By Jo Jacobius, Communications Consultant for the Water Dispenser & Hydration Association (www.twha.co.uk)
Fluid intake is fundamental to health and well-being. Yet in care settings where water should be readily available, hydration is all too often not prioritised not because people don’t care but just because they are sometimes not trained to understand that many people in care, especially those with cognitive impairment, need to be reminded to drink and importantly need to be helped to drink.
It pays to hydrate people. It is scandalous that in the UK today, vulnerable people are dying of thirst. Apart from the human misery caused by dehydration, it costs the NHS and care homes dearly due to illness that can result from dehydration. Older people admitted to hospital from residential care settings have been found to be 10 times more likely to be dehydrated than those admitted to hospital from their own home. The consequences of dehydration include cognitive impairment, lack of balance leading to falls, constipation, UTIs and respiratory tract infections. Lack of fluid can even cause fatalities.
Perhaps because hydration is a basic right, research has been limited and continuous training on this aspect of care is lacking. The situation may have worsened during the Covid pandemic, where care has been hindered by lack of visits from relatives who often are the first to note a cognitive decline that may result from dehydration.
Drinks are not the only means of delivering fluid. Soups, fruits, and vegetables for example, all have a role to play. One of the best means of hydrating people healthily however is water.
Some solutions are simple. In some care homes, water is often provided in plastic jugs where the fluid becomes unpleasant to drink and may be left out of reach. Even when the vulnerable person can reach, those who have dementia don’t have the trigger mechanisms to know they need a drink unless encouraged. Coloured drinking cups along with encouragement to drink, and improved palatability of the water can help.
A report resulted written by Dr Lisa Wilson for the International Longevity Centre, Hydration and Older People in the UK: Addressing the Problem, Understanding the Solutions, concluded that hydration policies should be “mandatory with practices in place to monitor and evaluate these to ensure they are being carried out effectively”. Good hydration practice, it said, “must become a part of regulated and inspected care issues”.
Some hospitals have hydration champions or nurse leads. Care homes might wish to consider having a champion to ensure correct training. However, this individual is not present all the time and so a culture of hydration should be built into everyone’s job: managers, catering staff, care assistants and carers.
Fluid charts aren’t the answer either. They can be overly complicated, misunderstood, and not completed properly. Phillipa Atkinson-Clow, general manager of the WHA, said: “There is no substitute for reviewing the client’s symptoms. Is the mouth dry? Are lips cracked? Does the tongue look wrong? Is the urine dark in colour? These obvious symptoms can often be addressed by simply offering fluids and noting if the symptoms quickly clear. Often they do.”
If your care home uses water dispensers, these may come in a variety of formats: bottled water coolers, mains-fed (bottle-free coolers), integrated tap systems in the kitchen area, or other forms of water station or water fountain. Whichever you choose, hydration must be delivered safely so you need to ensure your system is provided and maintained by a WHA-Safe supplier. WHA stands for The Water Dispenser & Hydration Association, the body that trains and annually audits suppliers to ensure good practice. They also have a Find a Member section so you can check if your dispensers are WHA-Safe.
Phillipa Atkinson-Clow adds: “It is essential to provide convenient and safe hydration. Potable water must be on hand. Risk assessments are necessary. Whatever the means of providing water or other fluids, there is a need to service the machines or taps and sanitise touch points, although increasingly touchless machines are becoming widely used”.
Staff need to be well-hydrated too. Hydration breaks should be as much a part of working life as handwashing.
The problem of dehydration is easily identified: it’s one of the cheapest forms of preventative treatment. Don’t risk clients dying of thirst.