Improving the nutritional status of elderly residents of long-term care homes

High rates of malnutrition exist in long-term care residents in Canada. Residents may be admitted in a malnourished state or may become malnourished while in care. Nutritional decline of residents may be due to medical conditions but may also result from the failure to provide for the unique nutritional needs of this population, through an inadequate menu, inadequate swallowing and functional assessments, and lack of assistance with dining.

A project for the implementation of regional food services policies and practices was deployed with the ultimate goals to reduce nutritional risk and enhance the quality of life of the individuals residing in the 29 long-term care homes in the Saskatoon Health Region. The objectives were: to ensure that food and nutrition staff were competent; to provide adequate nutrition to residents; and to ensure nutrition screening, assessment and appropriate intervention, as approved by the resident or their relatives, was provided. Implementation consisted of: extensive communication of the problem; the development of draft Saskatchewan Food Services policies; planning regional goals, tasks, accountabilities and indicators; delivering meal assistance training to staff; and establishing a Regional Menu Advisory Committee.

Outcomes have been clearly articulated and methods to collect data clearly defined. Interventions in progress include: the development of key relationships among the health region's long-term care staff, managers and directors; communicating a clear understanding of resident-directed care; determining the baseline knowledge of food service staff; and assembling a project tool kit for implementing food and nutrition policies at each home. STRATEGIES FOR QUALITY IMPROVEMENT: Although the expectation was that food services policy implementation would be presented to all homes simultaneously, a more intensive pilot schedule has focussed on early-adopter sites. The three-year implementation plan is designed for sustainability.

Malnutrition is multifactorial and a concerted effort of all caregivers and service providers is important to address root causes.