What I want within reason, mealtimes in care homes

As the number of older people living in care homes is set to rise, Healthwatch Surrey has made it a priority to amplify the voice of older people in care homes and ensure that their experiences, and the associated learning, are shared with homes across the county. In an effort to hear more from residents themselves a programme of 20 Enter and View visits were conducted with the aim of hearing from care home residents, their friends and relatives, and care home staff. Visits were conducted by a team of Authorised Representatives made up of Healthwatch Surrey staff and volunteers. The information gathered through this programme of visits highlights a number of themes, explored in this full report, which will be shared with care providers, commissioners and other organisations across Surrey.

Across the homes visited there were examples of person-centred care and of small actions homes had taken to promote dignity and respect; these included the use of large napkins instead of protective aprons at mealtimes and preparing fruit for easy eating. We also saw examples of staff working flexibly to ensure residents’ needs were met, for example providing finger food, using a clock face as a reference to help a visually impaired resident enjoy their food at mealtimes, and offering ice lollies to encourage fluid intake. Homes told us they often celebrated special occasions such as birthdays and Christmas with special foods, with some homes going the extra mile to make meals varied and enjoyable for residents: for example preparing a special Halloween menu, holding themed meals such as a ‘seaside theme’ and making use of outdoor spaces during good weather with barbeques and garden parties. Many homes were proactive in inviting friends and relatives to get involved, with some homes offering visitors the opportunity to eat with residents and a handful also holding ‘coffee mornings’ and special lunches for friends and relatives to attend. The involvement of friends and relatives was something highlighted as important by the visitors we spoke to and residents also commented that they enjoyed these occasions. On the whole homes did have methods for gathering and welcoming resident and visitor feedback, however the responsiveness to this feedback varied and some homes appeared to be more proactive, using varied methods of engaging with residents (e.g. residents’ meetings, feedback books). One method of gathering feedback that appeared to be particularly appreciated by residents was face to face contact with the chef, often towards the end of a mealtime, to check the food was enjoyed and listen to residents’ comments. One area that particularly varied was choice at mealtimes; although all homes stated that residents had a choice of main meal and had access to alternatives, residents explained that sometimes they did not have a choice or were unaware that there were alternatives available. Some residents also reported that they did not have access to condiments/ seasoning, would like healthier snack options, and would like more flexibility with meal times, particularly at breakfast. It is possible that choice is available, but residents are not always aware of this. In some homes we noted that choices were not clearly presented, for example residents were asked to make decisions about meals ahead of time, menus were unavailable or had small print, and special diet options seemed limited in some cases. During busy mealtimes we noted that in some homes staff were slow to respond to and assist residents; staff, residents and visitors noted the pressure on staff and in some cases this led to residents moderating their expectations.