Jordi Casamitjana, who secured the protection of ethical vegans from discrimination in the UK, investigates the issue of whether elderly vegans in need of care can continue to follow their vegan lifestyle in a nursing, care, or residential home.
I let my beard grow.
I have had a beard most of my adult life, but in the last decade or so I did not let it grow much, one centimetre at the most. But a few months ago I decided to stop trimming it, and I also stopped cutting my hair. I wanted to see how I look like now, as my hair is already completely silver, and I lost most of it from the top of my head. During most of my life, people have told me that I looked much younger than I was — and I often replied that that’s because I am vegan — but when my 59th birthday was approaching in 2023, I decided to let my beard grow so I could see if now I finally look the age I am.
On my birthday, I posted on social media a photo with my new look, asking people if they thought that I now qualify as a “tribal elder” — of the vegan tribe, that is. After all, from my next birthday, I will qualify for a free “older person” travel pass for my city’s public transport (one of the perks of living in London, UK), if I were living in China, I would be entering my official retiring age, and if I lived in Greece or Luxemburg, I would only need to wait a couple more years to retire and be entitled to a state pension.
All this made me begin to imagine what the life of an officially retired “me” would look like, and then, something worrying struck me. At the moment, I live alone, and I do not have a family. Not only have I never married or had kids, but I came to the UK over 30 years ago from Catalonia, and I do not have any contact with the remaining members of my extended family over there. This means that, in a few decades, I may be in a situation where I may no longer be able to look after myself, and I may need to go to a care home of some sort, where strangers will have to look after me. There is no point in feeling upset about it… if it must happen, it will happen, but what I would hate is that, in this situation, I may be forced to abandon my vegan lifestyle.
I became an ethical vegan 22 years ago, and since I adopted this philosophy as the guide of my lifestyle, I pledge to be a “vegan for life”. This means that, no matter what, I will not willingly abandon manifesting my vegan philosophy in all my choices and I will never stop seeking to exclude all forms of exploitation of, and cruelty to, sentient beings of any species. But what if I am no longer in control of my choices? What if, because I am too old or too ill, I need to be looked after in an institution for the remaining years of my life, which will make most of my choices for me? What if I end up having some dementia and I forget I am a vegan? What if non-vegans take advantage of me and force me to consume animal products against my most precious beliefs?
I know that, no matter what happens then, I will still be a vegan because, deep down, I will still follow the vegan philosophy as my “creed” and ethical framework, but I would like to be able to do more than that. While I am still in this world, I would like to continue to manifest such philosophy with the food I eat, the clothes I wear, the furniture I use, and the products I consume, so I can be a vegan who lives a vegan lifestyle “for life”, as I pledged. Would I be able to? Would my last days be a misery if I could not?
Perhaps if I want to guarantee that I can, I should start looking into this right now, when I am still young and healthy enough to be able to fight for my rights — which perhaps in a few decades this may become too difficult for me due to the inevitable burden of age. I better start to investigate this in some depth, not only for me but for all the other ethical vegans like myself who will become elderly people who, in some cases, may need institutionalised care.
I better prepare.
What Are the Rights of Elderly Vegans?
On 3rd January 2023, Employment Judge Postle ruled something in a hearing at the Norwich Employment Tribunal (east of England) that no other judge had ruled in any relevant court in the world. In paragraph 39 of his 12-page written judgement on the pre-hearing of the Casamitjana v The League Against Cruel Sports (3331129/2018) case, he wrote, “I am therefore satisfied and find it easy to conclude that there is overwhelming evidence before me that ethical veganism is capable of being a philosophical belief and thus a protected characteristic under the Equality Act 2010.” This means that, since then (as the judgement was not appealed and no other judge has ruled against it), it has been unlawful to harass, victimise, or discriminate against any ethical vegan in Great Britain. That’s lucky for me because that’s where I live, but I am doubly lucky as I was the claimant of the case that led to that protection (yes, that “Casamitjana” was me).
The Equality Act 2010 protects anyone with a recognised protected characteristic not just in the workplace, but also in housing relationships (such as landlord-tenant), and in the provision of services (both public and private). So, any ethical vegan (a term that just means a vegan who follows the official definition of veganism of the Vegan Society in which all forms of exploitation of animals are sought to be excluded, not only those related to food, as is the case of the so-called “dietary vegans”) should be covered in a setting of a care or residential home, as this qualifies as both a housing situation and services being provided. And because age is another protected characteristic, giving the same protection to elderly vegans as to young vegans should be guaranteed. Also, Article 9 of the Human Rights Act 1998 protects people’s right to their beliefs and their right to practice these beliefs — and nobody has disputed such beliefs include ethical veganism.
All that’s good. Should I stop the article here and assume that any institution I may end up living in (as long as it is in Great Britain) will cater for my needs based on my philosophical belief because otherwise, they would be breaking the law? If it only was that simple.
The Equality Act is part of civil law, not criminal law, so in order to enforce it, anyone who has been discriminated against because of a protected characteristic can only get a legal remedy by initiating litigation against the discriminatory institution, with all the cost, stress, and time this entails. As most people cannot really have the funds, the motivation, or the resources (physical or psychological) to deal with litigation, many institutions can get away by breaking the Equality Act for a considerable time. It’s perfectly possible that, right now, any care, nursing, or old people residential homes could be in breach of the Equality Act and discriminate against their elderly ethical vegan residents/patients/clients (if they have any) because none of them have complained of any discrimination or harassment yet, let alone started legal proceedings to assert their rights. And it is perfectly possible that none have complained yet because either they do not know that veganism has become a protected characteristic, or do not have the energy or resources for a legal fight.
If there were vegan care homes vegan lifestyle care would be guaranteed, but If there are not, the problem of unchecked discrimination against vegans cannot be ruled out without investigating this issue. As I was involved in the case that secured the recognition of the protection of vegans from discrimination, I feel I have to investigate this myself and re-energise the Vegan Rights momentum I initiated.
The first thing I should be looking into is finding out if there are specialised care homes for vegan people, and if not if there are any vegans in regular care homes — because if they are, I would like to know whether they have been discriminated against even if they have not officially complained, and what can be done about it.
Are there Vegan Care Homes in the World?
I thought that the best way to answer this question would be to ask vegan organisations about it (by the way, for simplification, from now on I will be using the generic term “care home” to mean either residential homes for older people, nursing homes, or care homes for people with especial care requirements). I contacted 17 vegan societies around the world (from Australia, Austria, Canada, France, Germany, India, Ireland, Israel, Italy, Kenya, Lebanon, New Zealand, Norway, South Africa, Switzerland, the Netherlands, the UK, and the USA) and I sent them this message in August 2023:
“I am a UK freelance writer on veganism issues. For an article commissioned to me by Vegan FTA, can I ask you for information about care and nursing homes for old people? Are there any in your country which is vegan and only have vegan residents? If so, can you please tell me which ones?
When I say that is vegan I mean that only gives vegan food, all the toiletries are suitable for vegans, and none of the furniture or bedding contains animal products such as wool, leather, silk, etc.
If there is none completely vegan, is there at least any that only serves plant-based food (not vegetarian, but plant-based)?
I am not talking about homes that can cater to vegan residents because they can provide vegan options, but homes that are specifically aimed at vegans and plant-based people.”
After more than two months of waiting for them to reply, 11 vegan societies did. They all said that they do not know of any vegan care or nursing home or any home that only serves plant-based food. These are extracts of some of the replies I got:
- “Unfortunately, I have to disappoint you regarding institutions that are fully vegan as you described it. So far, it is still a challenge to find care homes that even offer vegetarian or vegan menus. I only came across one institution that offers a vegan menu for the elderly.”
- “No such places exist in our country, as far as we are aware Most older vegans would have difficulty even being properly catered for in such homes, let alone vegan-only places. We are pretty far behind and have a very small population.”
- “Sadly, as far as I’m aware, there isn’t such a place.”
- “We have, to my knowledge, no care and nursing homes in our country that are exclusively vegan. Unfortunately, there are also none that offer vegan food (if so, then certainly only in individual cases).”
- “As far as we know there is not a single vegan home in our country. The only one that comes close is vegetarian.”
- “Unfortunately there are no vegan nursing homes for the elderly here and none only serves plant-based food.”
I also contacted the only non-governmental organisation I know that represents older vegans and vegetarians: V for Life (VfL). This is a UK-based organisation that defines itself as “the leading authority on diet and healthy living advice for older vegans and vegetarians.” It was formed with resources from the Vegetarian Housing Association (VHA), which provided sheltered housing and meals to older vegetarians in the UK, and which was established in the 1960s. In 2007, VHA decided to wind down its housing activities and redirect its resources to funding the formation of V for Life. Therefore, they would be perfect to answer my enquiries. On 7th August 2023, they replied the following:
“Unfortunately, there are not yet any care homes in the UK that are entirely vegan, or that serve a completely plant-based menu. The closest to this so far are three vegetarian care homes, including Karuna Manor and Kailash Manor (both in Harrow) that have entirely vegetarian menus, which include dairy. Both are run by the chain TLC Care. We suspect that the lack of fully vegan care homes is because of the relatively low numbers of vegans requiring such services at the present time…
…Below are a few points regarding VfL’s decision not to pursue establishing vegan care homes at this time. With the above complexities in mind, VfL has pursued a different strategy, aiming to raise the standards of catering for the estimated 6,500+ vegans and vegetarians living in UK care homes.
- VfL is becoming more effective and impactful at influencing positively the lives of older vegans and vegetarians wherever those older veg*ns are. We think our current approach is increasingly successful in ensuring that our influence is wide and reaching more and more people.
- Running a care establishment is complex and demanding, and we have concerns that such a development would demand VfL’s time and resources to the detriment of everything else we do.
- Older people in care nowadays are increasingly frail and experiencing multiple pathologies — and life expectancy is about 18 months. To focus on people’s dietary needs is all very well but we would need to be expert in multiple medical conditions too and be supported by the expertise of GPs, psychiatrists, psychologists, physios, occupational therapists, dietitians, speech and language therapists, activity therapists, opticians, podiatrists, dentists, continence nurses, palliative care teams — because at some point they would all be needed. The quality of care would rely on so much more than what we do. Even if the focus is on fitter older people, things change.
- We would be serving a small number of people in a facility that would cost a great deal to operate to a high standard. Research suggests that people do not generally relocate miles away from family, friends and community when entering care, calling into question whether they would do this for the sake of living in an exclusively veg*n care home.
- This would of course mean being part of a private and independent sector currently awash with issues and subject to major policy changes throughout the UK. VfL feels uncomfortable with separating older veg*ns out from wider society — much happier to work on greater understanding and inclusion.
- Others have tried to fundraise for (and in the case of Vegetarian Housing Association, operate) such schemes, including the Beulah Charity Trust. Fundraising efforts generally only get so far when the organisers appreciate the scale of financing needed to get such a project off the ground — not least ongoing staffing costs.”
So, I think it would be safe to say that there are no vegan care homes yet in any country — and it is unlikely there will be any created soon as the organisations that could be pushing for this decided not to do so yet. Therefore, any vegan living in a care home may indeed be exposed to a situation where either the policies of the institution discriminate against vegans, or their carers do. Elderly vegans everywhere are, then, exposed to this problem, and this is a serious issue that, with the population of vegans increasing and the life expectancy of humans growing, it may get worse with time in terms of numbers.
Vegans Living in Care Institutions
How many elderly vegans are currently exposed to such risk? The vegan societies I contacted were not able to provide me with information about how many vegans may be in care homes. Perhaps there are only a few. If so, is there any explanation for this? I could think of several. The most obvious of all is that there are not enough vegans in the world yet, and the average age of a vegan is still relatively young.
As I live in the UK perhaps I will be able to find more information about this here. According to the Office of National Statistics, the proportion of the usual resident population aged 65 years and over living in a UK care home decreased from 3.2% in 2011 to 2.5% in 2021. Within the 65 years and over care home population, 56.4% of residents were aged 85 years and over (this is a decrease from 2011, where 59.2% of residents were aged 85 years and over). This means that even if the UK population is getting older, fewer people end up in care homes, and so far they do not even reach 3% of the population.
Also, according to the latest polls, about 3% of the UK population in 2021 followed a plant-based diet (not all of these would be ethical vegans), so there would not be many vegans who, just because of population size, may be living in care homes. I would like to have a rough idea about how many, though. So, I asked the clever AI chatbot GPT-4 (as you do, these days). This is what it replied:
“To answer this question, we need to make some assumptions and calculations based on the available data. First, we need to estimate the total UK population in 2023, since the data on care home and vegan populations are from different years. According to the Office for National Statistics, the UK population was 67.1 million in mid-2020 and projected to grow by 0.5% annually. Using this growth rate, we can estimate the UK population in 2023 to be about 68.2 million. Second, we need to assume that the proportions of care home and vegan populations are constant over time, and that they are independent of each other. This means that the probability of being a vegan does not depend on whether one lives in a care home or not, and vice versa. These are simplifying assumptions that may not reflect the reality, but they allow us to make a rough estimate. Third, we need to multiply the total UK population by the proportions of care home and vegan populations to get the number of people in each category. According to Statista, 3% of the UK population described themselves as vegan in 2022. According to the Office for National Statistics, 3% of the UK population lived in care homes in 2021. Therefore, we can estimate the number of vegans in the UK in 2023 to be about 2.0 million (68.2 million x 0.03), and the number of care home residents in the UK in 2023 to be about 2.0 million as well (68.2 million x 0.03). Finally, we need to multiply the number of vegans by the probability of living in a care home, which is the same as the proportion of care home population in the UK. This gives us the estimated number of vegans living in care homes in the UK in 2023, which is about 61,000 (2.0 million x 0.03). Therefore, based on these assumptions and calculations, we can estimate that there are likely to be around 61,000 vegans living in care homes in the UK in 2023. However, this is only a rough estimate and may not reflect the actual situation, as there may be factors that affect the relationship between veganism and care home living that are not accounted for in this analysis.”
I think this is a good reasoning and a credible answer that checks out under the assumptions laid out, but the estimation is far too high. The real number must be smaller for several reasons. For instance, it may be that vegans, for following the healthiest lifestyle possible (well, that if they follow a Whole Food Plant Based diet) may be very healthy at an old age and tend to live in their own homes without the need to go anywhere for external help. Another reason (the most likely one) could be that, right now, due to the popularity of veganism among the younger generations, the average age of UK vegans is relatively young, so there may be relatively fewer elderly vegans in comparison with the proportion of elderly people in the UK population.
The numbers may be small, but they are not zero. We know there are vegans in care homes. However, it may be difficult to contact any because, essentially, once people end up in such homes tend to become disconnected from the outside world, so it would be difficult to reach them — vegan or not. It may be as difficult to contact vegans in care homes as it may be to contact violinists, environmentalists, or pharmacists, due to the isolation, protection, and privacy of the care home space.
There is another way I can find vegans living in care homes. I cannot ask the institutions themselves as they would have an obligation to keep this information confidential, as this is personal information protected under data protection legislation. I cannot ask the government either as I am pretty sure it has not made any study about it and the question of whether one citizen is vegan or not is not part of the national census yet (but I think it should be). But what I can do is to ask vegans I know whether they know anybody in such institutions.
So, I wrote this in several vegan Facebook groups I belong to: “Do you happen to know any vegans living in a nursing home, a care home, or a residential home for old people?” One person replied, “I have worked in three separate care homes. I have yet to come across a vegan resident.”
When I contacted the vegan societies around the world I also asked if they knew any vegan currently in a care home. One replied, “We just had one of our members move into a retirement village, but they are self-catering still. It will become an issue, but not at the moment. The member said they thought it would be hard to be catered for them. It’s hard enough for vegans to get decent foods in hospitals, let alone nursing homes or care homes.”
I did manage to contact Annelies Hofma, a vegan who stayed in a Dutch care home. This is the translation of what she wrote to me:
“I am a 69-year-old woman and last year I had an unexpected bleeding in my head. After a few weeks in the hospital, I went to rehabilitate at a rehabilitation centre for the elderly. At the intake, I indicated that I eat vegan food. Then, I didn’t get any decent hot food. I was still offered cheese, for example. Furthermore, the food was tasteless and often lacked a meat substitute. After several comments from my side, there was no improvement. Then, my home front cooked for me. The centre is working with another meal supplier. One that does cook decent vegan food. A number of departments of the rehabilitation centre have already benefited from this. For that reason, I was able to use this a few times in the end.”
The experts on this issue in the UK, the organisation V for Life mentioned earlier, wrote the following to me:
In 2019, VfL conducted a survey of 1,000 representative, randomly sampled UK care homes. This found that the average percentage of residents across the surveyed UK care homes who were vegan was just 0.20% (credit VfL, 2019). This showed an increase from 0.09% in 2014. Wales was slightly higher than the UK average with 0.66% of residents being vegan. Of the homes surveyed, the most vegans living in any one faculty was 6, though it was far more common for there to be 0 or otherwise a max of 2 vegans per home.”
According to the Care Quality Commission, there were 15,517 care home locations in the UK as of March 2020, which represents an average of 129 residents per home. So, using the VfL 0.2% percentage of vegans from those people in care, this represents 0.16 vegans per home (one vegan in every six homes at the most). Therefore, a generous estimation of vegans in UK care homes is about 4,000 (15 times less than the amount ChatGPT assessed earlier considering an equal probability that a vegan and a non-vegan may end up in a care home, possibly because the average age of a vegan is much younger than the average age of a Briton — for now).
So, we now definitively know that, as we suspected, although there may be not many vegans in care homes now, there are thousands in the UK alone, and their numbers are growing(although who knows how many of these are ethical vegans). These, especially for being in such low numbers likely making them “the only vegan in the home”, may be exposed to a higher risk of being discriminated against for being vegan and not feeling able to complain, so looking at their situation is something that should concern both vegans and the authorities alike.
Three things we know, though. Firstly, because there are not many vegans in care homes, this increases the chances of their demands and needs not being accommodated due to lack of adequate policies or training, so we should not forget them just because we haven’t been able to talk to them or even register where they are. Secondly, as the average life expectancy grows in countries such as the UK, in the future there will be very old people who may need a home, who in the past may have not reached such an advanced age to need one (According to the Office for National Statistics, the number of people aged 85 and over in the UK is projected to reach 3.1 million, 4.3% of the UK population, in 2043). Thirdly, as the population of vegans has been consistently growing everywhere in the world, the number and proportion of vegans ending up in care homes is bound to increase with time. Perhaps by the time I may be needing a home (if I ever do), there may be many more of us needing it.
Are Vegans Being Discriminated Against in Care Homes?
I have very little doubt that vegans are being discriminated against in care homes because vegans are discriminated against in most places, even when they still have full faculties and can complain about it. Someone with authority has already looked into this in the UK (the country where, theoretically, should show less discrimination against vegans). In December 2020, the All-Party Parliamentary Group (APPG) on Vegetarianism and Veganism in the UK met to explore the issue of food security for vegans and vegetarians, and sent recommendations for action to government ministers. In 2021, the APPG, with the support of V for Life and the Vegetarian Society, produced a report that highlighted cases where the diets of older vegans and vegetarians had been misunderstood or even ignored.
On publication, the Chair of the APPG on Vegetarianism and Veganism, Christina Rees MP said, “The report sets out some shocking and deeply upsetting failures in the care of vulnerable people who have not had their rights protected. This is clearly unacceptable and those of us who express our philosophical beliefs through our choice of diet will rightly feel saddened. However, everyone should be appalled by the failing to protect basic dignity that the report highlights. It is right that these examples are highlighted but I am also proud that the report sets out recommendations that will see improvement across the care sector. Some of those recommendations are simple and could be implemented easily. Others are more wide-ranging and will require support from all sides with the help of organisations such as Vegetarian for Life and The Vegan Society.”
The report, titled “Respect For Religious And Philosophical Beliefs While Eating In Care,” shows several case studies. The vegan actor Peter Egan (V for Life ambassador) narrates a short video summarising this report. In the video, he says, “In October 2019, the all-party parliamentary group on vegetarianism and veganism launched an inquiry into respect for religious and philosophical beliefs while eating in care. Around 10 per cent of the UK population may have special dietary requirements because of the beliefs that they hold… In the course of the inquiry, our researchers came across many harrowing stories of people being given foods that went against their wishes and against the wishes of their loved ones.”
The video also shows the following anonymous testimonials:
- “My father was vegetarian for about 60 years, but as he reached his mid-80s he was diagnosed with dementia and he had to go into a care home. They knew he was vegetarian but when I visited him one day I found that he’d been given a ham sandwich. I checked his care plan and it clearly stated that he was vegetarian. It was bad enough having to see him with dementia but I wanted him to maintain his dignity and for his beliefs to be respected. I lived too far away from the home to visit him every day and I depended on them to care for him properly. I was very concerned that if I kicked up too much fuss they might treat him unfairly. It was a very distressing time.
- I said I was vegetarian in hospital and was given chicken curry.
- I’ve worked in care homes for over 14 years and a lot of them don’t seem to care about people’s beliefs, even when they’re written into the care plan. In one home we were looking after a 95-year-old woman. She was non-verbal and couldn’t move her arms and legs without our help. We gave her the same meals every day: porridge for breakfast and minced meat with mashed potatoes and peas for dinner and for tea, but she often refused the food and became angry with us. New staff were told she was aggressive and a bite risk. One day I looked at her care plan and discovered that she was listed as being vegetarian. I was horrified. Her care plan hadn’t been read or had been completely disregarded. When I spoke to the manager I was told to carry on feeding her meat as she needed it for nutrition. It was very sad and she passed away without things ever improving.
- As a strict vegan, I would hope that my choices would be respected if I were in care but I have serious doubts.
The report makes the following recommendations:
- Strengthening care regulations and related guidance – By recognising that philosophical beliefs are as important as an individual’s religious beliefs or cultural background.
- Introducing mandatory training – Helping carers to learn more about religious and philosophical beliefs including veganism, and to fully understand the importance of these beliefs.
- Dietary guides in kitchens – Ensuring that dietary practices arising from protected philosophical beliefs such as veganism and vegetarianism are easy to understand and accessible for chefs.
The report is upsetting to read. It made me realise that, despite religion being a well-established and recognised protected characteristic for years, if religious people and vegetarians are still been discriminated against in care homes, what hopes would ethical vegans have to avoid such discrimination? If I ever end up in care and the situation does not improve, what are the chances that the toiletries used on me, or blankets added to my bedding, will be suitable for vegans? My hope is that, since the report was compiled before ethical veganism became protected, and its recommendations can indeed make a positive difference, by the time I may need a home the situation has significantly improved.
The good thing, though, is that politicians are talking about it, and they use the concept of philosophical belief, but I can’t help to think that perhaps the rights of ethical vegans (not just dietary vegans) are not fully represented in these conversations yet, especially because we seem to often be lumped together with vegetarians (which is not surprising because the V of V for Life, the NGO more vocal about this issues, stands for “vegetarians”). However, Amanda Woodvine, the current VfL Chief Executive (at the moment of writing this in November 2023), has been vegan for over 20 years — which is encouraging — and in a recent talk with London Vegans she said that, despite its name, the organisation has a “policy statement around our ultimate goal being people switching to a vegan diet — but we appreciate not everybody is there yet.”
When she has been interviewed, Amanda often mentions the case of Serena Coles, one of the vice presidents of the Vegan Society, who had appeared in a BBC2 documentary from the 1970s talking about her passion for veganism. Kirsten Jungsberg, a former friend, tracked her down many decades later and found she was living in a care home with dementia, and, unfortunately, she had been fed meat and fish. Spotting the Vegan Society badge her friend was wearing, Coles remembered her beliefs and said “I am vegan”. A battle with the care home caterers began, made all the more difficult by Serena’s family who seemed to be against veganism. When Selene died at 95 years of age, her veganism was finally being supported by the care home due to the continuous pressure of her vegan friends. This very story inspired the creation of V for Life in 2008.
This is distressing. If a prominent member of the Vegan Society ended up being discriminated against in a care home like she was, what chances do I have to avoid such discrimination? However, that happened before veganism was legally recognised as a protected belief (even before the Equality Act 2010 existed), so hopefully this unfortunate and sad situation will be less likely to happen now because there will be better policies and guidance (and organisations fighting for the rights of elderly vegans). However, policy may be ignored, and when that happens, this could be improved with more staff training, as well as ensuring that nobody who has strong views against veganism (at the veganphobe level) is employed in care positions.
What Are the Current Policies that Can Help Vegans in Care Homes?
The UK government, the devolved governments, the local authorities, the care sector, and the care home providers are all “in charge” of the care of any vegans who end up in care homes in the UK, so I better ask them what are their current policies that are specifically tailored to vegans.
Firstly, I already know that Article 9 of the Human Rights Act 1998 protects people’s right to their beliefs and their right to practice these beliefs. And I know that the Equality Act 2010 now protects ethical vegans of any age from discrimination, harassment, and victimisation. However, I need to find more specific policies about care. I started by sending a Freedom of Information Request (FoI) to the Minister for Care and Mental Health and to my local authority. On 6th September 2023, I wrote them the following:
“This is a Freedom of Information Request
Can you please email me the following:
1. Any current policy or guidance from the Department of Health and Social Care that regulates care homes and/or nursing homes for older people, regarding issues of equality and/or type of food provided to residents.
2. Any internal or external communications of your department from 1st January 2020 to today regarding care homes and/or nursing homes for older people that contain the word “vegan” and/or “plant-based” (with or without hyphen).”
My local authority replied with a blanked “No such information is held” to both questions, but the ministry replied that it could not answer the second question as this would exceed the cost limit for FoI enquiries (it was a long shot anyway), but regarding the first question it replied the following:
“The Care Quality Commission (CQC) is the independent regulator of health and social care provision in England, including care homes. CQC provides guidance on its website to CQC registered providers about the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 14 about meeting nutritional and hydration needs of service users. More specifically, guidance on 14(4)(c) states that: –
• People should be able to make choices about their diet.
• People’s religious and cultural needs must be identified in their nutrition and hydration assessment, and these needs must be met. If there are any clinical contraindications or risks posed because of any of these requirements, these should be discussed with the person, to allow them to make informed choices about their requirements.
• When a person has specific dietary requirements relating to moral or ethical beliefs, such as vegetarianism, these requirements must be fully considered and met. Every effort should be made to meet people’s preferences, including preference about what time meals are served, where they are served and the quantity.
You may wish to contact the CQC as they may have further information. They can be contacted via this link. https://www.cqc.org.uk/about-us/our-policies/how-ask-us-about-official-information-held-us-foi. “
I checked the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and indeed paragraph 14(4)(c) says what the ministry wrote. This regulation intends to make sure that people who use services have adequate nutrition and hydration to sustain life and good health and reduce the risks of malnutrition and dehydration while they receive care and treatment. The CQC “can prosecute for a breach of this regulation or a breach of part of the regulation if a failure to meet the regulation results in avoidable harm to a person using the service or a person using the service is exposed to a significant risk of harm. In these instances, CQC can move directly to prosecution without first serving a warning notice. Additionally, CQC may also take any other regulatory action.”
In addition, guidance on 14(3) of the regulation states:
“Providers must follow people’s consent wishes if they refuse nutrition and hydration unless a best interests decision has been made under the Mental Capacity Act 2005. Other forms of authority such as advance decisions should also be taken into account. CQC recognises that some services may vary the way they apply this regulation to take account of people’s assessed needs and wishes.”
Section 10 of the regulations states the following regarding protected characteristics:
“10.—(1) Service users must be treated with dignity and respect.
(2) Without limiting paragraph (1), the things which a registered person is required to do to comply with paragraph (1) include in particular—
(a)ensuring the privacy of the service user;
(b)supporting the autonomy, independence and involvement in the community of the service user;
(c)having due regard to any relevant protected characteristics (as defined in section 149(7) of the Equality Act 2010) of the service user.”
Section 13(1)4 also states:
“Care or treatment for service users must not be provided in a way that—
(a)includes discrimination against a service user on grounds of any protected characteristic (as defined in section 4 of the Equality Act 2010) of the service user,
(b)includes acts intended to control or restrain a service user that are not necessary to prevent, or not a proportionate response to, a risk of harm posed to the service user or another individual if the service user was not subject to control or restraint,
(c)is degrading for the service user, or
(d)significantly disregards the needs of the service user for care or treatment.”
Also, Regulation 9(1) says the following:
The care and treatment of service users must—
(b)meet their needs, and
(c)reflect their preferences.
We can see that section 14 of the guidance does cover the issue of vegan food, but what about clothes, toiletries, bedding, etc? I think sections 9, 10 and 13 cover them, but as this is not explicitly mentioned, I decided to ask directly the Care Quality Commission (CQC) with this FoI request:
“Any current policy or guidance from the Care Quality Commission, or used by the Care Quality Commission during its inspections, that relates to care homes, nursing homes, and/or residential homes for older people, regarding issues of equality relevant to residents who may be ethical vegans, and who would have requirements regarding their protected philosophical beliefs that may go beyond diet (i.e. clothes, bedding, toiletries, etc.).”
On 8th December 2023, they sent me a full — satisfactory, I must say — reply:
“CQC does not hold any specific guidance on ethical veganism within care homes. Our assessment framework and approach to assessing providers is based around how providers are meeting people’s needs and outcomes for people, which should always be individual and person-centred. CQC recognise the fundamental importance that the choice of food and the experience of eating has to peoples’ quality of life. This can be a significant part of our sense of identity, community and well-being. Providers must ensure they meet peoples’ nutritional and dietary needs, which absolutely includes their religious or cultural requirements or preferences. This would also include ethical considerations beyond food, such as medicines, clothing, bedding and toiletries.
CQC have recently reviewed and updated the regulatory approach and single assessment framework to be clearer about what we expect providers to do, and the outcomes that people using services want and can expect. You can find this information on our website here.
Our website describes the five key questions that we explore when inspecting and monitoring services, and we set out Quality statements, which are the commitments that providers, commissioners and system leaders should live up to.
For example, under the key question of ‘Caring’, there is a quality statement on treating people as individuals. We expect that providers will:
We treat people as individuals and make sure their care, support and treatment meets their needs and preferences. We take account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.
It is about their approach to understanding and responding to individual people’s circumstances, choices and preferences, needs and strengths; how they support existing supporting networks around people where they exist, or build new networks where they don’t, and helping people to have as full and meaningful a life as possible.
It is for the provider to determine how they meet the requirements of the regulation and to assure themselves and CQC that they have effective approaches in place. It is beyond the scope of CQC to direct providers in how they must meet this regulation.
Where CQC find concerns about people’s needs, rights and preferences not being met, lack of person centred care, poor practice, care plans not being followed, this could lead us to explore the skills, competency and training of members of staff, and to explore with the provider how they are assuring themselves they are equipping their staff to fulfil their roles appropriately. Where shortfalls or concerns are found in such areas, CQC are able to signpost them to relevant bodies such as Skills for Care for further support and guidance on assessing learning and development needs and accessing appropriate training providers or other opportunities to improve. This could be in addition to any regulatory action we deem necessary based on what we have found.
CQC are strengthening the link between the culture of the service respecting the rights of people they support, and linking to staff training, but also crucially enabling the right culture and environment for staff to be able to always deliver person centred care.
Under the key question of ‘responsive’ CQC also have the quality statement Equity in experiences and outcomes. CQC are aware that there is caselaw that ethical veganism is covered under the protected characteristic of religion and belief under the Equality Act 2010. If a care home did not provide appropriate care for ethical vegans, this could also impact on the scoring of this quality statement.
Our regulations, which include the fundamental standards of care, enable us to take legal action. These also linked to the Equality Act 2010, especially Regulation 10 and regulation 13. This means that if our threshold for enforcement action was met, aligned with our enforcement policy and enforcement decision tree we could take legal action if a provider was not providing appropriate care to people with the protected belief of ethical veganism. Our enforcement decisions consider, as one factor in decision making, whether there has been a significant infringement of any person’s rights or welfare.
CQC sets out on the website that there is currently very little national good practice guidance that is specifically about meeting people’s individual needs. However, guidance that is relevant to person-centred care, involving people, and communicating with people, for example, is all relevant. You might find these items useful.
I was right. Regulations 9, 10, and 13 do cover the non-food requirements of ethical vegans under care (and Regulation 14 the food requirements), and the current legislation and guidance could be used to complain against (or even prosecute) care providers who discriminate against ethical vegans. It’s good to get familiar with the Care and Quality Commission as this is one of the organisations I could complain about any discrimination I may experience under care — another one would be the Ombudsman — and in their response, they clearly stated that they would deal with breaches of the Equality Act 2010 that would affect ethical vegans.
In Scotland, there is a different regulation, the Regulation of Care (Scotland). The Public Services Reform (Scotland) Act 2010 created the Care Inspectorate (CI), which is the national regulator for care in Scotland. In 2017, the Scottish Government launched its Health and Social Care Standards, which updates all previous standards published under the 2001 Act, and the CI has been using such standards since 2018. Point 1.37 of these standards states, “My meals and snacks meet my cultural and dietary needs, beliefs and preferences.”
In Wales, we have the Regulation and Inspection of Social Care (Wales) Act 2016, and the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. In this, regulation 25 states that individuals have the right to expect respect and sensitivity, and that protected characteristics under the Equality Act must be respected. The Statutory Guidance for Providers of Care Home and Domiciliary Support Services in Wales does not specifically mention philosophical beliefs in addition to religious beliefs (let alone veganism), so I guess there is a need to update this policy and guidance. There is also a Care Inspectorate in Wales.
So, it seems that, in Great Britain, there are plenty of laws, regulations, and policies to cover ethical vegans’ requirements under care. I don’t expect that other countries would have better policies for vegans.
What Do Care Homes Say About Their Suitability for Vegans?
After all my enquiries with organisations and decision-makers, it was time to ask the care homes themselves. The UK care home sector is diverse and fragmented, with a mix of public, private, and voluntary providers. The largest provider is HC-One, which operates 329 care homes across the UK, followed by Barchester Healthcare. However, most care homes are small and independent, with most having only one or two locations. The average size of a care home in the UK is 29 beds, but this varies by region and type of care.
V for Life has an online directory with more than 1,500 services that have pledged to cater well and ethically to vegetarians and vegans. These services, including care homes, have made the Memory Care Pledge to ensure vegan or vegetarian food is served even if you or a loved one have forgotten your preferences and beliefs. One in every six UK care homes are members of the V for Life UK List of care homes that signed their pledge. That’s really something, but this is not legally binding and only seems to focus on food, not on anything else that ethical vegans would need.
This is what the pledge says:
“1) At mealtimes, I am provided with a choice of vegetarian and vegan meal options. My opinions on meals are solicited and considered.
2) I am supported in my vegetarian or vegan beliefs and am provided with the opportunity to explore and engage with vegetarian and vegan resources and services.
3) I am catered for during celebrations. If I am vegan, I am provided with vegan alternatives to birthday cake, barbecues and festive meals. If I am vegetarian, I am provided with vegetarian alternatives to birthday cake, barbecues and festive meals.
4) If it is my preference to do so, I am given the opportunity to eat at a vegetarian-only or vegan-only table when possible, unless doing so would cause me distress. This involves having a table where people who selected the vegetarian and vegan options dine together.
5) If I am experiencing issues with capacity or cognition, and accidentally choose a meat-based dish, or appear to ask for meat, I will instead be offered an alternative dish that upholds my philosophical beliefs. The alternative dish might make use of alternatives to meat and/or dairy, with my caterers providing appropriate vegetarian or vegan fortification of dishes when needed. “
As I suspected, this only covers food, although point two is vague enough that it could be interpreted to cover the rest. Specifically, this is what vegan-friendly care for ethical vegans like me should be covering:
- Food and Drinks (no ingredients of animal origin, no animal products used during processing, no animals used for work in the manufacturing, not tested on animals)
- Vitamins and supplements (no ingredients of animal origin, no animal products used during processing, not tested on animals)
- Clothes, footwear, fashion accessories (no animal fibres such as wool, leather, silk, fur, tortoiseshell, ivory, or bone)
- Toiletries and cosmetics (no ingredients of animal origin, no animal products used during processing, not tested on animals).
- Household products, including those used to wash bedding (no ingredients of animal origin, no animal products used during processing, not tested on animals).
- Bedding (no animal fibres such as wool or silk)
- Furniture (no animal products such as leather, fur, wool, or silk)
- Entertainment options (not outings to places that exploit animals, such as zoos, petting farms, or animal races)
- Hobbies (no exploitation of animals, such as fishing, hunting, aquaria, or keeping exotic pets)
- Decoration (no taxidermy and paintings depicting animal exploitation such as hunting, fishing, bullfighting, animals in circuses, or animal farming)
I don’t think the pledge is explicit enough to guarantee fully ethical-vegan-friendly services, but V for Live has produced a useful document titled “Veg*nism: More Than Just a Diet” that covers lots of this stuff. Also, I am a bit concerned that vegetarians and vegans are lumped together (while legally only ethical veganism is a recognised protected philosophical belief (vegetarianism was rejected a few months prior by the same judge who accepted ethical veganism), and even point 4 seems to imply that if we may not be OK sharing a table with someone eating meat, we do not mind sharing it with someone eating eggs or dairy (which may not be true, at least in my case).
So, having signed this pledge is not good enough for me. Consequently, I wrote to 14 care/residential home providers in my area (those in London that could provide me with their services plus the two major providers) the following email:
“I am an ethical vegan, and I am making enquiries in my city (London) regarding residential homes that could accommodate an ethical vegan like myself. It is not that I need their services right now, but as I live alone and have no family, and I am close to retirement age, I expect I may need them in the future.
Could you please tell me if your homes are suitable for ethical vegans? I don’t know if you are aware, but in 2020, ethical veganism became a protected philosophical belief under the Equality Act 2010. This puts this philosophy at the same level as any religion in terms of the provision of services, making it unlawful to discriminate against ethical vegans for their beliefs (as it is unlawful to discriminate against religious people for their religious beliefs).
This legal protection covers only ethical vegans, not vegetarians, and not just people following a vegan or a plant-based diet. For your information, ethical vegans try to exclude, as far as possible and practicable, all forms of animal exploitation, not just for food, but for any other purpose (such as clothes, toiletries, hobbies, etc.).
So, for a care home to be able to provide vegan-friendly services to an ethical vegan like me, not only should be able to serve vegan food and drinks to the vegan residents (in all meals, with no exceptions), but all the toiletries used on them should be suitable for vegans (not tested on animals or containing animal products), and none of the furniture or bedding for them should contain animal products such as wool, leather, silk, etc. (as far as medicines are concerned, as practicably all of them are tested on animals, ethical vegans still accept them even if they are in breach of the vegan philosophy).
Is this something you would be able to do?
Please consider that vegetarian options are not acceptable for vegans (as they may contain eggs, dairy, or honey), so when I say “vegan food” I mean without any animal product in them, or produced using animals in any way.
If you have any questions about what would be suitable or not for me, do not hesitate to ask.”
After more than a month of waiting (in most cases more than three months) no one ever replied to my enquiry other than asking me which particular care home I was enquiring about (in cases where providers had more than one), but when I told them those close to where I live and they said they would come back to me, they never did. That’s very telling, don’t you think? That suggests to me that none of the care homes I contacted would be suitable for ethical vegans like me, because if any have been, I think they would have replied (unless they never got my email for technical reasons…although most of them use contact forms in their websites that make it less likely that an email may end up been blocked).
There is a reason why I included the information about the legal protection of veganism in my email to the care home providers. I thought that, if they did not provide vegan-friendly care, my email could make them realise that they should, so if adding such information in my first communication may have reduced the chance of a reply, it may have increased the chance that it may induce a positive change in their policies and services (which is more important) — once a campaigner, always a campaigner.
If the reason why they did not reply is because they thought I was not serious about my needs, well, that indicates that they do not take ethical veganism as seriously as they should. It does not give me any reassuring feeling, to be honest.
My conclusion of the lack of response from the care providers is that, despite the legal protection of ethical vegans in the UK, in practical terms, it is likely that, right now, ethical vegans looking for a suitable care home will be facing very similar challenges in the UK than in any other country, as such legal protection is yet to be translated into a real understanding of what ethical veganism is at the carer level, and the correct policies at care provider level may not be in place yet.
What My Future Holds
Who knows what will happen to me in the future (I would never have dreamt that I would become a British writer when I was growing up in Catalonia); it may well be that I will never need the services of a care home or a nursing home (for good or bad reasons). However, it’s good to be prepared, and if there are no vegan care homes available then, I will have to ensure that, if I end up in a care home, it will respect my ethical veganism, and all carers are aware of how to do that.
I am glad that there are people already working for better care for older vegans. V for Life has produced something very useful that may help other vegans who find themselves in a care home at risk of being discriminated against for being vegan. It is called the Self-Advocacy Pack (there are different versions for England, Wales, and Scotland) and is sold with these words: “Are you confident about protecting your vegan or vegetarian identity and beliefs – now and in the future? VfL’s self-advocacy pack outlines the laws that safeguard dignity and choices in care. It details the steps you can take to ensure that you are cared for in line with your beliefs. Understand your rights as a vegan or vegetarian. Where to access support and information (care homes, legal, nutrition). Step-by-step guide to ensuring that your rights are respected in case of loss of capacity or cognition or when receiving care. Template letters to use if admitted to hospital or receiving care.”
I read it and was pleased that it mentions my legal case. I downloaded a free copy and bought a printed copy as well, and I would definitely use it. I will fill out the forms that will help carers know my wishes, and I am planning to send them to my GP and perhaps at one point always carry a signed copy with me, just in case. It is a very practical guide, and it gives good advice.
The idea of getting a Lasting Power of Attorney who is also vegan, or at least is someone who would commit to fighting for your vegan rights, is something that may be advisable (remember the case of Serena Coles mentioned earlier, the Vegan Society vice-president who ended up in care and those who legally represented her were hostile to veganism).
Am I totally comfortable letting organisations which seem to be aimed at vegetarians represent me on this issue? To be completely honest, I am a bit uneasy about it. Well, I would not fully trust anyone using the term plan-based instead of vegan to represent me when I am too old as the chances would be that they would forget about things such as wool or trips to a zoo. I probably would be more comfortable if the Vegan Society was taking care of this issue (either running vegan care homes, or getting a different vegan pledge for care homes to sign that explicitly covers all ethical vegans’ needs — perhaps the reason the care providers I contacted did not reply to me is that they realised that the V for Live pledge they might have signed is not enough to cover all my needs). However, is reassuring to know that, at least for now, vegans are in important decision-making positions in vegetarian advocacy organisations that deal with older people (at least now when lobbying is needed to ensure that the protection I secured is not forgotten and advances policy).
Perhaps I may need to move to Scotland because there have been some recent advances there. On National Older Veg*ns Day (1st October), a self-evaluation tool and guidance was launched based on the Scottish Government’s Health and Social Care, and produced from the collaborations between the Standards Vegetarian for Life and the Care Inspectorate. Titled Good Care for Vegetarians and Vegans, this guidance will be useful for inspectors to inform an inspection and for care services looking for best practice points. One key area included is the extent to which people experience a positive attitude from others towards their vegetarian or vegan identity, which is good news as it acknowledges that veganism is more than just a diet. Indeed, in the introduction of the guidance, we can read this:
“Veganism or vegetarianism can be a large part of someone’s identity and more than just their diet. When considering changes to capacity and unusual requests, it is important to recognise that a vegan or vegetarian may have lived this way for decades of their life, and while they have the right to change their mind, it is unlikely that they have changed their belief system. The right to follow dietary practice in line with religious or philosophical beliefs is fundamental and enshrined in law (veganism is a protected characteristic of religion or philosophical belief under the Equality Act).”
Even better, the guidance has this as an example of good standards:
“In all household goods and personal care, the person’s clothing, toiletries, bedding and so on are provided following consultation with the person experiencing care because they may wish these to be animal-free and to not have been tested on animals.”
Finally! At last, I can see something written that explicitly covers all aspects of a person’s life, which is what an ethical vegan like me needs. That’s real progress. I hope that England and Wales learn from this and adapt their guidance accordingly — and that other nations follow suit. And perhaps in the future, if lobbying to improve the situation continues, if all the recommendations of the APPG are adopted, and even if a discriminated ethical vegan in care gets inspired by my litigation and embarks in successful legal action — perhaps this is what it may take to close the gap between policy and practice), such guidance ends up being enforceable policy entrenched in the statute books.
However, notwithstanding how essential is to get the right policies in place, and how important is to get the people in charge of implementing them properly trained, I am well aware that, in a carnist world, and in a country where there seems to be a staffing problem in the care sector, discriminating against humans who can no longer complaint about it is something that may be practically impossible to abolish, so I should be prepared for that too — as I may end up being the unlucky vegan looked after by a veganphobe carer who slip through the cracks (or by an AI carer needing of a software update).
The fact no care provider replied to my enquiries is worrying — perhaps they do not want me as one of their service users, if they know who I am. I asked Amanda Woodvine, CEO of V for Life, what she thought about that. She said, “I was sorry to learn that you have yet to receive a reply from the care providers near you that you wrote to, to see if they cater to ethical vegans. While I’m unsure of which providers they were, if giving them a little grace, it might be that they have yet to have had a vegan resident, and are as such unprepared for this situation. Running some maths, after contacting say 100 care homes at random, based on the results of VfL’s 2019 survey the probability of finding one with a vegan resident is only 18.2%. We also know care establishments to be extremely busy environments, with registered managers receiving a very high volume of daily emails. I’m sorry though, that your experience was a negative one. Over the years VfL has built up a network of care homes that have pledged to cater well and ethically for older vegans and vegetarians. Membership is composed of around 1 in 6 of all UK care homes, and 4 of the ‘Big 5’ care providers by market share. It is called the ‘UK List’, is a searchable directory, and you can access it on our website vforlife.org.uk. Someone without internet access is welcome to give us a call on 0161 257 0887 and we’ll run the search for them.”
If they are too busy now, imagine how busy they will be when I may actually need them, with more people living in the UK and a much higher percentage of elderly people in the population.
In campaigning to improve the world, you always lose a bit transforming ethics to morals, then morals to laws, laws to policies, policies to practices, and practices to behaviours. If I want to be sure that not all is lost when it’s time for me, in addition to choosing the most vegan-friendly home and getting all the right paperwork about my wishes, I may need to do something more radical. Something that could even remind me who I am, in case I forget.
I may need to get a vegan tattoo on my forehead saying “ethical vegan.” Not just for me, but also to ensure that, if I no longer can verbalise my commitment to veganism, and all my paperwork has gone stray, the unwanted behaviour of my potential carers cannot be justified by ignorance of who I am (the author of the book Ethical Vegan who pledged to live according to the philosophy of veganism for life).
I very much hope that in the next decades, things have advanced enough on this front that I will not feel the need to get that tattoo anymore — which would be my first. I rather keep my exuberant white beard in a wrinkled face without any ink distractions.
But if that ends up being my last vegan campaign, so be it.