Improving food standards: 10 points to consider

The dining experience alongside the obvious benefits of good nutrition are important to the health and wellbeing of older Australians, although poor experiences are purportedly common in long-term aged care facilities.

The Royal Commission into Aged Care Quality and Safety Final Report released in 2021 identified food and nutrition as a priority area of attention. This recommendation led to a basic daily fee supplement of an additional $10 per day per resident from the Australian Government since 1 July 2021. This has since been replaced by the AN-ACC funding model which became operational on 1 October 2022.

Aged care facilities have already been innovative in their attempts to improve food quality and standards, and now a new discussion paper from the Aged Care Quality and Safety Commission offers new points of focus for further improvement.

1. Improved meal choice and quality

Appetite is clearly linked to the enjoyment and consumption of foods so menus should focus on promoting appetite by maximising flavours and aromas.

Choice, including food choice, is fundamental to the Aged Care Quality Standards.

Food presentation is also a key component of high-quality food service and food must be nutritious, familiar, culturally appropriate, well presented and part of a positive mealtime experience.

Regular and formalised collection and review of individual preferences should be undertaken to support satisfaction.

2. Alternative food service delivery models and innovation

To promote food intake, as well as resident satisfaction, alternative models of food service delivery could be considered.

Dining experiences that reflect a ‘normal’ home life in some way can provide comfort and familiarity. Residents should be enabled to make their meal choice at the point of service, or as close as possible, rather than ordering prior to mealtimes.

Innovative methods, such as assisted buffets, carts and room service, are potential options.

Residents could be involved in weekly menu design, shopping and meal preparation.

3. Evidence-based menu planning and assessment

Meal planning should be based on meeting the specific nutrition and dietary needs of older adults.

Where not in place at present it is recommended that dietitians and speech pathologists regularly review menu options to ensure these align with older adult dietary requirements and special chewing or swallowing considerations.

4. Routine malnutrition screening

Older people are at increased risk of unplanned weight loss and malnutrition.

Multiple validated nutrition screening tools are available to determine the nutritional status of adults within aged care settings. This can be enhanced with a multidisciplinary team.

5. Support for independent food and drink consumption

Accessibility of food may be further promoted through the provision of assistive mealtime eating and drinking utensils and placing food within sight and reach of the resident to encourage autonomy.

6. Food delivery, timing and temperature management

Food service timing and delivery should be considered to better accommodate resident needs and staff availability. This could include greater flexibility of mealtimes to enable increased time with each resident as necessary.

The temperature of meals can be monitored through the use of appropriate food utensils and consideration of the distance from the kitchen to the resident.

7. Ongoing quality review and consumer feedback mechanisms

Obtaining more detailed feedback from residents can help food service managers in identifying specific aspects of the food or service that are causing dissatisfaction.

Results of quality evaluation surveys should be used to benchmark and focus the food service’s strategies to enhance quality performance and customer satisfaction.

Surveys, comment cards, and personal interviews are some suggested methods to obtain valuable feedback about the food and service quality from residents.

8. 24-hour dining and access to fluids

Services to ensure snacks such as fruit or other nutritious food items are available throughout the day and between meals for residents as appropriate. These may include yoghurt tubs, custard pots, cheese and crackers.

To prevent dehydration, ready access to water and other fluids for all residents is critical.

9. Dining room ambience

A ‘homelike’ dining environment can improve resident enjoyment of mealtimes and contribute to a sense of comfort and familiarity.

Dining room environmental changes can include appropriate lighting, comfortable furniture, or playing music during mealtimes. Dining rooms, including furniture, equipment, crockery and utensils require regular review for cleanliness and hygienic practices associated with meal service.

10. Increased emphasis on oral health

Greater emphasis to be placed on ensuring oral hygiene, including frequent brushing of teeth and daily denture cleaning, to prevent issues with eating for residents. This may also entail seeking necessary care to respond to other issues affecting food and liquid intake such as dry mouth or ill-fitting dentures.

The establishment of a multidisciplinary team with members of the dental profession, speech pathologists and dietitians may contribute to the management the oral health, swallowing and hydration of aged care residents.

Image credit: iStock.com/Cecilie_Arcurs