Food, Nutrition and Dining (providers)

Our theme to inspire you is the ‘Happy Hour Trolley’. Think mocktails and fun snacks! 

The trolley serves up:

• bite-sized tasty treats and morsels (which can be held in the hand without the need for a plate or cutlery)
• colourful, fruit or milk-based smoothies served in decorative plastic cocktail glasses and garnished with little paper umbrellas, striped straws, and swizzle sticks to give a festive feel.

You can roll it out for special occasions or on a regular basis. When providers have presented this simple yet engaging idea to residents, they report that it generates a ‘buzz’, increases enjoyment in the dining experience and brings the community together. It can also have a positive impact on both the mental and physical wellbeing of residents. Add a little music to brighten the festivities.
 

Food and the experience of eating are important and enjoyable facets of everyday life for most people. Getting to choose what you want to eat is something most people also take for granted. These “simple” things are no less important for residents in aged care facilities. A well-prepared and thoughtfully served meal can make people feel cared for, comforted, and connected. It can ensure they want to eat. 

As reflected in the Aged Care Quality and Safety Commission’s recent report, ‘Analysis of food and dining experiences in residential aged care services’, “people bring a range of tastes, practices and attitudes regarding food with them on entry to long-term care settings”.  

It is therefore vital that residents’ individual preferences for food are understood, and that choice is offered and encouraged as part of their overall care and wellbeing. It is also important to know and detect what residents don’t like and don’t want, and to clearly avoid giving it to them. Staff can notice when a resident doesn’t like, or refuses, foods even when the resident can’t tell them.  

Why? Well, we know that: 

• Familiar food that aligns with or represents one’s personal and family background can provide comfort, support recovery from illness and help adaptation to new accommodation. 
• Traditions surrounding food consumption, learned within families as children and carried forward into families as adults, can provide a powerful link to identity and 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 you can support and encourage residents to have a voice about their food and dining experience. 

Positive story:

One aged care service in New South Wales has come up with a novel approach to give residents the ability to have a say about the kinds of foods they want to see on the menu and the way they are offered to them. The food service team has set up a wishing well in the dining area inviting residents to write down their ideas and requests. 

The word “well” with its multiple meanings is so appropriate here. The wishing well has not only provided a mechanism for direct feedback and suggestions, but its novelty has also fostered lots of discussion between residents, staff, and management on ways to provide a more fulfilling food and dining experience. This has added to residents’ sense of empowerment, community, and wellbeing. 

Ideas and feedback have included: 

• Regular BBQs 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 

Helpful resources  

We have developed a range of resources to support providers to focus on and deliver high-quality, safe, and enjoyable food and dining experiences. Many providers are already making meaningful improvements and have satisfied and better nourished residents with a better quality of life. 

• Goal planning tool – a planning document for providers to improve food, dining, nutrition, and consumer choice  
• Food and dining preferences fact sheet – a planning sheet for recording a resident’s preferences around food and dining  
• Webinars – topics have included the dining experience and consumer choice and the real-life case study of Whiddon to deliver good food and nutrition  
• Analysis of food and dining experiences in residential aged care services – a survey of residents in aged care services across Australia on their food and dining experience

Providers and aged care staff each have a role to play in delivering the right dining experience for every resident in their care. Thoughtful actions, even small ones, can lead to significant resident satisfaction.

Presentation and temperature of food and drinks can positively influence resident satisfaction. Residents tell us that they are less likely to eat meals that are not hot or cold enough (e.g., 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, time provided to eat and serving size.

More ideas on how to improve meals, nutrition and the dining experience for older people at residential aged care services can be found in the Residential aged care food services discussion paper and the Analysis of food and dining experiences in residential aged care survey final report.

Positive story:

While delivering hot toast and fresh coffee or tea may seem simple enough, for some services the distance from the kitchen to the dining room or individual rooms can be challenging. It can result in food and drinks being served hot, sometimes lukewarm or cold depending on the length of time it takes for staff to transport the meals.

A facility manager at a small residential aged care service considered residents’ feedback which highlighted the importance of serving foods and drinks at the right temperature. Residents were not satisfied with the temperature of the coffee and toast served during breakfast - the coffee was lukewarm, and the toast looked soggy and unappealing. The facility manager looked at solutions to ensure that residents would have a good experience to start their day.

Most of the residents at this service elect to have breakfast in their rooms as it enables them choice over when they eat and when they get up.

After exploring options, the management team agreed to purchase a breakfast cart with a coffee machine and a toaster. This was specially designed for the delivery of breakfast to residents’ rooms in a timely manner and at an appropriate temperature. The aroma of the freshly made coffee and hot toast also resulted in improved resident appetite and create a positive atmosphere.

There is no 'one-size-fits-all' approach to food delivery, timing and temperature management. What works well in one service may not work well in others, and this case study highlights how simple and creative solutions can deliver a great dining experience for residents. Temperature of meals can also be maintained using aluminium foil, warm plates, bain maries, hot box trolleys, soup warmers, thermoses and eskies.

Being treated with dignity and respect is essential to a person’s quality of life. This does not change after a person enters a residential aged care service. Standard 1 of the Aged Care Quality Standards – Consumer dignity and choice - captures the importance of a consumer’s sense of self.

When it comes to food, dining and nutrition, empowering residents to dine with dignity and ensuring a safe and enjoyable mealtime experience is as important as providing them with nutrition and hydration to maintain good health and quality of life.

Positive story:

A resident at a small residential aged care service has swallowing difficulties. The resident is unable to swallow certain foods or liquids as there is a high risk that their condition can cause the food or drink to enter their airway instead of their oesophagus.

The resident is required to have texture modified diets (TMD). This means that the texture of the foods and the thickness of drinks need to be adjusted to make them easier and safer to swallow. The resident did not want to eat in front of others as they felt embarrassed about the texture modified meals provided. They felt that the meals looked sloppy and unappetising, and very different from the food that other residents were eating.

This had a significant impact on the resident’s physical and mental wellbeing. The resident was unhappy and frustrated, and they began to lose weight and were at risk of malnutrition.

To support the resident, the service came up with a strategy to make the texture modified meals more attractive and appetising by changing the way the food was prepared and presented.

The food served to the resident with TMD is now moulded to look like the solid food that is served to other residents who do not have swallowing difficulties. For example, pureed carrot is presented in the shape of a carrot instead of scoops.

As a result, the resident is now happy to eat with the others, their health has improved, and they have regained the weight they lost.

Food and dining should be enjoyable, respectful, safe and based on what people living in residential aged care like and don’t like.

Standard 6 of the Quality Standards highlights the opportunities available to providers to enhance the consumer’s experience of food and dining by listening carefully to their feedback and acting on it. Just as positive feedback can reinforce things that work well, complaints can help identify what is needed to improve care and services. The Commission has a role to play here too, in receiving complaints and working on the complainant’s behalf to ensure that their concerns are addressed.

In the course of our complaints resolution process, the Commission works with the complainant and the service provider to help them come to an agreement on how issues can be resolved and what action will be taken. The aim is to resolve complaints quickly and effectively, and to assist aged care providers to improve the quality of their services.

The Food and dining – your choices matter fact sheet for consumers is now available to explain the Commission’s role in helping to address and resolve their concerns if the food provided doesn’t meet their expectations. 

Positive story:

A person receiving aged care services contacted the Commission raising concerns about the food provided at her residential aged care service.

The complainant was dissatisfied about the lack of variety in the service’s menu and that the food served did not match the menu. She also expressed her wish for lamb cutlets to be on the menu. The complainant told the Commission that other residents were also dissatisfied with the lack of choice about the food offered at meal times.

The complaints officer explored the consumer’s concerns with her and helped her to work out what she would like the provider to do differently.

The Commission then contacted the service to discuss the issues raised, assess the risk involved and talk through how the service could help fix the problem.

The service’s manager was open to this conversation and willing to identify actions that the service would take to improve things. The manager acknowledged that sometimes the food served didn’t match the descriptions in the menu. They also explained that lamb cutlets were not currently served because a number of residents weren’t able to eat them safely. However, the manager proposed having a BBQ once a week which would enable the consumer to have items of her choice. 

The manager also advised that the service was in the process of creating a new menu to provide more variety to residents. Following the complaint, the service sought further input from the complainant in this process. The service also consulted a dietitian to ensure that the menu met the dietary needs of residents.

Based on the information provided by the service provider, the Commission was satisfied with the actions taken by the service. The complaints officer advised the complainant of the outcome and she confirmed that she was satisfied also.

An Indigenous residential aged care home has a standing agenda item at its residents’ meetings dedicated to the food and the dining experience.

As most of the residents grew up in camp or mission locations, they expressed their wish for more barbeques at the home, as they love the smell of the fire and smoke and the memories this evokes.

The residents said kangaroo tail was everyone’s favourite food to barbeque. They also said that they loved tinned bully beef (or corned beef) with damper, as this reminded them of a treat they enjoyed when they were younger.

Both of these meals are now regularly served at the home. When staff can access them, kangaroo tails are bought and kept in the freezer. When they’re not available at all, oxtail is cooked in the fire instead.

These meals have become a treasured and meaningful experience for residents – and one that is not just about the food. Residents take a long time to eat these meals and savour every mouthful, while sitting together around the raised fire pit and sharing memories.