I was both humbled and also delighted to learn recently from Brian Preston, Catering Manager at Lister House Care Home part of the Royal British Legion, about the redesign work he is doing in his dining area for the people he supports with a Dementia and as a result, that his ladies and gents are enjoying a completely different mealtime experience.
Brian took part in my interactive Dementia Mealtime Challenge Workshop presentation back in October of 2018 at the annual Training and Development Forum for the National Association of Care Caterers, and I bumped into at him again this year’s event. He was very keen to tell me all about the changes that he had made, following on from what he had learnt in my workshop and in our Dignified Dining Guide.
However, I wanted to go and meet with him at his care home to see what he’d done with my own eyes, so last week I was delighted to be invited to go and tour Lister House and also to have a look at the dining room and see the changes that have been made, talk to the staff and look at the positive outcomes that they have achieved since making the changes.
So, I’m going to paint a ‘before’ picture to set the scene how the dining room looked before Brian got to work.
Before Brian started work, the dining room had been extremely bland and just completely emulsioned in magnolia. I learnt that previous Activities Staff had decided to decorate the walls with murals of flowers, sunflowers and butterflies which were widely adorned over all the walls. More recently, staff commented that with this decor, the dining area felt more like a garden room and that it was therefore confusing for the residents and not conducive with a positive mealtime experience. Having listened to and followed some of my top tips for improving the dining experience for people who are living with a Dementia, Brian went back and started his redesign, by removing all of the murals and introducing a range of food themed images which are known to stimulate appetite and renew interest in food.
‘Dining rooms should be welcoming and homelike and everything about them should prompt recognition that it is time for a meal’
Previously meals for the Dementia Unit would be fed through from the main kitchen on a hot trolley and the hot trolley would be situated in a satellite kitchen in the Dementia Unit. Because of this, lots of the residents were up and down, into the kitchen wanting to have a look and see the food, because they weren’t able to see it in the dining area. This was particularly an issue at tea-time when they had residents who were sundowning and led to quite chaotic mealtimes.
So, Brian having observed his residents going in and out of the kitchen, completely got that what they wanted, was better access to see the food that they were going to be served and there are measurable benefits to this.
Visually appealing food, including different colours and familiar smells of cooking can help stimulate the appetites of people living with a Dementia.
So it became very important to Brian that they move the hot trolley into the dining area itself so residents could physically see the food and the choices available and also to experience the delicious smells of the different dishes that were on offer. This led to a much calmer dining room area with less people feeling the need to wander around in search of food, as they could now see and smell the food on display on the hot trolley and as a result were less agitated and were able to sit for longer and gain greater enjoyment at mealtimes.
Extra staff were put onto shift to allow them to sit and eat with the residents at the tables which also resulted in more conversation over the meal tables.
Make eating a social activity: sit down and eat together – this is a proven way to increase nutrition levels.
People are now given choices and a lot of thought goes into their preferences for where they prefer to sit and eat.
Let people choose where they would like to sit and eat – some people prefer a social environment sitting with others whilst they eat their meals, whilst others eat better alone’
There is one gentleman in particular who will only eat when he is on his own so he likes to sit in one of the lounge areas at lunchtimes and have his meal on his own. Because Lister House support ladies and gents who are at different stages in their Dementia journey, some of whom like to be busy and therefore eat on the go, it was lovely to hear the Activities Lady, Sharon Cloak say,
‘If they won’t come to us, we go to them, with food!’
Staff have even identified that one lady likes to sit in the kitchen area and have her meals in there, where she can remember eating her meals at home. Some staff were saying but there isn’t a table in the kitchen and Sharon suggested they set one up for her, and sure enough they set a table up in the kitchen and this lady very happily sits there and eats her meals.
The pre-ordering of meals has been stopped so real food is plated up and taken around to show to each resident at mealtimes so they can see what they are going to be eating and they can choose according to what they fancy at that time and be served straight away.
There is a new hydration station set up in the dining room which includes a juice dispenser and also a coffee machine and Brian has found that this can be very helpful with people who perhaps aren’t eating vast amounts, for calorie intake, because they can instantly make a resident a milky hot chocolate or a milky coffee that they can drink straight away and really help to boost their calorie intake.
There are no set meal times as such at Lister House, and as I was walking around, I noticed some areas where residents are able to access different snacks and hot and cold drinks all day – fruit, biscuits and cakes, and there are also signs strategically positioned, inviting people to help themselves to the snacks and drinks. This is really important, as people living with a Dementia may see the food but not understand what they are supposed to do with it so providing appropriate signage will help to increase resident engagement and improve nutrition.
A couple of our top tips to help encourage eating for people with a poor appetite to reduce the risk of weight loss include:
The day I arrived it was Bonfire Night and there was a big activity planned around food for the day, there were going to be fireworks in the evening with jacket potatoes, mushy peas, hot dogs and chilli so a big night to have the activities based around food. That their residents would remember.
Also chatting to Sharon, the Activities Co-Ordinator, she organised lots of food based activities. She’d been involved with baking, decorating biscuits, food tasting including different cheeses and fruits and also making popcorn for when they have movie afternoons.
Brian and his fabulous team at Lister House are definitely on a journey of improving their mealtime experience. And they are looking forward to developing different meal choices after receiving their forthcoming IDDSI training.
Brian is also looking forward to some trials in the New Year, moving the main meal of the day to the evening. The team at Lister House have discovered that some of the residents are not motivated in the afternoons to do activities and get involved in home life and partly this is because they have had a good lunch which often will include a pre-lunch sherry and wine with their meal and a two-course lunch and then coffee, who wouldn’t frankly, I think I could do with a snooze after that lot! And traditionally the main meal of the day would have been in the evening.
Research and studies show that swapping meals around and having a good breakfast, a lighter lunch and a main evening meal can help in improving sleep patterns and reduce lethargy during the day and improved concentration and motivation levels in the afternoon. This should encourage the ladies and gents to take part in more activities and have more social interaction in the afternoons. I will be following this trial with interest.
If you would like any help, advice or information to help the ladies and gents you support to have an improved mealtime experience, we can help you with a copy of our FREE Dignified Dining Solutions Guide which is designed to help people with a Dementia eat better.
We can also provide the following services:
For more information on any of the above services please call us today on 01773 713713 or email us sales@hcsuk.co.uk
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