Contract Catering: Addressing the problem of malnutrition in care homes

25 April 2007
Contract Catering: Addressing the problem of malnutrition in care homes

As the nation gets older, it's more important than ever for the Government, local authorities and nutritionalists to address the serious problem ofmalnutrition in care homes. Janet Harmer reports

It's a sad fact that a proportion of the elderly who enter care homes every year are suffering from malnutrition. Then, once in the care home system, there is a lack of co-ordinated guidelines to help them eat well - a situation not helped by the fact that many of these older people have physical or mental ailments.

The problem is compounded by the fact that there are no national training standards when it comes to catering for the elderly, making it difficult to ensure that all staff understand the importance of good nutrition and hydration.

It might be overlooked, for instance, that as residents become frailer, their nutritional requirements increase at the same time as their appetites decrease. Hydration is equally important, highlighted by research carried out at a care home in East Anglia by Anglia Water. Its findings show that the installation of mains-fed water coolers has contributed to a reduction in falls among residents of more than 50%.

The announcement that the Government has launched a national action plan to tackle the issue of older people and nutrition has, therefore, been welcomed by leading charities for the elderly, nutrition experts and care home representatives.

Health Minister Ivan Lewis told a nutrition summit attended by all the above interested parties in March: "In my view, there is no excuse for vulnerable, older people not receiving the food they require and the necessary help to eat that food."

An action plan, incorporating nutritional standards, will be drawn up for publication in July. Further consultations will then take place before any recommendations are finalised.

"The summit was an excellent opportunity for all stakeholders to discuss the issues surrounding older people and nutrition," says Sue Hawkins, chairman of the National Association of Care Catering (NACC). "The Government has got to get the care, food, training and environment right for the elderly, and everyone involved needs to work together to achieve this."

As an organisation representing more than 500 caterers working in the care sector, the NACC hopes the action plan will increase public awareness of malnutrition among older people and include assessment of malnutrition within the community, nutritional guidelines relevant to care homes, and mandatory training for all personnel on good nutrition, hydration, identifying malnutrition and encouraging and assisting older people to eat well.

It is not that there is a shortage of advice for care homes. What is lacking, though, is a clear consensus between the different bodies handing out guidance on nutrition.

As well as the national minimum standards produced by the Department of Health, the Food Standards Agency (FSA) has a set of nutritional guidelines for care homes. However, the NACC, says the latter are not suitable for older people in care, claiming that "the FSA's standards are written for a healthy 75-year-old and rarely are such healthy people found in care."

The NACC had recently published its own advice on how to meet the nutritional needs of adults in care through a new manual - Menu Planning and Special Diets for Care Homes. Its aim is to exceed the national minimum standards by providing nutritional and wholesome solutions to common menu-planning problems and special dietary requirements.

Many individual homes and groups of homes do go above and beyond the national minimum standards, including both Barchester Healthcare and BUPA Care Homes (see panels).

However, catering can be challenging for small private homes or those run by local authorities where budgets are restricted. With more than 30 residents, economies of scale kick in, and the budgets go further.

Daily food allowances for residents vary considerably between care providers, with some basing their allowances on the recommendations made by the Caroline Walker Trust (CWT) in its 2004 report, Eating Well for Older People, or the guidance published last year in the Commission for Social Care Inspection's (CSCI) In Focus Report Highlight of the Day. The CWT suggested a figure of £18 per head per week, which equates to £19.09 today, while the CSCI's figure is £17.01 per person per week.

Dr Helen Crawley, science director for the CWT, explains that there are numerous factors that need to be considered when catering for older people. As well as adhering to minimum nutritional standards, she says, it is important to encourage activity among the elderly and encourage lunch clubs, ensure dental health checks and vitamin D levels are adequate, and have properly trained staff.

"The challenge is to ensure that all of these are included in a joined-up policy and that care is person-centred, so that the needs of the older person take priority over the structure set up to manage the issue," she says.

With a rapid growth in the older population of the UK - the percentage of people aged 65 and over is predicted to increase from 16% in 2002 to 23% in 2031 - the problem of malnourished old people in care homes is set to rise. The Government's pledge to formulate a co-ordinated policy to tackle the issue is, hopefully, the first step towards eradicating this appalling situation.

|National meals on wheels week

The event will take place on 1-7 October with the Mayors for Meals Day taking place on 3 October.

The meals on wheels service is celebrating 60 years of operation, having been started by the WVS (now WRVS) in Welwyn Garden City back in 1947. It now serves more than 40 million meals a year to about 200,000 recipients.

More information from the NACC on 0870 748 0180.

Care homes- the numbers

A total of 18,704 care homes in England provide accommodation for 441,067 adults - the vast majority of whom are over the age of 65. Of this number, 4,044 are classified as nursing homes, where the staff include qualified nurses.

The rest are classified as personal care homes and do not generally offer full-time nursing care. The majority of homes - 13,424 - are privately operated.

Source: State of Social Care in England, 2005-06, published by the Commission for Social Care Inspection

Barchester healthcare

Barchester looks after about 10,000 residents living in 166 care homes.

The fundamental aim of Barchester Healthcare is to provide good, highly nutritious food, served beautifully.

"We want our residents to look forward to enjoyable mealtimes, however meagre their appetites," says Terry Tucker, Barchester's director of learning, development and hospitality. "To this end we cook a variety of different and top-quality local foods, while all the time considering the needs of the individual. So, for instance, we serve food little and often to those people with small appetites and lots of different finger foods to sufferers of dementia to help them manage by themselves."

Barchester's Cooking with Care ethos encompasses a number of training programmes, including a Basic Chef's Diploma for apprentice chefs and a Master Chef's Diploma to enhance specific skills - such as game cookery - of chefs working at a higher level.

To further inspire and encourage Barchester chefs, celebrity chef Paul Rankin works with the company by holding cookery demonstrations and judging its annual chefs' competition, in which eight finalists take part in a cook-off at Westminster Kingsway College in London.

Keen to spread the word about the emphasis Barchester places on the importance of good food for older people, it has recently published an in-house book of favourite recipes from its chefs and residents called Cooking with Care. A second book, Nutritious and Delicious, will be available in bookshops later this year.

BUPA care homes

There are about 21,000 residents living in 296 BUPA Care Homes throughout the UK.

Serving residents the food they want to eat, blended with good nutrition, is the key to catering for older people, according to head of hotel services at BUPA Care Homes, Tim Brooke.

"It's all very well offering a menu that is nutritionally balanced, but it is no good if the person we serve it to won't eat it," says Brooke. "The important thing is serving food that our residents enjoy. That is why residents and their families are very much a part of the menu-planning process."

Chefs at BUPA Care Homes plan menus on a four-week cycle, aided by a number of in-house initiatives. Menu Manager provides guidelines on a nutritionally balanced diet developed by BUPA dietitians the Diet Directory offers extensive advice and links to websites on special medical and cultural diets and the Food Cube provides a resource for specific recipes.

Finally, the Night Bite Menu is a pictorial menu for residents who are hungry but not sure what they want to eat, during the hours that the main kitchen is closed - usually between 6.30pm and 6.30am. "The pictures help to entice the residents into choosing simple foods, such as beans on toast, sandwiches, yogurts and fruit," says Brooke.

All chefs in BUPA Care Homes receive extensive training on food safety, food hygiene and nutrition. Later this year they will attend one of four in-house conferences to discuss issues relating to care home catering, such as the modification of food for residents with swallowing difficulties and the means of adding calories to meals for residents with poor appetites.

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