‘A nutrition and menu audit completes the picture’
Ensuring good nutrition in aged care is so much more than providing great food, writes Ngaire Hobbins.
Ensuring good nutrition in aged care is so much more than providing great food, writes Ngaire Hobbins.
There are wonderful things happening in kitchens in aged care homes throughout Australia – chefs and cooks are preparing beautiful meals; developing new and innovative ways to present texture modified foods; and working with the people living in aged care to ensure the meals on offer support both body and soul.
But, it doesn’t matter how good that food is, unless it makes it into the mouth of every single resident, all that work and dedication can be for naught. As my colleague Professor Liz Isenring says: “It’s not nutrition unless it goes into your mouth.”
Malnutrition is still far too common in aged care despite the input of chefs and others promoting improvements in food supplied to those living there. And, given that food costs are very significant in the face of ever-tightening budgets, the waste of food that doesn’t end up supporting the nutrition of those needing it most, is obviously to be avoided at every opportunity.
When I go in to audit food and nutrition services in residential aged care, I naturally look at the menu and the way it is prepared and presented. But that’s just a very small part. I also follow the food from the stovetop, though corridors and into serveries, dining areas and individual rooms. I observe and chat with staff, residents and visitors. I watch and I listen.
And this is where I often find, sometimes seemingly insignificant system glitches, that end up meaning someone misses out. Sometimes it’s a consequence of a dining environment that fails to bolster flagging appetites or unintentionally creates disincentives to eating well. Occasionally staff are stretched too thin to be able to offer assistance to those needing it while the food is still fresh and at an enticing temperature.
But there are many other ways that systems employed in residential care can create a disincentive to adequate nutrition. That is what experienced aged care nutrition consultants target and work to resolve when we work with providers.
Most of the system faults I see that result in people missing out on the nutrition they need are not obvious to the untrained eye. The great thing though is that, once identified, any issues can be addressed to improve quality of life for residents and avoid costly, unnecessary waste of food.
Malnutrition creates additional costs in residential care beyond reducing an individual’s physical and cognitive capacity or their quality of life. It adds to wound care costs, increases the likelihood of falls, illness and infection, reduces the ability of individuals to dress themselves, get to the toilet and move around independently and much more.
Complaints about food cost staff time and money. It is much better to avoid them while also supporting the nutrition needs of people living in residential care.
It’s my personal belief that the kitchen is the heart of the home regardless of whether that home is the one shared with family throughout generations, or the supported environment of residential care. Chefs, cooks and food service staff offer up what is often the highlight of the day and deserve our utmost respect and support. But to ensure their good work does not go to waste, consulting a dietitian experienced in aged care and especially engaging with that dietitian in a detailed, on site nutrition and menu audit completes the picture. Without that, good food may not be enough.
The Dietitians Association of Australia has developed a Menu and Nutrition Audit Tool to be used by Accredited Practising Dietitians in aged care homes.
Ngaire Hobbins is a dietitian specialising in ageing and brain health, an author and an experienced aged care consultant.
We need to start using technology to measure food intake so that we can take action quickly when a resident or patient is not consuming the meal. As we know since the 80’s there has been no real everyday measurement of intake. There has been much done about improving the nutrition of recipe and menu content but really worthless if not measured. There are now reasonably cost effective softeare programs avalable to do this and should be included based on risk management alone and should be part of any accreditation program.
Ngarie is right there is some great work being done in aged care hospitality, there is certainly a change happening. Menus and nutrition should be linked to the funding stream for aged care providers, this would assist in creating a focus on the importance of this day to day activity that has such an impact on not only a resident but as Ngaire mentions above, the impact on the clinical cost to an aged care provider.
In line with the funding comment, having menus assessed not only on paper, but on site at the time of service is imperative. Dishes can vary greatly in nutritional value if they are either over cooked or held too long, to mention a couple of the number of touch points within the dining experience; if dishes can be assessed for nutritional value, plate appeal along with the dining environment, this would be a positive step forward. The change in the Quality Standards is a great first step…