Lack of funding and a “silo” mentality means dietitians are being under-utilised in residential aged care where they could play an important role in improving residents’ nutrition and dining experiences, a researcher says.
A study by Olivia Farrer, a lecturer in nutrition and dietetics at the College of Nursing and Health Sciences at Flinders University, found that cooks, chefs and food service staff want to work with dietitians, but lack the opportunity.
Her study, published in the current Australasian Journal of Ageing, comes amid reports that some facilities spend as little as $6 a day to feed each resident, and controversial claims by industry head Sean Rooney on Four Corners last Monday that aged care residents have a “low nutrition requirement”.
“It is widely accepted that meals in RAC are a key factor in residential satisfaction and nutritional outcomes,” she writes in The role of dietitians in aged care: How do cooks and chefs perceive their contribution.
“But institutional food services frequently receive criticism, particularly in association with a rising prevalence of malnutrition in aged care residents.”
The study grew out of evaluation of the Creating an Appetite for Life program created by celebrity chef Maggie Beer in 2015, in which chefs and cooks said they regarded having a dietitian as both a barrier and enabler for change.
“These comments obviously piqued our interest,” Farrer told Community Care Review. “We decided to further probe these ideas.”
In her subsequent study Farrer conducted focus groups and interviews involving 38 chefs, cooks and food service managers.
“Key findings were that there is great potential for collaboration, if we can maintain a good level of communication and be more accessible to chefs and cooks,” she said.
No requirement for dietitians in aged care facilities
There is currently no requirement to have dietitians employed onsite in residential aged care and they are usually contracted to review residents where there is weight loss or malnutrition.
Apart from that, dietitians are usually called once a year for menu review and reporting required for accreditation, although rural and remote facilities may have to rely on telephone or skype in lieu of a visit.
Farrer says as professionals with the skills and qualifications to provide expert advice, dietitians are ideally positioned to act as advocates for residents and a resource for food service staff.
She says her study highlights that while cooks and chefs want to benefit from the expertise of dietitians, there is a lack of funded time for this.
“In my experience it is not the norm for facilities to facilitate meetings between clinical and food service staff or dietitians, as would happen in an acute care facility,” she says.
“Unfortunately this means that often clinical and food service dietitians contracted to residential aged care homes are working in silo resulting in reduced clinical effectiveness.
“In an ideal world, food service dietitians would be funded to have more frequent visits to aged care facilities where we could offer a huge number of services.”
How dietitians can help in residential care
- Support and facilitate food focus forums with residents
- Assist with menu design and audit
- Observe meals and offer suggestions to enhance the dining experience
- Offer in-house training for care and food service staff
- Advise in presentation of moulded meals
- Advise on strategies to reduce needs for supplements
- Screen for malnutrition/weight loss
- Management of allergies
Farrer says despite various best-practice documents there are currently no mandatory guidelines for nutrition in aged care other than a requirement to meet accreditation standards, potentially creating inconsistency and confusion.
Her paper proposes a widely accepted guideline for nutrition and aged care that could be endorsed by key stakeholders such as food service staff, RAC management, Dietitian’s Association of Australia and dietitians to create more consistent practices between residential aged care homes and consulting dietitians.
Dietitians are also increasingly working with older adults in the community and home care sector, she says.
You can read Farrer’s study here.
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