You don't want a frozen patty out of the freezer. So the industry is shifting in that direction. Using local, seasonal ingredients—there’s just such a great health benefit from that.
Right—in some facilities, there’s a big difference between what dementia care was like 20 years ago and what it’s like now. I've seen facilities, too, that have their own gardenstomatoes, herbs, etc.
Right. They have gardens and herbs for the chef, and that creates activities for the residents too, to be out there gardening.
We have a client that’s set up with fresh, quality ingredients—fresh produce, fresh poultry, fish, meats—everything is made from scratch. They make their own stocks. They have a pastry chef. Just outstanding. But that’s still the exception, not the rule. The industry has come a long way and it’s shifting, but there’s still a gap within memory care and skilled nursing.
That’s where we can really help provide for that specific, unique, and complex group of individuals or residents. That’s where we partner with forward-thinking organizations that really see this as an area that needs to change. It’s a matter of really looking at it and saying “How can we improve the quality of dining and get the resident engaged and get better resident intake during meals?”
Mealtime, quite frankly, is often an extremely stressful time. It’s tough. The caregivers wheel the residents down and get them set and help feed them and things of that nature. Again, with our program, we want to help eliminate that. Eliminate that whole feel. When you go into the dining room with Grind Dining, it feels good. There’s less caregiver assistance needed, so the caregivers are able to be relieved of that stress and better able to concentrate on individuals who need help, rather than on helping so many.
So with that gap that you mentioned, I imagine that some of that has to do with budget. Are there ways that facilities can balance budget constraints with the benefits of fresh, high-quality foods?
Metrics are important. How do you balance this? I think a lot of it really has to do with finding a good leader in your kitchen, a chef, dining director, and a good team—and training that team. By doing that, you can save money. Or balance it out as far as having someone being able to cook from scratch rather than taking out the frozen, pre-packaged items.
If you get to having a leader in the kitchen and training staff and having them be part of the solution, I think you have a very good opportunity of really shifting. Then again, it’s about the mindset of the organizations as far as planning for this. So it’s really about combining talent and resources to make a whole, successful transition.
You talked a little before about how Grind Dining can really help take the stress out of mealtime. Can you tell us more about how it can help OTs, caregivers, nurses, chefs, kitchen staff, administrators, etc.?
Occupational therapists or speech therapists are used to assessing a person and seeing well, the resident can’t swallow. They can’t chew. They can’t use utensils. So the go-to diet is puree. Grind Dining is not a puree program.
This is where Grind Dining offers therapists and others another option or bridge before putting someone on a puree diet, because we really look at puree as being the last stage of dining. Puree is important and it serves a need. But it’s difficult for a resident to be on a puree diet. It’s difficult for the caregivers to spoon-feed, and it’s difficult for families to see their loved ones being spoon-fed.
We can bridge some of those residents who were on puree, bridge them to Grind Dining foods. Again, it’s easy to chew. You can pick it up with your fingers and it’s an option for those who make the decision of putting a resident on puree.

For caregivers and nurses, this is where with every community we’ve gone in to, we’re able to relieve caregivers at mealtime because the residents can eat more independently. When we rolled this out in our first community, it was breakfast on the second day. One of the caregivers came back at 8:30 in the morning and said “Chef?” I said “Yeah?” She said “They’re eating on their own—thank you,” and she gave us a big hug.
It just creates less of a stressful environment.
The kitchen and the chefs—they want the residents to be able to eat and enjoy their meals. With our program, you don’t have to cut your food up into little individual strips and put them in a bowl with some gravy. Our food is ground, but it’s presented neatly and nicely. The chefs can take a lot of pride in what they’re doing. And they can put their own stamp on these menu items.
Administrators see that this is an opportunity. They’re providing quality of life for individuals and it’s a win-win. The family members see this. You have resident satisfaction. They’re eating more. It’s healthier.
For family members, they say that there is a difference here and they appreciate it. Their loved one feels satisfaction, so they feel satisfaction.
Can you give an example of how the Grind Dining method changed things for a resident?
Recently we went into a facility and did Grind Dining in memory care, and in skilled nursing as well. There was a gentleman there who loves to eat, but he struggled every day. He ate less. Because it was such a struggle for him, mealtime wasn’t an occasion as it should be.
When we came in, it was instant. We had the social worker of the community there to observe as well because he knew the residents and how they ate and how they struggled with things like that. He said “Mr. B. ate his whole meal.” You could just tell that the gentleman was happy. It was different. He ate. He could socialize because he wasn’t struggling.
What do you hope to see change for people who have dementia?

I’m glad to see that there’s more awareness out there as a whole. We want to see more of that not just within health care, but across the board. Through awareness and education, there’s less of a stigma for individuals with Alzheimer’s or dementia. So if you see someone, say, in the grocery store and they’re acting in this way, you understand what it is and you’re respectful.
We also need to focus on the abilities people have rather than on what they’ve lost. Desegregating them from separate rooms is important too—similar to a dementia village, if you know that concept in Holland. We need to really do design that’s very specific in knowing the needs of dementia. Open floor plans. More dementia-friendly, supportive environments.
What you hope to see change for families and professionals who care for people who have dementia?
A couple weeks ago, I read a book called Slow Dancing With a Stranger. What that author has done over the past 20 years as far as being the caregiver for her husband and for her 81-year-old mother is incredible. Her whole thing is advocacy and change and a culture shift within society, and also research for Alzheimer’s.
For families, the caregivers, it’s just an exhausting process. I want them to have the support needed to be able to better care for their loved ones. And themselves. Training, support groups. There are even memory care cafés out there now where caregivers can go with their loved ones and be able to have a break in the action.
For professionals, the same thing. More tools in place and training to be able to accommodate the unique needs of these residents and to provide them a better quality of life with that condition.
Residents with dementia can’t speak for themselves. They don't have a Michael J. Fox bringing awareness to the public. So families, caregivers—we all need to be advocates.
Follow Grind Dining on Facebook and Twitter, and connect with Sarah and Stone on LinkedIn.