Many of you provide 'food' for your tenants, from coffee and biscuits to a three course meal with all the trimmings, depending on you facilities and expertise in the kitchen. We have treated these as, primarily, social occasions helping to provide opportunities to relieve the isolation that some may experience. But, according to the reports below, we could be providing a more basic need i.e. survival. After reading the reports I think we need to give more thought to these occasions and the fare we offer 'Food for Thought…….? We associate malnourishment predominantly with those that live alone but how often have we heard within our schemes 'it isn't worth cooking for just me' or 'only give me a small portion' then, given the social interaction and encouragement 'go on just try it', they proceed to clear their plate and look for seconds. We cannot reach many isolated individuals but we can educate the tenants within our schemes the importance of good quality regular meals.

At least one in four adults who go into hospitals, care homes and mental health units are suffering from malnutrition. More than 11,000 were screened and 28% were found to be malnourished, says the report from the British Association for Parenteral and Enteral Nutrition (Bapen). It is a problem under-recognised and under-treated.

Women and the elderly were most affected but malnutrition could strike any age, in any ward and hit people with a variety of conditions from cancer to broken bones, according to Bapen. Those transferred between care homes and hospital were the greatest risk, with 43% suffering from malnutrition. More than a third moved from hospital to care homes were also malnourished.

Charlotte Potter, of Help the Aged said: "The figures reveal worrying levels of malnutrition, especially among older people going into hospital. Rates are even higher among patients admitted from other hospitals and care homes. This suggests institutions aren't dealing with nutrition effectively. This is a huge concern. Older people won't respond to treatment or recover well if they are malnourished. It is impossible to talk about a world-class health service when basic issues such as malnutrition are not top of the list."

Patrick South of Age Concern, said: "Not only do people arrive in hospital and care settings already malnourished, six out of ten older people are at risk of becoming malnourished, or their situation getting worse in hospital"

Hospitals are throwing away as much as half of their food, NHS figures show. Up to 13 million meals were thrown away last year, with 33 hospitals dumping more than a quarter of their food; two had discarded more than was eaten!

Reasons given:        patients could not face them

patients were not given help eating

the bulk system failed to match orders with requirements

Meanwhile, almost 140,000 patients left hospital malnourished, double the figure of ten years ago. To further compound the situation, if that were possible, nutritionists said that the use of mass catering was 'stewing all the goodness out of food', while meals that traveled long distances were often in a 'congealed and unappetizing state' by the time they were served.

Many of you are bemoaning the increase in paperwork and form filling we are being asked to do. We are concerned that this will prevent us doing what most of us enjoy 'quality time with tenants', which is mainly undocumented and impossible to measure. But we are working in an aggressive and competitive market with shrinking budgets. (The Supporting People programme, for instance, is expected to be cut by 11% over the next three years) In reality there are lots of private providers coming in and winning these tenders at low salaries for their staff. We must be vigilant to make sure that the service we offer and our terms and conditions are not undermined. Big is not always beautiful, but we are witnessing a move from the smaller contractor in favour of larger firms that are more attractive financially. I remember a time when a cup of coffee would win me many small jobs that could not be invoiced, now if it has not been costed and on the list - tough! Many large providers are being forced to review salaries, pay cuts are on the horizon and working hours are being increased without extra pay. I am afraid we are going to have to face up to this one and fight our corner. We cannot take on the system but we can do our bit in our schemes, if it means extra paperwork then so be it.

But there are also dedicated folk who have embraced the new working practices and made them work for them, perhaps not fully enjoying the new regime, yet, but getting there.

Margaret Gibbs, Anchor, comments how closely she works with Age Concern, one of her tenants has a learning disability and is constantly getting into arrears, on numerous occasions Age Concern have come to the rescue. She is also invited, on a regular basis, to attend their Information Days. She takes various leaflets and Customer Enquiry Forms this has proved very beneficial and has resulted in a healthy waiting list!

We use the facilities already out there and work with the local Day Centre, we visit monthly and have quizzes, flexercise, games, carpet bowls etc... We are hoping to include other schemes and other members of the community, not necessarily in sheltered in the near future, writes Gill Turner, Bournemouth.

I have 106 clients on my patch and have now completed all my individual support plans, says Steffano Rezabeck, Carmarthenshire. The information collected has helped me to identify some of my clients needs. Many I have referred to Social Services for various packages e.g. home care, floating support, luncheon club, support workers, day centre. We were already responsible for a lot of these referrals it is just a case of putting it in a Support Plan rather than entering in a diary or keeping it all in our heads.

Carol Hubbard, Family Housing, takes part in a number of multi-disciplinary meetings she tries to do this with all those who require care packages, which include the local surgery and pharmacists.

David Ritchie, Brighton & Hove, is now part of the Single Assessment process - the assessments are completed by health care professionals, social services and SCHEME MANAGERS, they also complete their own support plan in the scheme. This has made a difference to the way she works. It has led to Scheme Managers being treated equally with other professionals. It also means that based on an assessment a Scheme Manager has completed, it has been possible to add to a care package, start a care package, get adaptations etc. without the need for another visit and another assessment. He also works closely with the Department for Works and Pensions and will refer someone to them if they need or want a benefit check. This has resulted in several getting allowances that they were not receiving before. A colleague has worked with the NHS to pilot a patient programme that is designed to help those with long term health conditions cope and mange their health.

Tony Price, also of Brighton & Hove accompanied a number of tenants from two schemes to take part in a Nintendo Wii mass playathon in support of Sport Relief 2008. The events were jointly organised by Age Concern Brighton Hove & Portslade and Brighton & Hove City Council Older Peoples' Housing.  The aim was to get older people play Nintendo Wii Sports, and for them to have fun whilst using modern technology as a gentle form of exercise and raise money for Sport Relief!

At this moment in time Westlea Housing Association are working with Age Concern Wiltshire. We are using Schemes in North Wilts for a toe nail cutting service for older people, this has been extremely successful, the service is run on an appointment basis and it's bringing more people into using sheltered accommodation facilities. We are also in a programme when decommissioning some of our supported housing schemes Age Concern Wiltshire have supplied independent support for tenants and their families during the programme of moving.

Andrew Pullen

I have worked with a service called Extra Home Maker. This service deals with persons who no longer able to look after their own affairs due to mental health deterioration or they just don't have the living skills needed. This can put them at risk of loosing their tenancy, having court appearances due to mounting debts and isolation due to having services cut off. I found this service very helpful as they were able to set up direct debits for all payments, check for benefits and pension credit, get up to date with all bills that have accumulated over time by an advocate service. The service was accessed by my employer Tor homes. They have a budget from which they can purchase this service.

When a tenant is not in sheltered accommodation, a similar service is provided by West Country.

I hope this is of some interest to you

Regards

Ellen Kirkbride