Collaboration to tackle malnutrition in aged care

In an initiative to tackle malnutrition in older Australians, Meals on Wheels Australia has partnered with nutrition advocates calling for the Federal Government to fund the development of easy-to-follow dietary guidelines for people over 70 years of age.

“If there was one underlying investment that the government could make, it would be getting these healthy eating guidelines for older people written in such a way that older people themselves could follow them, as could anyone supporting their care – particularly those supporting people in residential care,” MoWA president Sharyn Broer told Australian Ageing Agenda.  

Headed by MoWA, the collaboration of organisations – called the Nutrition for Older Australian Alliance – include Dietitians Australia, Nutrition Australia, the Public Health Association of Australia and the Maggie Beer Foundation.

In a pre-budget submission, the alliance has called on the government to:

• fund the development of a specific set of dietary guidelines for people over 70 years of age
• fund successful public education, implementation support, monitoring and evaluation of the dietary guidelines.

In order to action the recommendations, the alliance has asked for a government investment of $5 million.

While there are national guidelines for people providing community meals and home-delivered meals (designed by MoWA), “There is no national standard for nutrition of older people receiving residential care,” said Ms Broer.

“There’s a real lack of primary health information for people as they age to know what it is that their bodies need to keep them strong and healthy,” she added. “There are very few older adults who are aware that their body needs more protein as a component of their diet than they needed in their 50s or indeed in their 20s.”

The aged care royal commission cited studies that found two-thirds of aged care residents are malnourished or at risk of becoming malnourished.

Robert Hunt, CEO of Dieticians Australia, gave evidence before the royal commission. Mr Hunt told the panel that a supply of healthy, nourishing food for people in residential care was a “human right”. “I also said to the commission that there was a silent and faceless abuser in aged care, and its name is malnutrition,” Mr Hunt told AAA.

Research shows a causal link between malnourishment and a greater risk of fractures and falls, poor wound healing, muscle loss, a weaker immune system and a poorer quality of life.

The COVID pandemic has further exacerbated the issue of malnutrition in aged care settings. Under lockdown, residents have been unable to receive visits from loved ones who may otherwise had provided snacks or assisted with feeding.

Where’s the BDF supplement going?

In August last year, the government introduced a Basic Daily Fee supplement of $10 a day to help providers pay for daily living services in exchange for reporting quarterly on expenditure related to these services – particularly food.

However, Mr Hunt told AAA that the cash isn’t going to the caterers. “I’ve been advised by a number of senior executives in catering companies that they have seen no increase in spend coming their way to provide food into the aged care sector,” he said. “If you look at an average home of a hundred residents,” continued Mr Hunt, “that’s $1,000 a day, and it’s not going to food – so where’s it going?”

Grant Corderoy is senior partner at aged care benchmarking specialist StewartBrown. Speaking to AAA, Mr Corderoy was quick to point out that the BDF supplement was not intended to be spent entirely on food. “It was used to make up the shortfall of the everyday costs of the basic daily fee,” he said.

Of the $10 a day, for the first quarter of September 2021, Mr Corderoy said only about $2 was additional expenditure. Of that, $1.20 was related to additional food expenditure. “The actual physical ingredients went up from $12.50 to $12.92 … 50 to 60 cents per bed per day. The rest was probably spent on preparation or supplements.”

While Ms Broer acknowledged the government’s effort “to encourage providers to spend more on food,” it is, she said, “the tip of the iceberg”. “It’s not just about investing in the raw ingredients that people are consuming,” said Ms Broer.

Citing anecdotal evidence from colleagues in the residential aged care sector, Ms Broer said a major challenge for providers is being able to maintain adequate care staff on the floor during mealtimes. “The catering team could’ve put together the most nourishing, most delicious menu that they possibly could, but if the consumer can’t functionally manage to eat the food independently, then that person simply won’t be eating well enough.”   

Mr Hunt said that in order to tackle the issue of malnutrition in residential aged care homes, we at first need to know the extent of the problem. “Every person going into a residence or getting a home care package should be screened for malnutrition,” he said. If someone is identified as being malnourished or at serious risk of being malnourished, then an accredited dietician could then be brought in to devise an eating plan.

“The evidence has shown quite clearly that if you don’t get the nutritional impact right, the oldies will trip over, fall, and break a hip,” said Mr Hunt. “They go to public hospitals, and they never come back.”

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