Nutrition and hydration in the care home has got to be one of the most important elements of promoting well-being, and in order for this to have the desired outcome (i.e. happy, well-nourished and healthy residents), all staff in the home need to understand the part that they can play to make this a reality.
Nutrition isn’t just about making sure everyone is ‘fed’ (we really must get away from such disempowering terminology), it’s about the whole celebration of food and what comes with that; the ambiance, the social setting, receiving individualised support and enjoying good, wholesome food (and drink!).
Over the past couple of decades, we have moved from a nation that sat down to meals together, to a faster paced lifestyle where food and nutrition has become something to consume at the office desk or on the move. Most days, I won’t actually be able to recall what I ate that day, or when; eating and drinking only to quieten the protesting stomach or quench a thirst. When I do get home, I’m often too exhausted to cook and therefore something convenient (with the nutrition value of the cardboard box it came in) will get shoved into the oven or the local take-away will be called (speed-dial of course) and my husband and I will sit in front of the TV, eyes glazing over, mechanically shovelling food into our mouths.
So how do we break that nonchalant attitude towards food and nutrition when we are so often relying on a generation who now see this as the norm? It’s like any other change we need to make in the home – it’s about re-energising and re-educating, inclusion not seclusion. So, what does that mean in practice?
Good Quality Nutrition & Training
Nowadays, wholesalers and local food providers offer a huge range of options for care homes to choose from. It’s often not what they buy that goes wrong but what they do with it once it’s in the home. I have seen many a culinary disaster over the years and most of it due to a lack of understanding about the importance of food and the pleasure that can be given, and received, if it is prepared and served properly. A home manager once said to me, ‘I spend a fortune on good quality ingredients, only for the chef to macerate it’. I have also met chefs and cooks who are passionate about preparing quality meals, who take pride in what comes out of the kitchen – only to have their hard work undone at the point of serving as it is ‘dolloped’ onto plates.
Both catering and care staff should have good knowledge about nutrition and hydration for the elderly and what the objectives are. This should include knowledge about the consequences on health and well-being of a poor or imbalanced diet. Training should also be given in the fortification of food and how this can be achieved naturally. In addition, training should also address the modification and presentation of diets that need to have different textures for those residents who may experience swallowing difficulties, as well as specific information regarding other special or cultural diets that residents may have. Don’t assume that your catering staff will automatically have knowledge of these things as this in itself is quite a specialist area of care; furthermore, make sure that there is a clear system of communication in place that allows catering staff to have up to date information from care and clinical staff about the current needs of individual residents.
Plan your menus
Who better to be involved in the planning of the menus than those who are going to partake in the end product? Introducing a menu committee into the home can bring both staff, residents and relatives together. Ask for people to volunteer to become members and think of novel ways to engage their taste buds whilst also providing healthy nutrition.
Firstly, ask your staff to conduct a food survey, gathering ideas and thoughts from all residents and their relatives about likes and dislikes, and asking for suggestions about what they would like to see on the menu. Ask your catering staff to keep an eye on waste and to think about what meals resident most enjoy. That doesn’t have to mean that if residents love beef stew, that that has to be on the menu three times a week, but if beef is a popular choice then the committee and the other residents can then come up with ideas for other dishes based on this main ingredient. Remember that meals should also include drinks and therefore planning a choice of different drinks to enhance each meal will also help to add variety to residents’ intake and promote hydration.
When you have gathered your information, you are then in a better position to start planning your menu. Bring the committee members together and decide together a 4 week rolling menu. When you have put together the first draft, think about holding a tasting meeting. This can be great fun for all and helps the catering staff to get a much more authentic idea of what works and what doesn’t. Get the members to think about aesthetic appeal as well as taste, after all, we eat with all of our senses including our eyes. Something may taste delicious but for some people, they won’t get to know that if it appears off-putting, as they won’t even get over the first hurdle and get the food into their mouth.
Once the new menu goes live, this shouldn’t be mission accomplished! Gaining feedback is key; ensure your catering staff are present at dining times to ensure that the appearance of the food served is appealing and to gain ‘on the spot’ feedback by asking residents whether they are enjoying their meals, observing facial expressions and gauging waste. Gather the menu committee back after the first month has elapsed and compare feedback; making amendments and adjustments to the menu based on this.
Offering real choice
Ideally choice of meals and drinks should be given at the time of serving, however this often isn’t the reality within a care home setting. Residents are often asked to choose what they would like for dinner tomorrow on the day before. This is a relatively easy choice if the person clearly doesn’t care for one of the dishes but in all honesty, how many of us really know what we will want to eat tomorrow when it actually comes to dinner time? Budget restraints mean that it is not feasible to prepare double the quantities on a ‘just in case’ basis so how do we make a basic judgement on just how much to cook? I’ve worked with a lot of care homes who really do get this right and it appears to be based on a number of elements.
The first element is using information gathered in order to be able to offer person-centred choices. Knowing your resident should include knowing their nutrition preferences, likes and dislikes when it comes to food. This information should be sought at pre-admission and should be an ongoing process of fact finding as we get to know residents and what is important to them. It isn’t just about food preferences either; it’s about all the little idiosyncrasies that we often have about food. As an example, I find it difficult to eat anything if it isn’t covered in vast quantities of salt, to the point of carrying my own salt around with me! Add to that my aversion to foods on my plate ‘touching each other’ and it would be easy to see just how subtle changes for me may be the difference between me eating and not eating.
Another important element of giving real choice is the method employed to give choice. Menus on tables and on a menu board are a good way to give information but remember that not everyone will be able to see the print, or possibly understand the written choices. Some residents will be far better equipped to make choices if these are presented to them, firstly in pictorial menus and then as real meals in front of them to make a choice from. If you know your residents’ food preferences, you are likely to be able to gauge how much of each dish to cook, therefore minimising waste.
Setting the Scene
Focussing on the dining experience as an opportunity for social engagement and fun is likely to have a much more positive outcome than if it is viewed solely as a task to complete periodically throughout the day. Take a fresh look at your dining room and think honestly whether it is a place that you would feel comfortable eating. Think about the décor, the cleanliness and the lighting – are they conducive to a pleasant dining experience where residents have ample room and are able to see their meal clearly? Are the tables set in a pleasant and orientating manner, or are they bare and void of cutlery or condiments that would help to indicate that a meal is about to be served? Do residents have the choice of sitting with people who might have the same interests and therefore give greater opportunities to have meaningful conversations? Do staff have the opportunity to sit down and facilitate those conversations and be on hand to give needed support at each table, while having a bite to eat themselves? These are all things to consider to enhance the social meaning of dining.
For those residents who choose not to eat in the dining room, the enhancement of their experience shouldn’t be forgotten. Ensuring that tray service includes condiments, napkins and correct cutlery is of equal importance as is the delivery of one course at a time. I have never been to a restaurant that serves my main meal at the same time as my dessert, yet this appears to be a common practice within care homes.
Ensuring positive support
Person-centred care should ensure that each resident receives the correct amount and type of support to be able to receive a good diet full of nutrition. Having a good supply of adaptive cutlery and crockery can help you to help your residents to remain as independent for as long as possible. Developments in recent years have focussed on products that are dignified, rather than stigmatising, and if these products (such as lipped plates, two handled china cups and dignity napkins) are made available, they may help to reduce any embarrassment associated with requiring support. Dignity in dining should be afforded to all.
Some residents may also require full assistance to eat their meals and this again should be offered and carried out in a sensitive manner. Standing over people to assist not only draws attention to the resident but also increases the risk of the person choking if they are having to overextend their neck. It can also be quite an intimidating experience for the resident and may lead to feelings of being rushed or ‘fed’ rather than a pleasant dining experience where both food, nutrition and company are enjoyed.
Getting nutrition right is extremely satisfying for all. Residents who eat and drink well will benefit in so many areas including increased energy levels, quality sleep and better physical health. Catering staff will feel a greater sense of satisfaction in their roles if their talents are show-cased and enjoyed by all. Care staff will feel less rushed if they take the time to focus on the importance of food as a whole; having greater opportunities to get to know their residents better and offering a far more personalised service. They may even get to relax with residents and enjoy a light snack as part of the new dining experience, therefore helping everyone to look forward to mealtimes.
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Guest blog on behalf of http://www.carehomecoach.com/