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What Does The Future Hold For Care Home Nutritional Standards? Lee Sheppard, Divisional Manager – Care Homes
AIMS OF THE SESSION • Quiz – Understanding? • Malnutrition in the UK – Causes & Consequences • Standards & Guidance • How Are We Doing? • What’s Needed?
WHAT IS MALNUTRITION? “the literal meaning of malnutrition is 'bad‘ nutrition and therefore the term can encompass wasting (undernutrition) and / or obesity (overnutrition).” BAPEN the British Association for Parenteral and Enteral Nutrition, 11 November 2003
TRUE OR FALSE? • The costs of dealing with malnutrition in the UK are twice that of dealing with obesity • Quality of the diet matters even more as we get older • Signs of malnutrition take several months to show • Our sense of smell can be reduced by up to 90% as we get older • The threshold for detecting sweet taste is 3x higher in older adults than adolescents • The entire skeleton is turned over every 7 years • % of Care Home Residents at Risk of Malnutrition • On admission • Overall
SCALE AND COST OF MALNUTRITION IN THE UK Three million people are living at risk of malnutrition in the UK, with the cost estimated to be £13 billion every year (BAPEN 2009)
MALNUTRITION: PREVALENCE & CONSEQUENCES • PRIMARY CARE • hospital • dependency • GP visits • prescription costs HOME General population(adults) BMI <20kg/m2 : 5% BMI <18.5kg/m2 : 1.8% Elderly: 14% SHELTERED HOUSING 10-14% of tenants Prevalence of malnutrition HOSPITAL 28% of admissions CARE HOMES 30-42% of recently admitted residents • SECONDARY CARE • complications • length of stay • readmissions • mortality
WHY SO COMMON IN OLDER ADULTS? Nutritional requirements stay high or increase but appetite decreases The entire body is turned over every seven years – materials come from diet Immune system & muscles start to show deficiency after just a few days
FACTORS AFFECTING APPETITE • Depression • Loneliness • Apathy • Constipation • Pain • Side effect of drugs • Taste loss & smell loss
SENSE OF TASTE & SMELL • Impaired senses of taste and smell • Sugar detection threshold 3x higher on older adults than adolescents
WHY DOES IT MATTER? • Slow wound healing • Recovery from surgery or injury • Susceptibility to pressure ulcers • Loss of muscle & bone strength • Poor Immunity • Mood • Weight loss • Dehydration • Longer length of stay in hospital • Mortality
WHAT IS THE STANDARD? - CURRENT REGULATIONS National Care Standards Standard 13 – “Eating Well” Standard 14 – “Keeping Well” Regulation and Quality Improvement Authority Standards 8 & 12 CQC Outcome 5 “Meeting Nutritional Needs” National Min Standards for Care Homes For Older People Standard 16
WHAT IS THE STANDARD - LOTS OF ACTIVITY......................... CQC Essential Standards for quality and safety (2010) 10 Key Characteristics of Good Nutritional Care (2007) Patient Environment Action Team Assessments (annually) Age UK Hungry to be Heard (2006) 2001 DH Nutrition Action Plan (2008) Better Hospital Food CQC Dignity & Nutrition inspections 2011/12 NI Get your 10 a day (2007) Protected Mealtimes (2003) Scotland – Promoting Nutrition in care homes for older people (2009) 2012 RCN Nutrition Now Campaign (2007) High Impact Actions for Nurses (2010) Council of Europe resolution (2003) WAG Nutrition and Catering Framework (2002) Scotland Food in Hospitals (2008) Healthcare Improvement Scotland – Improving Nutrition (2012) National Institute for Health and Clinical Excellence (2006) NPSA10 Key Characteristics of Good Nutritional Care Toolkit (2009)
STANDARDS AND GUIDELINES IN NUTRITIONAL CARE • Patient Environment Action Teams (PEAT), 2000 • Better Hospital Food, 2001 • Essence of Care, 2001 • National minimum standards, 2001 • Nutrition and Patients; A doctor’s responsibility, RCP London, 2002 • Council of Europe Resolution, 10 key characteristics of good nutritional care, 2003 • NICE guidance on nutrition support in adults, 2006 • Delivering Nutritional Care through Food and Beverage Services, 2006 • Malnutrition among Older People in the Community. Policy recommendations for change, 2006 • Malnutrition, what nurses working with children and young people need to know and do, 2006 • Good Practice Guide, Healthcare Food and Beverage Service Standards: A guide to ward level services, 2006 • Improving nutritional care. A joint action plan from the DH & Nutrition Summit stakeholders, 2007 • Nutrition Now, 2007 • Care Services Improvement Partnership factsheet 22; Catering arrangements in Extra Care Housing, 2007 • NICE Guidance on maternal and child nutrition, 2008 • NPSA factsheets on the 10 key characteristics of good nutritional care, 2009 • Social Care Institute for Excellence Guide: Dignity in Care; Nutritional Care and Hydration, 2009 • Improving nutritional care and treatment. Perspectives and recommendations from population groups, patients and carers, 2009 • Appropriate Use of Oral Nutritional Supplements in Older People, 2009
HOW ARE WE DOING? More than 1 in 3 Adults Admitted to Care Homes at “Risk” Source: BAPEN Screening Survey 2011
INCREASING REGULATORY FOCUS – CQC ENGLAND Dignity and Nutrition Inspections (DANI)2011 • Three month inspection programme covering 100 NHS acute hospitals across England • Reviewed how well the dignity, nutrition and hydration needs of older people are met in NHS hospitals • Reviews were carried out by CQC inspectors, senior nurses and ‘experts by experience’ • Requested by the Secretary of State of Health • National report was published in the Autumn 2011
INCREASED MEDIA FOCUS Elderly being 'starved to death' Inspectors rate hundreds of care homes as 'poor'. http://www.healthcare-today.co.uk/news/elderly-being
ONGOING REGULATORY FOCUS • 2012 DANI’s • 500 Care Homes inspected April-Jul 2012 • NACC “Meeting Outcome 5” • Healthcare Improvement Scotland • British Dietetic Assoc. • Carers UK Malnutrition's 'hidden cost for families' Leading charity Carers UK is calling for action to improve the nutritional care experienced by carers and their loved ones.
WHAT’S THE FUTURE? • Nutrition is a priority is here to stay • £13bn Cost • 4th largest cost-saving area for NHS • Nutrition in Care Homes is about Far More Than Food or Feeding The provision of food suitable for the sick is not just a hotel function, it is treatment’ – Simon Allison, BAPEN
WHAT DOES GOOD NUTRITIONAL CARE LOOK LIKE? • Meaningful from ‘bedside to boardroom’ • Demonstrates what good looks like • To care staff • To board members • To regulators • Demonstrates broad agreement across health and social services • Now adapted to apply across health and social care
WHAT’S NEEDED - GUIDANCE? • Greater understanding of the importance of Nutrition • Mandatory training • Homes and Assessors • Clear Nutritional Standards across all Regulators • Clarity and consistency of Guidance • Between Countries • Across Sectors (Health and Social Care) • Awareness that Care Home Catering is challenging
CONCLUSION • Malnutrition is a major issue for the UK Care Home sector • 41% of residents estimated as malnourished • Obesity has a far higher profile and is being tackled by government, yet the “costs” of malnutrition are far greater • Clear and tangible Nutritional Standards required • Consistency of Guidance • “Commitment” to Nutrition • Not a “Nice To have”
Questions? Happy to take any Questions?