Australian residential aged care foodservices menu design, quality and standards - a time for action

Abstract

Residential aged care homes (RACH's) operate in a very complex systems model with many systems having to work together. One of the largest of these is the meal environment system. The complexity of resident care, heterogeneous nature of the resident population, and the quest to provide meals within a home-like environment for a group of people sharing a common space while still recognising the needs of the individual is no small challenge.A comprehensive understanding of the significance of the meal environment system in RACH's is mostly unknown in Australia. This thesis provides the first unique look at the system which underpins the way the meal environment system functions. The Aged Care Standards are the governing system controlling the meal environment. For any system to work and achieve the nominated system goals, such as providing high level of quality care for the residents needs and allow them to maintain a high quality of life.One of the most important controlling aspects to the meal environment system is the menu, which is the underpinning aspect for any foodservice operation. Through a critical realism case study model the menu and the meal environment system was examined utilising a national survey, paper base audits, observational data collection and analysis of the Aged Care Standards.The findings indicated that the Aged Care Standards underpinning the control of the meal environment system are compromising the way in which this system operates. The outcomes-based nature of the expected outcomes and associated supporting documents allows for a wide interpretation of RACH's within the meal environment system. The outcome natures of the standards does not set a strong minimum compliance and this is evident by the lack of information written on menus, choice provided by the menu being inconsistent, poor compliance to any relevant tools which are available to support RACH's. Observational data further highlighted the inconsistent nature of standard interpretation of service delivery, high plate waste, poor food consumption, and temperature of meal, dining room set up, menu mistake and the poor communication of the menu.While menu planning for the general menu was laced with inconsistency and poor planning, the state of the vitamised/puree menu highlighted the plight of residents who received no choice with the menu frequently utilised left-overs as well as the same meals twice in one day. This was substantiated by the reduction in variety of foods and increased menu repetition. The Aged Care Standards have minimal in terms of expected outcomes which support the menu planning for vitamised/puree meals.iii For the meal environment system to be successful and operational, the Aged Care Standards underpinning this system need to be re-written or supported with guidelines which ensure that the meal environment system operates with a minimal standard eliminating factors as described in this thesis.Clearly, the current interpretation of the existing framework allows too much variation within the syst...

An investigation of recommended serve food portions and attaining energy and protein requirements in older adults living in residential care

“…As such, a review of the serve size recommendations that underpin RCH menus is warranted. Menu development is a complex task with the literature purporting portion sizes playing a small but crucial role (36) . The challenges of menu development based on a food guide's portion size and the number of serves are well documented (14) , with complications associated with ageing such as poor appetite affecting overall intake.…”

Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders

“…Key success factors include adequate resources such as skill, education, access, time, availability, and low staff turnover. Additionally, dietitians in Australia are rarely employed by aged care homes, which are primarily (91%) run by not-for-profit and for-profit private organizations, but instead work as consultants on a referral basis or at scheduled intervals [17,18]. So, whilst they might prescribe strategies such as food fortification, they rely on the onsite foodservice staff to oversee the preparation and delivery of strategies, as well as care staff to ensure the food is consumed.…”