An exploration of the factors that affect the extensive meal experience for the older person living in residential care.

Mealtimes in care homes can impact on resident wellbeing. There is evidence from the literature that food and drink intake in care homes can be influenced by individual concepts including person-centred approach, food-service, sensory factors, environmental factors, social interaction, and staff responsibility. However no single study has reviewed the complex nature of the holistic mealtime experience. An approach is needed to fully understand the complexity of food and fluid delivery in care homes from both the staff and resident perspective. The aim of the study is to critically explore the factors that affect the extensive meal experience for the older person in long term residential care in order to identify the enablers and barriers for good nutritional care and promote wellbeing and quality of life. A convergent parallel mixed method design explored the range of experiences and understandings of the mealtime experience from the perspectives of care staff and residents in residential care. A dominant qualitative thread of semi-structured interviews with 10 residents and 15 care home staff were corroborated by 15 structured mealtime observations. A quantitative questionnaire was distributed to care workers from a selection of care homes in Dorset (n = 52) to evaluate knowledge of food, drink and mealtimes. Thematic analysis developed the theoretical analysis of transcribed interviews and observations. Themes and sub themes are mapped to demonstrate their interconnectivity around the mealtime experience and corroborated with rich narrative quotes from participants. Quantitative data are presented as frequency and percentages of response rates through a range of pie charts and bar graphs. Cross tabulations represent relationships between significant variables tested using Pearson Chi2 test for independence. The collective findings are presented as a theoretical framework of the holistic mealtime experience for those living in long-term care from a staff and resident perspective. Key findings show the mealtime experience is influenced by important psychosocial influences of person-centred aspects of offering food choice, relationships with others and social environment as well technical aspects of food and drink service, sensory appeal, involvement with food and hydration. Training methods differ in their effectivity with greater staff empathy demonstrated through reflective experiential training. Importantly the following were significant to ensuring a good mealtime experience for older adults living in residential care: 1. Flexibility of staff should focus on person-centred delivery of food and drink day and night in an environment to suit individuals, rather than be led by institutional systems. This has the potential to positively influence resident autonomy, independence and dignity. 2. The mealtime experience is the responsibility of all staff within the care setting. This includes kitchen staff, who were not always seen as part of the care team. All staff did not always know how to offer appropriate food choice for those living with diet dependent conditions. 3. Socialisation and the influence of both staff and other residents can impact on the mealtime experience both positively and negatively. In particular, staff should consider resident security when allocating seating plans and the impact of difficult residents on the mealtime situation. Recommendations are made on how staff can improve the mealtime experience that concentrate on quality of life and wellbeing of the resident to improve overall training and practice of care home staff.