The rise of catering standards in care homes

In the past care homes were not known for their culinary delights. But in recent years – aided perhaps by the sharp investigative light cast over care standards as a whole and a growing knowledge about nutrition and hydration in particular – better food and drink and more choice for residents is becoming available.

Still standards in care homes are not uniform. As HC-One hospitality expert Paul Carpenter remembers from an excursion as a mystery shopper around the care homes of Britain – when HC-One was being set up three years ago out of what remained of the Southern Cross group – the standards vary enormously. “I was shocked to see how good and bad [catering] is being delivered in care homes,“ he says. “It is no longer acceptable to deliver a poor standard.”

In his opinion the main improvements to catering in care homes in recent times include giving residents “choice” and also defining “what a standard is”. As for HC-One, Mr Carpenter says: “The importance of nutrition cannot be over emphasised; getting person centred nutrition and our food service just right is one of the most important elements of good quality care.

"Good nutrition isn’t just about providing the right number of calories; it’s accounting for the fact that meals are the true highlight of the day, culturally significant and have an impact on general health and wellbeing.”

As a consequence, all food is now freshly prepared in each HC-One home and the company now provides two seasonal menus as well as including themed menus and diverse menus for different cultures such as Afro-Caribbean and Indian. And this is no mean feat, as in all HC-One cooks and chefs prepare three meals and two snack meals a day for more than 10,000 residents across the UK and Northern Ireland in 225 homes. That equals approximately 50,000 meals a day, every day.

More choices

Not surprisingly, resident choice is also at the centre of care home catering at the top end of the market. One example is Colten Care, a family-owned group that operates 19 high quality establishments in the south and south-west. Here the weekly menus are changed four times a year to follow the seasons, and among its most popular offerings are luxury dishes such as poached salmon with a dill sauce, summer puddings and the like. Also on the agenda are tasting sessions for residents where new potential dishes can be sampled and in the case of those living with dementia, relatives are often consulted about dietary preferences.

Fergus Davitt, Colten Care’s hotel services manager explains: “If you stepped back in time 25 years, it was all mince and mash then and no choices.” Now he and his chefs, many of whom have hotel experience or have been trained at Colten Care, are dedicated to preparing and serving “tasty and well presented” food using local produce where possible.

Mr Davitt says: “We’ve high standards and we make it as ‘dining room’ as possible – for instance, we always serve gravy and custard in separate jugs. We also have a separate sweet trolley.”

Catering to individual needs is key at Colten Care. Mr Davitt says: “Food is a joy to this age group. We only buy branded foods – and if, say, a resident wants something, then we go out and get it!

“All the food we serve at Colten is tasty, nutritional, well balanced and presented nicely. We hope they enjoy all food and that the last meal and drink we serve is as tasty and hot as the first one.”

It helps of course that – as a provider offering private care – he has a generous catering budget. “Yes, I know we are very lucky in the sense that Colten believes that it’s such an important part of the residents day, therefore our budget to provide exciting 5-star food is very generous.”

Training initiatives needed

According to Neel Radia, chairman of the National Association of Care Catering (NACC) there are several challenges facing today’s catering in care homes, the main one being training.

Training is something that larger groups are taking more seriously and increasingly there are in-house training initiatives. Terry Tucker hospitality director of the Barchester Group, one of the largest care home groups in Britain says that a high priority is to “further develop Barchester’s Chef Academy. We want to be at a stage where all of our Head Chefs go through it. The Head Chefs run the kitchen and take charge of everything that goes out. They are key to implementing the training back at the care home and the head chef is the person who needs to lead by example. “All of our chefs complete mandatory training and learn about Barchester’s standards but it is important that every chef has the opportunity to work with other highly trained Barchester chefs.”

And she rates training chefs as one of her greatest successes. “We set up the Academy because many chefs joined us with superb catering skills but lacked some of the knowledge we needed such as menu planning, nutrition and modified diets. The in-house training has also encouraged younger chefs to join us and they have brought new ideas too.

“We have more than 100 chefs and trainee chefs on the Chef Academy and have our experienced master chefs, training and assessing other chefs to make sure standards of menus are consistent throughout the company. This is how we strive to prepare high-quality cooked meals that are presented and served well.

Nutrition and hydration

As stories proliferate about care home residents being admitted to hospital in a state of dehydration and malnutrition, it is no surprise that NACC’s Mr Radia lists a lack of knowledge among care homes about nutrition and hydration as a further challenge. He adds: “There is also little or no understanding about areas such as dysphagia (a swallowing condition), texture modified meals and food intolerances, to name a few, and how to provide meals for residents with such specific requirements in a safe setting.

“The topic of choking risk is currently high on the agenda. This does not only relate to those cooking the meals but also the service of the meals by care staff – the dining experience, the environment and that the meals are served with dignity and respect.” The larger care home groups, however, seem to be mindful of the importance of tailored nutrition and hydration. As HC-One’s Mr Carpenter puts it: “One area we are concentrating on is to develop the food and beverages offered for resident specific diets. We currently have been delivering 19 texture-modified training forums around the country, in partnership with Fresenius Kabi and Robot Coupe for residents with dysphagia where food and drink has to be texture modified so they can swallow it without it being a choking risk. Through this partnership we can give a variety of tasty dishes and of a safe consistency.”

These are just a few of the care homes that are making every effort to get it right. As the number of older people needing care continues to rise, it is to be hoped that others raise the bar on their culinary standards so that nutrition in care homes of all types continues to improve. It is vital to the well-being of the residents.