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Food Quality and Culture in Elderly Care Settings

A key strand of the Food and Cornwall programme is to look at ‘Good food across the lifecourse’. We need to have healthy, nutritious food available to us, in an environment that encourages us to eat well, from birth until our elder years. Within Food and Cornwall’s overarching aim of ‘Creating food wealth so that no-one in Cornwall goes hungry’ we recognised that a priority was to identify groups who might be especially vulnerable to poor nutrition. We know that older people within our communities are one such group.

Addressing malnutrition in older people could reduce suffering, improve quality of life and generate savings in health and social care costs.

Malnourishment in older people, some key facts:

  • Over 3 million people in the UK are malnourished and of these, over one third (over 1 million) are over 65 (Age UK, BAPEN and BDA);
  • An estimated 1:10 of the over 65 population in England and Wales suffer from or are at risk of malnutrition(BAPEN);
  • The risk of being malnourished increases with age (BAPEN);
  • 37% of people aged 70 and over who have recently moved into a care home are assessed as being at risk of malnutrition (BAPEN 2011).

We also know that, in addition to causing individual suffering, malnutrition creates greater use of healthcare services and that the annual UK health and social care cost directly associated with malnutrition is over £13 billion.

Food in residential and nursing care settings for older people in Cornwall

As a first step in looking into how well older people in our communities are eating, we carried out a survey of food provision in nursing and residential care settings for older people across Cornwall. We wanted to find out if older people living in these settings are receiving healthy, nutritious food in an environment that encourages them to eat well.

We conducted a phone survey of 153 nursing and residential care settings and asked either the care home manager or catering manager a series of questions designed to assess the quality of food served, whether it is locally sourced and what the general ethos around food is within the setting. We know from working in other settings, such as schools that, in addition to the quality of the food served, the environment in which it is served has as significant impact on whether a person eats well and healthily.

So, for example, we asked settings whether residents had a choice at mealtimes, whether they had the opportunity to sit with other residents and socialise at mealtimes, whether they had the opportunity to have input to the menu and could feedback to the chef about food served and whether the setting welcomed family members to come in and eat with residents. The ‘whole setting’ culture around food can also encourage residents to eat well, so we also asked settings whether residents could get involved in activities like food preparation or food growing and whether they held food based special events for residents during the year.

What did we find?

Overall, the survey gave a very positive picture of food quality and culture in nursing and residential care settings for older people across Cornwall.

We were able to get responses to our survey from 103 of the 153 care settings contacted (response rate 67%).

Some of the key findings were that:

  •          94% of settings cook meals fresh, from scratch with only 6% using some frozen meals or buying in meals from other organisations.
  •          85% of settings source ingredients locally, most commonly meat, eggs, vegetables and dairy products.
  •          99% of settings have a dining room where residents can socialise at mealtimes, although all said residents can choose where to eat, maybe staying in their room if unwell or not wanting to socialise.
  •          All settings offer a choice at mealtimes.
  •          99% of settings said family members are welcome to come in and eat with residents.
  •          96% of settings said they work with residents and/or family members on feedback about the food and on menu planning.
  •          Whilst most settings hold coffee mornings and celebrate birthdays and Christmas, 50% also hold food celebration events during the year such as barbecues, garden parties, St Piran’s day celebrations and themed evenings (such as Italian or French).
  •          65% of settings provide opportunities for residents to get involved in food related activities such as cooking sessions with the chef, vegetable gardening, baking and pasty making.
  •          95% of settings support their catering staff with ongoing training.

It was also clear from the survey that settings were innovative in their approach to food according to their own particular circumstances and resident’s needs. This meant responses to our questions could vary quite widely but also provided some great, creative examples of ‘best practice’ in promoting a ‘positive food culture’ within a setting.

Some best practice examples included:

  •          Providing linen, flowers and a drinks licence in the residents dining room;
  •          Playing music whilst residents are dining;
  •          Partially sighted residents being provided with coloured bowls which help them see their breakfast cereal more clearly.
  •          Providing picture menus to assist with food choices  for residents with memory problems;
  •          Welcoming community members, including older community residents who normally take meals-on-wheels, and grandchildren in to dine with care home residents;
  •          Staff taking their meals with residents;
  •          Including residents’ favourite recipes on the menu;
  •          Residents choosing a seasonally changing menu as part of their residents meetings;
  •          Residents experiencing a ‘virtual cruise’, featuring a different menu from each country each month;
  •          Residents helping to tend the care home vegetable garden and chickens.
  •          Residents helping with food preparation for the home and participating in baking sessions.

Areas for further development:

We also asked whether the menus served to residents were compliant with national guidelines on food and nutrition in care settings for older people. This question revealed that, in terms of awareness of the relevant National Association of Care Catering (NACC) or Caroline Walker Trust guidelines:

  •          Only 27% of settings were aware of the guidelines,
  •          10% were unsure,
  •          63% had not heard of them at all.

Where settings were aware of guidelines, they tended to be part of a larger care home group, where nutritional guidance is worked on centrally and disseminated to settings.

Despite a minority of settings having awareness of the relevant nutritional guidelines, it was however clear that menus are being planned with diet and nutrition in mind and settings use a variety of sources of guidance for this, including:

  •          MUST screening;
  •          National healthy eating guidelines such as ‘5 a day’;
  •          Care plans specifying specific needs such as fortification and soft diets;
  •          Information gained on food and nutrition training courses and study days for staff;
  •          Advice from NHS partner organisations.

Promoting awareness of the relevant nutritional guidelines in care settings for older people is therefore clearly an area for potential improvement in future.

90% of settings expressed an interest in being involved in future work to help improve food quality and culture in care settings for older people. The most commonly expressed idea where support would be welcome was in networking with others to share best practice.

What's next?

The next steps for this strand of the Food and Cornwall programme are to build on the findings of this scoping exercise. These were very encouraging, both in terms of the quality of food being served in care settings for older people and also the positive ethos around food being promoted by staff committed to food as an essential element of resident’s wellbeing. However, some clear priority areas for future development were highlighted.

We found excellent examples of innovative best practice aimed to support residents to eat well, but it was recognised that settings would benefit from networking and sharing these examples. We know from previous work with school cooks, that staff can really benefit from a network where they can share ideas and be supported with training needs.

Raising awareness of, and providing training related to nutritional guidelines relevant to care settings for older people will also be a priority for future work.

For further information about this strand of the FAC work, please contact us

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