Britain's blue chip index closed up over 143 points, or 2.8%, at 5,294, just before the UK Prime Ministers daily briefing

FTSE 100 index closed in positive territory on Tuesday and Wall Street also bounced back as markets cheered efforts to minimise the economic effects of the Covid-19 pandemic.

Britain's blue chip index closedup over 143 points, or 2.8%, at 5,294, just before the UK Prime Ministers daily briefing and UK chancellor Rishi Sunak announced more emergency economic measures to keep UK Plc afloat.

Saying the government woulddo 'whatever it takes', Sunak detailed new measures including330bn of government-backed loans or credit to businesses, equivalent to around 15% of GDP.

Also extended for small and medium sized businesses (SMEs)will be a loan scheme, which will offercredit of up to 5mln. Talks will take place coming days on how to aid airlines and airports, he added.

Despite these fiscal measures concentratingon the UK, the moredomestically focusedFTSE 250 index finished lower, shedding over 424 points to 13,924 as it benefits less from the pound's weakness.

Joshua Mahony, senior market analyst at online trader IG, said European markets are on the rise thanks to "global efforts to minimise the long-term impact of this epidemic helping allay fears over huge unemployment and economic decline".

"Investors have started to strategically pick over the damaged pile of UK stocks today, with traders becoming more selective and strategic about their approach following a dramatic period of declines which has seen both risk and haven assets hit hard."

On Wall Street, the Dow Jones added over 442 points at 20,662, while S&P 500 added over 80 points at 2,467.

It was the best of days, it was the worst of days but at the end of the day (nearly) it was a welcome rally.

The FTSE 100 was up 87 points (1.7%) at 5,239 with half an hour of trading to go, helped somewhat by sterling plunging two-and-a-half cents against the US dollar to US$1.2015.

The dollar has strengthened after the US Federal Reserve set up a commercial paper funding facility to make it easier for corporations to get debt-based funding.

Just as investors were starting to seriously flag once again, the Fed actually managed to pull-off a market-boosting intervention after a string of false dawns.

The central bank announced on Tuesday that it would be launching a Commercial Paper Funding Facility, i.e. a way for it to buy up short-term debt issued by struggling companies seeking to raise cash.

It seems that, after being sceptical of the Feds rate cuts and trillion-dollar stimulus injections, the creation of this new special credit facility was the kind of thing investors were hoping for, said Connor Campbell at .

The greenback went on a tear once the CPFF was revealed, surging 1.6% against the yen and pound, and 1.9% against the euro. Cable is now stuck under $1.2065 for the first time in close to six months, Campbell noted.

The topsy-turvy day continues with the FTSE 100 now in positive territory after the latest move by the US Federal Reserve to ease a corporate credit crunch.

The central bank has established a commercial paper funding facility to support the flow of credit to companies, whipping a tool out of its locker that it used during the 2008 credit crunch.

Commercial paper markets directly finance a wide range of economic activity, supplying credit and funding for auto loans and mortgages as well as liquidity to meet the operational needs of a range of companies. By ensuring the smooth functioning of this market, particularly in times of strain, the Federal Reserve is providing credit that will support families, businesses, and jobs across the economy, the Fed said.

The FTSE 100 was up 57 points (1.1%) at 5,208, driven higher in part by grocery delivery technology company (), which is doing a roaring trade in this period of social distancing. The online grocer has stopped processing new customers bookings until further notice.

Ocados shares were up 18% at 1,347.5p.

In contrast, the postponement of the Euro 2020 football tournament were now going to have to refer to it as Euro 2021 has dealt a blow to terrestrial broadcaster (), which is down 13% at 65.28p.

Emulating what the Footsie did this morning, the US benchmarks opened higher but quickly went into retreat.

The Dow Jones index was down 228 points (1.1%) at 19,960 and the S&P 500 was off 7 points (0.3%) at 2,379.

Back home, the FTSE 100 was down 74 points (1.4%) at 5,081.

Gold is in favour, rising US$6.40 on futures markets to US$1,492.70 an ounce but the price of Brent crude has fallen below US$30 a barrel to US$29.42, down 63 cents.

There has apparently been no progress in attempts to mediate between Saudi Arabia and Russia, with sources saying that an OPEC+ technical meeting planned for Wednesday had been called off. Neither side appears likely to blink in the short term, with stating in an earnings call that it was likely to sustain higher output through May and was very comfortable with $30 oil, said Jack Allardyce, an oil and gas research analyst at Europe.

The company had said it would raise production to a record 12.3mmbopd next month [millions of barrels of oil per day], including 300kbopd from existing stocks, as it looks to capture increased market share following the dissolution of the previous OPEC+ pact. With major Russian producers also suggesting they would up supply, and demand in freefall due to the economic impact of the coronavirus pandemic, April is expected to see record surplus production and we would expect downward pressure on prices to continue in the near-term, he added.

We believe that current prices are below achievable breakevens for the majority of producers, meaning that benchmarks will recover in the longer-term, although the impact on balance sheets even in the best case is likely to be significant, Allardyce predicted.

While investors wait for the chancellor, Rishi Sunak, to emerge with his replica bazooka, the Footsie is making an attempt at a lunchtime rally.

Londons index of leading shares was down 51 points (1.1%) at 5,096, having started the afternoon session at around 5,044.

The ongoing rout in equity markets raises an obvious question: what could break the circuit? Unfortunately, monetary or fiscal policy are less suited to break the circuit in a crisis of the real economy that stems from medical emergency than in a financial crisis, said Holger Schmieding at Berenberg.

The pandemic and the lockdowns to contain it are delivering a shock to the real economy on a scale that seems unprecedented in peacetime. Because of the unknown trajectory of the virus, with case numbers surging and lockdowns being tightened, it may be more difficult than during a financial crisis to deliver a policy announcement so stunning that it would restore market confidence and put an end to the equity bear market, he added.

Of course, a hypothetical central bank promise to buy almost unlimited amounts of equities and thus turn itself into a potential majority owner of a countrys productive capital could end the equity selloff. But we do not expect policy makers to go for this hypothetical variant of whatever it takes, he added, possibly to the regret of those singing The Red Flag in the background.

Schmieding goes on to suggest that bailing out equity markets could be at least as unpopular as bailing out the banks was in 2008/9, although possibly not with anyone with a pension plan.

Its not all doom and gloom on the Footsie, with a substantial minority of stocks defying the trend, including Paddy Power and Betfair owner (), which is up 4.1% at 5,944p, having been hammered yesterday after it made its best guess at how much the cancellation of major sporting events is likely to cost it.

Otherwise, todays winners include many of the usual suspects that people turn to in times of market turmoil, namely grocery sellers, such as () up 17%; essential household goods makers, such as Group PLC () - up 7.2%; utilities, such as PLC () - up 5.3%; and drugs companies, such as PLC () up 6.7%.

US markets are expected to open higher although spread betting quotes on the likely opening levels are changing rapidly.

The Dow Jones, which crashed by almost 3,000 points yesterday, is expected to open 421 points higher at 20,610.

The S&P 500, which plunged 325 points yesterday, is tipped to claw back 56 points of those losses this morning to open at 2,442.

In the UK, the FTSE 100 was down 84 points (1.6%) at 5,067.

The retail sector remains a war-zone, with () giving up the ghost and () seeking permission to rescind its final dividend payment after a reduction in footfall across its estate.

Laura Ashley has collapsed, with the company laying the blame squarely on the immediate impact of the coronavirus outbreak. Shares are suspended and it looks to be the first domino to go. It's a classic case of being able to service high debt loads when cash flow remains steady but as soon as the revenues dry up, the debt crushes you whatever interest rate you may be able to get. It highlights the very real limitation in monetary policy right now - debt is about cash flow, not interest rates, for businesses, said Neil Wilson at markets.com.

The Footsie has been up and down like the Assyrian Empire this morning as confusion and panic continue to reign.

The index is currently down 48 points (0.9%) at 5,103, having bottomed out at 4,979.

Somewhat lost in the torrent of coronavirus-related news this morning were the UK unemployment numbers.

The UK employment rate in the three months to January 2020 was estimated at a joint record high of 76.5%, 0.4 percentage points higher than a year earlier and 0.3 percentage points up on the previous quarter.

The unemployment rate was estimated at 3.9%, flat year-on-year but up from 3.7% in the previous quarter.

Estimated annual growth in average weekly earnings for employees in Great Britain was 3.1% for both total pay (including bonuses) and regular pay (excluding bonuses).

In real terms (after adjusting for inflation), annual growth in both total pay and regular pay is estimated to be 1.5% in the three months to January 2020, down from a recent peak of 2.0% in the three months to June 2019.

In real terms, annual growth in total pay is estimated to be 1.4% and annual growth in regular pay is estimated to be 1.8% in the three months to January 2020.

There were an estimated 817,000 vacancies in the UK for December 2019 to February 2020, which is 19,000 more than the previous quarter but 30,000 fewer than a year earlier.

This could be as good as it gets for quite some time, warned Sarah Coles, a personal finance analyst at Hargreaves Lansdown.

Jobs in pubs, restaurants, hotels and other venues are at risk, airlines are warning of massive job losses, shops are under increasing pressure, and small businesses are laying off staff wherever they can, in an effort to keep going. For the 15% of the workforce who are self-employed, the prospect of losing work and getting ill without sick pay is particularly alarming.

People working in the retail, hotels and restaurant industry were already seeing the slowest wage growth at 2% for regular pay - so theres a real risk they havent had the opportunity to put any savings aside to get them through the tough times, Coles noted.

Samuel Tombs, the chief UK economist at Pantheon Macroeconomics, concurs with Coless analysis, saying all was fine before the virus hit but now

Employment was 184K, or 0.6%, higher in the three months to January than in the prior three months, beating the consensus, 140K but the headline, three-month average, unemployment rate increased to 3.9% in January, from in 3.8% in December, above the no-change consensus.

Meanwhile, the headline rate of year-over-year growth in average weekly wages, including bonuses, increased to 3.1% in January, from 2.9% in December, marginally above the consensus, 3.0%.

Looking ahead, however, it wont be long before employment starts to fall. The election does not appear to have had a major positive impact on firms appetite for labour. The three-month average measure of job vacancies was a mere 19K, or 0.1% higher in February than in the three months to November, and remained a hefty 5.1% below its January 2019 peak. Moreover, COVID-19 looks set to mean that firms in the travel and discretionary services sectors cut headcounts aggressively, while most firms will pause on hiring plans. Wage growth likely will slow over the next year too, Tombs warned.

Talking of firms in the travel and discretionary services sectors, package tour operator () and sportswear seller (), down 14% and 10% respectively, are among the hardest hit blue-chips this morning.

Fergusons cautious outlook statement has had a knock-on effect on Ashtead PLCs ([emailprotected]) shares, which are down 6.5%; like plumbers merchant Fergsuon, Ashtead and its tool hire business is heavily dependent on the US construction industry.

Londons rally lasted barely half an hour and the Footsie is now sporting a loss that would have been regarded as severe a month ago.

The FTSE 100 is down 126 points (2.5%) at 5,025.

Blink and you missed it. The FTSE very briefly moved higher on Tuesday before resuming the sell-off. The move lower comes after the Dow closed on Monday down 12.9% in its worst one day sell-off in over three decades. US futures are managing to cling onto gains, reported Fiona Cincotta of GAINCapital.

Central bank action and the prospect of further fiscal support are in focus on Tuesday. Rishi Sunak has announced a major bailout scheme and extra measures for businesses after Wall Streets sell-off overnight. The new package will build on the 12 billion set out in last weeks budget.

With new social distancing measures coming in and the prospect of businesses grinding to a halt over the coming weeks, the markets have made it clear that the original measures of support were inadequate. Given the resumed sell-off, doubts exist over whether these measures will be able to contain the coronavirus chaos, she added.

Pantheon Macroeconomics in its daily coronavirus update an hourly update is going to be needed soon at this rate noted that the rate of the increase of cases in major western European countries has slowed from its peak pace in late February but the number of cases continues to rise rapidly.

The UK has abandoned its previous policy of allowing the disease to spread in the hope of creating herd immunity. This was always a crazy idea, and the UK is headed towards restrictions just as aggressive as in other parts of Europe, said Ian Shepherdson, Pantheons chief economist.

With the resumption of broader testing, UK case numbers are likely to rise rapidly, but probably won't reach continental European levels because the infection rate is lower at the time restrictions are imposed.

Reported US cases continue to accelerate as the pace of testing is ramped up, and the virus continues to spread. The number of daily US deaths is likely to rise for several more weeks, at least. City lock-downs are spreading, so the rate of increase of new infections ought to start slowing by early April, he added.

PLC () is the worst-performing blue-chip with a 20% fall at 888.6p after it issued a profit warning this morning.

Results from plumbers merchant () sent the shares down the pan.

"Given the strength of our first-half results, we had intended to confirm our full-year trading profit outlook for 2020; however, due to the dynamic situation unfolding with COVID-19 it is too early to understand its impact on current trading, the company warned.

Ferguson shares were down 15% at 4,426p.

The FTSE 100 made a positive start to proceedings Tuesday, though you suspect it wont take much to derail progress.

London's blue-chip shares opened 94 points to the good at 5,245.40

The VIX, a measure of market volatility that is also known as the 'Fear Index', overnight topped levels seen during the maelstrom of the financial crisis.

Overnight on Wall Street, the Dow Jones Industrials Average closed 13% or almost 3,000 points lower, with broader-based US stock indices following suit.

Until there is better knowledge of the situation on the ground, until the economic damage is known and until we see a genuine spike in cases in the US and Europe, volatility levels will remain extremely high, said Neil Wilson, senior analyst at Markets.com.

There had been chatter that regulators would start to think it's time to call a halt to this, that they will step in to shutter stock markets for a limited period in an attempt to regain control of the situation. Jay Clayton, the SEC boss, said otherwise, but it remains a possibility.

Heading the risers were presumed beneficiaries of the coronavirus outbreak.

So, Pearson (), electronic publisher for higher education, will, the market is guessing, receive a boost as universities move online for the final term of the academic year. Its shares advanced 8%.

Just Eat Takeaway.com () was being touted as a winner,winner chicken dinner (quite literally), adding 5% after the nations restaurants were effectively (but not officially) shuttered.

Pubs operators Wetherspoons () and Marstons () were off 11% and 10% respectively with Britains high streets expected to host to tumbleweed rather than revellers after the latest stay indoors advice from the UK authorities.

Also on the declinewas contract caterer Compass () after warning on coronavirus closures. It lost 11%.

() has agreed a doubling of its existing zero-coupon, second-ranking, unsecured convertible loan note facility by8mln to 16mln. The loan is provided by an institutional family-office investor based in the Bahamas The expansion of the facility will see immediate additional cash inflow of 1.8mln.

() has launched carrier billing payment services for Hatch, a monthly subscription-based 5G games streaming platform. Hatch allows users to stream top tier gaming titles to their phone without the need to use storage capacity on their devices. In a separate announcement reporting its results for the year ended 31 December, Bango reported that adjusted earnings (EBITDA) had swung to 450,000 from a loss of 870,000 in the prior year while revenues jumped 41% to 9.3mln.

() said it has signed an agreement that will see the medical formulation of its weight loss product sold in some of the worlds richest countries. The group has inked a one-year deal with Lebanon-based Prosperous Pharma, a pharmaceutical distributor that also supplies nutraceuticals to doctors, pharmacies and consumers. It will have exclusive rights over OptiBiotix's SlimBiome Medical for the Gulf Cooperation Council States and the Levant.

Stobart Group Limited () has responded to press speculation and confirmed it has had talks about selling a minority stake in London Southend Airport. No acceptable terms have thus far been agreed and discussions have been put on hold while both parties navigate the current coronavirus outbreak.

() is now considering reverse takeover targets in sectors other than oil and gas, following several months of commodity price volatility. The oil price has traded significantly down in recent weeks. The company has particularly focused its efforts on the environmental industries sector and is pleased to confirm that it is in discussions with several potential targets.

e-therapeutics PLC () is in late-stage discussions regarding a number of exciting potential collaborations, Ali Mortazavi, the executive chairman has revealed. Mortazavi, the former chief executive of Silence Therapeutics, took the helm last month and revealed in his first full-year results statement with the company that he did due diligence for more than three months before purchasing his stake in the drug discovery company.

() has initiated an independent analysis of the nuanced datasets from last years AEGIS-H2H clinical trial of its lead product, an iron deficiency drug known as Feraccru here in the UK and Accrufer in the States. It will assess the methodology used around determining the treatments non-inferiority against a leading intravenous medication in treating iron deficiency anaemia in adults with inflammatory bowel disease.

() (OTCQB:ITXXF) said it was making operational efforts to conserve its 300,000 cash reserves in the face of the mounting disruption to global business caused by the Covid-19 outbreak. It will maintain production, but reduce costs, negotiate payment terms and is assessing asset sales as well considering whether to maintain its AIM listing.

() has unveiled several measures to reduce costs and preserve cash as it moves to lessen the impact of the coronavirus outbreak on its operations. The AIM-listed group said it will reduce employee costs both at its head office and its pubs around the UK, which its directors will also have their salaries reduced by 25%.

Seeing Machines Limited () says it is implementing several contingency plans and cost containment initiatives which it says leave it in a strong position to mitigate the impact of the coronavirus outbreak on its business. The AIM-listed firm, which develops driver monitoring technology, said that while the short to medium-term outlook was uncertain and that it may be impacted by current market conditions, there was positive momentum across all transport sectors and the company had significant confirmed order books for both its fleet and automotive divisions".

() is to reduce costs at its Santa Cruz Sur assets in Argentina. In a statement, the AIM-listed firmsaid that, in light of the current weakness in oil and gas prices, the Santa Cruz Sur assets are no longer cash-flow positive. As a result, Echo is exploring all options available to it to preserve existing cash resources at a corporate level and, together with the operator of Santa Cruz Sur, has identified and prioritised a number of field operating cost reductions to seek to ensure that operations are sustainable at current commodity prices.

() (TSX:COG) announced that, following an exercise of warrants, it has issued 500,000 new ordinary shares in the company at a subscription price of 31p each, for which it received gross proceeds of 155,000.

PLC () confirmed that both its 2019 Annual Report and Accounts and Notice of Annual General Meeting (AGM) are available within the Investors section of its website, http://www.veronapharma.com. The AGM will be held at the offices of Shakespeare Martineau at 60 Gracechurch Street, London EC3V 0HR, United Kingdom at 10.30am on April 16, 2020.

The FTSE 100 is expected to rally a little on Tuesday as the country prepares to go into quarantine for several weeks to limit the spread of coronavirus after a dramatic announcement by the UK Prime Minister, Boris Johnson on Monday.

Londons blue-chip stocks were being called 124 points higher by spread betters ahead of the open, though this is small beer after more than 2,000 points have been lost in the past month as the coronavirus pandemic has taken its toll.

Read more from the original source:
FTSE 100 rallies as Fed"s silver bullet bolsters US dollar - Proactive Investors UK

We present our findings through four overarching and interrelated themes and sub-themes that emerged from the interviews (see Table4).

Most of the patients found that their nutritional status was deteriorating. Their family caregivers agreed: Her nutritional status is much poorer than it used to be. I think its due to her old age. She has lost a lot of weight the last 3 years; she eats less and is less active (FCG8). The patients described struggling with on-going health problems: My health is still very poor because I have cancer in my whole body (P9). They also experienced new health problems: Since I came home from the hospital, my mouth and tongue have suddenly become very sore. It really hurts and I cant taste the food. I dont understand what causes it (P5). All of the patients described challenges related to food and meals. Most of the patients described a lack of appetite, and many said they never felt hungry: I eat and it doesnt really taste bad, but. .. A lot of strange things have happened to me. It is just like I dont feel much like eating anymore. I dont know why. .. I probably dont want to become fat again (P8). Some patients experienced reduced appetite due to nausea, and some had difficulties chewing or swallowing food due to tooth problems, dysphagia and sore mouth and tongue. Patients also described that food no longer tasted like it used to: The food doesnt taste [like] much. I have been wondering about that. .. I make ham with mayonnaise and spices, but it just doesnt taste [like] anything. It may be due to the medications (P3). In general, the patients took many medications. Some of these had to be taken before food, some with food and some after food. Having to plan meals according to medications seemed to negatively influence their nutritional situations. They also described not being able to cook anymore because of functional limitations. Several patients made statements along the lines of I only eat because I have to. The patients understood that food was a necessity for their well-being, but the challenges described above made it difficult for them to ensure sufficient food intake: I feel full so quickly, and I cant force myself to eat, that cant be right, thats ridiculous (P8). One patient described becoming very ill because he could not eat enough: I was very sick and felt so dizzy that I almost didnt know where I was. This happened because I ate too little (P9).

Most of the patients had recently lost weight; this was a fact they were aware of, but for most, they were not worried. The weight loss only seemed to become problematic when it became visible to others or was related to practical problems such as not having any clothes to wear: I dont feel that I am undernourished. The only problem I can think of is that I dont have anything to wear, because all my clothes are too big (P14).

Many of the patients that lived alone experienced loneliness, and this seemed to affect their appetite and meal experience. Several patients described eating alone as depressing: I am very fond of food, and when I eat homemade bread with butter and honey, I feel that my mood gets better. But I can be quite depressed at times. .. I think it is pretty lonely being here all alone (P6). Some also talked about their inability to participate in social activities, such as going to a cafeteria with friends or to dinners, because of restricted mobility. They talked about eating more when they ate together with someone; this was also the family caregivers impression. One patient was interested in eating at a senior centre but was put off by the idea because she had been told there would be many people with dementia there. Some of the patients occasionally ate at a local nursing home for variety from the meals at home and to socialise, but this was not necessarily a good experience: A lot of the people there already know each other, and they sit together and talk. When I come from outside I dont know anyone and end up sitting alone. That feeling of loneliness hurts. I eat my food fast and then I leave (P3).

Most of the patients were very pleased with the care they received in hospital. The healthcare personnel were focused on their nutritional needs and the nurses tried their best to provide them with food to their liking. Some of the patients had a consultation with a nutritionist during their stay and were prescribed nutritional drinks and instructions on how to enrich their meals. However, they did not seem to follow these instructions at home after discharge. The care at home seemed to lack respect or consideration for each patients unique needs and preferences concerning food and meals. One patient said, No one has been here and told me that you need more of this and that and that we need to make your food richer in calories. It is more like, What do you want? And then thats what you get (P13). None of the patients could remember home care services asking them about their nutritional problems, the reasons behind the problems or discussing possible solutions. They believed that many of the staff lacked competence about nutrition and knowledge about their nutritional needs and preferences. The home care staff were often students studying other fields than healthcare who were working part time in home care while studying. The patients said that qualified nurses seldom visited them: The nurses seldom stop by. They are supposed to be here twice a week, but that doesnt happen very often (P13). In general, the patients experienced few changes in their care between the first and the second interview.

The food they were served by home care usually consisted of slices of bread for breakfast and lunch and ready-made meals heated up in the microwave for dinner. Some of the patients thought this food was ok, but several of the patients disliked these meals: I can actually make sandwiches on my own. I cant stand the sandwiches they prepare for breakfast and put in the fridge the night before. The next morning, they are ice cold and I think they are horrible (P14). Especially, the food prepared for dinner was problematic for some. All the patients living alone described eating ready-made meals for dinner regularly, and they described cooking as pressing a button on the microwave. They felt that because these meals had to be made within the sparse time the home care services had for each of them, their diets were limited. One patient said, I had to get a microwave oven, because that was the first thing they (homecare services) asked for when they started coming here. I dont like such food. I want to make homemade food. I dont know what kinds of food I am supposed to buy. I cant eat only ready-made meals. First of all, I cant stand the taste of these ready meals, and secondly, I find them too expensive (P1). The family caregivers explained that they bought these microwave meals for practical reasons even though they generally knew that the patients were not fond of them. Several patients described being served tasteless meals and food they disliked, which resulted in a reduced food intake: We get some fish cakes without taste with grated carrot without any dressing, with potato and maybe a spoonful of butter. You dont enjoy that. It doesnt taste anything. Then I just eat a little and leave the rest (P3).

Many of the patients described a longing for tasteful meals; this was often traditional foods or food normally served during holidays. The patients also described pleasurable meal experiences: Patient: You know, I get so happy when the food finally tastes good and we get a tasty sauce or something. Aah. .. today we had herring with onions, red beets and sour cream and I had two filets and two potatoes. Today the food was lovely and it made me happy. Interviewer: Im glad to hear that you had a good meal. Patient: Yeah, that is so important for my wellbeing and everything (P3). Tasteful meals, meals made by family caregivers and eating in social settings seemed to stimulate the patients appetite and inspire them to eat more: The other day I really ate too much for dinner. My daughter served fried sausages with red cabbage and potatoes and it was just so good! (P13).

The patients reported that care was organised in a way that seemed to lack respect for their daily routines. Home care staff often did not turn up when they were supposed to, and patients described not being able to go out because they had to wait for staff, which restricted their freedom: On Sundays, they phone me at quarter to twelve and say, Hi, we are a bit delayed today. They come to make me breakfast at quarter past twelve! It is a bit like that. It is often because of shortage of staff (P13). The patients also told stories of home care services not turning up at all. Additionally, when they tried to phone them, they could not reach anyone: It is impossible to call them, and no one answers the phone during the day. No one. You cant get hold of anyone (P13). One patient who was almost blind and unable to prepare food experienced this several times. Fortunately, she could call her daughter who lived close by for help. When home care staff did not show up or did not turn up at the right time, the patients were not in charge of their life situations.

Sometimes, the home care visits were scheduled too early or too late and were not in accordance with the patients preferences. When being dependent on help for meals, bad timing of the meals could result in patients not eating for many hours or eating less: I dont eat much besides dinner. I: At what time is that? P: At one oclock, that is a ridiculous time. .. I set my alarm clock at 1011, I then get up and sort out my medication and Im not hungry, and then I just wait for dinner. If dinner had been at three oclock instead, I would have made some breakfast (P3). The patients reported that the care services were always in a rush, not having time to care for them or talk to them: For many people living alone, the only human conversation they have during a day is with the people from home care services. I think it is important that they take the time to talk to these people, not just rush in, make food and goodbye (P13).

Most of the patients were striving to maintain independence and control, and they wanted to manage their food and meals themselves; however, they needed help. For some, becoming dependent on help from others was an inner struggle: When you are used to managing everything yourself and then you suddenly become dependent on help to prepare a sandwich. Can you imagine? It is a bit depressing just thinking about it (P13). One patient valued her independence so much that she kept her problems with food and meals hidden from her family for a long time and rejected care services help. One of her family caregivers said, She never told us about her problems. They reduced the home care from every two weeks to every third week. The weaker she got the less help she received. But then they told us in one of the meetings that she has been offered help several times, but she has not been interested. She prefers to manage on her own (FC14).

The patients emphasised the importance of having a voice in the matter of food and meals I want to have a say in the matter too (P15) and the importance of being able to eat the food they wanted whenever they wanted. The patients who needed assistance preparing meals did not have this freedom; they had to eat what the care services could manage to prepare within their short timeframe.

Although the patients expressed a desire to be independent, they were not offered any self-management support from the care services. They were dependent on additional help from family caregivers, neighbours and friends to manage their daily lives, to understand information and to communicate with healthcare services, indicating a paternalistic approach to care. These disempowering experiences with home care resulted in dissatisfaction with care.

The patients described a lack of mutual comprehension of information about their health, treatment and care. They told stories about not understanding or remembering information they received in hospital. In fact, most of the patients who received a consultation with a nutritionist in hospital could not remember the content of this conversation: Two nutritionists came to talk to me when I was in hospital. Interviewer: what did they say? Patient: I dont know, it was so complicated, I just gave up (P9). The reasons they gave for this were that they were too ill, there were too many different people involved in their care and that they experienced medical terminology and information overload. Many of the patients were not able to understand the written information they received in hospital: I received a lot of written information, but I dont understand half of it (P8). Family caregivers generally had to help the patients communicate with the healthcare services and explain written information.

The patients experienced a lack of essential information about their own treatment. One patient who was seriously malnourished and almost blind could not obtain information about her nutritional treatment. During the first interview, she showed us an envelope she had received at the hospital; it contained a detailed nutritional plan that she was supposed to follow. She had no previous knowledge of this plan and could not remember if anyone at the hospital had informed her about it. She was not able to read it herself because of her poor eyesight. Her daughter, who did all her food shopping, had not been informed. She said, They have made her a nutritional plan. It must be this one. They didnt talk her to about it they just put it in the envelope with the rest of the papers (FC13). The patient was supposed to inform the home care services about this nutritional plan herself, but as she did not know she had received it, the care services were not informed and did not provide her with this necessary treatment.

The patients said that no one had talked to them about the risks associated with weight loss. Interviewer: did the doctor tell you why it is important not to lose any more weight? Patient: No, he did not. He is so thin, and probably thinks I shouldnt be any bigger (P8). Several of the patients were happy to finally have lost some weight: I dont understand why this has happened, but I am happy that my waistline is reduced. It doesnt bother me that I lose some weight (P3).

The lack of mutual comprehension undermined the patients involvement in their healthcare decisions. Many experienced a lack of shared decision-making, and for some, this caused distress. For instance, decisions about their nutritional care were made without consulting them; receiving help against their will caused resistance: Patient: They have started to prepare sandwiches for me, but I have told them to stop doing that. I can manage on my own. Interviewer: Did they start doing this after you came home from hospital? Patient: Yes, but I dont know who have told them to do that (P9). Another patient said, I dont know whats wrong with me. I just got a prescription for some new vitamin tablets. They cost a lot and I have refused to pay for them. I need an explanation of whats going on (P3).

The patients experienced a way of communicating that lacked respect and sensitivity to their needs and values. The dialogue about food and meals with the home care services generally consisted of What have you eaten?, What would you like to eat? and It is important that you eat. Some of the patients found this stressful. One family caregiver said, They constantly urge her to eat and she says that she is fed up by it. Thats what they do, the people that visit her in the morning and the afternoon (FC14). Some felt like they were disrespected in the dialogue about food and meals or that food and medication was served to them without them agreeing to be helped or in a way that felt violating. One patient said, Would you believe it, they went over and felt the casserole to see if it was warm. It was just like they didnt believe us (P10). Another patient said, They gave me some vitamin B and said you should take these. I dont understand why. They just give me the pills and say take these, and then they leave (P2). Another patient experienced poor communication with the home care services when they just stopped visiting him without telling him why. He suspected that it was because they meant he could manage without help. The poor communication negatively affectedthe participants perceptions of thenutritional care.

Not being provided with care according to their individual needs at home resulted in patients being dependent on additional support from family caregivers, friends or neighbours. All of the family caregivers that participated in this study regularly did the grocery shopping for the patients. Occasionally, they brought homemade food and accompanied the patients during meals. They provided support that was essential for the patients nutritional well-being; still, they were generally not involved or informed by the healthcare services about nutritional care, and some lacked knowledge about the patients nutritional situations and needs: I really think you need to be good at asking the right questions to get the information you need as a family caregiver. I myself may also seem a bit ignorant about these things? (FC1). One family caregiver described conflicting opinions between her and her mother about how much help she needed with meals at home: They used to come four times a day, and then she told them that she only needed them to come three times a day. Sometimes when I come to visit around six oclock she says, Im so hungry, they havent been here. It was her that wanted them to come three times a day. But now I have asked them to change back to four visits a day so they can cook for her (FC6).

Although the caregivers were generally thankful for the care that was provided to their loved ones, some family caregivers experienced disempowerment during meetings with the care services and felt they were not given the necessary support as caregivers. They felt it was demanding and sometimes exhausting caring for their loved ones because the care services were not able to provide care according to the patients needs. One daughter said, I am her only family and I just cant take it anymore. It is so exhausting, especially since she is so depressed (FC6). When the patients were living together with or close to family caregivers, home care services relied on the caregivers to provide nutritional care, which in some cases resulted in inadequate patient follow-up and burdened the family caregiver: I experience that they keep on asking me to do things. And then I find out that that no, that is not my responsibility (FC6).

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Older patients' and their family caregivers' perceptions of food, meals and nutritional care in the transition between hospital and home care: a...