Although much of the research carried out for this thesis, both desk and field, was conducted prior to the current COVID-19 pandemic the resultant focus on care homes, and in particular the catering services, thoroughly justifies the current and future need for systematic research into care home catering. There has been a burgeoning volume of research seeking solutions for improved nutrition for people living with dementia in residential care homes. My thesis explores how the feeding and nutrition of residents of Long-Term Care Homes living with dementia is carried out by professional caterers and catering companies and offers a contribution to knowledge but, above all, offers a contribution to improved practice. The literature review examines previous research carried out on the medical and dietetic elements of feeding and nurturing those residents. It was surprising to note there is a paucity of research related to the physical, operational, elements of food and beverage provision, or how the caterers can fulfil their rôle in the provision of nutritious and sustainable food and drink. It is important to note, however, that the majority of residential care homes are in business for profit and just as Important to appreciate that even non-profit organisations need to control their expenditures in order to minimise losses. This completed thesis is presented as a first-person piece of work. It is often said there are no “I’s” in academic writing but all that would do is remove my active voice, my distinctive self, and result in ambiguity. Qualitative researchers have, for many years, had research papers rejected because they had been written in the first person. See Chapter 1.5. Positioning myself for detail. The qualitative case-study approach was chosen as being the most appropriate, using semi-structured interviews and questionnaires to collect rich, contextual, data. The use of multi-method, or mixed method, research has found greater favour over the last few years. Sector participants were chosen from a database generated through the NHS Enabling Research in Care Homes (ENRICH) on-line directory of care homes willing to take part in research. Five care homes were selected from the database, in accordance with the pre-determined criteria for selection, reflecting the general reality of the sector, and allowing for a degree of generalisation. There was one care home response added to the list following an open invitation to participate and a further care home identified for a pilot survey, giving a total of seven participant care homes altogether. In each of the care homes participants included all those involved in the provision of care with direct contact with residents: Resident Managers; Health Care Assistants; Nursing Staff; Chefs; Cooks and Food Service staff. None of the care homes directly employed nutritionists or dietitians. These staff were asked to either take part in a semi-structured interview or to complete a questionnaire. Some questionnaires were distributed by hand and respondents completed the questionnaire during the visit to the care home, others completed the questionnaire remotely, online, via Qualtrics. Key to the research were the additional insights obtained from individuals who were either currently working in the care home sector or the NHS catering services at a group level, or had recently retired, as well as senior executives within the foodservice supply industry. These were a key part of the research. This research extends the boundaries of knowledge in the long-term care home sector, signalling a significant contribution to the care home catering industry knowledge, enabling practitioners to resolve many of the challenges faced at a strategic level, rather than the common, tactical, solutionsoften found in practice. The overarching results of the research signpost to the following: • There is a significant lack of education and / or training in effective Food and Beverage provision within the sector. • Catering production and food service staff have indicated a desire and need for further training. • There is a significant lack of funding for that education and training in the sector. • There is a significant underspend on Food and Beverage provision within the publicly funded sector to ensure good, high quality, products. • There are significant differences in understanding of the rôles of catering staff by nutrition and nursing staff. • Catering staff do not feel valued or trusted by medical, dietetic, and nutritional staff. • Several of the care homes are using antiquated and ineffective kitchen equipment. The above results show a commonality in direction. Each of these points will be discussed in greater depth and detail in the main body of the thesis. Each chapter will begin and end with links, via the Golden Thread, hopefully creating a sense of anticipation and encouraging you, the reader to keep following the narrative, referencing upcoming chapters, and piquing your curiosity to ensure a smoother flow from one section to the next.
