Posted tagged ‘drink’

Esential Standards Outcome 5c – Nutrition

February 29, 2012

 Promote rights and choices

5C Where the service provides food and drink, people who use services can make decisions about their food and drink because they:


●● Have accessible information about meals and the arrangements for mealtimes.


●● Have a choice for each meal that takes account of their individual preferences and needs, including their religious and cultural requirements.

Do your menu’s offer the client a choice in meal or dictate what they will have?

Are there vegetarian, vegan or halal choices as appropriate for  someone?

Do you have clients with special diets that require them to be nut-free, gluten-free, lactose-free etc.?  


●● Have access to snacks and drinks throughout the day and night.


●● Have mealtimes that are reasonably spaced and at appropriate times, taking account of reasonable requests including their religious or cultural requirements.  

Meal times are perhaps easier to plan for and accommodate in residential and nursing care than within domicilary care. Never the less, the client should be eating at times that are reasonably spaced and should have an idea of when those times are. Particulary relevent at the moment are religious and cultural requirements as we go into a fasting time for many muslims for Ramadan. 


●● Have information on what constitutes a balanced diet to help them make an informed decision about the type, and amount, of food they need to address any risk of poor nutrition and/or dehydration.

 This information is equally relevent and important for the care team as well as the clients themselves. All too often we hear that carer’s preparing food for client’s that is not well balanced because they do not understand what a balanced food intake is either. 


Here’s some useful information about healthy eating and malnutrition taken from the leaflet produced by Leeds NHS:-


What is malnutrition?
Malnutrition is when a person is not eating enough of the right foods. This means they don’t get all the nutrients, such as proteins,
vitamins and minerals, they need.
Being malnourished can make you ill as your body does not work as well as usual. Being ill can also lead to malnutrition as this often
results in poor eating habits. Malnutrition is not just something which happens as you age. It is important that you don’t dismiss the signs as being a part of ‘old age’. There is much that can be done to
help prevent malnutrition. The key is to ensure that the underlying causes are assessed.

Who is at high risk?
· those with reduced mobility which affects shopping / cooking;
· if you are housebound;
· if you are living alone;
· if you are showing symptoms of depression; and
· those with dementia.

Dental / mouth problems can cause malnutrition because they can make eating difficult and painful –

Spotting the signs and symptoms:
· losing weight unintentionally;
· eating/ drinking less than usual;
· experiencing any choking or swallowing problems;
· constipation or diarrhoea;
· unable to keep warm;
· loss of muscle;
· dizziness (prone to falls);
· difficulties recovering from illness;
· pressure ulcers, dry skin;
· recurrent infections;
· difficulties chewing or swallowing; and
· sore mouth, or tongue, bleeding or swollen gums. 


What to do if you are concerned?
You can help prevent malnutrition in yourself or others:
· recognising the early warning signs;
· supporting access to both social and health services;
· planning visits around mealtimes to get a sense of what you / they are eating and if you / they have any difficulties eating;
· sitting down and eating socially with friends or relatives;
· having a look in the fridge or cupboards. A lackof food, too much of the same foods or foods past their sell by date may signal a problem;
· encouraging extra snacks and drinks; and
· keeping active, as it stimulates an appetite and maintains muscle mass.

How can you improve access to food?
· Sharing meals with others / going to relatives or informal carers.
· Attending local cafes / pub lunches /visiting voluntary, community or faith organisations with luncheon clubs.
· Using private shopping services and / or meal preparation services.
· Using online supermarket home delivery services (including frozen meals).


Well worth sharing some of this information with your care teams. Maybe copy and paste the bullet points where useful as reminders for staff. How many of thier suggestions could you  adopt or adapt to meet  the needs of the people you look after?



February 3, 2012

What CQC outcomes say about Eating and nutritional careselection of fruit

The outcome that relates to eating and nutritional care is:

Outcome 5: Meeting nutritional needs – Requires services that provide food to ensure:

  • a choice of suitable and nutritious food and hydration, in sufficient quantities to meet people’s needs
  • food and hydration provision meets any reasonable requirements arising from a person’s religious or cultural background
  • support, where necessary, for the purposes of enabling people to eat and drink sufficient amounts for their needs.

Regulation 14 of the Health and Social Care Act 2008

So here are some interesting facts from the Social Care Institute for Excellence

Eating and nutritional care and dignity – key points from policy and research

  • Food, nutrition and mealtimes are a high priority for older people and a top priority for older people from black and minority ethnic groups (PRIAE/Help the Aged, 2001).
  • Malnutrition affects over 10 per cent of older people (British Association for Parenteral and Enteral Nutrition, 2006).
  • Between 19 and 30 per cent of all people admitted to hospitals, care homes or mental health units are at risk of malnutrition (British Association for Parenteral and Enteral Nutrition 2007).
  • The UK Home Care Association estimates that up to 90,000 people who receive home care services could be at risk of malnutrition (Grove, 2008).
  • Public expenditure on disease-related malnutrition in the UK in 2007 has been estimated at in excess of £13 billion per annum (Elia.M, Russell, C.A. Combating Malnutrition – Recommendations for Action BAPEN 2009)
  • Malnourished patients stay in hospital longer, are three times as likely to develop complications during surgery, and have a higher mortality rate (Age Concern, 2006; BBC, 2006).
  • The needs of people from black and minority ethnic groups, including ‘basics such as food’ are not always met by mainstream services (PRIAE/Help the Aged, 2001; Afshar et al, 2002).
  • Key points in bringing about a culture change in food, nutrition and mealtimes are: good leadership, staff induction and training and adequate staffing levels (Commission for Social Care Inspection, 2006).
  • The NHS Standards for Better Health requires healthcare organisations to ensure that patients have a choice of food that is prepared safely and provides a balanced diet; and that ‘individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day’ (Department of Health, 2004e).
  • In February 2006 the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care launched clinical guidance to help the NHS identify patients who are malnourished or at risk of malnutrition.
  • The NHS Essence of Care benchmarks for food and nutrition include attention to nutritional assessment, the environment, presentation of food and appropriate assistance (Department of Health, 2003c). These can be used by care homes, as well as healthcare providers, to benchmark services.


  • The evidence suggests that good hydration can help prevent falls, constipation, pressure sores, kidney stones, blood pressure problems and headaches (Ellins, 2006).
  • Poor hydration has been shown to contribute to obesity, depression, inactivity and fatigue and to prolong healing and recovery (Ellins, 2006).
  • There is some evidence to suggest that dehydration can increase mortality in stroke patients and prolong hospital stays for patients with community-acquired pneumonia (Water UK, 2005).
  • For some older people the sensation of feeling thirsty may be impaired and may not be an accurate indicator for good hydration (Kenney et al, 2001; Caroline Walker Trust Expert Working Group on Nutritional Guidelines for Food Prepared for Older People, 2004) particularly for people who have had a stroke and those with dementia (Albert et al, 1994; Water UK, 2005).
  • Following a study of four care homes, Anglian Water has launched the Health on Tap campaign (Anglian Water, 2008) to improve hydration for older people in care homes. The key findings of the study were:
    • Availability, visibility and reminders were some of the key factors to drinking more water.
    • After a regime was introduced and a water cooler installed, anecdotal evidence from one home reported: a 50 per cent reduction in falls; a greater than 50 per cent reduction in the number of residents taking laxatives; and a decrease in GP call-outs and urinary infections.
    • There were language barriers for some staff, with 50 per cent not having English as a first language.
    • Hydration does not feature as a specific training topic in its own right.
    • Residents’ fear of increased toilet trips was the main barrier to drinking more water (the report states: ‘Once the bladder had adjusted and was able to hold more volume, toilet trips soon settled down to pre-trial levels.’)
    • Peer-to-peer learning, rather than formal training, plays a large role in the knowledge and working habits of staff.
    • Knowledgeable and committed managers generate positive results.
    • Visual and mental impairments were a problem for many residents, with a high dependency on care staff to instigate water intake.
    • Staff said they would like promotional materials for themselves, residents and their families, to remind them of the importance of hydration.
    • The ability to spread and share good practice was seen as very important
      (Anglian Water, 2008).