FOOD & DRINK Making a Meal of It

Helen Fuller, Managing Director at Care 4 Quality, discusses the worrying issue that many care providers are failing to provide safe and well-led care when it comes to nutrition and hydration.

It is a regulatory duty for care providers to ensure they meet the nutritional and hydration needs of those receiving care. Yet, recent analysis and collation of current research reveals that a staggering three quarters of care homes rated inadequate were not compliant in this respect. Many people would argue that, as access to enough food and water is a basic human

right, failure to deliver adequate care in

this regard will have a dramatic impact on the quality of life of those receiving care.

Many of the problems identified within care homes stem from the overall mealtime experience itself and the quality and quantity of food being below standard. To make matters worse, poor recording of food and fluid intake also means that staff are oſten unaware of when a resident last ate or drank. Research has also identified that changes in weight are not being flagged or acted upon, with inappropriate diets being offered, both of which can have a detrimental effect on residents’ lives.

Regulation 14 of the Health and Social Care Act 2008 (regulated activities), Regulations 2014 stipulates that care providers have a responsibility to ensure that people receiving care are given adequate nutrition and hydration to sustain good health and that risks around nutrition are reduced as far as possible. Providers also have a legal responsibility to observe people’s preferences, religious beliefs and cultural requirements.


The legal consequences of failing to meet this regulation means providers can be prosecuted immediately without being served a warning notice first. Residents in care homes tell us that mealtimes are the most important times of the day for them. Being able to make meaningful and informed choices about what to eat and drink is an essential part of the personalised approach around nutrition in care. Any care manager will tell you that ‘food’ is a common topic of conversation and oſten recorded in many

residents’ meeting minutes as the main focus of discussion. Mealtimes are also a way for residents to engage socially with each other including staff and relatives who may want to join them.

There is an automatic assumption that the barrier in providing good nutritional care for older people is a financial one. According to recent data from Sheffield Hallam University, the average spend in care homes is £2.44 per resident per day. This figure is still less than the allocation per person for inmates serving prison sentences.

The truth is, mealtimes in care homes have slowly become rather stagnant over the years and task-oriented as opposed to being considered as a fantastic regular opportunity for interaction and sensory stimulation. Sadly, meals and menus oſten revolve around the convenience factor for the home, catering and care staff. For example, cold, ‘snack’ type meals in the evenings are oſten provided due to kitchen staff not being present in the building. Interestingly, lunchtimes in homes are also a time where staffing may be reduced due to staff taking their own rest breaks.


Care homes need to start making mealtimes a valued and positive experience for residents because it can have a really positive impact on the care provided. Of course, this requires a change in mindset and oſten some lateral thinking, particularly in smaller, non-purpose-built settings. Despite these challenges, those forward-thinking care home providers and managers out there are finding ways of improving mealtimes and quality. A good example of this is a care provider that decided to change their evening meals to a more substantial hot meal and pudding and, as a result, had found this to be a contributory factor in helping residents living with dementia to settle in the evening and get a better night’s sleep.

Another care provider investigated the

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