In January 2018 a report by the All-Party Parliamentary Group on Hunger an influential cross-party group of MPs called for care home staff to be trained in screening the elderly for malnutrition. The recommendation follows on from evidence given to the group by Managing Adult Malnutrition in the Community who estimate that 35% of people recently admitted to care homes are malnourished. This chimed with the oral evidence given to the MPs by the Hertfordshire Independent Living Service, which found that approximately 40% of people referred on to its books are malnourished.
The evidence received suggests that malnutrition is most likely to arise amongst older people following an accumulation of setbacks – bereavement, illness, a loss of community transport services, and a nearby shop closing, for example – which leave them unable easily to access food. Over and above these cumulative setbacks.
What is malnutrition?
Malnutrition arises when a person’s body does not gain the nutrients it needs to function properly. Older people are particularly at risk of becoming malnourished, due to a range of unique medical, physical, and social reasons.
The World Health Organisation defines malnutrition as: ‘deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
On the most recent estimate, the report claims that 1.3m older people were malnourished or at risk of malnutrition at a cost of £11.9bn to health and social care services.
The cross-party group estimates this figure will rise to £13bn by 2020 and £15.7bn by 2030.
The report calls on Secretary of State for Health and Social Care Jeremy Hunt to ensure that care staff are trained to use the Malnutrition Universal Screening Tool, or an equivalent mechanism, to identify older people who are at risk of malnutrition and ensure they receive appropriate food and support to improve their condition.
The report recommends social care providers are given the duty and appropriate funding to ensure elderly people at risk of malnutrition receive at least one hot meal a day with nutritional supplements if necessary.
Care providers should also be given responsibility to ensure older people receive the necessary help to prepare meals and undertake any other activities that can help keep malnutrition at bay.
On a practical level care services should carry out a nutritional assessment as part of the assessment process or when there are concerns about a person’s loss of weight or lack of appetite. This is advocated in the Bettal Quality Management System.
The Report goes into some detail about the outcome of savings through the introduction of screening for malnutrition. It does not take into account the cost of carrying the process out. That would involve: undertaking the screening, documenting evidence on appropriate decisions on how to pursue the diagnosis underlying any malnutrition or risk of malnutrition, intervention plans to combat the malnutrition and timelines for review and or re measurement.
Criticism of the report
Margaret Wilcox, President of ADASS, was critical of the report’s findings, arguing it was the “wrong approach” to impose a further duty on social care providers.
“The way forward is to deliver more personalised care, and that requires more resources, not more rules,” she said.
“Placing more duties on already-pressured social care staff to tackle one issue, rather than providing the funding needed to address the underlying care crisis, will hinder rather than help.
“If new duties are imposed, then as a bare minimum social care providers must be given adequate funding to ensure they are effectively carried out, otherwise sorting out one human tragedy will create another, as resources are pushed from pillar to post.”
All-Party Parliamentary Group on Hunger highlights the growing problem of malnutrition. It is a shocking indictment of our society that according to Managing Adult Malnutrition in the Community 35% and the Hertfordshire Independent Living Service who estimate that approximately 40% of people admitted to care homes suffer from malnutrition.
It is good practice to carry out an assessment of a person’s nutritional needs on being admitted to a care service, including with their consent measuring height and weight.
However, we must also take into account the costs of carrying out the process and staff training. With or without extra funding social care services have a duty to care, and must embrace the full meaning of safeguarding to ensure that people who use their services do not go undernourished.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy