NHD Issue 150: The central role of care caterers In delivering quality, safe, Person-centred meals

SOCIAL CARE

THE CENTRAL ROLE OF CARE CATERERS IN DELIVERING QUALITY, SAFE, PERSON-CENTRED MEALTIMES In any home, the kitchen is at the heart of our social, physical and emotional wellbeing. It nourishes us, stimulates happy memories of times gone by and encourages us to come together with others and share conversation, company and experiences. This is no different for residents of care homes up and down the country.

In the past two years, I have been honoured to be an invited speaker at the Scottish NACC (National Association of Care Caterers) conference. Care caterers have a vital role to play in enabling our service users to enjoy, look forward and live life to the full. They are core team members, to be included in meetings and conversations about care planning; getting to know each person in our care; and developing a holistic understanding of how to keep residents happy and well.

In care homes up and down the country, new residents are being admitted probably feeling a bit anxious, homesick, lost and upset; maybe they’ve been recently bereaved, or have been discharged from hospital without having the chance to see their old home. One of the first people who can help to offer some comfort, show interest in them and a provide a warm welcome, will be the chef.

After the initial admission process and maybe a cup of tea, what would your first thought be? “I wonder what’s for lunch – I’m starving!” “It smells as though they’re cooking fish and chips today – my favourite!” “I don’t think I could face much to eat – maybe some soup?” Most admission documentation will (hopefully) include a conversation about an individual’s food and drinks preferences. It would be all too easy to take that at face value, but taking time to tease these out can reap greater rewards. A good care chef will know that sometimes people will prefer specific brands (tomato soup springs to mind!); residents might

prefer the way food is cooked in the home, eg, macaroni cheese, rather than by the person they were living with before admission. It can take a few weeks to get to know someone’s true likes and dislikes.

Our tastes can of course change due to a variety of factors, including medication, oral health, available choice of food and drinks and illness. We all have different preferences/comfort foods when we are poorly, so our care chefs need to know these for each resident too, helping them to regain their strength and health quickly.

Food presentation and the type of crockery, glassware and cutlery can also impact on whether people choose/are able to consume meals and drinks. Using small shot glasses or ramekins to serve minidesserts and knowing which type of cup someone prefers to drink from, are small factors, which can encourage improved eating and drinking. Choosing bright bold coloured products, which stand out against a plain white tablecloth can help service users to help themselves, while occupational therapy colleagues can advise on purchasing individualised adaptive aids and equipment to enable greater independence and enjoyment of mealtimes.

Evelyn Newman Nutrition and Dietetics Advisor: care homes NHS Highland Award winning dietitian, Evelyn Newman, is well known throughout the profession for her writing, volunteering with the BDA and innovative work.

She currently holds a unique role in The Highlands.

REFERENCES Please visit: https://www. nhdmag.com/ references.html

CHALLENGES AND DIFFICULTIES

Some of the major problems I’ve noticed over the past six years working with care home cooks is their lack of nutritional knowledge or experience of working in care homes; their inability to prepare a range of texture modified meals and www.NHDmag.com December 2019 / January 2020 - Issue 150

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SOCIAL CARE ask a colleague or family member to feed you your next meal to give you insight. If care cooks struggle to offer a good variety of tasty, safe, person-favourite meals, the knock-on effect on care staff workload will be negatively impacted.

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snacks and the lack of cover for them to have time off. The NACC website1 offers a great selection of information and training opportunities and the Care Inspectorate Food and Fluid Hub2 includes practical YouTube clips, menu planning ideas, links to the IDDSI website and apps. In Highland we have a multi-agency group of staff working with the University of Highlands and Islands, who are trying to develop a pilot model or care cook training. This will provide a career opportunity that many school leavers or existing cooks may have never previously considered. This will result in a higher standard of motivated, capable catering staff who are more able to support the high-quality meal service that our frail elderly clients deserve.

We have increasing numbers of residents and day service users who require texture modified diets to keep them safe and well.3 As people live longer with dementia, and other similar neurological conditions, they may experience increased challenges in eating well. People with dysphagia have a 50% increased chance of being malnourished and a 70% chance of developing dehydration if we don’t have well-motivated skilled caterers to help to address this.

How often are menus updated by the cook where you work? Are they very person-centred and appetising? How much variety is offered to prevent menu fatigue? How many people need assistance to eat and drink? It is very challenging to experience this and I would encourage you to 38

We all know the implications of malnutrition and dehydration and the likely need for prescriptions.

In the Highlands, we proactively promote a foodfirst model of nutritional care, which requires catering staff to work closely with residents and service users to coproduce opportunities for varied person-centred meals, snacks and drinks. Staff have described how this has helped reduce the incidence of UTIs, constipation, weight loss, headaches and falls. The consequence of this is to reduce the need for clinical referrals (dietetic and GP), prescriptions for antibiotics, laxatives and oral nutritional supplements,4 which helps to reduce wasted food and frees up care staff to spend more time interacting with residents, instead of administering medicines and personal care. Not surprisingly, residents are noticeably happier and healthier.

The risks of not getting care catering right for residents must be recognised and mitigated against. Incidents and consequences of death by aspirating unsafe textures, reactions to allergens, dehydration and weight loss, are all avoidable.

The risk of not having the cooks with the right training and skills must also be a consideration, plus making appropriate arrangements for cover when the chef is off or during periods of vacancy, which happens all too frequently in the care sector.

Having frozen meals, especially for specialist diets, can ensure that people eat well, whether the meals are cooked inhouse or bought in from an external supplier. Many of the care settings in Highland safeguard against risks by purchasing meals from private catering companies and many of our careat-home service users benefit from a contract with Apetito5 meals. This is positively evaluated, especially with the added challenges of our remote and rural geography, which is often compounded during challenging weather conditions.

We all have a duty to help safeguard people from nutritional risk and as dietitians we can also use our networks and influencing skills to develop and share innovative, transformational approaches to all our care catering settings.

www.NHDmag.com December 2019 / January 2020 - Issue 150

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