Lunch Club – Getting Care Home Catering Right

Warning – this article does contain strong language.

I’ve been scratching my head a little recently.

I eagerly listened to the recent BBC 4 The Food Programme documentary on food in care homes (aired 2nd August 2021) and was left with quite a flat feeling, A missed opportunity perhaps? Something wasn’t quite right.

We will look at the areas of concern raised in the program, and there are some really important improvements that are needed, at a later date,. The overall impression given was that the care sector has it all wrong. The people that take on roles of vital importance; supporting vulnerable people to eat, and eat well, don’t understand the impact they can have; they are unskilled as well as inadequately resourced; and systemic failures compound the issue. The future is bleak.

Even the ray of light emitted by the newly available health and social care catering course is suggested to be an opportunity missed. With virtually no training centres, low uptake and the question of whether employers will stump up the cash to train a clearly undervalued area of the service. The future will remain bleak.

It is great to have scrutiny and transparency, especially from outside perspectives and from experts in research and reporting.

So why do I feel flat? Head scratching…

I understand the pain, anxiety, and depressing narrative from the program only too well.

I had expected that cooking in a care home was going to be a transient role for me. I love cooking, I love food and drink, I love eating and drinking with other people, it must be in my make up.

Having spent some time as a restaurant chef, and with a head chef offer in the restaurant scene in Cambridge, I was having a sabbatical while I organised my thoughts, and resources, for the next step… A trendy food truck with an interesting, playful name; or a supper club cum cookery school – social events with humour and food. The shoots were green, but it was no business, yet.

So I took a role as head chef in a large care home in the city.

It was interesting to hear what people had to say and what their perceptions were…

“So you’re giving up cooking then and going to just serve slop?”

“You’re going to have to boil the shit of everything, you know?!”

“That’s not food, that’s just crap.”

Well let’s see, shall we? I walked positively into the kitchen, knowing I had the skills and the inclination to serve the people in the care home delicious food that would make them happy and healthy… I was buoyant, 76 residents across residential, dementia and nursing care, I had an opportunity to fit in and help these people’s lives.

Arrival…

I wouldn’t describe it as a kitchen. A kitchen is a place where you can create. It’s a bright and vibrant space to be in, both literally and metaphorically. Where thoughts and plans can be turned into delicious dishes, eagerly anticipated by those being served.

This was a dark place, both literally and metaphorically.

It was clean, but the walls had a grey, yellow tinge, and a light flickered in the tiny, disordered office situated between the back door and the pantry.

Everything was decaying: none of the shelves in the fridges were original; two of the eight hobs didn’t work; a useful combination oven and steamer stood, derelict, where it had once been the workhorse of the kitchen (there was no budget to repair it nor to maintain or service it, so it was left where it stood); the pots and pans were old and cheap, made of aluminium they had thin bases, guaranteed to catch and burn sauces and stews, tainting the flavour of everything. The silver metal dissolved during cooking to give light coloured food a grey tinge. Grey food from a grey place.

There was, though, a BIG mixer, plenty of trays, large bowls, whisks and spoons.

As Wolff’s Law states: “Form Follows Function”. This wasn’t a place to cook, this was a place to mix and reheat. The were virtually no raw ingredients, just packets and packets of expensive branded, or cheap basic processed food ‘solutions’ that save you time… to do what?

Well, it turned out that there was such a lack of management, energy, care, and pride in ‘that’ kitchen that a high state of entropy had been created; no thought or effort was needed because nothing of any quality could or would be made.

Want a pudding? Pull out the flan base, whip up some cream substitute and spoon on some tinned fruit salad. Done.

Fancy some soup? There was great choice available… Minestrone, cream of tomato, wild mushroom, farmhouse vegetable, cream of chicken? Just pull out the tub of soup powder you want and whisk into boiling water. Done.

Mash? Powdered.

Desserts? Powdered.

Main course options? Well, anything pre-made that was on the frozen order sheet, which meant: fish fingers, sausage rolls, Cornish pasties, faggots, sausages, fish portions, fish cakes…

(When things had settled down a bit, and I had broken down the established norms and attitudes (and some people had left, obviously); we had a motivated and energetic team; and the vast majority of options were made from raw ingredients, I did a little in-house study on salt content in our menu. The food we provided varied between 3g to 3.5g per day over a 2-week period. Cross analysis with the processed menu I have described showed that between 13g and 15g was being served! That’s not care, that’s not caring.)

The kitchen’s position…

I must have been quite disparaging to the chefs (and they were chefs – working in the care home to top up their ‘real’ jobs in high quality commercial restaurants and colleges in the city). I must have tutted, or looked shocked or something… because I was given some cursory advice from the old head chef, who no longer wanted the ‘hassle’ of ‘management’:

“Don’t worry if it doesn’t look like real cooking, it’s what they want. There’s no point in trying to do anything interesting, they only complain, it’s what they do, old people, complain.”

I remember it vividly, because of his matter-of-fact manner and assertion. Clearly warning me not to do anything silly, like change anything; and because at the time he was mixing raw beef mince into a powdered béchamel sauce bubbling on the stove, which was, as always, being served with powdered mash and frozen vegetables that had been put onto boil as soon as breakfast had been wrapped up.

Specialised diets…

In the brief interview I had for the head chef job, the (interim) manager had made it clear that individual needs were so important and that there were many residents with specialised dietary requirements. It was right up my street, not only providing delicious, good quality food for everyone, but also the opportunity to apply cookery skills to help people with profound dietary needs.

The reality was a long away from the story I had been given. For those with dysphagia, for example, once all the general cooking tasks were completed, various tubs were taken out from the hot-trollies and ladled into a blender. A short whizz of the machine and there you have it…. Brown sludge. No thought, just portioned, covered, labelled and into the trolley to be taken away. Out of sight, out of mind.

It was probably best for them not to think about it too deeply, or at least put it’s vulgarity down to the medical conditions causing the need for texture modified foods. Just a task. Got to do it. Sad for them. Sleep better at night.

The senior care manager overseeing the team supporting residents with dementia quite rightly paid us a visit. Taking me aside and with tears in her eyes, “Why, why! Why does the blended food always have to be brown? ALWAYS BROWN!”

The memories I have are vivid and the experience of the first days, weeks, months, and eventually years: trying, failing, successes, research, setbacks, improvements, consistency, quality, happiness, pleasure, health. All this underpins the philosophies and drive at Oak House Kitchen.

Resident feedback…

One final memory from that first glimpse, first step – they say that’s always the hardest.

In the interview the ‘chef walk around’ was discussed. “We like to find out feedback direct from the residents. It keeps our menus current and well-liked;  and you will be able to get to know everyone better, find out what people want. Remember we work in their home; they don’t live where we work.”

As I walked into the downstairs, residential dining room I got it all barrels.

“WHAT THE FUCK IS THIS SHIT THAT YOU SERVE US?! I WOULDN’T FEED IT TO A FUCKING DOG!”

That is an indelible memory. The chap was obviously right to say what he did, he was trying to take action. He must have been saying it before, maybe until he was blue in the face and until the inertia of the unresponsive chefs made it pointless.

He was taken to his room, and I was the one that got an apology.

Fight or flight?

I won’t lie, I didn’t want to go back into that for long. It wasn’t my doing yet I was getting all the blame. But it was my responsibility. I just made myself two promises: 1. Try and make every day slightly better; and 2. Avoid turning into them.

Those early experiences galvanised me and, over time, transformed the operation: creating a kitchen culture based on culinary skills and knowledge; a motivated and inquisitive team (one member worked one day a week in a Michelin starred restaurant and gleefully came in one day to tell me that some of our recipes were the same – it’s just cooking, eh?); we proved to the local college that care chefs should be eligible to do the Professional Cookery qualification; homemade bread, homemade stocks, real chocolate – all absolutely achievable with good management, systems, skills and motivation.

Most importantly people were happier, more content and had a better quality of life.

No extra budget, no fancy equipment, and £3.50 per resident a day.

So why the head scratching?

The Food Program documentary exposed the realities, just like I described. This is what is needed for change, right?

Well, the above were my first experiences of one care home with poor practices, bad management, and appalling delivery. It could well have been an isolated example. Sadly, that’s not the case, but we’ve been in hundreds of care home kitchens and worked with 1ooo’s of chefs  and there are many excellent examples out there.

I think that’s the crux of it: the examples, the Vox pops, chosen to expose inadequate and inhumane practices were real, sad, and tragic. The program left it there, with the shock, anger, and fear of likely horrors out there. A damning indictment.

That first promise I made, to make things a little better every day, still applies. No longer in ‘that’ kitchen, but in the sector, through Oak House Kitchen.

We, and many others, have not left it there…

There are many people working to ensure challenging questions are being addressed and tackled head on. Health and social care catering operations must strive to deliver the best possible experience for those in need so that they are well nourished and dignified, while maintaining independence and as much pleasure and social experiences as possible.

Within this aim there are many factors to consider: uncontrolled weight loss, dementia, learning disability, physical disability, mental disability, physical decline, acute and prolonged illness, palliative and end of life care, sensory decline, hormonal changes, effects of medication, loss of independence…

These are profound challenges, which can be, and are, overcome daily. Not everywhere, by a longshot, but effective practices are out there. They will, in the same way good clinical practice spreads, become more commonplace over time as small cohorts prove effectiveness. For example, our dysphagia training and systems are being evaluated in the hospital in Guernsey, for meal service provided to an acute stroke ward.

The sector, as a whole, does care. They are searching for solutions and improvements all the time, we see this on a daily basis, as well as when working with NHS trusts, councils and care providers large and small.

We will look to discuss many of the points raised in the program and offer some insights and solutions over the coming weeks. I will leave you with one final example that highlights some of the difficulties in finding solutions that residents and patients need when basing this on our personal beliefs and experiences.

To the Lunch Club

At Oak House Residential Home, we run a lunch club for local in the village. They are largely all in their 70s and live healthy and independent lives. We offer the same menu at the lunch club as we have on the residents’ menu on that day; it reduces the burden of preparation, and we are very happy with the quality of our menu.

The paying guests arrive and wait in the comfort of the lobby, while the dining room is reset after our residents’ lunch. There is palpable excitement. Many of the guests book their place for the following event before they sit down to eat. Chatter is jovial and light-hearted, with talk returning to food, drink, and travel. It is always a wonderful atmosphere. The meal service is wonderfully upbeat with complements and general good humour.

The same service, same food, same staff.

Now walk into the dining room an hour before, and the contrast is profound. It’s quiet, there is concentration, it is not light-hearted and carefree. That should be no surprise, the residents have profound differences in their needs. Most have some sensory impairments, hearing or eyesight, making conversation and the task of eating difficult. Frailty makes using cutlery a challenge and so independence is prolonged with adaptive crockery and plates. From time to time there is a requirement for food to be suitable for swallowing difficulties.

It doesn’t look the same…

Oak House Residential Home has a reputation for well nourished residents and effectively dealing with the complexities associated with care home catering, but, as the name describes, it is a residential home. Far more complex are the needs of those residents in dementia or nursing homes.

When The Food Program held up a kitchen garden as an exemplar operation of excellent care home catering standards it showed that its naivety and lack of intelligent investigative reporting. If we are going to judge care home food service and hospitality by holding it up against high end restaurants and hotels with kitchen gardens to see how they match up we are most certainly never going to get it right.

Needs, wants and desires – A care home with a kitchen garden is wonderful, and great work for achieving this. It is desirable but not needed to achieve what residents across the sector want and deserve: well cooked food that they like, served in a way they enjoy, can manage or require.

Remember Wolff’s Law, if form follows function then it won’t look the same… but it can still be high quality.

It was puzzling. I scratched my head…