This article is sponsored by US Foods. This article is based on a Senior Housing News discussion with Rob W Burkart, VP, National Sales Field Ops at US Foods and Sean Rowe, CEO & President at Mealsuite. The discussion took place on June 6, 2023 during SHN DISHED/WELLNESS Conference. The article below has been edited for length and clarity.

Senior Housing News: Let’s start with a buzzword that I have been hearing. It’s something that I think people have been experimenting with on their own. How do you see ChatGPT impacting the senior living industry as it relates to dining, if at all?

Sean Rowe: Put your hand up if you’ve ever used ChatGPT. Can you imagine that I opened it up 30 seconds ago and I asked it to design me my Menu for the entire week at home. I specifically said I wanted healthy, easy-to-make options. It came back with great options that include grilled chicken, vegetables, stir-fries, omelets. I just wrote back, “That’s great. Make it vegetarian.” It took every one of those and then in 30 seconds made it vegetarian. Then it gave me my grocery list, which is even more incredible.

Would you believe that I just wrote to it, “Take that same menu and make it easy level three compliant and write the recipes.” It came back and just completely gave me that in about 30 seconds. This technology is going to entirely change how we design menus. It’s going to entirely change the way that we are compliant. You can now actually feed state regulations into ChatGPT. It will learn the regulations for each state that you operate in, and you can tell it, write me a menu that is less than $7 a day that is compliant in the state of Illinois, targeted for this particular Resident base that uses fresh ingredients. While it’s not entirely perfect yet, I think within the next several years we’re going to be there. Then you can take that same menu and say, “Translate it to Italian, and Spanish.” It’ll put that out in another couple minutes. Just imagine the time that is saved. I think we are truly at a pivotal time in this space to entirely transform how we operate.

SHN: Sean, I think you’re using ChatGPT in a better way than I am. I’m just basically asking them to write silly stories for my nephew. [chuckles] That’s a better use case. What are some of your most innovative customers prioritizing when it comes to implementing technology in their dining? What are some cool things that you see out there?

Rowe: I think what we’re starting to see now is operators seeing this incoming wave of technology, of artificial intelligence, of the benefits of if you can get a single unified view of your data, it allows you to capitalize on this. What that means is you can’t have segregated systems. If you’re building your menu in one system and then you’re costing your recipes in another, and then you’ve got your point of sale system that doesn’t speak to your property management and your billing systems, which doesn’t speak back to the residents.

You’ve got all these isolated data sets that you won’t be able to leverage as these technologies become easier to pull into the picture. Then they’re also bringing in different service tools, self-service tools, and other things to ultimately make it easier for the resident, make it easier for the staff members just to bring efficiencies to the mix.

SHN: Rob, how do you see these new technological innovations changing the way that operators purchase Food and the relationship between the customer and the distributor?

Rob Burkart: As Sean mentioned, the technology is advancing very quickly. I think what’s really critical is that integrations of the data are going to be the foundation to making these programs successful in the future. If you think about all the data that goes between a customer, a distributor, a third-party provider, it’s important that these talk to each other, as Sean mentioned, in order to get the maximum value. Then just think of the applications of AI and machine learning across that integrated data set. It’s really exciting what we could see coming in the future.

At our organization we’re really focused on helping customers take out the redundant tasks of their operation and reducing those mundane tasks. There’s a couple examples. We’ve implemented our Master List Management with Auto Substitution process that allows customers to select their ingredients, identify pre-approved subs to those products based on nutrients, allergens, and cost, and then we’ll automatically substitute the product if the original item isn’t ordered. Again, that’s a time-saving opportunity for the operator.

Integrating with Blueprint 360 (powered by Meal Suite). The typical online order process can take 35 to 45 minutes of ordering your groceries. With this integration, we can now do that in five to 10 minutes.

If the average operator places 52 or 104 orders a year, that time savings can be redirected back into other parts of the resident care setting. Then lastly, we’ve got a new tool that we’re excited about that just came out in February of this year, which is Trendview 360, which looks at the financial diagnostics of the operation, provides a daily dashboard to how you’re performing, then analyzes with algorithms whether or not your changes in performance from one community to the next are driven by price census or volume metrics. We firmly believe that AI and machine learning are going to fold on top of this to really provide great insights for operators to improve their outcomes and their results.

SHN: Sean, what do you see as the biggest barriers to fully realizing the benefits of machine learning and upcoming evolutions in technology?

Rowe: The first thing will be the lack of interconnected data. We did a survey, we called 1,000 senior living operators and we were just curious to what was going on in the space. We asked three questions, what’s your biggest pain point right now? We asked how hard was it to stay on budget? Then we also asked, what do you do for menu planning? 55% of those that we talked to said that they still build an Excel document, they build their recipes on paper, they then go to their distributor, they grab the pricing, they calculate the cost for that recipe, then they calculate the cost for the menu, and then from that they build their grocery list and that’s the six-month window.

The issue is, with today’s economy, we’ve heard multiple people say about just product availability, cost fluctuation. Five years ago, you could build a menu and the cost might go up 7% over a six-month period. Now if you’re not looking at every category almost every day, we know that it can fluctuate so much that it’s too late by the time you identify it. We need to get the foundation in place first for all these technologies to layer on top of that data. Because if you don’t have the base menu, you don’t have the base recipes, you don’t have the base resident, all that data flowing in, machine learning, ChatGPT, it’s not going to help you because there’s nothing to act on.

SHN: What changes are you seeing from customers related to menus and dining trends?

Burkart: I think some of the topics discussed earlier today touched on some of this, but you think about Generation Z and the millennials and they’re very much known as being more socially aware and socially conscious. We’re actually seeing that our senior living customers are also finding a great need to provide sustainable and local product offerings for their residents. US Foods we are very successful with two programs, “Hungry for Better” and “Serve Good”, which are platforms offering thousands of products that offer clean ingredient decks and are responsibly sourced.

We’re seeing that that is a big trend and seeing a lot of increase in utilization in that space. As we know, food is and always will be the stalwart that drives resident satisfaction. It has a big impact whether satisfaction’s high or not as high in a specific community. We think that the movement to hospitality-focused menus is really the next trend. That resort-style living, wanting that lifestyle experience that was mentioned in a number of the conversations earlier today, is very important. We’re also seeing just the life expectancy trends that I really find interesting.

If you think about back in 1960, the average age of Americans was 69 years of age. In 2020, that number has extended to 79 years. The projections are that by 2040, that number will be 82 years and by 2100, the average life expectancy is to be 89 years. We’re living longer, we’re living healthier lives, we’re looking for more fulfillment in our lives. I think one of the other trends, which is touched on in some of the other discussions, is lifestyle and wellness being ever more important for residents and what they’re looking for in the communities in which they want to have care given.

SHN: Rob, how do you measure the ROI of integrated systems? Is it in time savings or are there other benefits?

Burkart: We’ve actually built an ROI calculator for customers to identify what are the cost savings, where’s the impact going to be on budget, better buying practices that Sean could talk of in his platform, and how it will automatically analyze the items that you’re purchasing, identify the lowest cost product to fit that recipe with the nutritionals and the allergens factored into that decision.

You’re having real-time product decision-making to maximize your budget as opposed to set and forget which are on the shopping list and then it’s a manual process to review, which is happening in many cases today. We’re also going in and looking at the actual labor. How much time is it taking to go from the EMR system and double-enter the data into your menu system or your resident application? There’s time savings there that may not pull a car out of the parking lot in your operation, but those hours could be redeployed to other elements in the food service department.

SHN: Sean, I wanted to ask you, obviously we know that tech for dining solutions aren’t free. Tech investment, and investments as we know, are not always easy to sell to upper leadership. How does an operator need to position the costs of this tech and how can they best sell this to those people who might hold the checkbook for some of this stuff?

Rowe: It’s so interesting how on the care side when it comes to things like training, you say somebody needs 20 hours of training and they don’t even blink. Someone will write the check, no problem. You have a new dining manager come in, they need training on a system. No, there’s no budget for it. We see that all the time everywhere and I see a bunch of you nodding so you felt that pain too. I think dining’s been something that’s always worked. It’s always been there. It’s been this necessary evil. We’ve had clients that propose a $ 200-a-month menu system to automate and save 20 hours of that manager’s time and it gets turned down.

Meanwhile, you look at the cost of what food is, you look at that line item, you look at the staffing and labor associated with it, it’s mind-boggling how sometimes that executive leadership looks at it and just says, “No, you don’t need anymore.” My recommendation is always first look at where you can generate revenue because it’s much easier to generate revenue to cover costs to a system versus where it is to try to show savings because when you have to show savings, you have to build that business case, you’re speaking to that executive that may not necessarily see it. It takes months and months of work.

If you can put in a system, you put in any great point of sales system here and you can generate revenue because now the first glass of wine is free but the second one’s $6. If it’s automated and integrated back to your billing property management system. You don’t add that additional work for accounting and they’ll accept that work and they’ll add that $6 charge. If it’s easy for staff to do it, where they’re not having to run to the front desk to grab a credit card machine to charge for a guest meal and they can do it on the spot, it’s not an inconvenience for them anymore.

Generally, when you put in these tech solutions, look for the revenue opportunity, because we’ve seen a lot of clients and I’ve seen so many case studies from so many great point-of-sale vendors in the room on how they’ve been able to help that community ramp up that revenue to 10X the return on that system. Now they don’t have to beg for the money, they turn into a revenue center and then you get to look like a rockstar because the system then helps you with the food cost savings.

It helps you with efficiency. If it’s integrated back to the medical record system or the property management, there’s 10 hours of a manager’s time manually putting it back and forth, the finance team, whatever else. Try revenue first. If that doesn’t work, you can always go to the savings but it’s a heck of a lot more work.

SHN: Rob, do you have any insights on why so many senior levering operators don’t have things like digital menu management solutions?

Burkart: I think Sean’s research said that 55% of the units are not using menu systems today. To the point, maybe historically, the price volatility in the market and the supply chain issues didn’t necessitate one, and the paper binder process was working just fine. As the challenges of labor staffing, cost management, and resident satisfaction continue to be more prevalent, we’re seeing more and more customers seeking out access to these digital type platforms and these end-to-end solutions. As groups start to grow and scale as well, we’ve got clients coming to us saying, “We were 50 units and now we’re 100 units, we need a system to help us manage that growth and manage that scalability of our business.” We’re seeing an explosion there in the marketplace.

I think the reason that these systems aren’t more prevalent today is that they’ve been viewed as being cumbersome to implement. To Sean’s point, they’re not fully integrated. You’re implementing pieces of a system and having to stitch them together to get the operation to implement the way you want it to, and that requires a lot of change management. One of the things that we’ve actually done within my team is we’ve redeployed our menu specialists specifically to be focused on the implementation of this end-to-end type platform system moving forward.

SHN: Rob, what do you see as best practices in menu design? They give some examples such as timeframe, structure, selection of items, etc.

Burkart: What we’ve done in our business is we have a menu team that’s built a number of template menus. We have 10 dieticians that work and support this effort. They’ve designed various style menus for different levels of care settings. Then we’ve built those into the MealSuite platform in terms of the products required, the shopping lists that are needed, the products that are stocked in our various distribution centers. That work has really been taken upon our groups shoulders to help make it easier for customers to move forward with a menu application.

SHN: Sean, do you have any thoughts about best practices in menu design?

Rowe: Caitlin had a quote earlier, what was it? “One size fits one?”

SHN: Yes.

Rowe: I really like that. That’s the reality I can say with everybody we work with in this space. I don’t know if there is necessarily a best practice. It’s whatever the best practice is for you, the residents you’re serving at that community to try to standardize it across the board. Every community is different in terms of the population who you’ve got there, what they enjoy, the team, the community that you’re in, and the hiring pool you have available, what the kitchen looks like, the resources that are available to it. I think at the end of the day, it’s really just building a menu that you’re proud of and that is going to work for the back of the house and the front of the house.

SHN: Another question along these lines, and this is a question that I have chatted with many folks about. What’s the latest technology that restaurants and food service operators are using that senior living operators should be looking at now? Do you have any ideas?

Rowe: Self-Service. We have so many clients deploying self-service right now. Entirely changing, and there were several people on the last panel talking about changing their venues to turn them into different layouts and different styles at different times. The concept of grab and go, being able to walk up to a device, tap on it, tap a badge, grab items out of the fridge, take it to my suite, or the ideas of even reconfiguring venues to change for staffing. AX Retirement is doing a really cool initiative where they’re renovating a whole bunch of their communities. What they’ve done is they’ve actually gone to a situation where it’s self-ordering, very similar to fast foods or at the airport, for example.

They’ve actually retrofitted all dining venues. They’ve put touchscreens on different walls and what they have is a resident committee. The resident committee is volunteers that train other residents on their first interaction with these devices. The resident walks up, they tap or fob into it, and the menus are dynamic, they choose from the touchscreen of what they want, and then they put a basket of table toppers and the table toppers just have number 1, number 2, etc. The kiosks ask, “What’s your table topper?” They say it’s number 12, and then they can choose, “Do I bill it to my room or do I pay with a credit card?”

Then they always have at least one cashier, but these venues typically had three or four cashiers. They’ve dropped down to one and that one is just doing cash transactions and they’re the concierge if someone gets stuck. Then from there, what they’re doing is now they’ve got one runner in the kitchen that’s bringing food out and one concierge. They’ve reduced down at a minimum two staff, if not three, and the residents are really enjoying that. Now their next stage is actually going to apps and they’re on portals where they’re then integrating it in so they can order on the fly anytime and get rid of the kiosks in the future. That’s been the biggest trend we’ve seen recently.

Burkart: If I could react to that. If you think about some of the metrics, in 2010, there were 10 million people in this country over the age of 80. At that time there were 17 work-age folks between 20 and 64 for every one of those seniors over the age of 80. Today, that ratio is now 10 to one. In 17 years, by 2040, the number of available work age folks, aged 20 to 64 will be seven to one (7 to 1) because there’ll be 28 million Americans aged 80 and above. We think we have a labor staffing concern now, it’s only going to continue to accelerate when you think about 40% fewer workers in 2040 versus what we had in 2010.

Automating the process, self-service, kiosks, it’s all going to be coming very rapidly to us and it’s going to be a tidal wave of change that we’re going to have to go through in order to accommodate feeding these residents.

SHN: Absolutely. As the boomers bring their preferences with them, I’m assuming they’ll want more and more of this stuff as well. Can you offer benchmarking of performance of communities based on my purchase?

Burkart: Yes, we can. Our TrendView 360 tool allows you to track all of your communities against one another on a daily basis. You have a daily dashboard to see how they’re performing on a PRD basis and then again, what’s causing one to have a variance and then we’ll bring our specialists in. If someone’s having a challenge and certain communities are getting out of scope or not performing as you expected, it will bring some other value-added tools to the table to help get them back in line towards your targeted benchmarks.

SHN: Great. Does your menu system have a family portal? Can you talk a little bit about what people can do in that?

Rowe: Yes and I know a whole bunch of the point of sale systems here do, so I’ll speak to our capability. It’s very similar to what a lot of different groups are doing now and it’s just that demand has come and I think it actually plays on Rob’s comment about as we’re going into the next several years, the dependency ratio has switched. We’re approaching the point where we as individuals in that middle bracket have more people dependent on us because we’ve got the parents and then we’ve got the kids.

That middle layer is looking for efficiencies and they’re looking for ways to make it quicker to absorb information and get it immediately. The idea of having to call to check on something, the idea of having to, for example, go in on a Thursday to look at the menu, those efficiencies are where families are looking to gain. Generally, what you’ll see in family portals are things like access to menus. You’ll see access to what the resident actually ordered. For example, one of the most common complaints that food service managers get is they get a call from a family member saying, “My mom says you’ve been serving the same meatloaf every night this week. How dare you offer that to her?”

Which we know is not the reality of the situation. When they look in the portal, they see mom actually had steak on Monday and she had pasta on Tuesday and fish on Wednesday. Generally, these portals will give visibility into ordering history. If you’re dealing with meal plans, they’ll usually give visibility into what’s the burn down ratio. You can see mom ordered three bottles of wine on Tuesday, so she’s going to be out of meals by Thursday, which is actually a shockingly common thing you see too. In addition to that, they can often help actually place orders for those family members if there’s a memory care situation or just they’re looking for support so they can write within those family portals, actually make the order for next Tuesday, for example, if there’s advanced ordering in place.

SHN: With today’s supply chain challenges, how can technology help with the constant battle of the right food not showing up for your menu that day or the next day?

Burkart: I’ll start and then Sean may have something to add. I’d mentioned our

Master List Management tool earlier, it is an integrated system that actually allows the operator to see their menu, identifies products that are going to be problematic, that are on their shopping list and can actually go out to the next three POS that we have in our system to replenish that product. It’s an early alert warning system to let the operator know ahead of time, is there going to be a problem with this item on my menu? Do we need to make a proactive change as opposed to the truck that showed up, it’s not here and now I have to react.

SHN: Yes.

Rowe: From a technology standpoint, we’ve been working for several years on trying to solve this issue and the way that we’re doing it now is and I think all the vendors in this room are now working closer than ever together. If you look five, 10 years ago, the idea of integrated pricing lists and integrated systems where data would flow from one medical record system to the menu system or whatever it is, was very few far in between. I think it’s become mandatory for all vendors now to step up to the plate and start sharing data and stop trying to own the entire piece of the operation. We’ve seen that as just a general trend.

I know from a lot of the CIOs that we talk to, they’re mandating that as a part of their procurement process is making sure that their vendors have APIs and they’re willing to interchange data. The reason that that’s important is because as we interchange this data, we can make systems smarter. For example, we’ve got great integrations with all the broad line distributors for pricing data with several of them. We now have live inventory data. We know at US Foods when a customer’s building their shopping cart for their drop on Thursday, we can analyze that distribution center and say, “Yes, your preferred product is not in stock, however the alternative pack size is.”

For example, “There is an alternative two pound fresh chicken breast that meets our buying preferences that is on my GPO contract and it has the nutritionals and the allergen preferences that I’m looking for.” As we start to intertwine all this data that’s going to make these machine learning things, these algorithms and these processes even smarter to empower teams.

SHN: How do you use technology efficiencies as a selling point when trying to draw new residents?

Rowe: There’s so many people in this room that can answer this better than I can because they do such a successful job marketing it. I think it comes back to a lot of the talks around the dining experience and the fact that residents and family members are looking for that as one of their top priorities. It’s that thing that you do three times a day consistently and things like digital menu boards, things like, for example, the fact that there’s a point of sale in place so that it makes it a great experience for that resident so people aren’t running around crazy and it’s a personalized experience.

The fact that a lot of the point of sales will filter out things like allergens and they can help build nutritional profiles for that resident, that is truly a marketing differential. That is a personalized concierge, to some degree. I do see a lot of operators going to now having digital menu websites where it’s always live and it’s great for the family member to interact with it and see that as a part of their marketing. I will say, when you build those menus, if your menu website isn’t as delicious as the food when you read it, if your mouth doesn’t water, you’re doing a poor job selling your food and dining program.

SHN: That’s a good point.

Burkart: I would add to that, Sean, then the other benefit, you may not be marketing to future residents but is vitally important is that’s the back of the house efficiencies that these tools can bring. This is about the labor crunch that we just mentioned and bringing new hires into your kitchen and the fact that these systems can push the recipes right to the kitchen display system, right to the area where the salad prep person or the grill person’s doing their work with the recipe lined out step-by-step with the image and how it should be plated, allows maybe a less talented staff member to come in and still do a great job to provide a really quality consistent meal.

US Foods^® is one of America’s great food companies and a leading foodservice distributor, partnering with approximately 300,000 restaurants and foodservice operators to help their businesses succeed. With nearly 28,000 employees and more than 70 locations, we provide our customers with a broad and innovative food offering and a comprehensive suite of e-commerce, technology, and business solutions.To learn more, visit: https://www.usfoods.com/.

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