Hertfordshire Independent Living Service (HILS)
“More than just a meal”… Welcome from the Nutrition & Wellbeing Team
Annabelle de la Bertauche Nutrition & Wellbeing Project Officer
Michelle Dewar Team Leader - Nutrition & Wellbeing
Emmy West Dietetic & Wellbeing Project Officer Overview
Who is HILS?
More than just a meal
New Services
Nutrition & Wellbeing Service
Training Opportunities
When and How to Refer Who is HILS?
Charitable, not-for-profit social enterprise
Est. 2007 by Hertfordshire County Council
Range of services to help people stay independent, healthy and happy in their homes A Few Stats & Facts…
200 Staff
64 Vehicles
365 days a year
500,000 meals delivered every year
Approx. 1,400 meals delivered every day Four Operational Sites
Letchworth Stevenage, North Herts & East Herts
Ware East Herts
St Albans – Jubilee Centre Broxbourne, Harpenden, St Albans, Welwyn & Hatfield
Hemel Hempstead Dacorum, Hertsmere, Three Rivers & Watford Our Food
Food supplier for our main lunch service is apetito – same food as Wiltshire Farm Foods
Wide range of meals for cultural and religious choices including: Halal, Kosher and West Indian food
Wide range of food for special diets coded on our menu including: gluten free, vegetarian, high energy, heart healthy, lower sugar desserts Our Food Locally sourced – all beef & pork is British or Irish
Provide over 1/3rd of a person’s daily nutritional requirements
Nutritionally balanced and comply with National Association of Care Catering (NACC) guidelines
apetito have in-house nutrition expertise and work closely with British Dietetic Association More than just a meal
Our teams talk to their clients and get to know them
Welfare checks on every visit – No reply policy
In winter, we check to see homes are adequately heated
In summer, we check to see that clients are adequately hydrated
We give small gifts throughout the year to our clients, including personalised Christmas cards made by local school children
We help people stay independent, healthy, and happy in their homes Other Services
• Seven dementia clubs across the county
• Community alarms
• Advocacy
• Welfare bags / Home from hospital bags
• Lunch Clubs
• Community Transport Other Services
Watch a HILS News report Nutrition & Wellbeing Service
The service started in 2014 with one part time Current dietitian, and since July 2015 the team has grown to practices and include two dietitians and a registered nutritionist. develop new services Our new and bespoke service aims to…
Raise Identify Address Improve awareness
Malnutrition & nutritional issues facing older people Raising Awareness
Education for all • To teach our staff, older people, their We’vefamily, trained… friends, carers, 150 and health membersprofessionals of staff • Key nutritional issues covered – Coveringoverall good34 a nutrition, health malnutrition and social and varietydehydration of care workers • Half day training forA referrerstotal of 75 •subjects Bitesize sessions fortraining older and hours 81vulnerable older and people vulnerable• All sessions people are interactive with games and quizzes throughout to keep people engaged Raising Awareness
Information and drop in sessions 1300 free cream teas provided To raise awareness of our service and nutritional issues during key calendar events of the year Free education and specialist crockery, cutlery and drinking aids Raising Awareness
‘A day in the life’ article Presenting at the East & North Herts Food Matters Live Table Nurses Conference ‘Train to change –how Talk newsletter fun, interactive training & May 2016 is helping to tackle NHD Magazine malnutrition in the community’ We have produced various articles and information to support our service and Food Matters Live Table spread the word about good practice! Talk newsletter A holistic approach to tacking malnutrition in Presenting key data the community at Food Matters Live Conference in British Geriatric Society London e‐newsletter August 2016 November 2016 Identify & Address Issues
Nutritional & dietetic enquiries • Supporting clients with a range of nutritional needs; • Low potassium diets for clients with kidney problems • Controlled carbohydrate diet for poorly controlled diabetes • Allergies and intolerances • 1-2-1 tailored dietetic advice for those who require more in depth help • And many more! Identify & Address Issues
Nutrition & wellbeing checks • MUST (Malnutrition Universal Screening Tool) to determine risk of malnutrition • Ask health and lifestyle questions to determine what in-house and/or external services our clients may want or need; e.g. mobility issues, loneliness & isolation, mental health and mood, sight and hearing, continence concerns, shopping Identify & Address Issues
Prioritise those with complex needs or lacking support
Asking staff to refer clients who may be at nutritional risk
Adapt our meal service including our Nutrition Boost service – extra food free of charge! Identify & Address Issues
Completed over 75% are frail Support at Home Lunch Clubs 200 nutrition 7‐10% clients 20% are lonely and wellbeing screened are Engaged in Mobile checks prescribed oral Befriending partnership opticians nutritional working… supplements Since October 25% clients were 2015 we have… Community medium or high risk Bladder & Bowel Mental Health We are preventingThose at greatest of malnutrition, ServiceReferrals have beenTeam offered ourunwanted weightrisk have We have so far made to support nutrition boostloss and seeingreceived 1‐2‐1 re‐screened 18 Nutritionalservices status has interventionsour malnourished clients remained stable or clients gaindietetic weight support improved for 89% of clients Together, we are making a difference Further full analysis to follow in the summer… Identify & Address Issues
200 nutrition 75% are frail Support at Home Lunch Clubs and wellbeing 7‐10% clients 20% are lonely Partnership Mobile opticians checks screened are completed prescribed oral Befriending working to since October nutritional achieve the best Community supplements Over the last 6 Mental Health 25% medium or high months, we have… results Team risk of malnutrition Bladder & Bowel Nutritional status has and have been Those at greatest Service remained stable or offered our nutrition risk have We have so far improved for 89% of clients boost interventions re‐screened 18 received 1‐2‐1 We are preventing unwanted dietetic support clients weight loss and seeing our malnourished clients gain weight Together, we are making a difference Further full analysis to follow in the summer… Improve Current Practice Menu Planning • Ensuring there are a variety of meal options to suit different dietary needs • Nutritional coding that is useful e.g. not just low fat, low sat-fat but is actually meaningful • We code our menus according to nutritional and health need, such as ‘heart healthy’ which looks at the nutritional content of the meal as a whole and ‘higher energy’ for those at risk of malnutrition Improve Current Practice
Work with University of Hertfordshire NutritionHow & Dieteticdoes the students nutritional Loneliness,Comparison Frailty of nutritional and risk of balance of meals on wheels • VoluntaryintakeMalnutrition work of free placements living in Community adults aged compare to ready meals and • Undergraduate≥75Dwelling years projects receivingOlder andPeople home are they suitable for the needs opportunitiesreceivingdelivered for ameals theseMeals withto on be Wheelsdietary of an older population? publishedWhat is nationally thereference relationshipService values Exploring the perceived(2016-17) role of •Investigation Staffbetween wellbeing grip of strength, theproject nutritional involvement frailty meals-on-wheels delivery adequacyand malnutrition of ‘meals on in olderwheels’ • Trainingdrivers and delivery their potential for for peoplean older living population in the • Wellbeingidentifyingcommunity? champion malnutrition: opportunities A • Befriendingpreliminary(2016-17) opportunities study Case Studies
Case Study 1: Dietetic intervention adopting a food first approach and removing the need of the ‘sticking plaster’ supplement…
Dietetic concern Client at medium risk of malnutrition, prescribed supplements and on puree meals yet managing other textures
What Emmy did… Contact to hospital discharge team to determine suitable texture and SALT assessment Change from puree to fork mashable meals –more enjoyable and met with her needs Bespoke advice how to enrich and include higher energy dietary choices
Outcome at review 8% weight increase to healthy range BMI Change from medium to low risk of malnutrition Increased enjoyment of foods Supplements no longer required Case Studies
Case Study 2: Identifying the root cause of malnutrition
Nutritional concern Following on from the nutrition and wellbeing check, the client was found to be at high risk of malnutrition due to unintentional weight loss. The MUST screen used in isolation can only identify the problem. The wellbeing check is used to identify the cause of concern and following this visit, it became apparent that malnutrition was linked to anxiety, which was resulting in poor appetite, food avoidance and selective eating and agoraphobia and becoming housebound
Intervention Referral to local mental health home visit service to address root cause of concern In the meantime adapt meal service to best suit client’s needs
Outcome Weight gain achieved, change from high to low risk of malnutrition Mental health becoming more stable , client has started to go out in his garden, medication helping stabilise mood Client is moving towards more normalised eating habits Case Studies
Case Study 3: Taking a holistic approach to wellbeing
Nutrition Concern Client at high risk malnutrition due to very low BMI, eye sight had not been checked for over a year, poor mood
Intervention Client quote: Nutrition boost extra started and higher energy meals encouraged ‘When you haven’t got anything in the Education booklet provided for advice and information diary, it’s nice knowing someone will be Mobile optician arranged coming in to see you, and they’re always very punctual. They also did one or two Outcome at review things for me when I was unwell and Happy with new glasses and improved sight unable to get out of bed.’ Enjoying the extra free snacks provided Very happy with the wellbeing service as well as the meal delivery team and knowing somebody is looking out for her She remains at high risk malnutrition due to low BMI but so far has gained 16% which is fantastic news Case Studies Case Study 4: Challenging traditional food labelling looking at nutrients in isolation and developing a new way of determining suitable meals that address nutritional and health needs
Nutritional issue Client had poor understanding of food labelling and relating this to their nutritional and health needs
The enquiry Referral from our support team where client had requested low salt meals –very restrictive in terms of choice Contacting the client revealed no medical need but this had been selected as a perceived healthier choice
How we helped Provided advice and information about heart healthy options which better address health need Provided education around isolating nutrients verses meals that are lower in salt, low in saturated fat and medium or low levels of overall fat and looking at these nutrients together rather than in isolation Resulted in many more options available to the client but also more suitable to his health needs Case Studies Finally, a client’s account as to how meals on wheels has made a huge difference…
My mum passed away August 2013 and dad had to try and cook for himself, eventually we moved onto frozen meals from Wiltshire Farm foods. After a difficult few months and realising something was changing in dad and the 'blowing up' of 3 microwaves, a friend mentioned her mum had meals on wheels.
My dad started having the meals on wheels at the start of October 2015 and was formally diagnosed with dementia and given medication in December 2015, at this time the meals were a blessing. I changed my lunch break to 12 to 1pm so that I could remind dad that a meal was being delivered and that helped.
My first point of contact on the telephone was with a very helpful, understanding gentleman who guided me through the process. Next, the lovely people who deliver the meals, always friendly and smiling, very positive for someone with dementia… Case Studies Continued… Fortunately, in December we received a telephone call from the Nutrition & Wellbeing Service offering a visit to discuss Dad's wellbeing and him remaining independent in his home. I was so pleased to receive this call, as I felt I was struggling trying to help dad.
The visit was brilliant, Dad enjoyed the attention, and after the weight check we were told that Dad was slightly underweight and they could provide a daily nutritional boost for him to enjoy. We also discussed Lunch Clubs, which I didn't know about, and I hope to take dad to one when it gets warmer.
The boost has worked so well and he particularly loves the soup. The daily biscuits and cheddar snack are perfect for him to have by his chair so that he sees them and it reminds him to eat, this has obviously helped his weight gain. Also, selecting the meals from the advice given by the Nutritionist, has helped when we chose from the menu.
The whole service has been fantastic and Dad is happy and loves his food.
Review of this client revealed that further to our advice and assistance, he has gained weight and gone from medium to low risk of malnutrition Training Opportunities for You
• Our training is currently undergoing review • Due to be re-launched in the Autumn 2016 • Minimal attendance charge • Referrer training – certificate, BDA endorsed, workbook to take away • Bite-size sessions – small charge for participants, free resources and booklets
We can come to you to train your team. Just tell us… When? Where? Numbers? Needs?
Email us! [email protected] When to Refer - Eligibility
Does the person have difficulty in preparing or cooking a meal?
Is the person unable to shop regularly for food or obtain a meal from any other source?
Does the person need temporary cover or service? When to Refer - How
Complete the online referral form and email to our support teams at
Don’t forget, if you think the person would benefit from a nutrition & wellbeing check, please copy in the nutrition team and request this on the form:
Watch the HILS Video Any questions?
Contact us at: