meal times and dignity for those with dementia

Hi Amanda.

If I've got the problem right - that dementia patients who are receiving 1:1 help with feeding feel like humans, but trying to 'feed' more than one person at a time makes the patient feel 'dehumanised' and isn't good for the carer either {and, as you say, might be dangerous} - then I can't see any other solutions beyond your own two. You either need to spread out the timeline for feeding (your first suggestion) or introduce more 'feeders' (your second solution).

I can't see how any other solutions, are possible in principle ?

But I could be wrong.

HI Mike, thanks for your reply and I want to keep this a rolling topic to see what else may come up in due course. best wishes amanda

Please note, I 'feed' my cat, I 'feed' the birds, I never 'feed' people, i merely assist them to have their meal if this is a requirement. Dignity in care please.

You are so right!!!

E Jane Osiecki : Fair enough - I should have said 'help with EATING', but Amanda did use quotes around "double feed".

I work on the night shift, so i have not come across this situation. I can only imagine how this would make both carer and resident feel. When it comes to the "night time drinks" most residents are in bed. They are asked if the require anything, the residents that require assistance are aided to do this, as they are in their rooms they all get one to one. I would not feel comfortable assisting more than one person at a time.

Supporting people with any task should be performed with the utmost of dignity, respect and compassion. People should be empowered to be involved with the task - done with or done to? How can anyone feel valued if a carer is feeding two people at once. It is inappropriate when a basic, essential, need is met in a such a disrespectful way. Yes carers are busy - yes people need to eat or drink but systems, routines and practices need to be revisited to ensure that carers are able to deliver compassionate, respectful services with dignity. The National Dignity Council advocate the role of a dignity champion is to: *Stand up and challenge disrespectful behaviour rather than just tolerate it.
*Act as a good role model by treating other people with respect particularly those who are less able to stand up for themselves
*Speak up about Dignity to improve the way that services are organised and delivered
*Influence and inform colleagues
*Listen to and understand the views and experiences of people who use services and carers.
It would be good to hear if you have challenged disrespectful behaviour, how did you do it and what difference did it make?

Yes I used the word "double fee" in quotes because i abhor the use of that demeaning vocabularly as was so beautifully illustrated by E. jane's comment . I hope that as dignity action day approaches that the improvement of the mealtime experience for residents and patients can be looked at in greater detail, there is so much that can be done as Jan illustrates in her comment. Happy dignity day . amanda waring

Forgive me for asking, But what is Double Feeding?
I work in a care home and haven't yet come across this.

The info would be greatly appreciated

Hi David I'm glad you haven't come across it - and i hope you never do. It is when one person feeds two people at once - not dignified at all. Thank you for taking the time to ask though you never know you may have resolved the question for others. Keep campaigning for dignity!!!!

Jan,

You've just done exactly what I did earlier ! I think this shows how people can inadvertently use the wrong language, because they are thinking about the physical concept in a non-verbal way ?

'It is when one person feeds two people at once - not dignified at all.'

As pointed out above:

E Jane Osiecki
Please note, I 'feed' my cat, I 'feed' the birds, I never 'feed' people, i merely assist them to have their meal if this is a requirement. Dignity in care please.

thanks Mike I stand corrected - not empowering language. Point taken.

Jan, I don't really think 'by using words' - I'm a 'thinking in patterns' person.

So I find it annoyingly easy, to then [inadvertently] use the 'wrong' word to describe my conclusion: also, there is a lot of variation, in how 'sensitive' people seem to be, about 'what language people are using'.

Mind you, there is also a huge problem with different people using the same word, but that word meaning very different 'concepts' to different people !

I have never fully understood what the aversion is to having meals that occur over a period of time rather than at a set time. Every day I eat my meals in a different way, my 'midday meal' can occur at any time between 11.30 if I've been up early and am feeling hungry, to 3.00 p.m. if I am busy or just not feeling particularly hungry. There are also days when I graze and never actually have a meal. One member of staff assisting two or more people to access nutrition seems to occur when the mealtime is the driver rather than the individual need. So although Amanda's are the only two apparent solutions, i.e. rolling mealtimes or more people to assist residents we may really need to change the ways in which we think about food and meal times.

Too true Liz - routine and regime v person centred care does need to be questioned. yes we should think about food and meal times and what does that mean to the person themselves. Yes routines and staffing levels do need to be taken account of but it can be done!!!

Liz and Jan - the problem seems to be the fact that 'organisations' (be that a hospital or a care home) like to have 'defined behaviour'. You can easily see both why this is helpful (it makes 'auditing good behaviour' easier) and unhelpful (it makes 'being responsive to users' harder).

So Liz's 'I eat when I can or when it suits me' type of behaviour, is far harder to achieve within an organisation - but flexibility makes sense, until it impinges unacceptably on 'the running of the operation'.

Slightly off-topic, and re Liz's 'there are also days when I graze' comment, there was a recent piece in Nursing Times online about malnutrition in older people. The authors seemed to attribute this to a lack of understanding of nutrition among the elderly, but I commented that there are I suspect other factors. One is that I think some older people find it hard to eat a lot in one go, and another is that I think the sense of taste declines with age, so food becomes less tasty and thus less appealing. Encouraging the elderly to 'graze' is probably a good thing, I suspect ? (unlike for younger people, where grazing tends to lead to putting too much weight on).

Yes you are right Mike, I have certainly practical experience of residents with dementia beginning to eat more and indeed more healthily when there is food readily available. for example small sandwiches, pieces of fruit, and even vegetables, as well as the odd cake and biscuit. I also agree with what you are saying about organisations, I think it is often easier for smaller scale operations to provide more flexible access to food, but that shouldn't stop us trying to make the service fit the need, not vice versa.

Hi Liz

'that shouldn't stop us trying to make the service fit the need, not vice versa'

In my 'particular area of debate' with the 'Clinical Establishment', I keep comming across protocols which instead of being designed to deliver 'sensible and balanced behaviour at the point of contact' instead seem to be designed with a view to 'making the behaviour auditable (in other words, forcing the behaviour to fit the paperwork)'. This is something that seriously angers me.

I think you are right, that this 'rigidity' (for all behaviour) tends to increase as organisations get larger - partly, I suspect, because different 'managers' are tasked with conflicting objectives in large organisations, and partly because most people are somewhere within a hierarchy, and are not able to independently make decisions.

I have only come across this once, when i used to do day shift. now i do night shift it never happens. it only happens here when there are staff shortages. I hate doing it to, it feels like your igbnoring one resident whilst feeding the other and that is not person centred care. It also presents a choking risk i one of the residentss you are feeding is unable to communicate vocally.

What a terrible position to encounter Michael - the risks - are bad enough but where is the dignity? Its seems like you are left with feelings - I wonder what feelings the people who are on the receiving end feel? Thanks for sharing this example - staff shortages are problematic but I wonder what is done to make sure that this doesn't have to happen again?

hi I have just become dementia and dignity lead in my home and am very looking forward to any tips and advice for me to implement into daily life in my home thanks x

very interesting reading we at my home also used to "double feeding" until it was stopped, we now stop all work in the home at meals times even the manager assists residents with their meals, cleaners, laundress everyone. meal times are vital for the daily routine of residents. xx

Hi Natalie
Congratulations on your appointment to Dignity and Dementia lead - our website is under review at the moment, however there are resources available that could help in your lead role but if you are doing anything specific or need to know anything do not hesitate to ask myself and other champions we are always happy to respond. We also have a very active Facebook group - Dignity in Action if you have not joined in please feel free to do so, champions are very responsive on there too. By the way good to hear that meal times have been positively changed to meet the needs of the people in your home.

Hi Natalie and Jan,

Yes - I was impressed by:

'we now stop all work in the home at meals times even the manager assists residents with their meals, cleaners, laundress everyone.'

as well.

It is good to see that this thread continues to attract comment, given the importance of the issues. I was recently contacted by the nutritionist resource group who made the following comment

I came across your website today and thought you might be interested to hear about our site Nutritionist Resource (www.nutritionist-resource.org.uk).

Here at Nutritionist Resource we believe that healthy eating could hold the key to a long and healthy life, which is why we have established a website that provides the public with easy access to nutritional advice from professionals.

We offer information about the areas in which nutrition might help, articles written by nutritionists, and the latest industry news. To ensure the professionalism of our website, all listed nutritionists have provided us with qualifications and insurance cover or proof of membership with a professional body.

I have had a look at the website and there is some helpful information on there.

I have just signed up as a dignity in care champion.I work in a residential home with elderly clients.I am very passionate about dignity in care.Reading your messages about mealtimes ,yes we have lunch at 12noon every day but clients have a right to choose whether they would like to eat at that time,they may choose to have their lunch at 1pm.By respecting the clients wishes their lunch would be served to them at their prefered time.At the end of the day I would not like to be told when I have to eat.Assisted feeding should be done in the privacy of a clients room not in front of others ,that is what I call dignity and respect .

Thank you for signing up Joyce and thank you for joining our campaign to promote and uphold dignity at all times. Great to hear what happens in the residential home where you work and great to hear that dignity, choice, privacy and respect are paramount. All adhering to the dignity challenges we [The National Dignity Council] recommend everyone follows. Keep in touch.

Well having a shortage of staff is a failure to the organisation as it is their responsibility to have a adequate amount of staff on shift to meet the needs of service users. I suggest the organisation should start looking for more care staff before matters get even worser. Its not fair that these service users have to suffer. Mealtimes are meant to be a great experience for individuals, it is their time to enjoy their meal in the most dignified way. And its a shame that this organisation delivers such a poor service.

Too true Naseem - well said.

hi im a dignity champion and nutritional advocate in our day centre for older adults im currently working for silver award.
I have lead regular meetings inviting clients and their carers to gain their advice. in what they feel is important, I introduced colour coded place mats. that the client make themselves,
the colours start at purple for independent then we have yellow, where a client needs a staff member within vicinity, then green. for clients needed aids to assist with their dining experience, and of course red, for clients needing assistance eating, staff sat with them due to high risks of choking, their names and menu choices are written on, so that staff don't have to shout their names, and the client can remember what they have ordered .
it has proved highly invaluable, at meal times, and a very dignified way of recognising the needs of our clients