Key Words: Dietary Managers, Assisted Living, Long Term Care, Food Service, Food Quality
According to a review of literature, one of determinants of satisfaction for seniors in assisted or other long-term
care living arrangements is the quality of food and food service (Howells, 2007; Amarantos, Martinez, & Dwyer,
2001). Part of the determining factor of satisfaction is the management of any food service operation, including
preparation of food. This study examined the minimum qualifications of dietary managers in Illinois compared
with telephone interview responses from senior living telephone interviews. Results indicated that a majority
of participants were unaware of the qualifications for dietary managers in Illinois and very few participants
in the survey required qualifications beyond the minimum state requirements for dietary managers.
Howells (2007) suggested that “long term” is a generic term and is used in multiple ways to include
a number of living arrangements for seniors, including assisted living, independent living, continuing care retirement,
and even aging at home assisted by home health care arrangements. Specifically, assisted living facilities are
alternatives for seniors who need more assistance but do not need strict medical and nursing care. Food and nutrition
are important aspects of the “good life.” Palatable meals may also add security, meaning, and structure
to an elderly person’s day (Amarantos, Martinez, & Dwyer, 2001). Food quality has been identified as
a very important aspect for a positive mealtime experience, and research has shown that quality food and service
delivery greatly impacts health, happiness, and quality of life in long-term care residents (Howells, 2007).
Howells further stated that “food and foodservice experiences may have a greater impact on long-term care
residents compared with hospital patients because their stay is longer and mealtimes become part of their daily
lives.” Quality of life refers to “overall life satisfaction” (Amarantos, Martinez, & Dwyer,
2001). Residents of long-term care facilities have few food choices and mealtime alternatives. Dietary managers
play an important role in food choices and food delivery. A dietary manager’s role in long-term care is
to manage dietary operations by administrating menus, purchasing, and food preparation (Dietary Managers Association,
2009). Thus, dietary managers are an important determining factor in food quality served to residents. It is
logical to suggest that the quality of food served is related not only to the kind of food purchased but also
the skill of the dietary manager responsible for food preparation. The minimum qualification for dietary managers
in Illinois is an Illinois Food Service Sanitation License (Department of Public Health, 2010). The purpose of
this study is to compare the minimum Illinois requirements for dietary managers with the qualifications required
through foodservice contracts and employers of dietary managers in long-term care facilities.
Before beginning this study, we completed Collaborative Institutional Training Initiative (CITI)
to ensure ethical standards were upheld throughout our research. Our project outline to the Bradley University’s
Committee on the Use of Human Subjects in Research (CUHSR) was approved for our research. All potential study
participants were contacted via phone interviews using the following phone interview script:
Phone Survey Script
Hello my name is ___________. I am a senior dietetics student at Bradley University and am conducting a research
project with another senior dietetics student. The purpose of our study is to determine hiring qualifications
for dietary managers by Illinois companies who provide food service to senior living communities in Illinois.
We would appreciate any information you would be willing to share. Your company will not be identified in any
of our analysis as each company’s response will be coded. You can be assured your company will remain
anonymous throughout our study and in our final report. Original responses to this research will be destroyed
once our analysis is complete. This survey only has one question; we anticipate it should take no longer than
10 minutes for you to answer. Should you have questions about this research and its status with Bradley University
Institutional Review Board, please contact Dr. Nina Collins at 309-677-2433. We sincerely thank you for your
willingness to participate in our research.
Question: What are the minimum qualifications for dietary managers to manage long-term facilities that you currently
contract or manage?
A convenience sample of eighteen assisted living facilities, predominately from the Peoria, Illinois area were
contacted to collect information about contracted foodservice venders/suppliers used by Illinois long-term care
facilities during February and March 2010. The initial study group included 11 foodservice suppliers commonly
contracted by long-term care facilities in central Illinois. Of the 11 foodservice suppliers contacted, six agreed
to participate and completed the interview. The remaining five were either unavailable or unwilling to participate.
Due to low response rates, the study was expanded to include assisted living facilities that directly employed
dietary managers rather than using a contracted food service supplier. The second sample included ten assisted
living facilities in central Illinois. Of the ten assisted living facilities contacted, nine participated and
completed the interview. One did not respond.
Of the initial study group of contracted foodservice suppliers, six participated and completed the study interview.
Of those six foodservice suppliers, five (83.3%) did not know or did not contract with dietary managers. Only
one (16.7%) required additional training beyond the minimum state requirements. Out of the second sample group
of assisted living facilities, nine participated and completed the interview. Of the nine assisted living facilities,
zero (0%) required the minimum state requirements, four (44.4%) required additional training, and five (55.6%)
did not know or did not employee dietary managers. Results are presented in Table 1 and Figure 1.
Table 1. Study Participant Results
Food Service Suppliers
Assisted Living Facilities
Not known/ Do Not Contract/
Do Not Employ
Figure 1. Total Results Comparison
A majority of participants were unaware of the qualifications for dietary managers in Illinois. Less than half
the participants that supplied information required qualifications beyond the minimum state requirements for
dietary managers. Literature review suggests that additional requirements specifically addressing the food
preparation skill of dietary managers may indicate higher food quality served at facilities.
The minimum requirement for dietary managers in Illinois only addresses sanitation and says nothing about food
preparation skill. There were only five total responses that indicated requirements above the minimum state requirements.
Those responses included: “…must be able to cook from scratch”; “…must be a chef”, “…must
have one year experience in food preparation”.
Intuitively one would expect that the quality of food, including its overall palatability is linked to the skill
of dietary managers. Palatability is defined as “introspective evaluation of the hedonic (pleasurable)
qualities of food (Morley, 2001). According to Morley, highly palatable foods enhance food intake. Employers
that require food preparation skill above the minimum state requirements should have higher quality food that
is pleasantly presented to long-term care residents. Results from this small sample indicate that lower quality
of food may be served to residents in long-term care facilities because of lack of food preparation knowledge
and skills of the dietary managers employed.
Limitations of Study
The results in this study were based on convenience samples located in the Peoria, Illinois area. Results for
dietary manager qualifications are limited to central Illinois and may differ by region. The small sample size
may not accurately portray typical dietary manager qualifications. An additional study with larger sample size
should yield more accurate results. Also, studying dietary managers alone may not accurately depict the quality
of food commonly served to residents of long-term care facilities. The collaboration of other health professionals
within long-term care facilities may also affect foodservice and food quality. Sufficient numbers of well-trained
professionals are needed to assure quality food service (Crogan, Evans, Severtsen, & Shultz, 2004). Further
studies should include a larger sample of dietary managers from differing regions before definitive recommendations
could be made to contracted food service providers or to long-term care facilities.
Previous study results suggest that quality of life is linked to qualifications of dietary managers
in long-term care facilities (Crogan, Evans, Severtsen, & Shultz, 2004). Additional requirements for the
employee primarily responsible for food service should lead to higher food quality satisfaction of senior level
residents. These results indicate that few dietary managers are required to have additional training beyond the
minimum state requirements. These findings may be associated with lower food quality in long-term care facilities
and perhaps an overall lower quality of life for their residents.
Amarantos, E., Martinez, A., & Dwyer, J. (2001). Nutrition and quality of life in older adults. Journals
of Gerontology, 56A, 54-64.
Crogan, N. L., Evans, B., Severtsen, B., & Shultz, J.A. (2004). Improving nursing home food service uncovering
the meaning of food through residents' stories. Journal of Gerontological Nursing, 29-36.
Department of Public Health, Long-Term Care Facilities. Food Service (Section 295.8000).
Public Health Retrieved March 30, 2010, from
Dietary Managers Association. (2009). Cdm, cfpp credential. Retrieved from http://www.dmaonline.org/About/CDM_CFPP_credential.shtml
Howells, A. D. (2007). The Impact of perceived quality on assisted living residents’ satisfaction
with dining experience (Master’s Thesis, Kansas State University).
Morley, J. E. (2001). Decreased food intake with aging. Journal of Gerontology, 56A, 81-88.