1. What Does The Future Hold For Care Home Nutritional Standards? Duncan Levey Sales Manager – Care Homes

2. AIMS OF THE SESSION Quiz – Understanding? Malnutrition in the UK – Causes & Consequences Standards & Guidance How Are We Doing? What’s Needed?

3. 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

4. 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

5. 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)

6. SECONDARY CARE   complications   length of stay   readmissions   mortality CARE HOMES 30-42% of recently admitted residents HOSPITAL 28% of admissions PRIMARY CARE   hospital   dependency   GP visits   prescription costs SHELTERED HOUSING 10-14% of tenants HOME General population (adults) BMI <20kg/m 2 : 5% BMI <18.5kg/m 2 : 1.8% Elderly: 14% Prevalence of malnutrition MALNUTRITION: PREVALENCE & CONSEQUENCES

7. 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

8. FACTORS AFFECTING APPETITE Depression Loneliness Apathy Constipation Pain Side effect of drugs Taste loss & smell loss

9. SENSE OF TASTE & SMELL Impaired senses of taste and smell Sugar detection threshold 3x higher on older adults than adolescents

10. 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

11. WHAT IS THE STANDARD? - CURRENT REGULATIONS CQC Outcome 5 “Meeting Nutritional Needs” National Care Standards Standard 13 – “Eating Well” Standard 14 – “Keeping Well” National Min Standards for Care Homes For Older People Standard 16 Regulation and Quality Improvement Authority Standards 8 & 12

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

13. 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

14. HOW ARE WE DOING? Source: BAPEN Screening Survey 2011 More than 1 in 3 Adults Admitted to Care Homes at “Risk ”

15. WHAT HOMES ARE AT “RISK?”

16. LENGTH OF STAY RELEVANT?

17. 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

18. INCREASED REGULATORY FOCUS

19. 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

20. 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.

21. WHAT’S THE FUTURE? Nutrition is a priority is here to stay – £13bn Cost – 4 th 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

22. 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

23. 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

24. 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”

25. Questions? Happy to take any Questions?