1. Malnutrition In The UK – An Avoidable Problem? Andrew Williams - 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. 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

4. 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)

5. Communities with no or little contact Communities in contact with services Care Homes Hospital 93% 5% 2% 3 million malnourished 3 MILLION MALNOURISHED

6. 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

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

8. 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

9. 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

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

11. CARE HOME CHALLENGE

12. INCREASED REGULATORY FOCUS - CARE HOMES Inspection 500 Homes 2012 1 in 6 NOT meeting Nutritional Needs 1 in 5 Nursing Homes failing Minimum Standards 4000 Homes – 140,000 residents

13. ONGOING FOCUS NACC “Meeting Outcome 5” Healthcare Improvement Scotland British Dietetic Assoc. Malnutrition Task Force

14. WHAT DOES GOOD NUTRITIONAL CARE LOOK LIKE? Top tips Have Nutrition and hydration Champions, one carer and one from the catering team Ask your local speech and language specialist and dieticians to do training sessions Suppliers to provide free specialist training on food preparation and service for special needs Use Regulators Quality standards to evaluate your service before inspections Have regular feedback from Residents and implement what they say! Robert...................

15. WHAT’S NEEDED - GUIDANCE? Greater understanding of the importance of Nutrition – Mandatory training – Homes and Assessors Clear Nutritional Standards across all Regulators Clear Nutritional Standards across all Sectors Awareness that Care Home Catering is challenging

16. Questions? Happy to take any Questions?