Lee Sheppard, Divisional Manager, Care Homes, apetito, looks at some of the challenges involved in catering for the elderly...
Hospital food has already been under the spotlight as has school food, and it would appear that the care home sector is next as the Care Quality Commission undertakes its review of ‘meeting the healthcare needs of people in care homes.’ The question is whether the report, due to be published in November, will recommend legislation, regulation or stronger guidance?
The Market
In a market which spans a wide range of operators from small independent, to large multiples, the quality of food varies widely. And it’s not surprising ‘feeding the elderly’ is moving up the political agenda when one considers malnutrition affects 10 per cent of the elderly population, and in financial terms costs the government £7.3 billion per annum – significantly more than it spends on obesity (£3.5 billion). All care home operators are aware that nutritious, appetising meals can make an enormous difference to resident wellbeing and overall quality of life; however achieving it can be easier said than done. Interestingly, the quality of food, its nutritional content, and the menus offered are not often investigated in-depth by relatives when selecting a care home. Good food is seen as a given, yet too often expectations are not met, and the quality of food provision forms the second highest complaint category about care homes, according to a recent survey by the OFT.
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The nutritional needs of the elderly are complex. As we get older our bodies do not process food as efficiently as younger people, and factors such as illness, drug interactions and a decrease in taste and smell results in reduced appetites. To compensate for this, diets must be nutrient dense, high energy and rich in protein to avoid malnutrition. Strict guidelines are in place for catering for our children due to the ‘Jamie’ effect but surprisingly there is no such directive on feeding the elderly. The little legislation there is in place is sketchy at best. At present, care homes work to the guidelines of the Care Standards Act 2000, which simply states a requirement for the provision of ‘a wholesome, appealing, balanced diet’. The onus therefore is on the individual care home. But what is wholesome food? What constitutes a balanced diet for an elderly resident? And whilst attempts can be made to make food appealing, how is this achieved for example, for those with dysphagia?
For those responsible for catering in care homes, there are often more questions than answers. It’s a complex issue and it’s not simply a case of striking a balance between nutrition and taste to provide a simple, one meal suits all approach. There’s a whole host of dietary requirements to consider, from gluten free, low salt and diabetic meals, to catering for those allergies and different cultural considerations. Add into the mix the requirement for texture modified and pureed meals for those with dysphagia and a kitchen preparing meals for 30 residents can be tasked with preparing many different dishes at every meal time. It’s a daunting task, and as a result, a career specialising in care home catering does not always appeal to chefs and cooks who, instead of experimenting with new ingredients, find their creativity restricted by dietary requirements.
Raising Standards
For care homes looking to improve the standard of their meals the cook-freeze method offered by apetito is one solution. We have over 50 years’ experience of feeding elderly and vulnerable people and produce over 200 different dishes including special diets and ethnic dishes. Each batch of which is subjected to the highest possible scientific and health scrutiny, including no fewer than 8 key microbiological tests. Among the many advantages of cook-freeze is the flexibility to heat food only in the volumes required and when residents are hungry, which not only reduces wastage – 30 per cent of fresh food in Britain is at present thrown out - but has been found to aid consumption. It also preserves nutrients; in particular vegetables that are regenerated just before eating suffer minimal vitamin loss.
Whilst, we eagerly await the results of the CQC’s report later in the year we’re anxious to ensure that food provision does not get bogged down in legislation.
It seems to us that the present guidelines are potentially too vague and we would welcome a tightening up. However, our feeling is that any new guidelines would be best policed by the industry rather than enforced remotely from Whitehall.
For small-scale care providers, top-heavy legislation could prove to be overly prescriptive. While their residents have the right to expect the same quality of food and service as residents of larger chains, for the small-scale operator – more than 54 per cent of the country’s 21,500 care homes have 20 rooms or fewer - a strict one-size-fits-all set of rules and regulations could prove to be a very blunt instrument with which to improve what is only one, albeit important, aspect of the care home experience.
For further information on apetito, visit www.apetito.co.uk or call 01225 753636
