Special report on meals for older residents

Meals are the highlight of the day for many older care home residents, a report by the Commission for Social Care Inspection found last week.

CSCI chair Dame Denise Platt pointed out that it is a timely bulletin because the quality of the food we eat is never out of the news.

Thanks to chef Jamie Oliver, children’s school dinners have received vast amounts of publicity, followed by subsequent government action. But care home residents could do with a torrent of coverage about their nutritional needs too. Indeed Liberal MP Paul Burstow and charity Counsel and Care have suggested Delia Smith as ideal to raise the profile and importance of care home food. So far she has not risen to the challenge.

In the meantime, CSCI figures show that meals provided at one in six care homes for older people fall below government national minimum standards.

This means there are nearly 2,000 care homes in England that do not offer residents “a wholesome appealing balanced diet in pleasing surroundings at times convenient to them,” as laid down in the standards.

Voluntary sector and council-run homes performed better than private sectors, in the CSCI research. Almost 90 per cent of voluntary-owned homes met standards, compared to 83 per cent of private homes. There were wide regional variations.

As the commission points out, the majority – 83 per cent – of homes are up to minimum standards. Two years ago, the figure was 78 per cent, so there is improvement, albeit small.

The new CSCI publication gathers best practice on improving the quality of meals and mealtimes.

Chief inspector David Behan said, “Meals need to be prepared and served professionally. Care homes need good management, proper facilities, the right equipment and good staff training to make meals and mealtimes a satisfactory experience for all their residents. Homes also need to have enough staff to help older people eat their food if they are too frail or ill to feed themselves. The best care home often bring in external nutritionists and dieticians to help them provide better food for their residents.”

The commission identifies the challenges facing care home providers on meals including:

• Finding the right balance between what residents want to eat and providing healthy food

• Catering for diverse needs

• Promoting older people’s independence when providing meals, while keeping them safe and well

CSCI encourages care homes to take more account of the views of service users when providing meals.

The report includes a checklist for care home managers, staff and caterers.

Quality, limited availability and choice are the main complaints about food dealt with by CSCI. The report includes a small sample of complaints, to illustrate issues raised by service users and their families.

These include evening meals regularly consisting of sandwiches; failure to cater for Caribbean service users, or for vegetarians; and cooks not on duty at weekends.

But is the fact that most care homes meet minimum standards good enough? Or are the standards set too low and should the government and social care have higher aspirations for its older people?

Care homes spend £2.43 per person a day on food, according to Joseph Rowntree Foundation research cited by CSCI.

The commission says the figure “appears reasonable” when compared with money spent of prison food (£1.74 per person daily) and school dinners (35p a meal but set to rise).

So is £2.43 a day sufficient to buy nutritious food for an older person?

The Caroline Walker Trust publishes nutritional and practical guidance for older people in residential care. “It is not necessarily more expensive to eat well,” said director Helen Crawley.

The trust estimates the cost of providing “nutritionally adequate” menus for care home residents is about £2.57 a day – not much more than current spending.

However cost is not the only issue.

“Many care homes do not know what constitutes a nutritionally adequate diet and need support to ensure that they offer an appropriate menu: inspectors need tools and training to ensure that they know how to monitor and support homes to produce appropriate menus,” said Crawley.

CSCI says it focuses on the “quality of the provision and delivery of meals in care homes, rather than nutrition itself.”

While it is important for care homes to serve nutritious food to residents, notes CSCI, the situation is more complex than that.

“Although food quality and…resources to buy good food are essential, stimulating people’s appetite and making mealtimes the ‘highlight of the day’ require consideration of wider factors,” says CSCI.

“Merely putting nutritious food on the table does not mean that older people will then eat it,” says the report.

CSCI says it is important to meet older people’s wider “physical, social, cultural and emotional needs” to stimulate appetite. It cites “sensory, physical and cognitive impairment; long-term medical conditions and the side effects of certain medications; and emotional, cultural and social issues” as factors that can lead to loss of appetite so need to be addressed.

However Liberal Democrat MP Burstow is concerned that the minimum standards say “next to nothing about nutrition.”

His private member’s bill, currently before parliament, calls for “clear nutrient based standards for all care services for older people.”

Burstow said CSCI is “right to say that the training of staff and choice of food on offer are important but it must also be a priority for the government to ensure there are clear national standards for nutrition in care homes.”

Crawley at the Caroline Walker Trust says the standards are an “enormous improvement” on earlier versions. But the trust would like to see the description “wholesome and nutritious food” in the standards explained in more detail.

Burstow has described cases reported to him of care home residents living on diets including Angel Delight and beans on toast or tinned corned beef and packets of Smash or tinned stew mixed with tinned soup for dinner and tinned soup for tea.

Menus like that seem unlikely to be anyone’s highlight of the day.

Download Commission for Social Care Inspection report Highlight of the day? – Improving meals for older people in care homes

Care homes for older people: national minimum standards, Department of Health

Caroline Walker Trust