Food for thought | Aged Care Quality and Safety Commission

We’re interested in creative ways to improve food, nutrition and dining in aged care.

These positive stories and case studies look at approaches that have effectively changed provider services.

A voice and choice: enhancing residents's food and dining experience

Food and the experience of eating are meaningful and enjoyable parts of everyday life for most people. Choosing what you want to eat is vital for everyone, including people receiving aged care. A well-prepared meal, served thoughtfully, can make people feel cared for, comforted and connected. It can also ensure they’ll want to eat.

The Commission’s recent report, Analysis of food and dining experiences in residential aged care services, says, “people bring a range of tastes, practices and attitudes regarding food with them on entry to long-term care settings”.

Providers must understand the food preferences of residents. They must also offer and encourage choice as part of a person’s overall care and wellbeing. Providers should also know what residents don’t like and don’t want. They should avoid giving them these things. Staff can notice when a resident doesn’t like or refuses food, even when the resident can’t tell them.

What we know

Familiar food that aligns with or represents a person’s personal and family background can provide:

comfort
support recovery from illness
help them adapt to new accommodation.

Traditions around food consumption can provide a powerful link to identity and a sense of self. It also links to all the senses, not just taste and smell.

When traditional or familiar foods are unavailable, the ability to maintain and reinforce individual identity is impeded, thereby affecting quality of life in the residential aged care setting (Evans et al., 2005).

There are many ways providers can support and encourage residents to speak up about their food and dining experience.

Positive story

One aged care service in New South Wales has created a unique way to let their residents have a say about the kinds of food they want to see on the menu and how it’s offered to them.

The food service team set up a wishing well in the dining area. They invited residents to write down their ideas and requests.

The word “well” has multiple meanings and is very appropriate here. The wishing well provided a mechanism for direct feedback and suggestions. Its novelty also fostered much discussion between residents, staff and management about delivering a more fulfilling food and dining experience. This has added to residents’ sense of empowerment, community, and wellbeing.

Ideas and feedback from residents included:

Regular barbecues for both the food and social opportunity
Cultural celebrations with traditional foods
Fresh cake slices as opposed to pre-packaged (potentially hard to open) options
Food outings such as visiting the market for fresh foods or visiting cafes
Incorporating “take-away style” meals into the monthly menu – hot chips are often a favourite.

Meals that evoke memories

An Indigenous residential aged care home has an agenda item dedicated to the food and dining experience at every resident meeting.

Most of their residents grew up in camps or mission locations. They love the smell of fire and smoke and the memories it evokes. They’ve expressed a wish for more barbecues at the home.

The residents said kangaroo tail was everyone’s favourite food to barbecue. They also mentioned they loved tinned bully beef (or corned beef) with damper. This reminds them of a treat they enjoyed when they were younger.

Both these meals are now regularly served at the home. The staff buy kangaroo tails and keep them in the freezer when they can access them. When they’re unavailable, they cook oxtail in the fire instead.

These meals aren’t just about the food. They’ve become a meaningful experience for residents. They take a long time to eat these meals and savour every mouthful. This is all while they sit together around the raised fire pit and share memories.

Improving food, dining and nutrition through resolving complaints

Food and dining should be enjoyable, respectful, safe and based on the preferences of people receiving aged care.

Standard 6 of the Aged Care Quality Standards (Quality Standards) highlights how providers can enhance the food and dining experience of their residents by listening to their feedback and acting on it. Positive feedback can reinforce things that work well. At the same time, complaints can help identify what’s needed to improve care and services.

We also have a role to play. We work with the people who send in complaints as well as providers. We help them agree on how:

the issue can be resolved
actions to resolve the issue.

The aim of this process is to:

resolve complaints quickly and effectively
help aged care providers improve the quality of their services.

The Food and dining – your choices matter fact sheet explains how we address and resolve concerns about food.

Positive story

A person receiving aged care contacted us to raise concerns about the food provided at her residential aged care service.

The woman wanted more variety in the service menu. She also mentioned:

the food didn’t match the menu
she wanted lamb cutlets to be added to the menu
other residents were also unhappy with the lack of choice at meal times.

The complaints officer examines these concerns with the woman who submitted the complaint. The helped her work out what she wanted the provider to do differently.

The Commission then contacted the provider to talk about:

the issues raised
assessing the risks involved
how the service could help fix the problem.

The service manager was open to this conversation. They acknowledged that sometimes the food didn’t match the description on the menu. The also mentioned that lamb cutlets weren’t on the menu because some residents couldn’t eat them safety.

The manager was willing to identify actions that the service would take to improve things. They proposed a barbecue once a week. This would allow the person who complained to eat food that fit her preferences.

The manager also mentioned that they:

were in the process of creating a new menu that would provide more variety to residents
worked with a dietician to ensure the menu met the dietary needs of their residents.

Based on the information provided by the service provider, the Commission was happy with the actions taken by the service. The complaints officer let the woman who complained know the outcome. She was pleased with it, too.

Dining with dignity: Texture-modified meals

Being treated with dignity and respect is essential to a person’s quality of life, even after moving into an aged care home.

Standard 1 of the Quality Standards covers consumer dignity and choice. It captures the importance of a person’s sense of self.

When it comes to food, dining and nutrition, it’s essential to:

empower residents to dine with dignity
ensure a safe and enjoyable mealtime experience.
provide residents with nutrition and hydration that helps them maintain good health and quality of life.

Positive story

A resident at a small residential aged care service has swallowing difficulties. They can’t swallow certain foods or liquids because there’s a high risk that it will enter their airway instead of their oesophagus.

The resident is required to have texture modified diets (TMD). This means that the texture of their food and the thickness of their drinks need to be adjusted to make them easier and safer to swallow. They feel embarrassed by this and don’t want to eat in front of others. They think the meals look sloppy and unappealing. They’re also very different from the food other residents are eating.

This had a significant impact on the resident’s physical and mental wellbeing. They feel unhappy and frustrated. As a result, they begin to lose weight and are at risk of malnutrition.

As a result, the service develops a strategy to make texture modified meals more attractive and appetising. They do this by changing how the food is prepared and presented.

The food served to the resident with TMD is now moulded to look like the solid food served to other residents who don’t have swallowing difficulties. For example, pureed carrot is presented in the vegetable's shape instead of scoops.

With these changes, the resident is happy eating with the others. Their health has improved, and they have regained the weight they lost.

Dining experience: Hot toast and fresh coffee

Both providers and aged care staff play a role in delivering the right dining experience for every resident in their care. Thoughtful actions, even small ones, can lead to a satisfied resident.

The presentation and temperature of food and drinks can positively influence resident satisfaction. Residents tell us that they are less likely to eat meals that aren’t hot or cold enough. For example, lukewarm soup or melted ice cream. Other factors that can affect the dining experience within aged care services include the:

environment
service
ambience
aromas
company
allocated time for eating
serving size.

For more information on how to improve meals, nutrition and the dining experience, read our:

Positive story

Making hot toast and fresh coffee or tea is a simple task. However, the distance between the kitchen and the dining room or individual rooms can affect how hot tea or coffee is when delivered.

A facility manager at a small aged care service looked at feedback from their residents. The feedback highlighted the importance of serving food and drinks at the right temperature. It showed residents weren’t happy with the temperature of coffee and toast at breakfast. The coffee was lukewarm, and the toast looked soggy and unappealing.

The facility manager looked at solutions that would help the resident have a good experience to start their day. Most of the residents at this service chose to have breakfast in their rooms. It lets them decide when they get up and eat.

The management team explored some options. They agreed to purchase a breakfast cart with a coffee machine and toaster. This cart was designed to deliver breakfast to residents’ rooms promptly. It also ensured food and drink stayed at an appropriate temperature. The aroma of the freshly made coffee and hot toast also improved the residents’ appetite and created a positive atmosphere.

This case study highlights how simple and creative solutions can help residents to have a great dining experience.

It’s also important to remember that there isn’t a ‘one-size-fits-all’ approach for food delivery, timing and temperature management. What works well with one provider may not work well with another. Providers can also maintain the temperature of food and drink using:

aluminium foil
warm plates
bain-maries
hot box trolleys
soup warmers
thermoses
eskies.

Submit a positive story

If you have creative suggestions for improving food, nutrition and dining in aged care, we’d love to hear from you.

Email your stories, case studies and ideas to info@agedcarequality.gov.au.

These positive stories and feedback from the webinars will inform further engagement and education activities for the broader sector.

You can also send any supporting videos, photos or other visual material. Ensure you have permission from anyone featured in videos or photos before sharing them with us.