Improving Nutritional Standards in Care Homes

How Food Services and Front-line Staff can Work Together to Improve

Standards of Nutritional Care

Helen Ream Registered Dietitian, Compass Group UK &

Ireland

Why Work Together?

38% of Residents in Care Homes are at medium or high risk of malnutrition (BAPEN 2015)

20-45% of people with Dementia experience significant weight loss in one year (Alzheimer's Disease International)

Up to half of Residents living with Dementia in Care Homes have an inadequate food intake

Estimated 60-75% of people in Care Homes suffer from some form of swallowing difficulty (NHS England)

Food Service Roles and Responsibilities

Care Teams Understanding Residents’ dietary needs and preferences, nutrition screening and care planning, providing assistance at mealtimes, serving food, monitoring food intakes, taking action where required and team working to ensure this is delivered

Catering Teams Menus, food ordering, preparation of meals, snacks, kitchen practices and food hygiene, food delivery, budget management, special diet menus and team working to ensure this is delivered Priorities For Both Dietary needs and preferences of each Resident, menus, special diets menus and provision, food service pathway, portion sizes and monitoring intake Visitors to the Home Speech Therapists, Dietitians, GP’s, Nurses

How Do We Ensure We Meet Joint Priorities?

Understanding of Roles and Responsibilities

Well Organised Processes for Food Services

Team Working

Communication

Trust

Ongoing Review of Practices

Working Together

Multidisciplinary Team

RESIDENTS RELATIVES

NURSES CARERS

DIETITIANS SLT

CATERING MANAGER/

CHEF

MENUS AND

FOOD SERVICES

Dignified Dining Toolkit

Food Element Includes Menus Special Diets

Service Element Includes Food Service Journey Food Passports Food Record Charts

Environment Includes Noise Signage Table Settings Crockery

Tools To Support The Delivery of Nutritional Care

Food Passport

Developed by Compass Dietitian Supports the Provision of

Individualised Nutritional Care

Dietary Needs Information

Bay Bed NBM Thickened Drinks NURSE ONLY

Puree C

Soft E

Allergy Menu

Religious and Ethnic

Menu

Red Tray Other Special Diets Such as Renal, MCT

etc

• Higher energy ( E ), healthy option (H), gluten free (GF) and moderate sodium (LS) are also coded from the normal menu

Morning Afternoon Nurse/Name _______________ Nurse/Name _______________ Signature _______________ Signature _______________ Host/Name _______________ Host Name _______________ Signature _______________ Signature _______________

Ward: ___________ Date: ___________ Tick Boxes as Required

Tools To Support The Delivery of Nutritional Care

Food Service Journey A process mapping exercise allowing teams to observe all aspects of the meal service

Food Record Chart

Name J Breakfast K Breakfast L Breakfast J Lunch K Lunch L Lunch J Supper K Supper L Supper

Tick the box above which best describes how

much the person has eaten

J K L J K L J K L

ate all or most ate about half ate very little ate all or most ate about half ate very little ate all or most ate about half ate very little

Training

Training should allow time for discussion, reflection and problem solving.

Training can include:

Meal and Food Service Standards

Nutrition Care Pathway

The Dietary Needs of Different Residents

Special Diets

Use of Supporting Tools

Changes to Practice as a Result of Tools

Changes to the amount of food on the hot meal trolley Reduction in delays in meal trolley collection Changes to the way meals were served eg. salad platter, sandwich platters Changes to where Residents sit for their meals and are offered meals Increases in food related activities with Residents Improvements in the labelling of special diets Understanding in kitchen about Residents needs for modified texture meals Better communication between the teams

To Conclude….

The provision of nutritional care for the older person is complex Meeting Resident needs should be at the heart of the way we work Multi professional teams should work together in all aspects of nutritional care Use tools and processes to support good practice Continually monitor and review