Protected Mealtimes

Helga Goutcher Palau de Congressos de Catalunya, Barcelona. 18th April

2007

Opportunity

Nutrition in the elderly has been a focal point of media attention. St Nicholas’ nursing home (a UK 176 bedded nursing home) looked at enhancing the nutritional health of clients with dementia by improving the dining experience.

• BUPA & BUPA Care Homes• St Nicholas’ care home• Protected mealtimes• How we got started• Actions taken• Outcomes• Advice: How to implement in your own home

Overview of Presentation

BUPA - Our Vision and Values

Vision

“Taking care of the lives in our hands” Values

CaringAccountableEthicalRespectfulDedicatedEnabling

BUPA Care Homes• Provident company – all profits returned to the

business, no shareholders• Established 1948• Approx. 300 care homes in the UK• Employs 27,000 people• 70% public (state) funded residents• 30% private funded residents• 19227 Residents in May 2006 (census 2006)• 5179 (30%) Dementia Clients (census 2006)• 77% of all residents show some sign of confusion,

challenging behaviour or depression.

St Nicholas’ Care Home• Multi-site.• 176 beds• 6 units• 4 frail elderly• 1 learning

disability• 1 dementia unit

(Gladstone House)• 208 staff• 88% Occupancy• Local authority

funded residents

Protected Mealtimes

• What are protected mealtimes?• External drivers

– Primary Care Trust– NHS hospital examples– No funding available

• Internal drivers– Already identified difficulties in dementia unit– Pre-admission assessments were identifying

malnutrition

How we got started

• Observational Audit– Random– Unannounced– Over two week period– Two people– Independent findings– All mealtimes covered– Nil intervention during audit– Conferred at end

Audit - Results from observationResident’s

perspective• Stressed• Challenging

behaviours• Anxiety• Aggression• Voted with their

feet• Poor food/fluid

intake

Environment

• Excessive noise levels

• Telephone interruptions

• Door bells ringing• Staff voice levels

Staff perspective

• Disorganised• No leadership• Haphazard• High level of

people traffic• Task orientated

High level of activity resulting in stressed residents and distraction from eating

Actions Taken

• Internal feedback to all staff• External feedback to agencies• Full involvement of families• Action plan developed

Action Plan Details

• Only people actively involved in mealtimes present

• Environmental-table presentation• Hostess service• Seating plans developed• Doors to lounge closed about 15-20 min

prior to mealtimes• TV turned off• Telephones redirected to admin

(cont…)

Action Plan Details (cont…)

• All care staff available and dedicated to groups of residents

• Gentle prompting of residents who may leave their seat

• Promote interaction between care staff and residents

• No housekeeping duties undertaken• Reduced voice levels• GPs, etc. visits rescheduled to more convenient

times• Changed times of administration of medicine

Outcome/Benefits

Privacy& Dignity

Weight increase

Calmer environment

Reduction in food supplements

More interested in activities

Reduction in challenging behaviour

Less food wastage

Highly motivated staff

Improved partnerships

Improved staff retention

Improved rapport with relatives

Enhanced reputation

R

e

s

i

d

e

n

t

Direct Indirect

Outcomes (3 months later)

(cont…)

Gladstone House Resident Weights1 0.

65 1 0.6

0

0.25

6.5

2.5

1.7

3.3 1.

2 1.5

2.55 3.

55

0

3.05 4.

1 0.45

4.8 4.73

-3.0

5

-1.3

5

-1.7

5

-1.5

5

40

50

60

70

80

90

Individual Residents

Wei

gh

t (k

g)

Pre protected meal times Post Prot-meal (gained weight) Post Prot-meal (lost weight)

Outcomes (3 months later) (cont…)

• Out of 24 residents, 20 showed an increase in weight with only 4 (17%) having weight loss

• The average resident's weight increased by 3%

• Some residents are not included:– 3 Residents have died in the intervening

period– 2 Residents have been transferred to frail

elderly– 1 Resident refused to be weighed

Comments by GPs , Nurses Relatives, etc

“We got our mum

back”

“Breathtaking innovation”

“Are these really people

with dementia?”

“We need to

buy bigger clothes”

“When are you

introducing exercise?”

“I can’t believe Mrs M’s weight

gain”

“I seem to be visiting this unit

less”

Advice: Doing this in your own home

• Start with a planned observational audit• Ensure you have the support and

cooperation of visiting professionals• Involve the residents and relatives in the

process• Have the hearts and minds of your staff

involved to make sure they are engaged

Thank you, any Thank you, any questions?questions?

Helga Goutcher, contact details

• Email: goutcheg@bupa.com

• Phone: (+44) 0113 381 6265

• Address: BUPA Care Services, Bridge House, Outwood Lane, Horsforth, Leeds. LS18 4UP