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?