Goodness is great

With a healthy mind often constituting a healthy body, we explore how you can ensure your residents have access to a nutritious and balanced diet and how this element can ensure you appeal to wider audiences.

Food consumption is essential to human life, with our bodies needing energy and hydration to function properly. Amongst older people in particular, and individuals who require full-time assistance, access to nutritional food and drink options is fundamental to good care.

Malnutrition is common in care homes for older adults because as age increases, so does dependence and frailty, meaning there is a heightened risk of developing malnourishment issues.

Fleur Key, Nutritionist at Brakes Foodservice, explained how a healthy diet can look different from one person to the next as residents are all diverse and have various tastes and needs.

Fleur explained that The Eatwell Guide shows us what the general population should try and include in a healthy diet: wholegrains, at least five servings of fruit and vegetables daily, protein from beans, pulses, meat and sustainably sourced fish (including at least one serving of oily fish); limited dairy produce, a small amount of unsaturated oils, plenty of fluid and limited amounts of foods high in saturated fat, sugar and salt.

“Adapting the Eatwell Guide to individual preferences can lay the foundation of a healthy diet as it encourages us to eat more fruit, vegetables and wholegrains, which I believe are the foundation of a healthy diet.”

Fleur continued: “Another important aspect of a healthy diet is the quantity eaten: we often misjudge how much food we need, or eat particular foods as a way of coping with certain emotions.

This highlights the importance of promoting a healthy relationship with food, which can lead to eating the right amount for our genetics, biology, and our own individual activity levels.”

A nutritious diet meets the biological needs of each individual, whereby we take nutrients from the food and drink we consume and use them to repair and grow cells in the body, which leads to optimum health outcomes such as a functioning immune system, diverse gut microbiota and a healthy body weight.

With dietary requirements broadening, it’s important as a care establishment that you can work to cater to specific needs such as lifestyle choices (vegetarian and vegan), cultural requirements and medical conditions, including diabetes.

Fleur explained how caterers must find affordable ways to tweak recipes and suit most residents, whilst also offering variety and choice for all. There are many ingredients that may be suitable for most without modifications, such as foods that are inherently void of allergens like meat, fruit, vegetables, and many different seeds, which lend themselves to a menu that could be made suitable for most.

Fleur added: “It is also important to ensure that you have appropriate alternatives to meat, fish, dairy or gluten, such as gluten-free bread to use in place of standard bread in a sandwich; tofu, beans and lentils to use in place of meat or fish in a curry.

“Fortified milk alternatives, instead of milk, reduce the need to introduce a completely different meal to a standard menu and helps residents feel like they are all being offered the same dishes regardless of their individual requirements. The advice for people with diabetes is to follow a healthy, varied diet, which is the same advice given to the rest of the population, and reinforces the importance of offering a balanced diet to all residents, regardless of their dietary requirements.”

At Brakes, they offer a lot of support for care home caterers. Their free online nutrition course covers meal planning, education on what a healthy diet looks like, IDDSI and diabetes. Brakes also provide customer demonstrations via their team of chefs, educational leaflets on hydration and diabetes, a menu appraisal service whereby their nutritionist highlights where a menu is meeting the needs of residents and where it could improve, and a whole host of product support from their technical and nutrition teams who can advise on which products meet the requirements set by the customer.

Getting the balance right between nutritious and delicious in your dishes is what will allow you to stand out to potential future residents when they enquire about your home. The important thing to remember is that you know your residents better than anyone when it comes to what they do and don’t like to eat. You’ll also know that if they don’t like it, even if it is the most healthy food in the world, they won’t eat it – it’s human nature, so you must continuously get feedback from residents on their thoughts about the food they’re eating.

“It is important, especially for older adults, that they enjoy their food as many could be relying on it to treat or avoid malnutrition, recover from illness or simply to have an enjoyable experience.” Fleur finished.

Regulation 14 of the Health and Social Care Act (meeting nutritional and hydrational needs) states: “the nutritional and hydrational needs of service users must be met.”

Prescribing Support Consultant Dietitian/Integrated Care System Lead Dietitian for the NHS and

Specialist Adviser on Nutrition for CQC Social Care, Alison Smith, explained how meeting these nutritional needs should rely solely on ordinary food and drinks. With many care homes nowadays offering a prescribed oral supplement in place of meals, Alison explained that prescribed oral nutritional supplements are not required to meet the needs of the vast majority of care home residents and low-cost homemade supplements (made by care home caterers) can provide the same nutrition in the same volume while being more palatable for occupants who suffer from malnutrition.

Alison highlighted an interesting fact as she explained how fortification of food and additional nutrient-dense snacks should not be provided for residents at low risk of malnutrition, as doing so increases their risk of developing obesity.

Care home chefs and catering companies are recognised as central members of the care home team when working to manage nutrition and malnutrition; Alison said: “Ensuring regular two way communication about each resident’s needs between care and catering staff is essential.”

Age UK’s Robert Ince recognises that good nutrition and hydration are essential for the maintenance of health and wellbeing, more precisely how the act of eating and drinking is important for developing and maintaining pleasure and social interactions.

Eating together is a core human activity and can help increase appetite and food intake, as well as helping individuals to make connections: “Mealtimes and food reflect our identity and are an important part of living with purpose, particularly for older people who live in care settings.” Added Robert.

As people age, they become more at risk of developing longterm conditions such as heart disease, COPD, and diabetes. We may also experience anxiety, depression, or the sadness of bereavement and loss. All of which may result in poor appetite and lead to gradual or rapid weight loss.

The ability to eat and drink can become more complex as we get older, which is why Robert recognises that more attention may need to be paid to environmental factors, including the availability of carers to help with eating and drinking, the choice and consistency of food, and eating in a comfortable setting.

Intake of liquids is just as important as eating sufficient meals as dehydration is a serious condition. Robert explained how older people are at risk when they rely on others for their drinking and care needs, whether this is in hospitals, care homes, or their own homes: “Some older people will unknowingly be dehydrated. Residents must have easy access to fluids throughout the day and night, as well as prompts, and help to drink when needed. Residents should aim for at least eight cups per day.”

It can be difficult to know how to design nutritious meals when people have special needs and likes and dislikes. The British Dietetic Association (BDA) have plenty of good advice and helpful tips for eating well in later life: www.bda. uk.com/food-health/food-facts/ older-adult-food-facts.html

With official food standards for care homes never being put in place, it has meant alternative and trusted outlets have taken matters into their own hands.

Last year, independent care home directory Autumna unveiled a new food accreditation to help care homes showcase their all-important dining experience and attract selffunding enquiries.

CHOICE Dining, a consumer- facing accreditation, offers ratings on Cuisine, Hygiene, Options, Individuality, Care and the Environment, allowing individuals to make more detailed searches and informed decisions about the things that matter to them most.

Autumna’s founder Debbie Harris said: “Our research shows the dining experience in the care sector is as important as the dining experience in a hotel. If someone is used to fine dining, they’ll want somewhere that caters for them, while the same applies for the individual with simpler tastes.

“The dining experience is a critical component of any care service and our CHOICE Dining rating helps differentiate care homes and offers people even more assurance when deciding on the right type of care provision.”

To be awarded the CHOICE Dining badge, care homes must have a premium profile on Autumna and be committed to delivering an exceptional dining experience. For more details, and to see which providers have already achieved the accreditation, visit www.autumna. co.uk/choice-dining

Choice Dining is the first foodfocused accreditation for the care sector. It was designed from the ground up to give care-seekers the ability to easily consider and compare the dining experience within different care settings, in turn enhancing their offering and enabling them to appeal to a broader audience.

Emily Stuart is a dietitian at apetito UK, the Wiltshire-based company who provide exceptional meals to care homes. apetito’s meals are expertly crafted by their dietitians and chefs. Emily told us “Good nutrition and hydration play a critical role in the health and wellbeing of residents. We know one size never fits all when it comes to catering provisions within a care home. There are many reasons residents may need - or want - to exclude certain foods from their diet, whether this be down to personal choice and preference around vegetarianism, pescatarian, or plant-based/vegan meals, or personal or religious beliefs, and not forgetting medical conditions which require a bespoke diet.”

Catering to a diverse range of needs is essential for residential care managers, and Emily explained the importance food holds in our lives, and how this shouldn’t change for residents in care: “Care homes should strive to ensure the diverse needs of residents are met and are equally included on all occasions, whether that is offering a choice of meals for vegetarians on daily menus, offering a slice of glutenfree cake as part of a birthday celebration or serving a Pureed Fish & Chips meal to those with swallowing difficulties on a ‘Fish & Chip Friday’.” apetito offer a number of solutions to combat malnutrition within care facilities: “With apetito, care homes are able to meet a wide and diverse range of nutritional needs that meet personalised pathways that supports residents’ care.

It provides more than 200 meal options for care homes to choose from including a wide range of main meals, and desserts giving huge flexibility. Menu planning and food ordering is all done online with each care home having a dedicated

‘myapetito’ ordering platform which is designed to be quick and user friendly” added Emily.

With food and drink being important for far more than their nutritional content, as food is associated with anticipation and enjoyment for most people, it is paramount to take the words of the experts on board. Offering nutritional and diverse options for residents and potential residents will benefit your care home further in the long-run.

Age UK’s tips surrounding Food & Nutrition in care homes:

• Everyone involved in food provision and service should be listening to the resident, as well as their family and friends. They should also be aware of the resident’s preferences and family traditions, bearing in mind that if a resident has dementia, their preferences could change and move back to previous likes.

• Care staff must undertake a nutritional assessment, identify what help is needed to support eating and drinking, and make sure this is recorded in their care plan and that everyone knows.

• Make sure there is a good choice of food available - little and often with small meals and snacks seem to be more manageable.

• Ridged set times for meals don’t work for everyone. Some people won’t be able to sit down for a whole meal or may be hungry at unusual times. Make sure a good choice of food outside of hours is available.

• For residents who find it hard to use cutlery, or prefer to sit/walk, a finger-food grazing menu should be available.

• Swallowing difficulties are common in older people and people with dementia. There is a risk of breathing in food particles that can lead to aspiration pneumonia. Specialist advice and support should be provided from a speech and language therapist (SLT).