It Ain’t Necessarily So – 17: Is adequate nutrition the same as good food?
– with JOHN BURTON
Caring Times, June 2014
Adequate nutrition and good food are not the same, but good food is likely to provide adequate nutrition. Ask any care home resident which they’d prefer and I think they will all choose good food, and it may mean something different for each of them.
Good food is a combination of varied preferences and priorities: taste, texture, colour, culture, nourishment, presentation, surroundings, company, time of day, how hungry you are, the quality and freshness of ingredients, memories and associations, health, digestion and teeth . . . I could go on!
Whether nutrition is adequate is a professional judgement answering the question: “Does this combination of substances nourish the body sufficiently to maintain it in optimum condition?” Sounds more like an intravenous drip to me . . . not very enjoyable.
There are circumstances when a doctor or nutritionist will need to ask this question and recommend or prescribe the diet needed, but most of the time we are talking about everyday food and mealtimes. Every care home should aim to provide good food, but is that “home cooking” or “haute cuisine”, or some of each? Steak and kidney pudding and curried goat aren’t particularly good for you but, because of their associations, they may actually be better for some people than a “healthy”, adequately nutritious alternative.
For others, simply prepared fresh vegetables, grains, pulses and fruit are perfection. Food that “hits the spot” and transports you to happy times must be good for you. The cook or chef in a care home is a key member of staff and, for many residents, good food and mealtimes are highlights of the day. The cook must know the residents: what their special likes and dislikes are, and what they need in terms of nutrition.
In too many homes, the kitchen tends to close down after lunch, and all that emerges is a boring selection of sandwiches, snacks and soup for tea and supper, most of which fails the adequate nutrition test and certainly doesn’t qualify as good food. While homemade cakes and biscuits for afternoon tea also fail on nutrition, the smell of baking, the delight of sweet, comforting cookies and buns signify special care, consideration, and love going back to the treats of childhood . . . that’s good food.
Care staff should have access to the basic ingredients for late evening snacks so that residents who like to stay up late can enjoy a bacon sandwich, a bowl of soup, a salad, or whatever takes their fancy while sitting chatting or watching TV. Adequate nutrition is only one component of good food, in the same way that bodily care is one component of good care.
We found a different way – Caring Times readers tell their stories
J.C. proprietor, Leicestershire: I do feel quite strongly about this, especially when it comes to ‘service users’ (residents) in our sector who, due to their dementia, need a high calorific and nutritional intake. It seems the NHS and LA contract monitoring people are either naive or just don’t know how to attack the issue.
Nutrition training is inherently poor and there is little or no work being done by dieticians to help providers to create generic – let alone individual – menus and nutrition plans. The industry cannot afford to employ highly qualified, nutritionally educated cooks and catering supervisors.
A completely different approach needs to be taken to assist them to meet the nutritional and calorific needs of patients and residents. It’s a huge piece of work, but to me that’s what some very well paid people should be focusing on! I believe that the term malnutrition is widely and inappropriately used by many, including dieticians. Over the years, we have often heard on the news of Third World countries suffering with starvation and hunger; that the people in these countries are desperately suffering from “malnutrition”. There are also people in this world who are obese and who are malnourished; they eat plenty of food, but not the right sort!
Here in Britain, many health and social care providers are challenged to conduct regular weighing, carry out risk assessments, formulate nutrition plans, etc. because their patients or residents could be at risk of “malnutrition”. To me, malnutrition means the ‘wrong’ (or ‘bad’ in French) food. Wouldn’t it be more accurate to suggest that people in hospitals, nursing and care homes could be at risk of “under-nutrition”? Yes, there is a wide spectrum of individuals who are at risk, and we must do everything possible to ensure we are looking after them to the highest possible standards; and yes, we might need to provide documentary evidence of it too.
Shouldn’t we be focusing on ways to increase nutritional and calorific input for those most at risk of not getting enough into their bodies?
Manager, West Yorkshire: I’m heartily sick of the food police telling my residents what they should and should not be eating. Some are under average weight and some are well over, but they probably have been all their lives, and it’s up to them what they eat.
Of course we’ve got to watch out for diabetes, worrying weight loss or gain, and people who need building up after an illness. We advise and we encourage and discourage, but we don’t lay down the law. And (back to recording) we don’t write down what everyone eats. We only do that when there’s a specific problem.
We’ve got two lovely cooks. One’s great at traditional English cooking (whatever that is) and one’s great on more exotic and unusual meals. It is surprising how the residents do like to try something new, but I suppose that’s only because they know that they can always have something else if they don’t like what’s on the menu today.