The nurse, nutritionist and former restaurateur is head of nutrition and hydration at Sunrise Senior Living, where her mission to keep residents healthy and happy earned her a Foodservice Catey. She speaks to Janie Manzoori-Stamford
Congratulations on being named the 2017 Healthy Eating Champion at the Foodservice Cateys. How did it feel to win? I was shocked but really chuffed. There are such good people in the industry doing such good stuff, so it was great to see that recognised. I'm privileged in my role because I get a lot of autonomy. I work on innovation as well as on the front line with some brilliant chefs and nurses.
What does your role as head of nutrition and hydration involve?
Anything from offering my input on menu planning to creating bespoke recipes for residents. I work on a practical level, so I can get grubby in the kitchen or I can step into a clinical role and look at how that menu is going to translate with the nurses.
I look at the dining service and how the care staff perform, as well as how we're setting up systems and collating information around nutrition and hydration, such as how we're tracking meals and fluids. It's very easy for clinical staff to step into a task-oriented role, whereas we're constantly working towards person-centred roles.
What do you mean by person-centred roles?
It means that your approach to care is about looking at the individual and what will be the best care for that person. For example, if they prefer to get up at 9am and to have their breakfast then, we need to make sure we have the breakfast provision that they want. We make sure we have enough choice for every individual to get what they want and that they're seated where they want to be.
Sunrise Senior Living operates Gracewell, which is a separate brand. How does it differ?
Tell me about the nutritional champions programme, for which you were recognised.
We have identified people who have a passion for nutrition. Being a nutritional champion doesn't have to be related to someone's job spec, so it doesn't necessarily have to be a clinical lead or a senior care worker.
I'm training the champions to be that very approachable member of staff who will support the existing systems as well as any new innovations. Every care home needs a nutritional champion. When you've got a good working relationship with the chef and you totally understand care and the individual residents' needs, you've got a system that works.
What does it take to become a champion?
When I started the programme it was opt-in and it wasn't linked to salary, so it was quite a challenge. What does it take? A passion for nutrition and a role in care. I train people with a bespoke programme. I hold forums every six months and we constantly work on the different needs that are coming up.
We've already got a nutrition and hydration manual on every site, and I have written a training programme on policies and procedures on supporting nutrition and hydration. My champions get a higher level of training in that manual and so they're more equipped to answer questions about the system.
Is there a champion on every site?
That's the aim. I started my first forum with about 20% of sites engaged. I've got 43 sites and some asked for more than one person. At my second forum I had more than 50% of the sites engaged. It was a massive leap because I was able to get the statistics to show the improved practices around nutrition and hydration.
Then it's about taking the people who are perhaps a little bit more resistant to change, who might get sent along by their regional nurse. Once they come in, they get a better explanation about why they're doing whatâ¨they do and they've got more control to help people's quality of life. It's a no-brainer.
How important are the targets you give the champions to the programme's success?
Very important, because if they haven't got a baseline, they can't help bring staff with them. One of their targets could be around how many people in the community are low weight and losing weight. If they know they have a certain percentage, they've got a target to work on.
When staff realise they have more control over those scores, they don't just accept that Nelly and Fred are losing weight and that's just how it is because of their condition. It's more about the fact that Nelly and Fred are losing weight and their condition is an extra consideration, but what else are we doing?
What might that involve?
They do some lovely things, which is all about personalised care. It could be working on a specialist recipe for hot chocolate because Nelly adores hot chocolate, but we need to make sure it has more protein and calories in it. Perhaps Fred is dehydrated but he responds really well to having a special mug with a nice big handle, and if he has that mug he'll drink more. It comes down to such basic things, but the more you give people the confidence to have an impact, the more of a difference they can make.
You target Sunrise staff with ensuring that the rate of malnutrition remains below 20%, rather than the 30% recommended for the sector. What are the challenges?
I try to go for even lower than that. I've brought sites down to nearer 5% and 10%. It's virtually impossible to get to zero because there are some people whose condition means their body no longer wants to process food and drink. Their muscle wastage is going to increase, so at that point we give them whatever they want, whenever they want it. You're not so much looking at calories and protein because you have to accept that their weight loss may continue.
You've got to understand the mitigating factors behind malnutrition, such as dementia, illness or depression. But they are not reasons - I never say reasons. The moment you say there's a reason for weight loss, you've almost stopped somebody from trying to change it.
How important is training in the care sector?
One of the areas I feel really strongly about is people who don't have training in nutrition and hydration. Chefs are trained in professional cookery, not nutrition. Similarly, care staff have no formal training in nutrition and hydration, which is vital.
From a wider, industry point of view we need to create a level two standard in nutrition and hydration in which everybody gets trained. As the deputy chair of the National Association of Care Catering [NACC], I'm proud that there's now a level two qualification for chefs in healthcare, but we still need to do that for care staff.
Is that one of the NACC's focuses for 2018?
It's one of the big focuses for me. Another big area we're working on is the International Diet Descriptors Standardisation Initiative [IDDSI]. Chefs and care staff need to be trained in new descriptors to produce the perfect texture for people with swallowing difficulties. If someone has dysphagia, a speech and language therapist will identify which type of swallowing difficulty they have and say this person needs their food to be a certain texture.
What will change as a result of IDDSI?
At the moment we're following UK-only texture descriptors that came out in 2011, but the international initiative means the descriptors are changing - they're now on seven levels and incorporate food and fluid thickness. As it's an international framework, it means there is one language being spoken that will benefit healthcare workers or residents who move countries, which makes a lot of sense.
The initiative will be introduced at awareness level from April 2018 and needs to be fully adopted from April 2019. It affects suppliers that are producing texture-modified food or thickeners, so they need to be well versed now. All of the providers need to ensure their staff are trained and ready for the change.
You're a registered nurse, nutritionist and former restaurateur. Is this diverse skill set the perfect CV for your role?
It is because it all marries together. I would encourage anyone to consider this sector because there are great career prospects. I'm biased, but we need more heads of nutrition linked to care homes who understand how it works - not someone to come in and spout off and say do this, do that. I did nutrition because I was passionate about it and now I've managed to combine everything into one job role.
Tell me about the difference between a supplement-based and a food-based approach to malnutrition.
In the care industry, supplements have never been the approach. There's such a debate about the benefits of supplements, and the supplement approach isn't widely accepted. Recently we started accepting that vitamin D supplements should be taken in the winter, but we're not going to see that across the whole industry. I can't say this categorically at all, but that's because there are implications to everyone having supplements, one of which is budgetary.
What does a food-based approach to malnutrition involve?
The more you look at enriched foods and have a knowledge about the right foods that are rich in certain nutrients, the more you can promote a healthy diet to people without needing to come across anything contentious. For example, I'm looking at a supplier who has a vitamin D-enriched product, rather than looking at giving our residents supplements.
It's the same with selenium. I think we're one of the only care providers to buy milk that comes from cows that receive selenium-enriched food. This in turn reduces their infection and mastitis rates and that makes for happy cows. That comes through in the milk in a bio-available form that we can absorb more easily, so our residents receive more selenium than most. There are also powder supplements that can be added to food so they don't have the difficulties of taking a tablet. We're enriching foods so that we can serve the most nutritious food we can.
So your residents get the pleasure of eating food rather than having to take a tablet?
Yes, 100%. Life should be about enjoying eating.
2014-present Head of nutrition and hydration, Sunrise Senior Living
2011-2014 Head of nutrition and hydration, Avante Partnership
2011-2012 Co-owner/manager, Mucini restaurant, Whitstable, Kent
2006-2012 Clinical nutrition BSc, University of West London
2002-2011 Project and development manager, Enterprising Opportunities
1992-1996 Nursing studies RNMH, Christchurch College of Education
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