What does this Standard mean for workers?

Standard 6 describes requirements for providing older people in the residential care home with nutritious, appetising and safe food and drink and enjoyable dining experiences*.

Tips for workers

Workers involved in assessment and planning

You should find out the older person’s needs, goals and preferences in relation to food, nutrition, drink and the dining experience and manage any associated risks.

Risks may include:

• clinical and other physical issues that impact an older person’s ability to eat, including:
  • oral health
  • ability to chew and swallow
  • the impact of medications on appetite
  • the impact dementia can have on appetite
  • dysphagia and dexterity
• dietary needs and modifications (including nutritional needs, allergies and intolerances, texture, and cultural and religious needs)
• preferences, including what they like and dislike, and favourite foods
• the level and type of support an older person needs to eat or drink, including:
  • seating and positioning needs
  • dexterity
  • needing physical help to eat and drink
  • needing to be reminded to eat
  • needing help cutting up their food for them
  • specialised mealtime assistance.

Older people who require enteral nutrition (nutrition and hydration that is delivered via a tube) will need careful and specific planning in line with contemporary, evidence-based practices and guidelines, and in consultation with relevant registered health practitioners and allied health professionals. This includes consideration of:

• the timing, temperature, and volume of enteral formula and water flushes, with consideration of any food or drink they may consume orally
• safe administration, including the skills of the person administering enteral nutrition, positioning, and cleaning of equipment
• the environment, such as temperature of the room and location in which it is provided
• regular ongoing monitoring and reassessment of nutritional requirements and tolerance

Workers involved in menu development and cooking

Your organisation should have processes for actively involving older people in designing menus. This includes finding out what foods and drinks should be on offer to create an enjoyable dining experience.

You should assist your organisation with getting feedback on a regular basis from older people about the menu, meal quality and dining experience. Use feedback to shape menu offerings, make sure meals meet the preferences of older people, and improve the overall dining experience.

You should follow the food safety principles outlined by your organisation. You should make sure the food prepared and served to older people meets their individual care and services plan, as required by legislation.

You should think about how to present food and drink to older people in an appealing and appetising way. This may include, thinking about:

• presentation
• temperature
• plating
• presentation of texture modified foods (including through use of moulds, piping or scoops).

You should offer choice and variety for older people. For example, by:

• offering a variety of options for every meal
• having different condiments or sides available to accompany meals
• changing the menu regularly
• having meals for special occasions, such as themed events
• supporting older people to make their own basic snacks and meals when they want to
• offering choice in the serving size.

You should have nutritious snacks or alternative meals available for older people who:

• want to eat between meals
• may have missed the regular food and drinks service
• don’t want to eat what is on the menu.

You should provide opportunities for older people to share food and drinks with their loved ones. Allow loved ones to join meals at the residential care home.

Workers involved in supporting older people to eat and drink

You should know and support each older person’s needs, goals and preferences in relation to food, nutrition, drink and the dining experience and manage any associated risks. This includes being aware of any allergies, food intolerances, dietary requirements and additional support the older person may need. These should be documented in their care and services plan. For example, you could consider:

• if they need to be reminded and encouraged to eat and drink if they need to be supported to safely eat or drink, and what physical support they need to safety eat and drink at their preferred pace
• if they have particular seating requirements or need certain utensils
• where they like to eat and who they like to eat with
• what makes a positive dining experience for the older person.

It’s important older people get the help they need to eat and drink, otherwise they can be at risk of malnutrition or dehydration. Your organisation should make sure sufficient workers are available to support older people to eat and drink in a way that meets their needs, goals and preferences and at a pace that suits them.

You should recognise and seek feedback when an older person has not eaten much and ask them why. It could be because:

• they didn’t like the food
• the serving size was too large
• it wasn’t served at the right temperature or in an appetising way
• they didn’t have the support they needed to eat or drink
• there are other issues (for example, where they are not feeling well or they are upset).

It’s important to monitor and document when older people are not finishing their meals. Let management know so such issues can be addressed.

Your organisation should support processes for getting regular feedback from older people about their food, drink and dining experiences.

It’s important to check how satisfied older people are with the quality, temperature, and presentation of their meals, as well as their preferences for dining arrangements and support. Workers should create opportunities for feedback and conversations, record any concerns, and bring them to management to help improve the dining experience, to support Standard 2 and Standard 6.

Key concepts

Dignity of risk

Dignity of risk supports an older person’s independence and right to make their own choices, even if those choices involve some risk. If an older person’s choices are possibly harmful to them, you are expected to help them understand the risk and how it could be managed to help them live the way they choose (linked to Standard 1).

Some older people may choose to consume food and drink that has been identified as a risk to them. For example, these risks could be:

• certain ingredients (such as sugar, salt or fat)
• the serving size, texture and consistency of food and drink
• fast food
• food cooked by family
• food that could be difficult to swallow or could lead to choking. Choosing to eat and drink things that have a health risk is known as eating and drinking with acknowledged risk (EDAR).

Older people can choose to accept these risks so they can enjoy their meal. You must respect their decision. Where an older person’s decision-making capacity is impaired, use supported decision-making to help them make informed decisions about their eating and drinking. This includes involving the older person’s supporters, family, carers and loved ones they want engaged in their care to help with their decision-making.

Supporting older people to make informed choices about all aspects of their food, drink and the dining experience is a key part of maintaining their quality of life in residential care homes.

Creating appetising foods

The food, drink and the dining experience can have a huge impact on an older person’s quality of life.

As older people age, they may lose their appetite and become less sensitive to flavour or experience conditions that impact on their ability to eat and drink. As such, creating nutritious, flavourful and appetising meals that meet older peoples’ diverse needs can be a challenge. Food is personal and preferences are complex. What is appetising to one older person may not be appetising to another.

It’s important to engage with older people to understand their likes and dislikes, and ways you can improve their enjoyment of food.

The dining experience

The dining experience is a combination of the food and drinks provided, the service, and the atmosphere. This experience impacts on an older person’s quality of life and wellbeing.

You should make sure food and drinks are accessible to older people with mobility or access needs. Meals should be easy to reach and seating or table arrangements should accommodate all physical abilities.

To support a positive dining experience, you may think about:

• table and seating arrangements and opportunities for social interaction
• music, temperature, lighting and ambience
• how the food is presented, including plating, serving size, temperature and smell
• how workers interact with older people to help them eat
• opportunities to promote an older person’s independence and reablement.

An enjoyable dining experience can bring pleasure to an older person, improve their wellbeing and quality of life and increase the chance of them eating their meals.