Catering for care home residents with dementia has many challenges including a decreased appetite, lack of interest in food and the loss of taste. Some may have no concept of time, which makes regular meal-times problematic.
Getting to know the resident, their likes and dislikes is essential in order to ensure they receive proper nutritious meals. Andy Cullum, national craft trainer, Four Seasons Health Care Group, says “The key is to concentrate on what a resident can do rather than on what they can’t.”
When a new resident arrives at one of their homes, the catering team has a meeting with the care team and family. Andy explains, “We issue a food passport (as a Word document) listing the resident’s likes, dislikes and allergies. The chef manager has regular meetings, so the food passport is updated, and this helps us improve people’s appetites. For example, one day a resident might like corned beef, the next day they don’t want it.”
WORKING UP AN APPETITE
A decreased appetite is a common issue. Residents with dementia might not want the food on the menu and push their plate away. Offering alternatives is a good idea such as sandwiches, snacks, omelettes or even finger food if they wish to walk round with it. “The key thing to remember is not to give up,” says Andy. “Just because someone pushed a meal away to start with and finds it hard to communicate, it doesn’t mean they’re not hungry. It’s just that they can’t express that they don’t like what’s put in front of them. The more you communicate with someone with dementia you’ll get to understand them. You learn how to tell if someone wants a pork pie or an ice cream.”
Another factor to consider is that residents start losing their tastebuds or their perception of taste “so you have to add flavouring,” says Dave. “For example, with a cauliflower cheese, we’ll add ingredients such as Dijon mustard and chicken stock to get their tastebuds picking up on those flavours again.”
Provision also needs to be made for residents with dementia who have no concept of time and don’t understand mealtimes. Dave says, “If they walk round the corridors all day, have finger food available. Place small plates around the home where they go. They may be in the “Midnight Club” – what I mean by that is some people with dementia may wake up at 1am. We would have a meal on hand for them. This would have been cooled down safely, with staff trained to regenerate and serve them.”
SUPPORTING LIFE DECISIONS
A resident who has dementia may forget that they follow a vegan or vegetarian diet. A vegetarian may ask for meat because they see others eating it or they may eat off the plates of others who are meat-eaters. Amanda Woodvine from charity Vegetarian for Life (VfL) says, “We have introduced the Memory Care Pledge for care homes containing five key measures to ensure that vegetarian and vegan residents can continue living their lives the way they intended. This includes respecting how people want to eat as well as what they eat, for example seating residents who are vegan or vegetarian on a meat-free table or providing a vegan birthday cake. We recommend holding a tasting session including foods such as vegan ice cream, vegan cheese and plant milks.”
THINK OUTSIDE THE BOX
Encouraging residents with dementia to eat and enjoy their food, is not just about the meal itself, the environment needs to be relaxing and inviting. Andy Cullen says “Don’t have the table legs the same colour as the floor as the resident might have problems finding where to sit. Dining should be an experience. Put flowers on the table and play relaxing music. When residents first visit, ask them what their five favourite songs are. Do that with all the residents, then put the songs on a memory stick and play them in the dining room. The area should be well lit. Have old pictures on the wall – maybe the old Oxo cubes ads. Arrange a nostalgia table with the activity team for more interest including items such as giveaway cars that were available in old Kelloggs cereal packets that remind them of their childhood.”
Lianne Garland, head chef from Elmfield Care recommends serving food on brightly coloured plates so they stand out from the tablecloths. “Add a variety of differently coloured food as it’s been found people with dementia can sometimes struggle with seeing colours. A dementia friendly table will have lots of contrasting colours for cutlery, crockery, tablecloths and plates. Heavier plates with a lip can help as they’re less likely to slip or spill.”
How food is presented to residents is also important. Dave Cliffe, regional support manager, Four Seasons Health Care Group, says “The food needs to look colourful, fresh and appetising. Show them the plate of food and let them choose. If you ask, ‘Would you like pork or beef?’ they may repeat the last word or they may not understand the question. It’s simpler if you show them a plate of food.”
At Harrogate Neighbours, a dementia food menu board has been created which shows pictures of meals available such as fish, chips and peas or a sponge pudding and custard. Sue Cawthray, CEO and national chair, NACC, says “This helps someone living with dementia to remember certain foods and can often encourage them to eat and enjoy a meal, especially if it is something they are familiar with. Picture cards and photographs are a good way to encourage a conversation around food preferences to ensure the catering team has the right information to prepare meals.”
