Care home mealtimes policy – is this normal?

[exiledfromcornwall]

My mother (93) has recently moved back to the small care home she was in a couple of years ago from a bigger home within the same group. The residents were moved out of the small home because it had to close for renovations.

Before she moved back there it was explained to her that certain things would be different from how they were before, because it is now a home catering primarily for dementia residents (my mother does not have dementia). One of the changes is that residents are expected to go down to the dining room for their meals, so having meals served in their rooms is not an option (except presumably in exceptional circumstances). She had the option to stay in the bigger home if she did not like the new arrangements, but she agreed to the new arrangements and opted to move back.

Now she is complaining about the meal arrangements, saying that if she doesn’t go downstairs she doesn’t get fed. Finding this hard to believe, I spoke to the manageress of the home, and she assured me that she would not just get left without, but that she did agree to all this prior to the move back, although my mother has evidently forgotten that she agreed to it.

My question is how common is it for residents of a care home to be “expected” to go down for all their meals? I have done a quick google search for random homes around the country and they all say, without exception, that although residents are encouraged to dine in the dining room, they may have their meals served in their room if they wish. Also, I have tried to find whether there is any legislation around all of this, but I can’t seem to find anything. Anyone know where to look?

Both my DGM’s were in homes in different parts of the country. Both had to go to the dining room for meals.
I didn’t know this wasn’t the case in most homes.

Yes I believe it's normal practice for the residents to be required to go to the dining room. It is around here anyway.

It would require much more time/staff/funds to wait on each person in their rooms.

all able residents would be expected to go to the dining room , this is also beneficial for the resident as it provides some social time , carers will only usually takes meals to bed bound residents who physically can't get to the dining room

No. Complain formally. Use share your knowledge form on their website to inform CQC.

It’s good to encourage people to have social contact but people’s right to choose should be fully supported. It’s about staffing. If people cannot choose to eat in the privacy of their room, it’s because they aren’t properly staffed to meet people’s needs.

There are many reasons people might prefer to eat alone. That wish should be respected.

I this would be fairly normal. If a lot of the residents have dementia, there may be greater need for help with feeding and therefore a greater staff presence needed in the dining hall.

Why doesn't she want to eat in the dining room?
Is there a good reason?
Yes, it is encouraged that residents eat in the dining room for multiple reasons, including their welfare, but if there is a very good reason for them not, this should be considered.
How is dm' s appetite & fluid intake? Does it differ between dining room & her preferred location?
Could she compromise and eat downstairs in another communal room?

I expect its difficult for your mum , she probably didn't understand the implication of eating all her meals with all dementia patients . But the home still has to try and meet her needs .

My late mother was in seven Surrey nursing homes, generally residents were allowed to have meals in their own rooms.
There was a straightforward reason for this. Many residents would be left in bed all day! This was the case in Barchester's Reigate Beaumont and Priory Court in West Ewell.
Both care homes I found appalling (this was 2014-16). Yet in this instance I'm not exactly complaining. You see, unlike in the family home or just 'at home' it's not possible for residents to just amble out and around, into the dining room, in their nightie or pyjamas. They have to be dressed, and of course many can't do the themselves. On the one hand, this upholds certain standard in the nursing home. On the other, it means you can't socialise unless you go through the time-consuming hassle of being dressed by staff, and with so many residents, it just can't be done for everyone, it would take all day.
Now, of course most rooms have TVs and so on. It's no great hardship.

But for this reason, meals would often be served to residents in their room. Otherwise they just wouldn't get fed.
At the Epsom Beaumont this would also happen because the dining room wasn't that large (this was back in 2011, it may have changed since then).
Now, really, I would have thought it was the simplest thing ever to drop a line saying look can you make an exception for my mother? Or is it a legal thing - are they worried that by herself she might choke and nobody notice? If your mother is smart and alert, that is unlikely perhaps, but with general dementia patients you better believe that might be a problem.
As for contacting the CQC, well, careful. In my experience they are a corrupt and dangerous regulator and of no help whatsoever. All they're likely to do is stir things up as the care home will obviously know it's you putting in a complaint. Plus, they famously 'don't investigate individual concerns'.
But if you do raise this, do it via email - that way you have a record of it and the care home knows you do - and do it in the friendliest, most beguiling way possible. One email like this is worth 10 'friendly, informal chats' to the care home manager that you find they can ignore in a passive aggressive way, to the point where eventually you get stressed, assertive and tactically angry - they can then make out you are abusive and intimidating, while you have no proof of your previous conversations.
I don't know if your parent is refusing to visit the dining room or somehow forgets to go. Is she unaware? If the former it can be made out to be her fault, if the latter I suppose a case can be made for having it in her room?

Oh, when I said 'if you do raise this, so it via email' - I meant 'if you raise this with the care home'. Advice remains, don't go to the CQC, they really are pretty rubbish and on the one hand they wouldn't help with a problem this trivial, on the other hand they might simply because it is trivial - they can 'easily' solve it and claim a success. Then again, they don't investigate individual complaints.

D1ngledanglers She is very up and down due to her medical condition. Some days she can't get out of bed, and those are the days when she doesn't want to go down. On her good days she will go downstairs.

I would imagine that it's easier to have all residents in the dining room. Because most residents have dementia so they need help/supervision with their meals.
I would imagine they don't want your mum to eat un supervised in case she chokes and they don't have the staff to accommodate individual cases rather than a group sitting

I'd have a conversation with the manager, discussing the reasoning & risks around dm remaining in her room.
Basically, they should be concerned about the risks, rather than staffing. Does dm have capacity to understand the risks & make an informed decision?
How often approx, does she have bad days?

Dad is in a small nursing home almost entirely dementia patients. He takes all his meals in his room. They have also offered to bring it him in the lounge. There was one lady who I’d often see eating a plate of fried eggs and chips (the usual alternative if a resident doesn’t like anything on offer) sitting in the reception area.

Dad doesn’t have a dementia diagnosis, and isn’t in danger of choking. I presume same is true for OPs mum

@MereDintofPandiculation

Dad is in a small nursing home almost entirely dementia patients. He takes all his meals in his room. They have also offered to bring it him in the lounge. There was one lady who I’d often see eating a plate of fried eggs and chips (the usual alternative if a resident doesn’t like anything on offer) sitting in the reception area.

Dad doesn’t have a dementia diagnosis, and isn’t in danger of choking. I presume same is true for OPs mum

That sounds like a lovely home offering personalised care and exactly as it should be.

@MereDintofPandiculation

Dad is in a small nursing home almost entirely dementia patients. He takes all his meals in his room. They have also offered to bring it him in the lounge. There was one lady who I’d often see eating a plate of fried eggs and chips (the usual alternative if a resident doesn’t like anything on offer) sitting in the reception area.

Dad doesn’t have a dementia diagnosis, and isn’t in danger of choking. I presume same is true for OPs mum

That sounds like a very similar type of home to my Mum's, and like your Dad, she doesn't have dementia. Yet his home seem able to have a much freer meals policy. I can understand homes wanting to "encourage" residents to take their meals together in the dining room, but there is a difference between "encouraging" and "expecting".

I work in a small care home and residents can have meals in the dining room or in their own room. We encourage them to come to the dining room if they are able to, but of course it is up to them. I'm slightly shocked that some care homes insist residents go to the dining room.

I think a lot depends on the manager. We have a superlatively good manager. It may help that she cared for her own elderly parent

@exiledfromcornwall

D1ngledanglers She is very up and down due to her medical condition. Some days she can't get out of bed, and those are the days when she doesn't want to go down. On her good days she will go downstairs.

If she is unable to get to the dining room, or feels too unwell to leave her room, she should have her meals in her room. If she wasn't given food / fed, it would be considered neglect & a safeguarding (or report to local authority adult social care safeguarding line)

It may be that this home is no longer right for her. Has she considered moving back to the larger home when they have a vacancy?

I've worked in many care homes, and yes that is often the policy. People will sometimes eat in their rooms, if they are unwell etc, but in the main there is the expectation that if they can get to the dining room, they should.

The reason is almost always the level of staffing. If 50 frail elderly people are going to eat at the same time, then obviously there will need to be "all hands on deck" with staff assisting them to eat, make sure nobody is choking etc. If multiple people are eating in isolation, they can't be assisted / supervised . And apart from the safety issues, socialisation is an important aspect as well. Eating together gives everyone a nice social experience instead of sitting in their room eating and watching TV.

I've never known of a home where the residents had to get dressed to go to the dining room. Most homes are very "homey" and people can go down in their dressing gown if they like. At breakfast time it's quite common for most residents to be in their night clothes.

I hope it all works out for your Mum.

Can she move back to the other one? She was specifically asked if she could/ would comply with the meal times as set up, and said yes, but has clearly changed her mind. If she wants the opportunity to eat on her own regularly, and this,place has already stated clearly before moving back in they don't operate like that, then surely she should go back to where she was?

Eating together gives everyone a nice social experience instead of sitting in their room eating and watching TV. how is it a nice social experience if all the other residents have dementia, especially since OP’s mum does not have dementia?

It's encouraged for residents to dine together, it's not mandatory. If your mum doesn't want to go down she cant be forced therefore her meal will be taken to her.