Making mealtimes matter in care homes in North Tyneside

Healthwatch North Tyneside produced a report on mealtime experiences at care homes after conducting Enter and View visits to 31 care homes between June 2016 and January 2017.

During the visits Healthwatch representatives focused on gaining an understanding of older people’s experience of food and drink in residential care homes in order to identify good practice and make recommendations for improvement. The aim was to understand:

- how homes perform in supporting resident’s emotional wellbeing through food and drink; and

- how homes enable residents to exercise choice and controlling eating and drinking.

Healthwatch spoke to 302 residents, 81 visitors and 250 staff during the visits. In addition, the research for the report also included an online survey for families and friends, a literature review of relevant legislation and regulation standards, analysis of spending data and a review of Care Quality Commission (CQC) reports.

The key positive findings on mealtimes in care homes are as follows:

- overall care homes gather information on residents’ food preferences and demonstrate flexibility in accommodating their needs;

- residents in most homes gave positive feedback on mealtimes and the quality of food;

- food and drink were available throughout the day in most homes;

- some homes provided good examples of differentiating weekday and weekend mealtimes by creating special events and routines.

The following key issues were identified as requiring improvement:

- homes need to clearly show how information gathered about residents’ food needs and preferences feeds into the development of menus;

- menus are not consistently available in accessible formats which take account of residents’ needs and impairments e.g. those living with dementia;

- for residents who need assistance or dined alone in their rooms, the experience of mealtimes varied and there was a risk of social isolation for those who dined alone;

- some homes’ feedback systems miss opportunities to capture residents’ views on meals because they do not reflect and support the needs and abilities of all their residents e.g. asking for feedback at a later date from residents with memory impairment;

- in some homes there was a lack of consistency in the quality and substance of food provided to all residents due to individual dietary requirements and location within the home;

- residents’ experience of meals could be improved by providing more opportunities to exercise choice and control in terms of portion sizes, sauces, dressings;

- there was a disparity across homes and within homes in providing ‘something special’ for certain occasions.

The report makes 10 recommendations to care home providers, commissioners and the CQC.

Care home providers:

1. Homes need to develop and implement a range of techniques and systems to engage residents, families and friends in feedback and planning. This should include gathering information on residents’ needs and preferences upon admission; auditing the accessibility of menus; gathering real-time feedback on meals; supporting residents with cognitive impairments to provide feedback; and developing a process to utilise resident information and feedback to influence menus and mealtime experience.

2. Home managers and activity coordinators need to review meals and the mealtime experience to assess their status as a meaningful ‘activity’.

3. Managers should:

- identify and address any disparity in dining accommodation within their home;

- offer residents the opportunity to dine with like company to enhance the social experience of mealtimes;

- review how all staff can contribute at meal times;

- regularly review and minimise the risk of social isolation for residents dining alone;

- actively encourage family, friends and volunteers to be involved at mealtimes to enhance the social experience of mealtimes.

4. Home managers need to review the quality and presentation of meals for all residents regardless of physical or cognitive impairment or special diets. This should include spot-meal taste checks, ensuring access to food and drink outside of mealtimes and providing opportunities for cooks across the region to network and share best practice.

5. Care homes should contribute to resident wellbeing through the regular provision of a variety of ‘special’ occasions complemented by food and drink.

Commissioners:

6. North Tyneside Council should consider how they can strengthen the care home contract specification and monitoring tool to ensure that homes have a structured, measurable approach to resident choice, engagement, feedback and planning.

7. North Tyneside Council should change the contract specification and monitoring tools with regard to: residents’ food preferences, real-time feedback on meals, measures to assess and prevent social isolation for residents dining alone, provision of snacks outside mealtimes.

8. North Tyneside Council should publish information for residents, family and friends about what they should expect from food and drink in care homes.

9. North Tyneside Council should carry out an audit of spend per bed across care homes to ensure that adequate provision is being made for people, and investigate where spending is below the average across the region to ensure the well-being of residents is not being impacted negatively.

Care Quality Commission:

10. CQC inspections should consider the mealtime experience in more depth by assessing how care homes facilitate social participation and inclusion.