How good is your care home diet?

Meals in care homes are criticised as unhealthy and lacking in nutrients. But is the criticism fair? Robert Mair investigates.

At Charnwood Oaks care home, Leicestershire, mealtimes have been abolished. Gone are the regimented time slots and set menus for residents and instead everyone chooses what they want, when they want.

Striking a balance between providing nutritious food and meeting a resident’s personal tastes, care home manager Philip Wright and his staff have an innovative approach to the conundrum of giving residents quality food on a budget.

They offer a 24-hour kitchen service, providing the 84 residents with access to food, day and night. The home provides a three-course breakfast from 8:30am, which contains everything from a continental style to full English. After 11:30am this transforms into a brunch, which in turn changes into a light lunch until 3pm. At 4.30pm, dinner is served and runs until 5.30pm, where it is replaced by a supper menu – which is available throughout the night.

Nevertheless, implementing such a comprehensive menu wasn’t without its headaches.

“The main challenge was breaking the habit of the institutionalised regime of breakfast at 8, lunch at 12 and tea at 4, because we took the main meal from the lunchtime and moved it to the evening,” Philip says.  “It’s hard to get residents to eat a good hearty breakfast, a three-course lunch and just a light tea and expect them to get through the night. Instead, we balance it out, they eat more and we make it a social event.”

Indeed, family members are encouraged to join residents for the evening meal and because of the flexibility it allows them to come along after work. The quality of food is also important, and makes the eating experience enjoyable for people who might otherwise find it difficult. They get to choose what they want, and are offered a range of different food at all times of the day.

“It’s the same approach as going into a place like Fenwicks,” Philip adds. “You get offered a range of products and you choose what you want to eat. Our suppliers are probably some of the best you could ask for, and include Brown’s the butchers in Rugby. Not only do they supply us, they also supply some of the top hotels in the area.

“Prime Life Group (which owns Charnwood Oaks) is very generous in its daily allocation of money, and without that we couldn’t do it. So they do have a really positive outlook to the food.”

The price of a meal

Unfortunately, this is not the case in many care homes. On average, £2.43 is spent per head per day. Although this compares favourably with school children (35p) and prisoners (£1.74), the budget has to meet some very specific dietary needs – and also provide an entire day’s food.

Current regulations set out in the National Minimum Standards state that care home residents should be offered three meals a day, and that hot and cold drinks and snacks should be available at all times. Moreover, a snack should be offered between breakfast and lunch, and in the evening.

Food should be varied, nutritious and wholesome, and served in a manner that is appealing. Some 86% of residential and nursing homes for the elderly meet this National Minimum Standard – meaning one in seven care home residents do not eat a healthy diet according to government guidelines.

As part of annual Commission for Social Care Inspection’s (CSCI) inspections, food quality is an area that is scrutinised closely. Ginny Storey is CSCI’s senior nursing advisor and acknowledges the difficulties many care homes face when providing good quality food on a budget:

“It’s a challenge, but it is not impossible,” she says. “In fact, freshly prepared food costs less. It may cost more in terms of staff time, but it can certainly cost less than buying food that is readily prepared. From a nutritional point of view, the fresher the food, the better too. It is possible to provide really good quality food on a budget.”

Tailored diets

Catering for a home of different people with diverse needs often leads to a broad menu. Individual screening plans are put in place to ensure people’s needs are met, and they get the best level of nutrition available. Although difficult to achieve on a budget, Ginny emphasises that this is the best way to provide a balanced, tailored diet for an individual:

“Care homes should make sure there has been a nutritional screening, and that any action resulting from it is acted upon. It is a requirement now in the National Minimum Standards and it should be a high priority for all providers.

Independent nutritionist Claire Baseley supports the idea that meal times should be tailored for the resident.

“One size does not fit all,” she says. “An individualised care plan should be provided for each resident, and their needs will vary wildly depending on the clinical condition they are in.

“If somebody is overweight and suffers from cardiovascular problems, they will need a very different diet from somebody who is suffering from kidney disease. Those at risk from malnutrition will need high-fat, high energy density diets that are quite small and contain a lot of calories.

“Those who are overweight with cardiovascular problems will need a diet that is low in fat, low in sugar, lots of starchy carbohydrates and fibre. It is very important to have an individualised care plan, and not just one that is designed to a set of standards.”

To achieve this, Claire has called for specialist training to be provided for catering staff working in the care industry:

“There is a need for better training packages for chefs that are population specific. If they are going to be working in a care home, for example, they should have adequate training in preparation of food for elderly people with various clinical needs. Otherwise there is a knowledge gap.”

Nevertheless, Claire believes that many care homes are now addressing the dietary issue – and are getting it right: “There are some very good care homes that ensure the food provision is balanced, including five pieces of fruit and vegetables a day, three dairy portions, starch and carbohydrates. Some even go as far as getting menu planning software packages. You can put your menu items in them, and they will balance against guidelines.”

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