31 January 2020
Nutrition Science Manager
This year's 2020 Olympic Games may inspire us to reflect on the core Olympic values of Friendship, Respect and Excellence. And on the eve of tomorrow's Dignity Action Day, the key value of Respect reminded us of the Care Quality Commission (CQC) report Time to listen in care homes, that explored dignity and nutrition.
In 2012 (another Olympic year!) CQC carried out unannounced inspections that looked at the care provided to older people across 500 care homes, including 217 homes registered to provide nursing care. The inspections looked at how nutritional needs were being met, and particularly focused on respect for, and involvement of, service users.
Many examples of good care being provided by care homes were found
The good news was that the majority, around 65% were caring for people with dignity and respect, while supporting them to make sure their nutritional needs were met. This typically involved having enough skilled and knowledgeable staff, taking appropriate steps to protect people from the risk of abuse, and accurate record keeping to support people’s care.
A culture of care that puts service users first was highlighted by inspectors as core to meeting standards, and they pointed to a number of areas of good practice that all service providers can learn from. These include:
- A clear understanding by staff as to the preferences and care needs of service users.
- A commitment by care home providers to ensure the way staff talked to and cared for people is respectful and appropriate.
- Recognition by staff of service users as individuals, along with supporting service users to live as independently as possible.
- Promotion of social interactions between staff and service users, recognising that these are as important as providing practical care needs.
- Identifying people’s preferences, their care needs and nutritional needs, and ensuring these are met.
- Discussing nutrition and care needs with service users and their families.
- Keeping accurate care records of each service user’s individual choices and decisions.
- Using a formal tool to identify service users at risk of malnutrition.
- Having processes in place to protect people from the risk of abuse, with both staff and service users being aware of how to raise concerns.
- Developing a practical relationship between user care needs and the number, skills and experience of staff required to meet these needs.
People living in 1 in 6 care homes were not always supported to eat and drink sufficient amounts
Where CQC’s inspectors did find problems, there were some common failings. People living in one in six of the care homes did not always have their privacy and dignity respected or were not involved in their own care, and did not always receive good nutrition care. The inspectors perceived that many of the issues raised stemmed from cultures of care that put tasks before people.
Some of the poorer practices involved included:
- Staff talking to service users using inappropriate words or manners.
- A lack of choice of food provided to service users or a lack of support to help them make a choice.
- A failure to identify or provide the support service users who were at risk of malnutrition needed.
- A lack of staff available to support people who needed assistance with eating and drinking.
Association between a reported failure to involve service users and failure to meet nutrition needs
Interestingly, care homes failing to respect and involve service users were also more likely to be failing to meet service users’ nutritional needs. Homes not meeting nutrition standards were also less likely to be achieving standards around staffing and record keeping.
So whilst the report was generally positive about levels of respect shown to service users and meeting their nutritional needs, it concluded that it is unacceptable that too many people living in care homes are not experiencing the same level of good quality care. In order to raise standards, CQC urge providers of care homes to make sure that people are treated with dignity and that they are shown respect at all times.
Meeting nutrition needs
In terms of nutrition needs being met, recognising the importance of good record keeping to reduce individual risk of malnutrition, person-centred nutrition care plans, and input from service users and their relatives were highlighted as essential. Adaptability to change was also cited as being key in good nutrition practice. With regards to staffing levels and skills mix, this should reflect and meet identified needs – having adequate staff to assist with eating and drinking is important. Staff caring for people with dementia in particular should have some training so that they have the appropriate skills, knowledge and experience, as nutritional needs in people with this condition can be complex.
We should all increase our focus on ensuring people are treated with dignity and shown respect. Let’s remember that respect should not be just an Olympic value but one that permeates throughout health and social care .
If you are interested in the report, this can be found on the CQC website here Time to Listen in Care Homes