AN OFTEN-OVERLOOKED VITAL ELEMENT
OF QUALITY AGED CARE PROVISION
Improving culture and standards around nourishing the aged must become a critical part of improved regulatory and accreditation practices.
utrition is often overlooked as an important factor in providing aged care services, yet it is an essential part of general quality of care—one of the themes identified in the recently published Review of national aged care quality regulatory processes. Despite clear scientific consensus that nutrition is crucial to maintain older adults’ health and independence, a number of basic food-related rights that the broader population takes for granted, are often not yet the ‘norm’ in the Australian aged care sector. When the people we care for are undernourished they are at much greater risk of illness, injury, and premature death. Falls are more likely due to their reduced strength and physical function, their wounds will take longer to heal and are more susceptible to illness, and their immune systems are compromised. Food also plays an important role in residents’ satisfaction with both their care and quality of life. Food and mealtimes are often one of the only normalities of life available to people living in residential care. Factors such as being able to enjoy a calm and homely dining space, having adequate time for meals, receiving visually appealing food and retaining dignity through eating have been proven to improve nutrition intake in residential care. The recent aged care quality review outlines the need for sector-wide regulatory reform to address the general quality of care, and inconsistency in identifying quality failings within the aged care sector. Echoing the key sentiments of the review, here are four key changes I believe we must advocate for to improve the culture and standard of nutrition care:
At the sector level 1. Adopt clearer accreditation standards Existing nutrition and hydration standards are vague and process-centred, focusing on the availability of food, drink and nutrition care rather than their implementation, uptake or
patient nutrition outcomes. We have significant inconsistencies in assessment, undermining the standards’ basic existence. To drive sector-wide improvement we must first update our basic regulatory processes to ensure they enable consistent assessment, are outcome-focused, and reflect known best practice in nutrition care. The adoption of national menu planning standards for aged care will be an important part of this task. 2. Introduce a sliding scale of assessment, and transparent outcomes There is currently no external motivator for facilities to improve the quality of care provided once accreditation has been secured. This results in a stagnant industry, where quality is not always the number one priority. Introducing a sliding scale of assessment (for example, using ‘working towards’, ‘meeting’ or ‘exceeding’ ratings) would provide facilities with incentive to not just meet the minimum required standards, but seek and maintain the highest expected quality of care. Making assessment outcomes publicly available via a national online register would further motivate these changes, driving a competitive culture that strives for excellence and continual self-improvement.
At the service level 3. Embed dietitians in core care teams Accredited Practicing Dietitians (APDs) are university-qualified health professionals who can provide thorough nutrition assessments, and work with the care team to develop tailored nutrition plans for patients based on their individual needs. Unfortunately, access to (and utilisation of) APDs remains incredibly variable (and in many cases sub-optimal) within the aged care sector. Embedding APDs into core care teams is an essential, logical and relatively simple step that is likely to lead to significant improvements in nutrition care, and patient health outcomes across the board.