2010Apetito

• 1 . Catering for older people
  Lee Sheppard, Divisional Manager Care Homes,
  apetito, looks at some of the challenges …

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• With an ageing population – approximately 1.3 million people in the UK are now aged 85 or over – how we feed hospital patients, the residents of our care homes and those in the community is set to rise up the political agenda in the coming years and operators need to be in a strong position to lead.
  Hospital food has already been under the spotlight as has school food and it would appear that the care home sector is next as the Care Quality Commission undertakes its review of ‘meeting the healthcare needs of people in care homes.’ The question of whether legislation, regulation or just stronger guidance is appropriate needs to be carefully considered.
  Feeding older people
  Strict guidelines have been introduced for school meals yet the feeding the elderly, whose bodies are often less able to cope with a poor diet than children whose robust constitution can see them through many hardships, and need to eat regular, high-quality meals has no clear, effective guidelines.
  Malnutrition, which affects 10 per cent of the elderly population, presently costs the government £7.3 billion – significantly more than it spends on obesity (£3.5 billion) - yet it does not enjoy anything like the same profile in the media. Bed sores, bone density and mental condition all benefit from a healthy diet and all are affected by a reduction in physical activity as people grow older.
  On top of this, the nutritional needs of the elderly are often much more complex than those of children. Whilst school meal provision may only need to offer a menu that caters for a handful of exceptions such as allergy or religious observance, care home operators often find themselves needing to provide as many different special diet menus as there are residents - and all on a strict budget. Furthermore, having produced a meal, the next task is to make sure it is eaten by the person for whom it is intended.
  Consumption is key. Inadequate food intake is cited as one of the most common causes of weight loss and malnutrition amongst dementia residents. We have found introducing additional drink and snack times and a variety of finger foods to encourage self-feeding can be helpful. For those with moderate to severe symptoms and/or who have dsyphagia texture modified food may also be a necessity.
  As a result of all these factors, a career specialising in feeding the elderly does not always appeal to chefs and cooks who, instead of experimenting with new ingredients, new dishes, new menus, are likely to find themselves producing pureed meals, low salt meals, gluten free meals and meals for diabetics, as well as cooking for diets that conform to Kosher, Halal or Afro-Caribbean traditions. Staffing the catering operation with suitably qualified people is one of the major challenges for the care home sector.
  What is wholesome, appetising food?
  At present, the guidelines of the Care Standards Act 2000 gives only very broadbrush guidance to operators and the interpretation of that guidance, which can be wide ranging, is at present monitored by the CQC but largely relies upon self-reporting.
  The National Association of Care Catering (NACC) has more stringent guidelines and The Caroline Walker Trust also offers useful guidance. But is that enough? Do we really need more regulation?
  apetito is a leading food supplier and has wide experience in Care Catering providing cook-freeze meals to 150 local authorities and 75 NHS trusts. We believe top-heavy legislation could prove to be overly prescriptive. Whilst, we welcome the CQC’s involvement in care homes, we’ve also seen the benefits of working with industry organisations such as the NACC.
  Care catering operators are well placed to set high, yet realistic standards and monitor them with the degree of fairness and flexibility that is needed. They understand the challenges. For example, feeding those patients with dementia presents a very real challenge and can this be understood from Whitehall? The complexity of a simple task such as eating increases ten-fold as the physical, psychological and cognitive impairment experienced by individuals affects their eating habits. Sufferers can forget or refuse to eat, get distracted whilst eating or due to dsyphagia simply can’t eat solid food. So in addition to the quality and nutritional appeal of the food, care caterers have to consider practical issues of improving the diet and intake of residents with dementia.
  Through our experience working with NHS Trusts and Local Authorities, we know that sensual cues such as providing a pictorial menu and being able to see the kitchen and smell the food cooking can stimulate appetite. Simple steps such as smaller portion sizes – with second helpings being available – help to avoid overwhelming the recipient and whilst we would actively encourage lunchtime as a social affair, for some residents it’s important not to distract them from eating their lunch. A quiet relaxed setting can help people with dementia to eat well, so perhaps offering two sittings; one for those who can feed themselves and one for those who can’t or need assistance. But none of this insight is within the current guidelines.
  Self-regulation, not Government imposition
  There should be some form of self regulation or accreditation scheme for meal provision – or at the very least, more detailed guidelines drawn up as to what a wholesome, balanced and appealing menu looks like in terms of quality, nutrition and choice. The scheme should be policed by the industry rather than enforced remotely from Whitehall and for those operators accredited to display a badge or similar as demonstration of attainment. The result will be a rise in the quality of resident feeding simply because everyone will want to meet the criteria.
  Looking wider, we would like to see clear standards agreed across all care catering so that operators, patients, residents and their families can be confident that whatever the type of care, the meal provision is appropriate. The industry needs to agree what a wholesome, balanced and appealing menu looks like in terms of quality, nutrition and choice. If standards are set for feeding older and vulnerable people, I am confident they will be met; if not, food provision becomes subjective and it shouldn’t be.