Support Individuals to Eat and Drink
1 : Be able to support individuals to make choices about food and drink
1.1. Establish with an individual the food and drink they wish to consume Service users should always have the freedom to make choices about food and drink, thus the carer has to support them to make these choices, also taking into consideration dietary issues (possible allergies, diabetes, food intolerance) and prohibited foods due to medication (e.g. cranberry when on Warfarin). This information, as well as the medication is included in the care plan. Then, by direct communication with the service user, using his/her chosen form of communication, the carer establishes what he/she wishes to have. Communication can be verbal, verbal and non- verbal combined (asking and pointing at the dish, or a jug), sign language, or using any body language the customer exhibits. Service users shall be given plenty of time to make a choice and there are instances when the carer has to repeat the offer.
In the case of service users living with dementia, the way in which options are offered depends altogehter on the service user’s state. With some service users, offering a choice between two items- having a fruit yoghurt, or a fruit salad, while showing them the respective foods, is a feasible way. With other customers, offer only one dish at a time, asking whether the customer would like to have it, or not. If the answer is no, show another item and repeat the yes/no question. If the customer does not have the capacity to choose that given day, the carer may make a choice for him/her, based on the likes/dislikes of the service user and the restrictive criteria described in the care plan and also ensuring a healthy and varied diet.
1.2. Encourage the individual to select suitable options for food and drink When encouraging service users to make suitable options when choosing food and drink the carer will communicate politely, with encouragement and empathy. Service users should be made aware of the reasons for a better choice. The suitable choice may be for dietary, or health and safety reasons (e.g. allergy issues), or to offer a larger variety of food and drink.
While discussing the service user’s likes and dislikes, the carer shall suggest that the service user try some of his/her dishes of healthy food, which are not only delicious, but also healthy. Vividly describe how good the suggested dish tastes and persuade the service user to give it a try. Thus, the service user is relieved of the stress of choice. Another way of introducing healthy dishes is if the carer is having his /her meal with the service user; the carer may cook for him/herself the dish, offering some to the service user to taste it. The same applies to a new dish, which would be advisable for the service user to have, and offer him some to taste; thus, the service user is relieved of the stress of being left without an option.
1.3. Describe ways to resolve any difficulties or dilemmas about the choice of food and drink Should the service user insist on his choice, if possible, try to employ a healthy way to prepare it, e.g., thicken meat juices to sauces with steamed and mashed carrots instead of corn flour; cooked carrots help digestion; . Soups can be thickened by liquidizing the vegetables; if the service user likes to have a cup of tea/ coffee after 6pm, encourage him to try a decaf variant of his usual brand, Horlicks in milk, or a herbal tea with honey instead and support him/her to understand the difference it will make for his night rest.
1.4. Describe how and when to seek additional guidance about an individual’s choice of food and drink Guidance about an individual’s choice of food and drink should be sought if the service user does not respond to suggestions and offers and his/her health is endangered, e.g., the customer refuses to drink, although the water/tea/fruit juice is being repeatedly offered. The line manager will have suggestions about how to persuade the customer, and, depending on the case, the GP and/or the dietician have also to be consulted.
2 : Be able to prepare to provide support for eating and drinking
2.1. Identify the level and type of support an individual requires when eating and drinking There is a need to identify the level and type of support an individual requires when eating and drinking. Any support while eating or drinking is to be provided respecting the service user’s human dignity, while the carer is exhibiting warmth and a calm attitude. The care plan informs whether the service user is able to feed him/herself, or needs assistance. Many service users will feed themselves when starting their meal, but will get tired and will then require assistance. The hands of service users with Parkinson’s may have to be gently directed so that they manage eating independently.
The carer may need to cut the food for the service user. Service users with chewing difficulties, or swallowing precautions, or a history of choking need to be supervised while eating. Of course, these service users will also get a soft diet. Service users living with dementia may reject food which to them resembles to gruesome things (e.g., they may think meat bits in a dark sauce are cocroaches), therefore person-centered support is important. Service users with learning disabilities may find it hard to estimate distances, so the carer will make sure plates and glasses are well within their reach.
2.2. Demonstrate effective hand-washing and use of protective clothing when handling food and drink Hands have to be washed the following way: wet hands, put soap on them and rub palms together until foaming; rub each palm over the back of the other hand; rub between the fingers on each hand;rub hands with the fingers together; rub around each of the thumbs; rub in circles ont he palms; rinse and dry, preferably on a paper towel. Gloves and aprons are to be worn when handling food; when no longer needed, they will be disposed with hazardous waste.
2.3. Support the individual to prepare to eat and drink, in a way that meets their personal needs and preferences While supporting individuals to prepare to eat and drink, the carer has to be aware of the service user’s preference of where to have his/her meal. If the service user likes sitting at a table, the table has to be laid by the time the service user is assisted to sit down to it. The service user may be invited to help out laying the table, his/her condition permitting it. Napkins will be at hand; if he/she agrees, it is practical to have a big napkin covering the service user’s clothing ( I often use an apron fastened at the neck with a clothes-peg). Many service users like having their meals on a tray, while seated in their armchairs. If possible, provide a tray with a bean sack, but a cushion placed under the tray will also do. It will give stability to the tray and the service user will be able to concentrate on the meal and enjoy it. The carer will prompt the service user to wash hands before meals, or will provide a water bowl or a damp towel for this purpose.
2.4. Provide suitable utensils to assist the individual to eat and drink Utensils may vary in their form, dimension, and colour. The carer has to be aware of any special needs of the customer, which should be available from the care plan. Some service users choose to use only a spoon for all their meals; individuals with difficulties opening their mouth will use a teaspoon. For individuals living with dementia, the tableware and the tablecloth have to be patternless, as patterns will distract, or even scare them. As elderly service users generally have a small appetite it is advisable to offer food on a smaller plate.
3 : Be able to provide support for eating and drinking
3.1. Describe factors that help promote an individual’s dignity, comfort and enjoyment while eating and drinking The carer has to assure a relaxed atmosphere during meals. Many service users like listening to music of their preference while having their meals and many like their carers to eat together with them ; others prefer eating on their own. If the latter be the case, the carer is to check from time to time wheter the service user likes the meal, or perhaps needs help. Service users shall be treated with a string of „simple” human dignity, such as giving them a napkin protecting their clothes, but asking beforehand; giving choices about the food they eat and take into account their preferences; warm foods should be served warm and cold foods cold; ensure, though, that the food is not piping hot for the service user to burn him/herself; the presentation and colour of food is important, as it will invoke feelings of desire for the food; liquidized or ground food should not appear messy, try to present it as if it were solid, in „isles”on the plate and explain what is what; if their diet allows, offer appropriate condiments to the dish; service users with swallowing precautions will have to be assisted- let it appear that you are just offering good companionship; when feeding, ask whether they are ready for the next spoonful before proceeding; before wiping their mouth or hands or touch their body, offer them the cloth, or ask for permission.
3.2. Support the individual to consume manageable amounts of food and drink at their own pace The carer shall support the service user to consume manageable amounts of food and drink at his/her own pace by observing their reactions and adapting to them; sometimes it is advisable to split the food and heat up the second part, after the first part had been eaten, or fed .
3.3. Provide encouragement to the individual to eat and drink The carer will exhibit an outgoing, warm attitude and will provide verbal encouragement to individuals to eat and drink,while guiding their hands, lauding every little success and showing empathy with the individuals after failures to achieve feeding themselves. This will make the service users feel included and will enhance their self-esteem.
3.4. Support the individual to clean themselves if food or drink is spilt If food or drink is spilt, the carer will support the service user to clean him/herself and ensure him/her, that it was an accident, encouraging him/her to give it another try, thus giving him a feeling of worthyness.
3.5. Adapt support in response to an individual’s feedback or observed reactions while eating and drinking The carer has to carefully watch the service user while eating- swallowing. Adapting support may mean slowing down and giving him/her time to chew the food; it can also have a more complex acception, when someone may need a professional assessment of their ability to eat (maybe they need their teeth examined or new dentures or have oral thrush). In this case, a dentistry assessment may be necessary, or the GP may need to be involved to ensure appropriate referral to a consultant.
4 : Be able to clear away after food and drink
4.1. Explain why it is important to be sure that an individual has chosen to finish eating and drinking before clearing away The service user’s personal dignity has to be respected by making sure whether an individual has chosen to finish eating and drinking before clearing away; some service users will eat at lenght, with big pauses and would not be able to protest if the plate would be taken away, but would feel frustrated and hungry.
4.2. Confirm that the individual has finished eating and drinking The carer has to ask whether the service user has enjoyed his/her meal, whether he/she would like anything else, to show the service user that there is no rush in him/her finishing eating or drinking, but then the carer shall ask the service user if he/she finished eating and the table may be cleared.
4.3. Clear away used crockery and utensils in a way that promotes active participation. Depending on the mobility of the service user, the carer will include him/her in clearing away used crockery. Mobile service users are happy to help, but even service users who can not hold their weight will fold up napkins and gather items on their tray. Individuals living with dementia will be offered to do a job together with the carer, e.g. carry a tray in two, so that the carer can support the weight. This will engender a feeling of joy, as they feel inclusion and participation along with a sense of worth.
4.4. Support the individual to make themselves clean and tidy after eating or drinking After eating or drinking, service users have to be prompted to wash their hands and face. Some will want to wash their mouth and have their dentures cleaned
5 : Be able to monitor eating and drinking and the support provided 5.1. Explain the importance of monitoring the food and drink an individual consumes and any difficulties they encounter It is important to monitor the amount of food and drink intake a service user has, to make sure that he/she is eating and drinking enough – otherwise he/she may become dehydrated or lose weight – or become overweight. It is also important to make sure individuals are receiving the correct nutrition and amount of food and drink they require.
It is also important to monitor any difficulties an individual is having eating or drinking and to find out the causes (e.g. service user does not like the food, has swallowing difficulties, or it is a sign of other health problems). It is also important to explain this to the service user to raise his/her awareness. 5.2. Carry out and record agreed monitoring processes
After meals, the carer records the quantity of food and fluid intake in the logbook, specifying the meal and the fluid the service user had, detailed sufficiently to ensure continuity of care, dated, timed and signed. Refusal to eat and/or drink are also to be recorded and the possible causes described; in this cases, the line manager is to be informed.
5.3. Report on the support provided for eating and drinking in accordance with agreed ways of working The carer has to make sure that the service user is having a balanced diet and sufficient fluid intake, due to the the right
amount of prompts, following the care company’s policy for monitoring food and liquid intake, the care plan, and risk assessment. The logbook will be completed in private, the information has to be accurate and factual. The logbook is always returned to the safe location indicated in the support plan.
