This page provides information on advice currently available to carers and makes recommendations on how this can be developed to achieve best practice.
• The key Care Standard for this area is Care Standard 15 of the National Minimum Standards – Care Homes for Older People.
• The current best practice guidelines are contained in the Caroline Walker Trust second edition of Eating Well for Older People.
Care Standard 15
Care Standard 15’s expected outcome is that “service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them”.
Recommendation: wholesome, fresh water should be included as a central part of this diet.
15.1 requests that “the registered person ensures that service users receive a varied, appealing wholesome and nutritious diet, which is suited to individual assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times”.
Recommendation: as a primary and essential nutrient, fresh drinking water should be made available as part of a varied, appealing, wholesome and nutritious diet and its consumption encouraged throughout the day.
15.3 indicates that “Hot and cold drinks and snacks are available at all times and offered regularly”.
Recommendation: as Care Standards now begin to consider the clear benefits of drinking water, it is likely that in the future care homes will be asked to ensure that fresh drinking water is available to residents throughout the day, free of charge.
Dehydration occurs regularly in older people. While resident choice for other drinks is a must, we must consider that there is nowhere in general public health guidance that you will find caffeinated, high-sugar soft drinks and fizzy drinks ever recommended. Unfortunately, many of the hot drinks currently on offer contain diuretics and make the body urinate. As a source of caffeine, they also act as a stimulant and can affect a resident’s ability to relax and to sleep. With care homes now investing such great effort and resources into creating a calm and relaxing environment, you may find it helpful to consider providing alternatives to caffeinated drinks.
15.9 asks that “Staff are ready to offer assistance in eating where necessary, discreetly, sensitively, and individually, while independent eating is encouraged for as long as possible”.
Recommendation: staff should also consider extending this guidance to ensure that residents are encouraged and reminded to drink appropriately.
Carers can obtain further recommendations on implementing the regulatory standard from the National Association of Care Catering ‘National Minimum Standards for Care Catering (Care Homes for Older People)’. This can be sourced at www.thenacc.co.uk
Eating Well for Older People
The Caroline Walker Trust second edition of Eating Well for Older People recommends: “A regular and adequate intake of fluids is extremely important for older people” and that “older people should aim to drink about eight cups of non alcoholic fluid a day” (just over 2.5 pints or 1.5 litres).
The guidance suggests that water should be part of menu planning for the two main meals of the day – lunch and the evening meal.
Recommendation: this is an excellent recommendation, and one that would be simple to progress to best practice by simply ensuring that fresh cool tap water is available from the time the resident is awake, and that it is included as an additional healthy option with every meal and snack.
The Caroline Walker Trust guidance suggests that residents should be offered additional drinks after meals so that they achieve the 8 cups of fluid a day.
Recommendation: another piece of reliable guidance. It is important to offer fresh tap water as one of the additional drinks and explain to residents why this is a healthy option. Many residents may only think of caffeinated or sugary drinks unless the benefits of hydration are explained and well presented water is available.
The Caroline Walker Trust guidance explains that tea and coffee are sociable and relatively cheap drinks, while fruit squashes could also be used to improve fluid intake.
Recommendation: while water is clearly stated as an option in menu planning, it is unfortunately not included as an option in the section on fluids (Chapter 4, p. 38). Drinking water is an important nutrient for the body, vital to life. Any guidance for fluid provision should recognise water as the primary nutrient and propose methods of implementing water in hydration best practice.
October 2005
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