How to improve nutritional standards in care homes

A care home in Wimbledon (pictured) has become an academy of nutrition as it responds constantly to residents’ food preferences while maintaining quality, reports Jeremy Dunning

PROJECT DETAILS

● Service: Nutritional support provided at Queens Court Care Home, Wimbledon

● Aims and objectives: To improve health and well-being of residents.

● Staff: One nutritional champion, employed as a senior care assistant, and head chef.

● What is provided: Nutritional screening through the Malnutrition Universal Screening Tool (Must); menus designed according to residents’ needs, likes and dislikes.

● Outcomes: 96% of the residents and relatives view their catering service as “highly favourable”; reduced prescription of food supplements by GPs.

A care home in Wimbledon has become an academy of nutrition as it responds constantly to residents’ food fancies while maintaining quality, reports Jeremy Dunning

Fresh food, a top-class dining experience and creative menus have led to improved nutritional outcomes for residents at a care home in London. “Our GP rarely prescribes food supplements now,” says Shaaron Caratella, manager of the Barchester Healthcare-owned Queens Court Care Home in Wimbledon.

The new approach to care home cuisine has been spearheaded by Queens Court’s head chef and head of hospitality, Mervyn Knights, and care worker Arceli Villanueva.

Villanueva, who trained as a nurse, was hired as a senior care assistant, but Caratella recognised her interest in nutrition and encouraged her to attend various courses on the subject. Now she helps induct staff into nutrition techniques.

Together, Villanueva and Knights are recognised across the company for their ideas and host quarterly nutrition meetings of regional Barchester homes inside the M25.

“We are sharing ideas with other homes and discussing strategies with them,” says Caratella, whose home was rated excellent by the Care Quality Commission last year.

High nutrition standards are vital in care homes. At least 30% of people admitted to care homes are at risk of malnutrition, according to a report last year from the British Assocation for Parenteral and Enteral Nutrition (Bapen).

Queens Court residents are screened using the five-step Malnutrition Universal Screening Tool to identify adults who are malnourished, at risk of malnutrition or are obese, and the menus provided are devised to improve health outcomes as well as to give residents food they enjoy.

It is one of 12 Barchester homes accredited as providing the “five-star dining experience”. To win the status, homes must “prepare menus which comprise fresh, seasonal ingredients so that every meal is not only nutritious but also looks great, tastes delicious and caters to a variety of preferences and dietary requirements”.

Villanueva and Knights work closely with residents, other care staff and GPs to work out dietary requirements and residents’ likes and dislikes to design a meal plan.

“Someone’s appetite can change over a short period, so I revisit my notes often and adapt care plans accordingly,” says Villanueva. “Sometimes a resident might have trouble swallowing and I relay my observations through my interaction with those I care for to Mervyn.

“In turn, when Mervyn sits down with a resident to discuss new dishes or try to introduce a new ingredient into their diet, he already has a wealth of information.”

Knights says a large part of the strategy depends on interaction with residents.

“When I do front-of-house I gain an understanding of what residents want” he says. “We have a zero tolerance of frozen food and ready meals and have a good understanding of home cooking. We’ve got a few who have put on extra weight, and need to lose it, so we help them with nutrition and help others gain weight.”

Both regularly attend sessions hosted by dietitians and nutritionists to keep abreast of new studies and practices.

The British Geriatrics Society praised the home’s approach as good practice that it would like others to follow. “Ensuring that older people in care homes receive the appropriate nutrition is not only a matter of maintaining their health but also promoting their dignity,” Dr Eileen Burns, consultant physician at Leeds Teaching Hospitals NHS Trust, says on behalf of the BGS.

Terry Tucker, learning and development director for Barchester, says Queens Court is at the heart of the company’s efforts to provide high-quality nutritional support to its residents. “Barchester has developed its own chef academy to ensure that all the chefs are trained to meet our residents’ specific dietary requirements as well as all their like and dislikes.

“In addition to being trained in how to cook delicious and well-prepared food, the chefs are trained in nutrition and special diets. Much of our chef academy training is based at Queens Court.”

CASE STUDY: Dementia prevented woman from recognising food

One woman with dementia was recently admitted to Queens Court Care Home having not eaten a piece of solid food for months. Now she is eating regularly and her health has improved. The turnaround started with a brightly-coloured piece of cake served on her first morning at Queens Court, says manager Shaaron Caratella.

“When you have dementia, bland colours don’t show up, but something eye-catching gets you interested and something in her wanted to taste it,” says Caratella.

The woman came to the home after her husband and daughter realised they could no longer cope.

She had not been drinking enough fluids and would only drink a pale tea. As a result she had urinary tract infections and became more confused and resistant to solid food put in front of her, which she would throw out of the window or on the floor.

When she would eat, the food had to be liquidised because she indicated she had swallowing difficulties.

“She could swallow, but the dementia was saying [that what was put in front of her] wasn’t food,” says Caratella.

After the success with the cake, Caratella realised she was prepared to give new things a chance and encouraged her to take part in music and art activities and circle dancing, and also to eat in the restaurant.

Now she is eating and her mobility has improved, the dizzy spells having dissipated. She has also a stronger grip and, as a result, is inclined to drink more.

Interaction with other residents has increased and her former career as a nurse manifests itself as she strokes the hands of other residents and speaks softly to them. “She’s communicates with the ones who are frailer whereas before she would sit in a corner with a tissue and pick it to bits,” says Caratella.

There has been such a transformation that her daughter has come in and had supper with her. “She said to me she doesn’t know when she had last eaten with her mother,” says Caratella.

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This article is published in the 29 September 2011 edition of Community Care under the headline “Stepping up to the plate”