Facilitators to providing nutritional support to older people in care homes: a qualitative study - Abstract

Background Dysphagia is a common, potentially life threatening problem for older people in care homes. Providing nutritional support to older people with dysphagia is challenging and sub-optimal treatment can lead to malnutrition, chest infections, choking and unnecessary hospital admissions. Care homes are required to identify and take action to support residents with dysphagia (CQC 2010). However, evidence suggests that not all care homes follow safe practice guidelines. Aim To explore factors influencing the management of nutritional support for older residents in care homes with dysphagia. Study Design A prospective qualitative study, funded by Abbeyfield Research Foundation, was undertaken in four care homes in the North of England. Care homes purposively selected to reflect different care-provider models. Semi-structured interviews conducted with care home managers (n=4); quality managers (n=4); and residents (n=6). Eight focus groups conducted with 37 participants, including, nurses, carers, cooks, kitchen staff. Data were audio-recorded, transcribed verbatim and analysed using a thematic framework. Findings Four themes illuminated factors influencing nutritional support of older people with dysphagia. Maintaining quality and safety details how dysphagia is assessed and managed; Food management illustrates facilitators and barriers to optimising nutritional intake. Facilitating training and education demonstrates barriers to up-skilling care home staff; Managing staffing levels explores how workforce planning contributes to dysphagia management. Discussion Care home staff had good awareness of assessing dysphagia in older residents however providing food choice and mealtime assistance was difficult due to workforce issues. A lack of flexible, work-based training/education for a largely non-professional workforce meant that keeping pace with increasing complexity of resident need was problematic. Care home managers found it challenging to adopt a strategic approach to workforce planning/education due to lack of focus at the organisation level. A co-ordinated organisational/care home approach to workforce planning and education is required to ensure residents receive optimal nutrition.