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Malnutrition screening reported lacking in aged care


L to R: Robert Hunt and Dr Sandra Iuliano

The system needs to focus on the individual and their nutritional needs because currently residents are malnourished and starving to death, the royal commission has heard.

A panel of experts told the Royal Commission into Aged Care Quality and Safety hearing in Cairns on Tuesday about the dire need to improve nutrition in aged care.

Qualified nutritionist and University of Melbourne researcher Dr Sandra Iuliano said the new Aged Care Quality Standards, which came into effect on 1 July, do not meet the needs of residents.

“We should be focusing on the resident and their needs and are their needs being met, not getting the resident and putting them into a system and moulding them to a system,” Dr Iuliano told the inquiry.

Aged care providers need to consult with residents to find out what they want and look at the timing of meals and accessibility of food outside of mealtimes, she said.

“Unless there’s an incentive to actually get those systems in place, I think we’re going to maintain the status quo, which to me at the moment is not appropriate, and it’s inadequate because basically these residents are malnourished and they’re starving to death,” Dr Iuliano said.

Dietitians Association of Australia CEO Robert Hunt told the inquiry that adequate nutrition was a human right yet the aged care system did not encourage nutrition risk screening to identify malnutrition and special dietary requirements.

“There’s no desire to do so. There’s no requirement to do so. And where it is done… one of the key issues is that the people doing the assessments are not necessarily holding the right training to identify, ask the right questions… and then deal with the responses to ensure that they’re getting the right information,” Mr Hunt told the inquiry.

Sharon Lawrence

DAA member and accredited practising dietitian Sharon Lawrence said aged care providers did not have the capacity to implement appropriate nutrition plans.

“At this moment they don’t have the capacity to do that just because they don’t have the skill and knowledge to be able to do that,” Ms Lawrence told the inquiry.

Dietitians are able to support cooks and food service staff to improve their knowledge around specific dietary needs of older people, she said.

“I feel that we’re able to support the services to do that but at this stage that’s not there. It’s not available,” Ms Lawrence said.

Improving nutrition

Dr Iuliano said not enough was being done to ensure that residents had adequate levels of nourishment.

“I find it quite sad that many residents have to rely on family members bringing in food in accord to achieve the foods they want and achieve the nutritional status they want. I think prevention is better than trying to deal with malnutrition,” she said.

Dr Iuliano said there should be a national mandatory minimum education level to work with food in aged care.

“I think if people are going to work in aged care and work with the elderly that we need some kind of standardised national education that they must achieve in order to work in that field because without it – it’s a very specific group of people.

“It’s like paediatrics, we don’t suddenly work in paediatrics with children, you have to be qualified and specialised. They’re as vulnerable as the children so it’s the same scenario,” Dr Iuliano said.

Mr Hunt said there needs to be a national nutrition policy that encompasses the health of all older Australians, a recommendation the DAA made in a written submission to the royal commission.

Nutrition needs to be elevated to the top of the health prevention strategy, he said.

“We have had a silent faceless abuser in the aged care sector for years. It has been tragic around what we’ve seen in terms of the safety of residents. But for years and years and years this silent faceless abuser called malnutrition has been around,” Mr Hunt said.

Ms Lawrence said there needed to be a stronger governance and accountability framework around nutrition across all aged care services.

“Older people want to age in their homes… So why don’t we have a system that supports that process to ensure that their risks of nutrition don’t escalate to a point where they become malnourished,” Ms Lawrence said. “We really need to look at the whole governance approach.”

The Royal Commission into Aged Care Quality and Safety Cairns hearing wrapped up on Wednesday. The next hearing takes place 29-31 July in Mildura, Victoria, and will focus on informal carers and family. The Brisbane hearing follows 5-9 August with a focus on aged care regulation.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. 

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6 Responses to Malnutrition screening reported lacking in aged care

  1. Anton Hutchinson July 18, 2019 at 7:56 pm #

    What a lot of nonsense. I have been in the industry for nearly forty years and without exception the homes I deal with and know all have menus designed by specialist dieticians. They are all aware of specific diets, likes and dislikes, allergies, gluten intolerance, lactose, peanuts and diabetic needs.
    When are we going to start dealing in facts? This ongoing and hysterical exaggeration that certainly doesn’t reflect the true position of the vast majority of Homes needs to stop!
    If you are able to purchase quality products at a better price, just like at home, then why not? Buying on bulk is perfectly acceptable and to buy seasonal products is perfectly fine so the argument that seems to exclusively revolve around price is irrelevant.

    Another factor that seems to be recently ignored is the Accreditation Process where competent assessors visit, check residents weights, menus and talk to residents and families. Do you also think that they allow residents to be starved? Nonsense!

    There has also been a lot of nonsense presented to the Royal Commission talking about “preventable falls”, the only way to prevent all falls is to not stand up at all! Many folk get to nursing homes because they have fallen at home so how about easing up on the BS and deal with some reality for a second.

    As to the recent belief that everyone is better off staying at home then you would do well to ask these carers how they are enjoying their life. They are not! But that also is a generalisation… see how easy it is to write down anything?

    But, if you want to stay at home until you are on deaths door, vulnerable to falls, injury and malnutrition then that’s your decision.

    But, why has it become the taxpayers responsibility to care for someone else’s parent? If you want to stay in your own home you should do it with the support of your family or friends. How did we start to believe that the taxpayer should be paying to mow your lawn or clean your house etc? It’s quite ludicrous and pangs of socialism!

    It’s also rediculous to have people dip into employer superannuation contributions so that you can get IVF or surgery for fatness!!!
    Superannuation was put in place to lighten the future pension burden of an ageing population and certainly not to pay for elective surgeries!

    The world has gone mad!!

  2. Caroline July 24, 2019 at 9:07 am #

    While malnutrition may seem a problem for people in residential care, I’m concerned about older people living at home with or without support and who are still malnourished. I’m not sure about the whole regulation/governance approach to nutrition. I struggle with the onus of responsibility in terms of who is responsible for an older person who is malnourished.

    But this is what I know. My mother was deemed malnourished as she moved through the recognition of a health issue, diagnosis of cancer, treatment, respite and eventually her recent passing of life. A dietitian recommended supplements but my mother’s tastes had changed as had her capacity to shop and cook, and then ability to eat. Yes, she had a L2 HCP but that was totally ineffective and useless. Who cares about the nutrition of older people living at home? Support staff didn’t really notice the changes nor did they report the problem. How could they? They didn’t know my mother before she started to change.

    I don’t have a solution but I do believe that older people living at home should be reassessed regularly by ACAT in collaboration with a GP and family. HCP funding should be adjusted up and down as a person’s need deteriorates and improves. Community ‘cooks’ should be a role in aged care that’s flexible to help a person maintain their nutritional intake. Maggie Beer supports a return to home-like environments in residential care, and validation of a chef’s technical competence. So why not the same in community aged care under the direction of a nutritionist or dietitian? Support staff don’t have the time while some support staff don’t have culinary skills. Here’s our opportunity to upskill a range of community aged care staff.

  3. Pat July 24, 2019 at 3:00 pm #

    it is a sad fact that women need to work these days, and can’t care for their parents. We were able to have our parents live with us when they were unable to live alone, and it was a pleasure which was shared by all. I recall grandmother and great grandmother living with family in their final years and for children, it was lovely to share time together. Support Workers are wonderful in the way they care for the aged, but they are underpaid and overworked. It seems the Providers are the only ones profiting from this situation !

  4. Susan Watson August 1, 2019 at 7:38 pm #

    I completely agree with the comment made by Anton, I have been in the industry a long time also and the providers big and small that I have dealt with have all had menus designed and regularly refreshed by dieticians and nutritionists, at a large cost, but well worth it, and in my experience those meals have been cooked by highly skilled and dedicated chefs, cooks and assistants. You will never please everyone EVER. Taste buds and appetite change dramatically with the elderly, and their children are usually the biggest complainers, as it may not be what they cooked at home for mum or dad before they came into care! Usually when the Auditors come in , the most vocal are the small group of chronic whingers, and then you need to bring out the large group of happy eaters to ensure the minority does not cause havoc.
    There may be a small number of homes who do not have great food? I haven’t seen it. A great deal of a budget goes on food as it should.
    I hope that these people giving this information to the Royal Commission are not just trying to feather their nests!

  5. James August 2, 2019 at 3:58 pm #

    The interesting thing is going to be when the baby boomers hit aged care. They are wanting their prawns and lobster for lunch everyday. I hear it all the time from the children of current residents.
    Guess what, the taxpayers cannot afford that. If they want their gourmet buffets then they are going to have to pay for it themselves!
    Try cooking for 120 people every meal, every day, not easy.

  6. Carmel August 2, 2019 at 4:10 pm #

    What a great article. This is the main issue I have with the home my husband is in. In nearly two years I have not seen or been told about a qualified (and I mean well qualified in being able to assess for malnutrition and nutritional requirements in the elderly) dietitian who has come to him or possibly anyone in the secure unit to assess each person’s individual nutrition and hydration requirements. All residents physical, cognitive and emotional needs are different and this has a major impact on their ability to eat and drink. t

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