What Does The Future Hold For Care Home Nutritional Standards?
Duncan Levey Sales 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)
Obesity Malnutrition0
2
4
6
8
10
12
14
4.2
13
Cost to NHS £billion
SECONDARY CARE complications length of stay readmissions mortality
CARE HOMES30-42% of recently admitted residents
HOSPITAL28% of admissions
PRIMARY CARE
hospital dependency GP visits prescription costs
SHELTERED HOUSING10-14% of tenants
HOMEGeneral population (adults)BMI <20kg/m2 : 5%BMI <18.5kg/m2 : 1.8%
Elderly: 14%
Prevalence of malnutrition
MALNUTRITION: PREVALENCE & CONSEQUENCES
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
Chemical senses in elderly free living
women
10
50
73
0 50 100
Smell
Salt taste
Smell and taste function as %of that in young womencontrols
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
CQC Outcome 5“Meeting Nutritional
Needs”
National Care StandardsStandard 13 – “Eating
Well”Standard 14 – “Keeping
Well”
National Min Standards for Care Homes For
Older PeopleStandard 16
Regulation and Quality Improvement
AuthorityStandards 8 & 12
2001
Better Hospital Food
CQC Dignity & Nutrition inspections 2011/12
Council of Europe resolution (2003)
10 Key Characteristics of Good Nutritional Care (2007)
National Institute for Health and Clinical Excellence (2006)
Protected Mealtimes (2003)
High Impact Actions for Nurses (2010)
RCN Nutrition Now Campaign (2007)
Age UK Hungry to be Heard (2006)
CQC Essential Standards for quality and safety (2010)
WAG Nutrition and Catering Framework (2002)
NI Get your 10 a day (2007)
Scotland Food in Hospitals (2008)
Patient Environment Action Team Assessments (annually)
DH Nutrition Action Plan (2008)Scotland –
Promoting Nutrition in care homes for older people (2009)
Healthcare Improvement Scotland – Improving Nutrition (2012)
WHAT IS THE STANDARD - LOTS OF ACTIVITY.........................
NPSA10 Key Characteristics of Good Nutritional Care Toolkit (2009)
2012
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?
2011 2010 2008 20070%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Risk of Malnutrition
Source: BAPEN Screening Survey 2011
More than 1 in 3 Adults Admitted to Care Homes at
“Risk”
WHAT HOMES ARE AT “RISK?”
Nursing
EMI
Resid
entia
l
Other
0%5%
10%15%20%25%30%35%40%45%50%
Type of Care Home
1-24 25-49
50-74
75-99
100+0%5%
10%15%20%25%30%35%40%45%50%
Size of Care Home
LENGTH OF STAY RELEVANT?
0-1 month 2-3 months 4-6 months Overall0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Risk of Malnutrition
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 REGULATORY FOCUS
Compliant Improvement Compliance Major Concern0
10
20
30
40
50
60
CQC “Dignity & Nutrition “ Inspections 2011
49% Hospitals not fully compliant
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?
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