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Exploring food choice and flexibility practices among staff and residents at care homes in Denmark
- Authors:
- NYBERG Maria, SYLOW Mine
- Journal article citation:
- Ageing and Society, 41(4), 2021, pp.854-874.
- Publisher:
- Cambridge University Press
With a growing number of people reaching older age, the need for care provided in long-term care institutions is increasing. Although the goal is to deliver person-centred care that includes choice and flexibility opportunities, pre-scheduled mealtimes and set menus are still used. The aim was to explore how food choice and flexibility practices were perceived and performed by residents and staff at three care homes in Denmark. Three food journey interviews with eight residents (aged 83–96) and three focus groups with 12 people from the care and kitchen staff were conducted. Food choice and flexibility practices were mainly performed informally and selectively by the staff, and through personal practices by the residents, implying that many residents were excluded from food choice and flexibility opportunities. However, food choice and flexibility practices were also inhibited by the staff's time pressure and unfamiliarity with choice possibilities, and by the politeness of the residents. Our findings suggest that food choice and flexibility practices must be understood and performed broadly, and include various ways of listening and responding to the residents’ needs and preferences. The study highlighted the importance of incorporating the essential embodied knowledge and emotional know-how, inherent in food choice and flexibility practices, into formal and inclusive strategies concerning how to think and act in relation to the food and meal situation. (Edited publisher abstract)
Structure and agency attributes of residents’ use of dining space during mealtimes in care homes for older people
- Authors:
- MALUF Adriano, et al
- Journal article citation:
- Health and Social Care in the Community, 28(6), 2020, pp.2125-2133.
- Publisher:
- Wiley
Research stresses that mealtimes in care homes for older people are vital social events in residents’ lives. Mealtimes have great importance for residents as they provide a sense of normality, reinforce individuals’ identities and orientate their routines. This ethnographic study aimed to understand residents’ use of dining spaces during mealtimes, specifically examining residents’ table assignment processes. Data were collected in summer 2015 in three care homes located in England. The research settings looked after residents aged 65+, each having a distinct profile: a nursing home, a residential home for older people and a residential home for those with advanced dementia. Analyses revealed a two‐stage table assignment process: 1. Allocation – where staff exert control by determining residents’ seating. Allocation is inherently part of the care provided by the homes and reflects the structural element of living in an institution. This study identified three strategies for allocation adopted by the staff: (a) personal compatibilities; (b) according to gender and (c) ‘continual allocation’. 2. Appropriation – it consists of residents routinely and willingly occupying the same space in the dining room. Appropriation helps residents to create and maintain their daily routines and it is an expression of their agency. The findings demonstrate the mechanisms of residents’ table assignment and its importance for their routines, contributing towards a potentially more self‐fulfilling life. These findings have implications for policy and care practices in residential and nursing homes. (Edited publisher abstract)
Highlight of the day?: improving meals for older people in care homes
- Author:
- COMMISSION FOR SOCIAL CARE INSPECTION
- Publisher:
- Commission for Social Care Inspection
- Publication year:
- 2006
- Pagination:
- 31p.
- Place of publication:
- London
This bulletin, focusing on National Minimum Standards for meals and mealtimes in care homes for older people, finds that the majority (83%) are meeting minimum standards. However, a significant minority, one in six, are not. Care homes that meet the minimum standards typically have sufficient staff who are properly trained and managed to provide a positive experience for their residents at meal times. The bulletin provides clear advice on what care homes need to do to improve the quality of meals and mealtimes for their residents.
Developmental evaluation of the CHOICE+ champion training program
- Authors:
- WU Sarah A., et al
- Journal article citation:
- Journal of Long-Term Care, July 2021, pp.230-244. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: Mealtimes in residential care homes are important for social engagement and can encourage resident relationships. Yet, training programs to improve mealtime care practices in residential care settings remain limited in learning approaches and scope. Objectives: To determine whether a one-day Champion Training session would improve participants’ knowledge, skills, and confidence to implement a relationship-centred mealtime program (CHOICE+) in their homes. Methods: The study employed a pre-/post-test design to evaluate a train-the-trainer model using paper-based questionnaires. Thirty-four participants attended the training session; 25 participants completed pre/post training questionnaires based on Kirkpatrick’s evaluation model. Training included: 1) program implementation manual, 2) best-practices document, 3) educational resources and evaluation tools, 4) presentation on theory-based implementation strategies and behaviour change techniques, and 5) group discussion on applying strategies and techniques, problem-solving for implementation facilitators and barriers. Findings: More than half of attendees worked as Food Service Managers or Registered Dietitians. Participants identified several organizational factors that could impact their home’s readiness to implement CHOICE+, though they felt training to be acceptable and feasible for their homes. Participants reported increase in knowledge (8.4 ± 1.1), confidence (8.3 ± 1.4), and commitment (8.8 ± 1.4) to implement the relationship-centred mealtime program. There was no association with pre-training readiness, leadership, or home characteristics. Limitations: Generalizability is limited due to small sample size. Follow-up interviews on results of training could not be conducted due COVID-19 pandemic research restrictions. Implications: Champion Leader training is an effective and feasible learning approach to up-skill staff on change management and relationship-centred mealtime practices in residential care. (Edited publisher abstract)
How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer–resident interactions
- Authors:
- FARADAY James, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(8), 2021, pp.3006-3031.
- Publisher:
- Sage
People with dementia who live in care homes often depend on care home staff for help with eating and drinking. It is essential that care home staff have the skills and support they need to provide good care at mealtimes. Good mealtime care may improve quality of life for residents, and reduce hospital admissions. The aim of this systematic review was to identify good practice in mealtime care for people with dementia living in care homes, by focusing on carer-resident interactions at mealtimes. Robust systematic review methods were followed. Seven databases were searched: AgeLine, BNI, CENTRAL, CINAHL, MEDLINE, PsycINFO and Web of Science. Titles, abstracts, and full texts were screened independently by two reviewers, and study quality was assessed with Joanna Briggs Institute tools. Narrative synthesis was used to analyse quantitative and qualitative evidence in parallel. Data were interrogated to identify thematic categories of carer-resident interaction. The synthesis process was undertaken by one reviewer, and discussed throughout with other reviewers for cross-checking. After title/abstract and full-text screening, 18 studies were included. Some studies assessed mealtime care interventions, others investigated factors contributing to oral intake, whilst others explored the mealtime experience. The synthesis identified four categories of carer-resident interaction important to mealtime care: Social connection, Tailored care, Empowering the resident, and Responding to food refusal. Each of the categories has echoes in related literature, and provides promising directions for future research. They merit further consideration, as new interventions are developed to improve mealtime care for this population. (Edited publisher abstract)
Statistics on community care for adults in Northern Ireland 2018-2019
- Author:
- NORTHERN IRELAND. Department of Health. Community Information Branch
- Publisher:
- Northern Ireland. Department of Health
- Publication year:
- 2019
- Pagination:
- 49
- Place of publication:
- Belfast
Statistical information on community care services collected from health and social care (HSC) trusts. The analyses includes: domiciliary care, re-ablement, meals on wheel, daycare, and accommodation services. It reports that on average 23,409 people received domiciliary care each week in 2017/18. On average, 481 people were starting reablement services each month across Northern Ireland, with 45 per cent of those discharged from reablement services requiring no ongoing care package. (Edited publisher abstract)
Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes
- Authors:
- CHAUDHURY Habib, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(7), 2017, pp.878-896.
- Publisher:
- Sage
Purpose: Drawing on therapeutic physical environmental design principles and Kitwood’s theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents’ mealtime experience and staff practice in two care units. Method: The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings: Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications: Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change. (Edited publisher abstract)
Reimagining nutrition care and mealtimes in long-term care
- Authors:
- KELLER Heather H., et al
- Journal article citation:
- Journal of the American Medical Directors Association, 23(2), 2022, pp.253-260.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; e.g., nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centred care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. This special article reimagines LTC nutrition by reframing the evidence-based recommendations into relationship-centred care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. The authors then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (e.g., food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents’ nutrition and well-being is required. (Edited publisher abstract)
Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub‐acute hospital, rehabilitation and aged‐care settings: a systematic review
- Authors:
- MCLAREN-HEDWARDS Taya, et al
- Journal article citation:
- Nutrition and Dietetics, early cite 8 January 2021,
- Publisher:
- Wiley
Aims: This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged‐care facility settings. Methods: Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. Results: Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non‐communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. Conclusions: Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large‐scale, well‐designed experimental studies to assess the potential impacts of these interventions. (Edited publisher abstract)
Statistics on community care for adults in Northern Ireland 2017/18
- Author:
- NORTHERN IRELAND. Department of Health. Community Information Branch
- Publisher:
- Northern Ireland. Department of Health. Community Information Branch
- Publication year:
- 2018
- Pagination:
- 93
- Place of publication:
- Belfast
Statistical information on community care services gathered from health and social care (HSC) trusts. It includes details of contacts with HSC trusts, the number of care packages in effect, number of people in receipt of meals on wheels services, residential and nursing accommodation and day care registrations. It reports that between 1 April 2017 and 31 March 2018, 29,228 people in the Elderly Care, Learning Disability and Physical & Sensory Disability were in contact with HSC Trusts in Northern Ireland. (Edited publisher abstract)