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Hydration in Care Homes (Scotland) Policy

Policy Statement

Access to high-quality meals, snacks and drinks and to a full system of nutritional assessment and support is a fundamental right of the people who use our services. In particular, the service understands the importance of adequate nutrition and hydration and will take all practical measures to ensure that the people who use our services benefit from a high standard of nutritional care.

{{org_field_name}}’s hydration policy is in line with the national care standards, My Support, My Life, which require service providers to ensure that their care users experience high quality care and that they have confidence in their care providers. For example, Standard 1.39 states, “I can drink fresh water at all times” as part of a healthy diet.

The home adopts the following methods to ensure that everyone’s hydration needs are met:

• hydration assessments to be carried out in accordance with recognised guidance
• water to be always available and accessible to people who use services — and other drinks to be made available periodically throughout the day (and night)
• people to be encouraged to drink independently if they are able, but to receive appropriate support to drink if needed
• hydration intake to be monitored where necessary to prevent dehydration
• people’s religious and/or cultural needs and preferences being recognised in their nutrition and hydration assessment, and subsequently met.

Background

Hydration refers to the drinking of adequate amounts of fluid to keep the body healthy. It recognises that having an adequate fluid intake is an important part of maintaining a balanced diet and is essential for health and wellbeing.

In this respect, {{org_field_name}} implements the recommended daily intake for an adult of six to eight glasses of water or other fluids (about two litres), also recognising that most people do not drink anywhere near that amount, particularly the elderly.

In adult social care settings, severe dehydration makes frail people more vulnerable to infections, dizziness and confusion, and to falls, from which many never fully recover. Studies in care settings where a campaign of positive encouragement to drink water has been run, have identified a number of positive outcomes, including fewer urinary infections and fewer falls.

Procedure

1. Hot and cold drinks will be made available and accessible throughout mealtimes and throughout the day. This will include fresh water, tea and coffee and whatever personal drinks choices particular people have.
2. Fresh water will always be available and will be presented in an accessible and attractive way. Staff should ensure that water is fresh and cool by changing it several times during the day. People who are not able to serve themselves will be provided with fresh water by their bedside or chair side and will be offered help to drink if they need it.
3. Sweetened squash or fizzy drinks will not be routinely provided for all individuals, but will be provided to people if requested.
4. People will not be expected to wait for a mealtime in order to eat or drink and will be assisted by staff to have a drink of their choice whenever they wish.
5. The importance of good hydration will be actively promoted to people who use services and their families and visitors.
6. All new people to our services will have a suitable nutritional assessment conducted on admission, which will include an assessment of their hydration needs.
7. Assessments will be carried out by a senior member of staff with appropriate training and skills and will be recorded in the person’s care plan.
8. Any new person with special nutritional needs identified during assessment will be, with their agreement, referred to an appropriate specialist service.
9. Each person will be asked for their individual food and drink preferences as well as their cultural, religious or health needs and these will be taken into account when planning menus and when making drinks available.
10. Specialist menus and therapeutic diets will be provided as required and indicated in individualised plans of care, including parenteral nutrition.
11. When a person is identified as being at risk of poor nutrition or dehydration, they will have their food and drink intake monitored and be provided with help to reduce the risks as necessary, including additional advice and support and, where necessary, referral for specialist help and assessment.
12. Eating and drinking difficulties, or a need for assistance when eating or drinking, will be identified within each person’s care plan and a plan of assistance agreed with both the person and their relatives, where necessary.
13. For anyone with a need for assistance with eating and drinking, reasonable arrangements will be made to help them to feed themselves with dignity, including the provision of special eating aids and special food preparation.
14. Staff will be alert to any difficulties that a person is having with regard to their nutrition or hydration and will report any worries or concerns to a senior member of staff.
15. Care staff should be alert to urine colour as a possible indication of hydration level. Odourless, pale urine will generally indicate good hydration levels. Dark, strong-smelling urine could be an indicator of poor hydration.
16. Where a requirement is identified for additional help or advice, the person will be referred to a suitable expert such as a dietician or speech and language therapist.
17. People will be provided with information on what constitutes a balanced diet to address any risk of poor nutrition and/or dehydration, which will help them make an informed decision about the type and amount of food and drink they need.
18. Where a person is reluctant to drink enough water/fluid and this is having a negative effect on their health, the service will consider other ways of increasing their fluid intake that are more acceptable to them, eg through breakfast cereals with milk, soup, and fruit and vegetables.
19. Where people have worries about possible incontinence related to increased hydration, especially at night, care staff should reassure them that help will be provided with going to the toilet. In such cases, it is best not to encourage the person to drink close to bedtime. Instead they should be encouraged to drink little and often during the day.

Implementation

All staff are responsible for the implementation of this policy. Overall responsibility for ensuring that the policy is implemented, monitored and reviewed rests with {{org_field_name}} manager.

Information on the policy will be:

• circulated to all staff
• provided to all new employees
• included in the Eating Well in Residential Care (Scotland) and the Food Safety and Hygiene in Care Homes.

Training

New staff receive training in this policy as part of their induction.

All staff will be trained about the importance of good hydration when they are trained about nutrition.

Those with specific duties and responsibilities under the policy will be offered additional training.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

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