Eating and drinking well in care: good practice guidance for older people
Food and fluid on offer should be:
varied and nutritious and reflect food preferences and any specific dietary needs for the individual
well prepared, cooked and attractively presented
evenly spaced throughout the person's wakened day – aim for a minimum of four hours between each main meal but individual preference needs to be taken into account
based on individual ‘nutritional’ needs which offer access/choice to a range of food & fluids that meet those needs.
Dining with dignity, creating the dining experience:
tables should be set to a standard of what you would expect when you eat out in a nice restaurant
noise and distraction should be kept to a minimum
consideration should be given to protecting the person’s mealtimes with a named person taking control of the dining room to coordinate activity and to make sure all staff ensure residents get enough to eat and drink. Some services call them a ‘mealtime coordinator’. Protecting mealtimes requires cooperation from visiting professional too, as being aware that disrupting a person’s meal can have a significant impact on whether they get a full meal or not and longer term health and well being issues
staff should be aware of how to assist someone to eat and drink and remember eating and drinking is a social experience that gives staff and people using services the chance to really connect.
It is recognised that good nutritional care, adequate hydration and enjoyable mealtimes can dramatically improve the general health and well-being of older people, as well as increasing their resistance to disease and their recovery from any illness, trauma or surgery.
It is important that care service staff are able to demonstrate and evidence good food and fluid knowledge. This should be supported by up to date policies and procedures that take account of the Health and Social Care Standards (2017), relevant best practice and Scottish legislation.
Health and Social Care Standards
The Scottish Government published Health and Social Care Standards: My Support, My Life in June 2017. The new Standards set out what we should expect when using health, social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld.
There are specific standards for eating and drinking (see below) and these should be taken into account when looking at people’s eating and drinking care needs:
1.33 I can choose suitably presented and healthy meals and snacks, including fresh fruit and vegetables, and participate in menu planning.
1.34 If I need help with eating and drinking, this is carried out in a dignified way and personal preferences are respected.
1.35 I can enjoy unhurried snack and meal times in as relaxed an atmosphere as possible.
1.36 If I wish, I can share snacks and meals alongside other people using and working in the service if appropriate.
1.37 My meals and snacks meet my cultural and dietary needs, beliefs and preferences.
1.38 If appropriate, I can choose to make my own meals, snacks and drinks, with support if I need it, and can choose to grow, cook and eat my own food where possible.
1.39 I can drink fresh water at all times.
find out what I like to eat and drink but remember my tastes might change over time, so ask me regularly
find out what portion size I prefer and when I like to eat my main meal, or if I prefer frequent smaller meals throughout my wakened day
find out how my favourite food and drink choices can be adapted to meet my current needs. For example, made sweeter or more savoury; the texture adjusted so I can eat safely; what would make it look more appetising to me if the texture has to be modified (for example, moulds, scoops, cutters)
involve my family and named carers to ensure you fully understand my eating and drinking needs and habits
use the information you gather to get me the support I need.
Film clips
To help you in implementing the above key messages in your own service, we have produced a number of films to support you in putting the above learning into action.
David Blackwood, Regional Catering Manager for Meallmore Ltd.
In this first clip David talks about the importance of being creative when involving residents in creating menus of foods and fluids they want to eat and drink.
In this next clip he discusses what services need to know when therapeutic diets are required.
Liz Campbell, Care Home Manager
Liz talks about the importance of creating the right dining experience that promotes the social aspects of eating and drinking.
Evelyn Newman, NHS Highland Dietitian
In her first clip Evelyn talks about using food and fluid to start conversations and reminisce.
In the second clip she talks about a whole team approach to involving people experiencing care in planning menus.
Kate Boyce, Director of Lifestrong Learning Ltd.
In her first clip Kate talks about food and fluid choices for all.
In the next clip she discusses the importance of involving people in all aspects of eating and drinking as things change.
Kim Stringer, Director of Vegetarian for Life
In this first clip Kim talks about the importance of honouring food and fluid beliefs and values.
In the second clip she talks about getting creative when providing vegetarian foods and fluids and the importance of presentation.
Related resources
Textured food and fluid template to record information
Water for healthy ageing: Hydration best practice toolkit for care homes
International Dysphagia Diet Standardisation Initiative - A group of volunteers from diverse professions including nutrition & dietetics, medicine, speech pathology, occupational therapy, nursing, patient safety, engineering, food science & technology from around the world who came together to develop international standardised terminology and definitions for texture modified foods and thickened liquids for persons with dysphagia
liaise with catering/kitchen staff to make sure my special dietary requirements are catered for
if I can’t tell you want I want to eat and drink, be creative. For example, ‘show and tell’ what is on the menus and hold taster sessions, recording my response (facial expressions, gestures) to foods and fluids
make sure my plan of care reflects my likes and dislikes and what texture my food and fluid should be, using the national descriptors
involve the right people at the right time to get me the help I need, for example a speech and language therapist (SALT), a dietitian or occupational therapist
the food that I eat and drink should help me maintain my health and wellbeing. For example, by reducing the risk of constipation, dehydration and skin breakdown.
Film clips
To help you in implementing the above key messages in your own service, we have produced a number of films to support you in putting the above learning into action.
David Blackwood, Regional Catering Manager for Meallmore Ltd.
In this first clip David discusses the wider health benefits of eating and drinking well.
In this next clip he talks about the importance of communication to meet the food and fluid needs of people experiencing care.
Sarah Duley, Food for Life Development Manager
Sarah focusses on soil to plate and how good food can transform lives for those experiencing care.
Evelyn Newman, NHS Highland Dietitian
In this first clip Evelyn focusses on the importance of a whole team approach to involving people experiencing care in planning menus.
In this second clip she discusses the role of a dietitian and how a dietitian can help.
Kate Boyce, Director of Lifestrong Learning Ltd.
In her first clip Kate talks about the impact of food and fluid on bowel and bladder health.
In her second clip she discusses who can help people experiencing care to eat and drink well.
Kim Stringer, Director of Vegetarian for Life
In this clip Kim talks about getting creative when providing vegetarian foods and fluids and the importance of presentation.
Related resources
Communication and Mealtimes Toolkit
Nil by Mouth Care Homes SOP example
what adaptations do I need to help me to eat and drink independent? For example, adapted cutlery, crockery, seating support
give me time to eat but make sure my hot food stays at the right temperature to keep it appetising. For example, use heated plates or consider smaller portions with the option of further helpings
give me time to chew and swallow and give me your full attention when you are helping me
make sure salt and pepper, other condiments and small jugs of water or other fluids are within reach, so I help myself or you can help me
if I am eating and drinking on the move, make sure you know how much I am eating and drinking to help you make decisions about me. For example, what help do I need if I am losing weight or not eating enough.
Film clips
To help you in implementing the above key messages in your own service, we have produced a number of films to support you in putting the above learning into action.
David Blackwood, Regional Catering Manager for Meallmore Ltd.
David talks about the impact that the five food and fluid key messages could have if put into practice.
Evelyn Newman, NHS Highland Dietitian
In this clip Evelyn talks about what staff need to think about when assisting people experiencing care to eat and drink.
Related resources
find out what makes the best dining experience for me and what I don't like, including who I enjoy sitting beside and who I would rather not sit beside
be aware of the noise levels and any distractions, adjust them as appropriate to help me focus on eating and drinking
make sure that I have been offered and/or used the toilet before I sit down to eat and that I have washed my hands
set the table for me the way I would like it set, no matter where I decide to take my meal
if you are helping me to eat and drink, sit beside me and take your time. If I am unable to talk to you, observe my facial expressions and gestures to know when I am ready for more or have had enough.
Film clips
To help you in implementing the above key messages in your own service, we have produced a number of films to support you in putting the above learning into action.
David Blackwood, Regional Catering Manager for Meallmore Ltd.
In this clip David discusses the importance of creating a positive mealtime experience.
Evelyn Newman, NHS Highland Dietitian
In this first clip Evelyn talks about the social aspects of eating and drinking.
In her second clip she discusses what staff need to think about when assisting people experiencing care to eat and drink.
Related resources
know what my MUST score is and what it is telling you – take appropriate actions. For example, fortifying my food to add calories
eating something is better than nothing and I may not prefer the ideal healthy diet. Respect my preferences but continue to offer me healthy choices
if I prefer not to sit for meals give me finger foods that I can carry around with me while I eat, or give me a named container I can snack from
ensure I can help myself throughout the day. For example, have ‘fluid stations’
make sure food and fluid is available all day so I can eat and drink when I want to. For example access to fluid stations, snack boxes
when preparing me for my meals, if required make sure I have the correct glasses on and hearing aids in, as this will help me enjoy and take part in my dining experience.
Film clips
To help you in implementing the above key messages in your own service, we have produced a number of films to support you in putting the above learning into action.
David Blackwood, Regional Catering Manager for Meallmore Ltd.
In this clip David discusses a food first approach, suggesting that when supplements are needed they should be chilled and well presented.
Liz Campbell, Care Home Manager
In her first clip Liz discusses the role of the care home manager in quality assuring the mealtime experience.
Evelyn Newman, NHS Highland Dietitian
In this clip Evelyn talks about the social aspects of eating and drinking.
We would like to acknowledge the invaluable input and guidance given from a range of stakeholders in pulling all this information together namely:
Residents who took part in the ‘strictly come dining’ experience that helped create some of the menus included in the menu and recipe section
Meallmore Ltd
Trust Housing
The Mungo Foundation
Scottish Care Integration Leads
Vegetarian for Life
Food Standards Scotland
Food for Life Scotland
NHS Highland and the wider NHS Dietetic Leads from across Scotland
NHS Greater Glasgow and Clyde
This site is just the start and we would love to hear your stories on how you help people who use your services to enjoy the experience of eating and drinking and what impact it has on their quality of life. If we all teach, we all learn.