Nourishing body and soul: food and mealtimes in long-term care

WATERLOO, ONT.—In many ways, we have made great strides in food and mealtimes in residential care, and in other ways we have a long way to go. Certainly, there has been growing recognition they are important to all of us, including the most vulnerable in our society. In December 2019, the Ontario auditor general’s report made several recommendations with respect to long-term care in this province including that residents deserve to have the pleasure of good quality, nutritious food they want to eat, as well as a pleasant, homelike dining experience. It's no longer good enough to just provide three meals a day. These are two issues that resonate deeply with me both personally and professionally. My mother lives in long-term care in this province. I’m from a farming culture, so we grew our own food, and having healthy meals was always a part of my life—her life. I think it still should be. I am also a dietitian who has worked in the health-care sector and researched older adult nutrition for more than 25 years. As adults, adequate nutrition is not about growth, we need it for the continual renewal of our bodies—keeping our brains and organs functioning properly. What you might not realize is that as we age, proper nutrition is even more important—it can help keep our skin from breaking down, may help prevent falls and help us to stay independent and doing the things we want to do. So how do we get the right amount of nutrition into residents in long-term care? Older adults need fewer calories but the same amount, or more, of vitamins and minerals than younger age groups. On top of that, older Canadians who live in long-term care are there because they need specialized care, the reasons for which likely impact how they eat. They may have reduced appetite or chewing and swallowing challenges. Our recent research in 32 long-term care homes across Canada found that 44 per cent of the residents are malnourished. That’s may seem like a staggering number. But there are many reasons why. We found most require some level of assistance to eat, and a high number of residents are at risk of having swallowing problems. We also found the food provided did not provide adequate quantities of nine essential nutrients—nutrients needed for things like strong bones and good cognition. We know there are also many reasons for these issues, including a lack of staff time to prepare quality foods and insufficient funding to hire skilled chefs and food service mangers to dedicate time to planning healthy menus. While these challenges are addressed at governmental levels, working with the Schlegel-UW Research Institute for Aging and the Ontario Centres for Learning, Research and Innovation in Long-Term Care, my team has and will continue to create, nutrient-dense foods that taste great. But as the auditor general points out, it’s not just what people eat but the environment they eat in that is important. Think of your own experiences—bad service at a restaurant can ruin a meal. I remember visiting a long-term care home in the 1990s where a padlock and chain were used to keep residents out of the dining room in between meals. We have certainly moved beyond that very institutional and authoritarian experience—but can we do more? We found that the mealtime experience was indeed important to food intake and—dining and food are central to residents’ views on their long-term care home. But mealtime experience goes beyond the physical space. We need to consider how residents interact with each other and staff. Residents deserve to be welcomed, feel supported, interact socially, and be able to relax and enjoy their meal. We have found this can be as simple as training team members to take the time to socialize with residents, asking them how they are and taking a moment to sit at the table and discuss life outside of the home. This is part of what we refer to in the sector as culture change, a shift from an institutional model of care to one where we see long-term care as ‘home’ to residents and their families. We can, and some leaders in the field are, doing better. It takes effort but has pay-offs for residents and team members alike. So, as we move into 2020, I am hopeful that we are on the right track for the next decade with respect to food and mealtimes in long-term care. We are poised to see universal improvements that will benefit these most vulnerable Canadians. Heather Keller is the Schlegel Research Chair in Nutrition and Aging for the Schlegel-UW Research Institute for Aging (RIA) at the University of Waterloo. The Hill Times