Aged care providers are using innovative and practical solutions to ensure residents with special diets are well-fed and well-nourished, writes Sandy Cheu.

A new approach to presenting texture modified food to aged care residents on special diets need means they need never miss out on enjoying smoked salmon or cocktail prawns at a facility food-based event again.

The residents living with dysphagia at Lifeview, a residential aged care provider with facilities in Melbourne, now have all of their party favourites pureed onto flat-bottomed soup spoons.

This technique has been a game-changer for residents because texture modified food often looks unappetising, says Stephen Milsted, manager hospitality services at Lifeview.

“Our residents have the same emotions as us and they have the same values except they’re in aged care and they’re dependant on us to make a nice meal for them. Their ideas of a nice meal are the same, except they can’t eat a normal piece of roast beef or a chicken Kiev, so we have to ensure that it at least looks presentable on the plate,” Milsted tells Australian Ageing Agenda.

Stephen Milsted

The idea to pipe pureed foods onto spoons came about when Milsted and his colleagues were looking for ways to ensure residents with swallowing difficulties would not miss out on enjoying the food other residents would be eating at their Christmas parties.

“When you go out to a cocktail party, you have your lovely prawns and homemade quiches and you just pick it up and eat it with no thought. And that’s just what you do. But when you have a swallowing difficulty, for instance, you can’t do that,” Milsted says.

“We looked at the presentation in the form of finger food. We had smoked salmon mousse pureed and put it on a flat Asian style soup spoon so it would be finger food for them too. It was presented differently, but it was actually the same food, so it wasn’t as if they were being left out,” he says.

Other food piped onto spoons at the Christmas party included plum pudding, chocolate ganache tarts, fruit mince and chicken. Lifeview chefs use similar techniques to cater for residents with swallowing difficulties at other events – including the 97-plus party to celebrate life – to ensure everyone is eating the same food.

During Nutrition and Hydration Week, the provider offered a range of soft foods, such as ice cream, milkshakes, and smoothies, to ensure residents with swallowing difficulties could also enjoy the items on the menu. Ensuring all residents are included at food-based events is a priority, says Milsted.

“When we have special events, we always make something different and we always have something that will help the residents feel included. We don’t want to exclude people because they have a problem swallowing. And we want it to look good. We don’t want it sitting on a plate looking like a lump of rubbish. We want it to look nice and we want people to be fed.”

Both staff and residents are benefiting from using different methods to present food, such as the spoons, but the feedback wasn’t necessarily from the residents straight away, he says.

“First it was from the carers who feed the residents, who thought it was great. And then people were saying residents were eating more and they were gaining weight, so from the health perspective, that’s fantastic.”

A Lifeview resident eating an ice cream

Food presentation is everything, says Milsted. “How food is presented is an important factor as to whether the person is going to eat it or not.” Techniques such as using an ice cream scoop for meat, vegetables and gravy “look hopeless and terrible,” he says.

Instead it’s about looking at how to present it in and what to present it in because the goal is for residents to eat real food, Milsted says.

“We want them to eat real food because that’s where the satisfaction levels come from. Residents enjoy the food and they’re happy because they’re well-fed and they get nutritional food. That makes a hell of a difference to the morale of the person and the morale of the home.”

Tools improve food delivery

Aged care executive chef Deborah Cairney says ensuring residents with special diets are well-fed and eating nutritious food is also the goal of Hunter Valley Care, which has four aged care facilities in regional New South Wales.

She and her colleagues use hospitality management system Aged Care Genie to help meet the food-based needs of residents and assist with meal planning. Cairney says the cloud-based tool supports them to create customised recipes for residents with special diets.

“When we put in our recipes, we link all the different diets, for instance gluten free, diabetic and residents who require pureed meals. And then the system allows us to identify all the different diets with those recipes,” Cairney tells AAA.

Deborah Cairney using Aged Care Genie

“When a chef goes in and clicks on the recipe, they can see that this recipe has to be made for gluten free people, diabetics or any other type of diet,” she says.

The tool has been instrumental in ensuring all residents, especially those who require special diets, are receiving correct nutrition levels, says Cairney. 

“Each menu is done to incorporate resident choice as well as their allergies. So when I put recipes into the genie, it will show consistency and any errors. If the menu doesn’t have the nutritional value required, it will tell you that,” she says.

The program also helps with  purchase control, and menu costing and a  stock-taking feature aids waste reduction.

“Each recipe I put into the genie is costed and it is all portion controlled. Each item is weighed for the recipe and then it costs it all out. That’s where you can see the savings and whether or not that meal is going to be too expensive or has the right nutrition in it,” she says.

 “Since implementing the system here, my wastage has gone down by 50 per cent. We do stock-taking monthly or every three months depending on what the facility requires and it will show you what stock you have on the shelves or what is not being used, so we cut back there,” she says.

Cairney says her food-related costs have decreased by 25 per cent since the provider first implemented the tool 18 months ago. The tool has also been beneficial for staff, who have been able to easily work with the recipes. 

“If your main chef is sick, you can have someone come in and click on the genie and just know exactly what ingredients are required for that recipe and instructions on what to do.”

It’s improved the delivery of food to residents because residents are getting the choice and variety they require, as well as the right nutritional values, she says.

“You know exactly what the residents are getting and the amount that they require to have for that meal in their proteins and carbohydrates and if they have any allergies. You have all that information there at hand.”

Another tool supporting residents with special dietary needs is Nutrition Professionals Australia’s benchtop guide to nutrition care and therapeutic or special diets known as Meal Plans for Older People.

Retirement living and aged care provider Aveo Group is among those using the guide to assist the planning of nutritious based menus for residents with special diets. Linda Clarke, Aveo Group regional catering manager residential aged care facilities, says the meal planner helps provide an understanding of the food items required for residents with special diets.

“With modified meals, it helps to understand exactly what is expected, such as how much protein or carbohydrates we need to give them,” Clarke tells AAA.

Linda Clarke

“As the elderly get a bit more frail, it is important to incorporate the extra protein with our modified meals.” Popular modified meals include milkshakes, porridge and desserts, she says.

Before using the guide, Aveo chefs were using “sheer luck” to assist with their menu planning, says Clarke. Conversely, the benchtop guide helps to provide good recipes for modified diets and supports Aveo to continue prioritising chemical-free meals.

“We work very closely so we don’t bring in chemical provided proteins. We try use natural proteins and that has been a great help because they’ve provided us with quite a few good recipes,” Clarke says. “The benefit is mainly the fact is that there is not the chemical aftertaste left.”

Clarke says residents have reported the natural approach tastes better. “Because sometimes with the chemical-based ones, you put in porridge and it just it takes the taste away,” she says.

Clarke recommends the guide as an extremely helpful to for supporting residents with special diets. “It’s easy to follow and it’s something to go back to if you need any help or any recall.”

Main image: Lifeview is piping pureed foods onto flat-bottomed spoons to ensure residents with swallowing difficulties do not miss out.

This article first appeared in Australian Ageing Agenda magazine (Jul-Aug 2020).

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