Wanted: New Approaches for Food Service Provision in Care Homes of the Future

Abstract

The increasing complexity of care home residents’ needs, driven by demographic shifts, multimorbidity and late-stage admissions, poses significant challenges for food service provision in Swiss care homes. Current systems struggle to meet individual nutritional and psychosocial needs due to staff shortages, financial constraints and rigid infrastructures. This perspective article explores the necessity for a more individualised and systematic approach to food services in long-term care settings, with a particular focus on developing resident personas as a guiding tool. Such personas, based on typical end-of-life disease trajectories, can support tailored food service planning and staffing. The authors highlight the inadequacy of current food service models, which often fail to accommodate residents’ diverse health conditions and personal preferences. They emphasise the importance of interdisciplinary collaboration and the integration of resident-centred strategies. Achieving this calls for a shift from fragmented, chef-driven decisions to a holistic, evidence-based system. By aligning food services with specific resident profiles, care homes can optimise resources, improve quality of life and enhance overall care. Future research should focus on applied, interdisciplinary solutions that address the interdependencies between nutrition, health and operational feasibility in care homes.

1. Introduction

We see it as our social responsibility to make sure that the quality of life of our elderly is provided adequately. Apart from good care, food services are an important aspect of health and wellbeing [1]. Swiss care homes, however, currently face great challenges in providing good-quality services. One reason for this is that elderly persons generally prefer to live in their own homes as long as possible and only enter the care home in a late stage, often suffering from multiple diseases, which leads to more intensive care due to more individual needs [2]. At the same time, due to demographic change, there is a shortage of labour and greater financial pressure for care organisations, exacerbating the challenges [3]. Systematic data and systematically derived concepts on how to provide food in a way that influences health and wellbeing under current conditions are scarce.

Over the next 20 years, demographic change is expected to worsen the situation [4]. This paper, therefore, aims to initiate new ways to support care homes in tailoring services to specific resident profiles. Such profiles are defined by combined health issues and encompass both care and food service provision.

2. Food Service Provision in Care Homes in Times of Staff Shortage and Increasing Multimorbidity of Residents

Food service provision in care homes must be understood within the broader context of demographic change, multimorbidity, and workforce shortages. In order to grasp the complexity of this field, it is essential to first define what constitutes a care home and who its residents are before examining how food services are organised and delivered. This chapter, therefore, provides an overview of the institutional setting, the characteristics of residents and the specific challenges that arise in ensuring adequate nutrition, wellbeing and quality of life under the current conditions of limited resources and increasing care demands.

2.1. Definition of Care Homes

Care homes are special institutions accommodating elderly people who need long-term care. They provide housing, healthcare and various support services to residents who have limited individual control over their provision. In Switzerland, care homes are defined as residential facilities that offer medical, nursing and personal care services on a permanent or long-term basis [5]. Beyond their medical function, they represent complex living environments that shape autonomy, quality of life and social participation of residents [5,6,7].

2.2. Definition of Care Home Residents

Care home residents are a heterogenous group of elderly people with individual needs which stem from both psychosocial and physiological changes associated with ageing and age-related chronic diseases [1]. In Switzerland, one third of the population in the age range of 83–89 is multimorbid, i.e., suffering from multiple chronic diseases, while one third of the female population and one fifth of the male population in this age range suffer from depression [8]. People older than 65 years are “characterised by an increased interindividual variability and vulnerability” (translation by the authors) in terms of their nutritional status [5] (p. 136) and [9]. On average, care home admission is at the age of 85, where the age of admission has risen in recent years [4,10]. Three-quarters of the care home residents are female, and the majority is between 85 and 89 years old; an almost equally large group is made up of 90- to 94-year-olds [10]. Usually, residents stay 2–3 years at a Swiss care home [10].

2.3. Food Service Provision in Care Homes

Food and eating play a central role in our lives; they are part of our daily routines and habits and are shaped in a lifelong process. The social perspective of eating is influenced by cultural norms, values, traditions and constructs that define what, how, when and with whom we eat and how we perceive food [11,12].

Food service in the context of care homes is characterised by long-term full board specifically tailored to the residents, whose situation can be compared to the notion of “captive consumers” [13,14], indicating that consumers are somewhat forced to use, accept and pay for the services offered [15]. Ref. [13] points out that such customers are generally harder to satisfy, particularly if no optional choices are offered; if, however, residents feel dependent on the institution they live in, since power is unequally distributed, they might be reluctant to speak freely in order not to upset or alienate the staff. Thus, silence does not necessarily indicate satisfaction but may reflect coping strategies common among older adults, such as conflict avoidance and maintaining harmony with caregivers. These dynamic risks normalising unmet needs, as dissatisfaction remains invisible in quality assessments [13].

Measuring and managing quality in such a context is, thus, important but may become difficult. Strengthening resident participation, for example, through anonymous reporting channels or structured involvement of relatives, can help counterbalance this asymmetry.

Compared to the food service provision in other institutions, the service in care homes is further complicated by any physical and cognitive impairment of the residents [16]. Besides general requirements of community catering such as hygiene, adequate technology for kitchen and logistics, budgetary conformity and ecological aspects, the following aspects are of great importance in care homes: nutritional balance for the needs of the elderly, varied meal planning, high gustatory qualities to increase the pleasure of eating, nutrient-preserving food production and temperature retention [17,18,19,20,21]. This leads to a complex collaboration between staff of different disciplines (e.g., kitchen and hospitality staff, care and medical staff, dieticians, hygiene staff, quality management, general management and internal nutritional committees) as well as relatives of residents [22].

2.4. Catering for Health, Wellbeing and Quality of Life in Care Homes

Health in old age is strongly determined by individual characteristics such as subjective wellbeing, quality of life or the degree of autonomy [8]. Ref. [23] defines health as a state of complete physical, mental and social wellbeing and not merely as the absence of disease or infirmity. Health-related quality of life (HRQOL) is an individual’s or a group’s perceived physical and mental health over time [24]. Food is declared an essential component of quality of life [1].

2.5. Current Challenges for Swiss Care Homes in Providing Their Services

According to [3], the major challenges of Swiss care homes are difficulties in recruiting qualified and specialised nursing staff, legal restrictions with regard to the temporal flexibility of staff, finding adequate financing, structural and building restrictions, as well as administrative burden/restrictions due to bureaucracy. Subsequently, the quality of care and, thereby, the quality of life are not up to par in some care homes. Considering current challenges such as staff shortages and insufficient resources, the need for increased professionalisation of support services such as food and beverage provision arises [6,25].

These challenges are amplified by demographic change, with a growing proportion of the oldest-old population expected to require institutional care in the coming decades [4,7]. Many facilities also struggle with ageing infrastructure that does not fully meet the needs of residents with multimorbidity, dementia or limited mobility [2]. At the same time, financial pressures continue to mount as healthcare costs rise, and institutions must balance public funding with private contributions [3]. Taken together, these factors illustrate that the problems experienced by Swiss care homes are systemic, combining workforce shortages, financial constraints and increasing complexity of resident needs [7,8,13].

2.6. Current Challenges for Food Service Provision in Care Homes

Multidisciplinary team collaboration between many different functions is considered important to ensure adequate nutritional intake, to maintain or improve nutritional status, and to enhance the clinical course and quality of life [20,26,27]. However, this is very demanding in practice, particularly considering the above-mentioned challenges. It is difficult to secure the daily routines with limited staff numbers and finances while simultaneously corresponding to the individual needs of both residents and staff in a sustainable manner [13,18].

3. Discussion

There is a broad consensus that residents’ overall wellbeing, including their physical and psychological health, is influenced by a well-designed, person-centred mealtime experience. Key elements of such an experience include a home-like dining environment, individualised diets and choice in food selection [1,18,22,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41].

However, according to [42], multiple gaps exist between evidence-based knowledge and current practice. There is a clear challenge in how individual choice and autonomy can be accommodated in mealtime environments [43]. Implementation strategies have mostly failed due to not considering a lack of staff; limited financial resources; the failure of staff to recognise the psychosocial aspects of mealtimes; inadequate infrastructure; policy restrictions; an inadequate involvement of the needs of all stakeholders, especially residents and relatives, and a non-holistic approach to food [36,42,43,44,45,46,47].

The current state of research manifests that measures to improve environmental and social strategies are largely lacking. Such strategies should promote self-empowerment and individual food choices, rather than reinforcing a more “medicalised” food services system. The former would allow enhancing food intake, health and wellbeing in residents. Research should, thus, focus on strategies to support the implementation of interventions to improve the mealtime experience for residents [48].

4. Conclusions and Future Directions

Based on the explanations in the previous chapters, it becomes clear that focusing only on individual aspects of food service provision does not do justice to the complex situation. Adjusting certain subareas might lead to deterioration of other aspects or cause excessive demands on staff and/or financial resources. We should, therefore, rethink research with a more applied orientation, find out about the interlinks between different aspects and take the existing challenges into account when developing approaches that are sustainable and realisable in practice.

We should find out what the specific needs of people in their later years and with multimorbidities are, particularly focusing on different manifestations of combined illnesses/impairments. Based on those findings, we then systematically assess what this means physically in terms of food intake as well as in terms of financial aspects. This should be the basis to find the implications for the food preparation process, the need for nutritional enrichment, the need for food intake support, as well as the discussion about financial models. In order to adequately address the challenges described and manage target groups equally, we thus suggest developing resident profiles—personas—that categorise individuals based on their end-of-life disease combinations and physical needs.

To illustrate the potential of this approach, the following example persona demonstrates how resident profiles can be constructed and applied in practice. Persona 1: Mrs. M., an 87-year-old woman with advanced dementia and type 2 diabetes. She experiences cognitive decline, requires assistance with daily activities, and often forgets to eat unless supported. Her diabetes necessitates a carefully balanced diet with controlled carbohydrate intake, while her dementia requires meals to be simple and recognisable. Based on this profile, food services can be tailored to ensure nutritional adequacy and reduce the risk of malnutrition, while staff training can focus on dementia-sensitive support during meals.

This would allow organisations to specialise their services in providing more need-based meal options, while simultaneously improving the efficiency of food preparation and employing specifically trained staff. At the same time, potential barriers to implementing personas must be acknowledged. Collecting and updating the necessary health and dietary data can be resource-intensive and bears the risk of being outdated. Therefore, it is essential, when developing such profiles, to consider the financing framework, particularly the balance between governmental and private payments. As food and health are connected to identity and, thus, are highly personal, such categorization always raises ethical questions, and clustering people usually carries the risk of oversimplification. These challenges can be mitigated by integrating persona development into existing care planning processes, fostering interdisciplinary collaboration and ensuring sensitivity in communication to support feasibility and acceptance.

The food service decision should not end with care home chefs, their habits or their personal preferences. This topic should be developed in a systematic manner, considering different perspectives and discussions about the advantages and disadvantages on different levels of all the services provided in a care home. With less need for differentiation in service provision for care, food and other services, infrastructure and service offerings can be specifically designed by the care organisation. In addition, stakeholder management becomes less heterogenous and, therefore, less complex and resource-intensive. This leads to less loss of resources, both human and financial, and thus offers more possibilities to provide a more integrated way of caring, allowing for more individualisation within the given profiles.