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New Aged Care Quality Standards by Morgan Pankhurst, APD

30 June, 2019

Aged care homes within Australia are governed by a ‘Standard’ which is essentially the minimum level of care that a home is expected to provide to residents in order to remain accredited. New Standards are coming into effect from the 1st July 2019 and with it we expect to see some very interesting changes occur.

Why do we need new standards? Traditionally health care has been delivered under a medical model where experts (such as doctors, nurses and dietitians) tell the recipient (patient or resident) what is best for them, often with little regard to individual preferences. Slowly, we have started to recognise that the individual is the expert in their own life and person-centred care (also called consumer directed care) has become the new direction for health care.

The new Standards contains eight sections which relate to the different aspects of care provided in an aged care home. These are:

  1. Consumer dignity and choice
  2. Ongoing assessment and planning with consumers
  3. Personal and clinical care
  4. Services and supports for daily living
  5. Organisation’s service environment
  6. Feedback and complaints
  7. Human resources
  8. Organisational governance

Today I want to talk about how these Standards may change the way meals are catered in aged care homes.

At the core of the new Standards is consumer dignity and choice which requires that each resident is treated with dignity and respect and that their identity, culture and diversity are valued. The other important point is that residents should be supported to take risks to make informed choices. In the context of food service, there are several items that are avoided in aged care homes because they are deemed to be high risk. Eggs are one such food that carry a high risk of salmonella which is why they need to be thoroughly cooked (72 degrees Celsius). Traditionally this has meant dishes such as soft poached eggs, hollandaise sauce, tiramisu, and eggnog have been excluded from the menu. A person-centred approach recognises that individuals have the freedom to eat these foods in their own home therefore residents living in their new home are also entitled to request these foods. This provides a new challenge for homes who also have an obligation to minimise harm to residents living under their care. This conflict between resident and organisational needs creates an interesting dilemma that may lead to food-service innovations such as switching to pasteurised eggs, which are safe at any temperature. Additionally, homes may need to arrive at solutions in consultation with a range of stakeholders including food safety experts.

Section 4(f) of the new standards pertains to services and supports for daily living and this is where food and meals are mentioned. For the first time the Standards now recognise that nutrition and hydration are not just a means to reducing the risk of malnutrition, the social and emotional aspects of mealtime are acknowledged and discussed. Although aged care homes generally work to cater for dietary requirements such as food allergies and intolerances (e.g. nut allergies, gluten free), they are now urged to take residents religious, cultural and other personal preferences into account. Meals in aged care homes often reflect our British heritage, such as fish on Friday and roast on Sunday with very little cultural diversity.  The institutional approach to food service tries to cater to the largest number of people possible and therefore leaves very little room for personalisation, autonomy or choice. The new Standards require that homes include residents in the menu planning and that meals meet their cultural, religious or other needs.

The other big change that has occurred is the timing of meals. The old Standards stated that meals should be provided at a time that is convenient for both the organisation and the residents however, in most aged care homes, the current system is very institutionalised. Typically, breakfast is served at 8am, the main meal is at 12pm and the evening meal is at 5pm, a schedule that suits the food service staff more than the residents. The new Standards state that residents should have access to food and drink whenever they are hungry. This doesn’t mean that the kitchen needs to be open 24/7 but it may mean that homes need to become more creative and have a range of ready-to-heat-and-eat options available for residents who don’t want to adhere to the regular meal schedule.

Section 5 relates to the environment through which care and services are delivered, in the context of food and meals this relates to the dining room. Are the dining areas warm and inviting or are they clinical and hospital like? Are meals served on trays like they would be in hospital, or are they served at a nicely set table like they would be at home? This section also states that homes should welcome residents’ families or visitors and provide spaces for culturally safe interactions with others, which includes mealtimes. I’ve spoken to hundreds of residents living in aged care homes, most don’t know that they are able to invite their family to dine with them or state that there aren’t adequate facilities to enable them to do so.

Finally, Section 6 is about listening to feedback and complaints. This is one of my areas of interest, finding meaningful and useful ways for residents to give feedback to homes so that the kitchen knows how to improve the food service. Some of the ways that homes currently use to obtain feedback are resident focus groups, feedback/suggestion boxes and surveys. Whatever method the home uses it is important that the feedback is listened to and acted upon. If residents are not happy with the food, they will leave the meal on the plate and dissatisfaction with the food service is one of the factors contributing to malnutrition.

Residential aged care homes have an interesting time ahead while they try and find ways to deliver meals in a more person-centred way whilst at the same time meeting the demands of institutionalised food service. Ultimately, we hope that homes can rise to the challenge and find innovative and creative ways to enhance the dining experience for residents.

Full details of the New Aged Care Standards are available at https://www.agedcarequality.gov.au/providers/standards