Posted by Debbie Harris
that nearly 40% of people entering a care home are suffering from mal-nutrition? It’s a shocking and sobering statistic. And it's seldom due to financial hardship.
For an old person living at home alone, existing on a minimal or nutritionally inferior diet is usually down to a combination of factors:
The role of a care home in the early days of welcoming and settling a resident is critical to improved health and well-being, and particularly in the area of Food and Nutrition.
For someone already apprehensive at the prospect of such a dramatic change in the way they live their life – despite it being in their best interests – there is often a strong tendency to resist any other changes, particularly around the food they eat.
Some people have become ‘creatures of habit’ and are very comfortable with being so. But it can mean that they are missing out on a variety of food that they might really enjoy, not to mention the nutritional benefits to be gained from eating the right balance of foods.
The way in which a new resident is introduced to the care home, and particularly the dining room, significantly influences the speed at which they will settle. That in turn gives the care home the best chance to establish a balanced diet that suits the individual and provides pleasure as well as essential nourishment through the food it provides.
The team at a care home we visited in Tunbridge Wells recently, does everything they can to encourage residents to eat well and enjoy their food, despite what can sometimes be a slow start…
‘I always bring a new resident down to lunch on their first day and I will have planned who I think they may get on with… the idea of coming into a big dining room full of people they don’t know can be quite daunting, so I try and find someone to buddy them with…’
It is important to realise that people need to be tempted, but they should never be forced. Which is why choice, portion size and individual preferences are such influential factors in encouraging people to enjoy their food.
Appetites change as people age and over-facing an elderly person with a plate of food that is too large, or too full, can be off putting.
‘There is one lady in here who is adamant that she doesn’t want any more on her plate than would fill a tea-cup… initially I though this was far too little, but I realise that for many people, it has to be little and often.’
This is why food needs to be easily obtainable throughout the day: most care homes offer breakfast, lunch and supper, but interspersed with refreshments available on each floor whenever people want them. Fresh coffee and tea are usually on tap, and home-made biscuits and cakes served in many care homes mid-morning and afternoon.
‘We bake our own bread here – all sorts of different types, using herbs, olives and salad tomatoes. On baking days, we leave the doors from the kitchen into the restaurant and hallway open so that the wonderful smell of baking bread floats throughout the home. Residents love it.’
Even when someone is willing to try new and different foods, they often need reassurance that there’s a back-up alternative to hand, and – perhaps most important of all – what is served on the plate needs to be simple and recognisable.
Flavour and texture are so important, but over-seasoning food can be a real barrier, particularly to someone who has only just arrived in the care home, having prepared their own meals for years and taken a very straightforward approach.
Complicated menu descriptions are a deterrent: people want to know ‘what it is, and what’s in it’! – they don’t need the Masterchef Fine Dining description – even if what is on the plate is of an equally high standard to what is delivered in a top restaurant!
‘When people are new to us, I try to find out what they have been eating at home… ticking their boxes initially with the old fashioned food they enjoyed – which may not necessarily be of a quality and value that we would normally provide here, but if it helps them feel comfortable, reassured, and ‘at home’ then we’ll do that before trying to gently introduce greater variety.’
Having breakfast on a tray in their room is preferable to most care home residents. People like their own private time in the morning, and the opportunity to prepare for the day at a pace that suits them.
A variety of options for breakfast makes for a tempting and flexible start. Most residents tend to have the same thing every day, but presenting plenty of choice allows them to ring the changes if they want to, caters for all sorts of different dietary needs and preferences, and provides every opportunity to start the day with a balanced meal.
‘We keep a range of cereals here, but if someone has a particular preference for Frosties which aren’t on our list, one of us will go out and get a packet. The hot option for breakfast changes daily – anything from fresh kippers, through scrambled eggs on toast to Full English.’
Whilst lunch is the main meal of the day in most care homes, supper also caters for every need here – but typically in a less formal way.
There may be toasted sandwiches or soup for supper; there’s often a selection of light bites, savouries and sweet – and always, always, plenty of beautifully prepared fruit.
There will be some residents in care homes who are bed-bound, so flexibility on what is available and when is important – as is ensuring that food served in their room is beautifully presented.
Like many care homes, the one we visited in Tunbridge Wells grows an increasing amount of fruit and vegetables, and the herb garden is a great source of flavour; the aim of the Hospitality Manager is to be growing 15% of what they need within the next two years.
‘Our residents love their fruit. Our meat bill is £300 a week – but for fruit, salads and vegetables, it's nearer £800. And gone are the days when a salad comprised little more than lettuce, cucumber and a tomato!’
For some people, lunch is the time for socialising. Here, residents tend to come to the dining room on the dot of 12.30, enjoy their meal with their friends, and then linger in groups throughout the early afternoon – perhaps staying in the dining room for coffee, moving to the lounge or maybe sitting out together in the garden.
Those of us who are still leading our lives at a fast pace perhaps need reminding that older people get tired easily – they tend to wake reasonably early, but with lunch being the main social focus of the day, they often become weary during the middle of the afternoon, and many go back to their rooms until just before supper time.
Recognising and understanding a person’s personal concerns is very important – no matter how long they may have been in the care home. For instance, when a person is sitting on their own in the dining room, it need not be because they are lonely – it can be deliberate:
‘Some residents feel that they have been talking for 90 years and just don’t want to do it any more…’
Others, on the other hand, are conscious of the way their physical limitations force them to eat now, perhaps requiring adapted cutlery or pureed food, and they feel self-conscious, preferring to eat alone and socialise afterwards.
‘People sit in the same place every time and we need to respect that; some prefer to eat alone to avoid embarrassment; others sit with the people they like and in ‘their place at the table’.
When we visited on a sunny day in June, we learned a lot from the care home team about ‘What good looks like’. There is no doubt that there is so much more to it than the magnificent salad bar and utterly superb sweet trolley that any 5-star hotel would be proud of, amazing though they are.
It is all about the people: the way residents’ preferences and needs are met by people who truly know how to care and are prepared to treat and respect people for the individuals they are.
Despite a tempting 3-course lunch menu celebrating fresh fish and a wonderfully colourful array of seasonal vegetables and fruit, Jim fancied a fried egg on toast… so that’s what he had.
Margaret, on the other hand, had selected her choice from the varied menu at her table, and when the fish, hollandaise sauce, new potatoes and asparagus arrived, realised that she had forgotten to order a starter – and it was her favourite! No problem – once she had finished her main course, Katy brought her a warm duck salad.
‘I don’t often have a starter, but if it’s prawn cocktail or duck, I do. But I won’t have a dessert today, I don’t think… although it is very tempting and I see there are fruit meringues there…’
Everything is made from scratch in the care home’s busy kitchen where a hospitality team of 10 people (including three full-time chefs) are at work every day. Not confined to the kitchen though, they mingle with residents in the restaurant to make sure they are happy with the food served.
‘We go out and speak to all our residents to find out what they enjoyed or did not enjoy. If we can change it, we will. They complete feedback forms every three months. The residents decide on all the food really – they choose what they want and we do our best to make sure we provide it.’
Whilst adapting to life in a care home may take time, and while there may need to be a softly, softly approach with menu, portion size and frequency of food for some, there can be no doubt that food is an area where there is enormous potential to deliver excellence and create contentment. The residents are certainly not slow to tell you what they think:
‘A glass of red wine never goes down badly, does it? Henry has a glass every day… I don’t, but if he has gone out and his wine is there for him, it never goes to waste…! They have excelled themselves today… although I have to say, it’s brilliant every day.’
And as the groaning sweet trolley was pushed into the centre of the restaurant by the lovely Katy, who has been working at the care home for 20 years and can’t imagine being anywhere else, Henry observed:
‘I had to get an extra size up in trousers – seriously – that’s absolutely true, and Fergus (of the red wine above) will tell you exactly the same.’
If you are concerned about how to identify the ideal shortlist of care homes, help and support is available from Chosen with Care. Call their Advice Line on 01892 300 530.