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Nutrition and hydration

The importance of nutrition and hydration in a care home setting

You may be thinking that saying food and drink is important is stating the obvious - What can I possibly need to know that I don’t know already?

The painful truth is that elderly people living in care homes are still suffering and dying unnecessarily from malnutrition and dehydration, or from complications associated with the conditions.

We all know failure to provide food or water is criminal neglect, do you know failure to prevent malnutrition or dehydration is also classed as criminal neglect?

Can you be certain you are doing enough?

Making sure residents in care homes have nutritious food and drinks, is essential to good care.  Food and water are fundamental to quality of life and, for many older people in particular, are critical to their health and well-being.  Unplanned or unexplained weight loss can mean older people are more vulnerable to disease and may be fatal. Borderline dehydration can affect concentration and balance leading to accidents and falls. People’s appetites also reduce with age, so keeping older people interested in food and drinking enough is a daily challenge.

The Care Quality Commission will be targeting care homes to specifically inspect how they are meeting Outcome 5 in the Essential Standards of quality and safety (2010) which states that:
People who use services:
       Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:
       Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrition and hydration.
      Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally balanced and supports their health.

Practical tips to ensure people are getting the most out of their food:

1. Offer nutritionally-dense foods
Since many older people aren't eating as much as they should, the food they do eat must be as nutritious as possible.
Use whole, unprocessed foods that are high in calories and nutrients for their size.
Some examples include: healthy fats (peanut butter, nuts, seeds and olive oil), whole grains (brown rice, whole wheat bread, oats and whole grain cereals), fresh fruits and vegetables (canned and frozen are also good choices), and protein-rich beans, meat and dairy products. This will help ensure that they are getting all the vitamins and minerals needed to maintain proper health.
As the desire to eat a normal portion size of food lessens, it becomes even more important to put as many calories as possible into the food on offer to maintain energy levels and good health. This is known as ‘fortifying foods’. It is helpful to add butter, cheese and cream to foods whenever possible, but do bear in mind that some people may be susceptible to being overweight.

2. Enhance aromas and flavours
Appealing foods may help stimulate appetite, especially in someone whose senses of taste and smell aren't what they used to be. Flavours can be intensified with herbs, marinades, dressings and sauces. Talk about food close to mealtimes; ask people if they can smell the food cooking. Use herbs or spices such as cinnamon, nutmeg or mint and take them round people for them to smell. Talk about any memories of food and cooking they evoke.

3. Make eating a social event – sit, or even better, eat with people at the table, especially if they need assistance. Encourage conversation with them and between them. Dress the tables with pretty tablecloths, cloth napkins and flowers. Serve vegetables in dishes, gravy in gravy boats. Use wine glasses, even if they do not contain alcohol. Fun and laughter raise the spirits and will help encourage people to stay at the table to eat and to enjoy their mealtime. Make mealtimes a special time rather than a ‘chore’. Be sensitive to the environment you are creating – standing around waiting for people to finish can be very off putting. Bear in mind also that if someone has had breakfast late, they will not eat a good meal at lunchtime so delaying their lunch could be helpful in maximising their food intake.

4.Encourage healthy snacking
Many older people don’t like to eat large meals or don't feel hungry enough to eat three full meals a day. One solution is to encourage or plan for several mini-meals throughout the day. If this is the case, make sure each mini-meal is nutritionally-dense with plenty of fruits, vegetables and whole grains
- smoothies, small sandwiches in bite size pieces,
fruit cut into slices, bowls of grapes etc

5. Take care of dental problems
Maintaining proper oral health can enhance nutrition and appetite. Make sure dentures fit properly and problems like cavities and jaw pain are being properly managed.

REMEMBER As a social care worker you have a duty of care to ensure people’s nutritional needs are met. Failure to meet people’s needs is considered to be neglect.  Care homes and their staff are being prosecuted, protect your self, maintain your quality and demonstrate how you are committed to correct provision nutrition and hydration.

To obtain workbooks to train your team either visit our Training Workbooks page or down load an order form here.

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