Issue 117 day in the life by NH Publishing Ltd

PAEDIATRIC NHD EXTRA: COMMUNITY

A DAY IN THE LIFE OF . . . A MEALS ON WHEELS NUTRITIONIST Annabelle de la Bertauche Registered Nutritionist Hertfordshire Independent Living Service (HILS)

Annabelle is currently working for Hertfordshire Independent Living Service (HILS), the largest meals-on-wheels provider in the country. She has held a variety of roles including nutrition research, Government policy and advice, healthy eating education for children and, most recently, with older people who are living with dementia and/or depression in the community at Age UK Hertfordshire.

ANNABELLE’S DIARY

9am - 12noon: I spend a busy morning delivering our Referrer Training to a team of charity workers. The team requested our specialist training as their work involves supporting older people in their homes, and they are always keen to improve their knowledge to better help their clients. We provide this training to any groups in Hertfordshire that want to support older and vulnerable people to eat well and help prevent dehydration and malnutrition. Taking just a few hours, our training covers how to identify the signs of malnutrition and what they can do to help. The team are so enthusiastic and curious about the subject matter that we have a fantastic morning of active discussion. 12:30 - 13:45: Lunch meeting I pop back to the office for a working lunch meeting to discuss our next project around eating well with dementia. We don’t have these meetings that often, but when we do, we choose one of our own (HILS) meals. Today I have chosen the vegetarian sausage casserole followed by ginger sponge and custard. It was delicious and I am now recharged and ready for the rest of the day. 14:00 - 15:00: I visit a client (accompanied by her daughter) to carry out a Nutrition and Wellbeing check. Our free Nutrition and Wellbeing check involves calculating Body Mass Index (BMI), by taking a weight and height measurement, assessing

www.NHDmag.com August / September 2016 - Issue 117

Nutrition training

for malnutrition risk using the Malnutrition Universal Screening Tool (MUST) and also exploring health and dietary needs through an informal questionnaire and discussion. The client has a healthy BMI and a good appetite and, importantly, she is enjoying our meals. However, we do identify that she isn’t drinking the recommended six to eight cups of fluid each day. The client knows how much she should be drinking and her daughter admits to have been ‘nagging her for months’ about it. After some enquiry about continence issues she reveals that she has been holding back from drinking due to having not made it to the toilet in time on a few occasions. I reassure her that this is a very common problem, but keeping herself in a state of dehydration will not help with this and will put her at increased risk of some very serious issues such as urinary infections and falls. They were both unaware of the dedicated NHS Continence Service that we have in Hertfordshire, and they agree for me to refer her directly. She also happily accepts one of our free water jugs and agrees that it would be useful if a drink could be prepared for her by the HILS Community team member who delivers her meal each day.

15:15 - 15:45: I carry out another client Wellbeing check; however, this time it’s a followup review for a client who I saw three months ago. At that time, he had an underweight BMI and had reported significant weight loss in the few months prior to my visit. He has since been receiving both our higher energy

meals and our ‘Nutrition Boost’ snacks, which we provided at no extra cost. Our ‘Nutrition Boosts’ are a few free extra items of food delivered with his meal each day. They are given to clients who are identified as being at risk of malnutrition. Nutrition Boost items include fortified soups, milky drinks and a variety of tasty snacks, all carefully selected so that they are small portions, but contain at least 200kcal each. Today, three months on, I find that he has put on 8lb which is great news.

16:00 - 17:30: I write up the summary letters to send to the clients I have seen and catch up on a few emails. An urgent email explains that we have a client who is allergic to Capsaicin (present in chilli peppers, bell peppers and paprika). I use our supplier’s dedicated nutrition software to run a search on these ingredients and send a list of our meals that do not contain them to our support teams, so that they can remove all of these meals from the client’s personalised menu profile. I also have several emails in my inbox from the support teams letting us know about new clients who would like a Wellbeing check, as well as messages from community groups who would like training. And so the work continues!

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