offered or the prices charged. Once in a care home the resident is more or less a hostage to the status quo. From April 2016, all care homes have been expected to display the results of CQC inspection ratings in a prominent position on their premises, much like the ‘Scores on the Doors’ systems for restaurant food safety. Just one of the major problems facing those people living with dementia in long term care homes is the reduced intake of nourishment, leading to malnutrition, regardless of the hospitality services. The potentially harmful effects include dysphagia (difficulty or discomfort in swallowing as a symptom of disease), apparent food refusal, stress and panic expressed by the resident when fed 22,11. Despite past and current government strategies to improve the nutritional intake for people living with dementia in long term care homes, surprisingly little research has been carried out into the operational, practical and staffing aspects of feeding those people. From a caterer’s point of view there has been much advice as to what to feed to the people within their domain 23,24,25,26. There has, in fact, been a long history of dietary and nutritional advice most of which seems to be both accurate and well intentioned. Method and Ethics The original intention was to develop a single case study based on the catering and hospitality provision at one long term care home where the residents were either totally or predominantly people living with dementia. Following an initial Pilot Study it was decided to extend the study to other long term care homes. The reasons for this change of tack were several: 1. it was felt that one care home would not offer sufficient scope to generalise the findings and conclusions; 2. the original care home in the pilot study was relatively small; 3. the care homes which also catered for residents who were not living with dementia tended to be larger and were more representative of the care home sector As suggested27, the units of analysis for the qualitative study were determined during the design stage. The Sampling Frame shown in Figure 1 describes the type of care home units to be studied. Figure 2, describes the individual units of analysis, the actors involved in delivering F&B services. The sample of care homes used has been randomly generated based on the National Institute for Health Research Enabling Research in Care Homes (ENRICH) programme Data Base of care homes actively willing to take part in research.
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