Residents in an aged care setting must receive the correct meal at the correct time, every day.
If a resident has a special dietary need, the details are recorded in the resident's care plan and communicated carefully to the kitchen staff to ensure all the dietary limitations are actioned. More importantly the resident is not unnecessarily restricted and as many choices are provided as possible. We can use a range of communication methods to ensure that this occurs.
The system for communication between nursing staff and kitchen staff should be effective, simple and safe. A Dietitian and Speech Pathologist often contribute to this food and nutrition care plan and will also communicate directly with the kitchen staff. The resident's dietary details list will need to be maintained. So, when there is a change for a resident, that change is immediately communicated with the kitchen and any lists used are immediately updated.
It must be very clear whose responsibility it is to update all lists to ensure they are accurate and reflect the residents' current dietary needs. These lists must also be referred to whenever providing food or fluids to any residents.
What system of communication do you use? Are you relying on paperwork or do you use a clinical software system? Are you using a dedicated food service software system? Reports from client software packages can ensure that all information is up to date at all times and they can generate usable lists that can be referred to in the kitchen. A key factor is to keep the system that you use simple. Minimise the number of lists- the more lists there are, the more likely it is that they will not match.
When NPA conduct audits of nutrition care it is very common to find anomalies when comparing the care plans with lists in the kitchen. Regular audits should be undertaken by the care home to ensure integrity of the information and to provide reassurance that the right meal is provided to the right person.
A goal in residential aged care is for residents to enjoy a range of meals throughout the day which includes delicious main meals, mid-meals and drinks. As our appetite reduces, so the need to provide nutritious snacks becomes even more important. The mid meal should be appealing and provide the nutrients that are likely to have been missed by having a smaller serve at the main meal.
When a resident commences a modified texture diet (soft, minced and moist or pureed) it is very common to find that mid meals are no longer offered! This can result in weight loss and malnutrition. Sometimes the only options offered are monotonous- the same fruit and custard or yoghurt every day with no variety. This soon becomes very unappealing and the resident's appetite can fall even further.
We know malnutrition is high amongst those needing modified diets, so the mid meals are even more important to their overall quality of life. It is important to continually look at interesting ways to present the main meals with molds, piping, layering, but it is also important to give the humble mid-meals the consideration that our residents deserve.
About the Author Nutrition Professionals Australia is a team of Accredited Practising Dietitians who consult to aged care homes across Australia. They have more than 40 years of combined experience in a range of roles, as Advanced Accredited Practising Dietitians, Food Services Coordinator, Residential Site Manager, Author of Nutrition Manuals and Consultant Dietitian.roles, as Advanced Accredited Practising Dietitians, Food Services Coordinator, Residential Site Manager, Author of Nutrition Manuals and Consultant Dietitian.
Is your home or service IDDSI compliant?
From May of 2019, the terminology used to describe and classify modified texture meals and fluids was formally adopted across the community, country and the world.
There are minor but very significant changes to the way the textures and thickened fluids are described. Many resources can be found at www.iddsi.org and there are apps available to help you through the journey.
It's important that all the members of the team - nursing, care, food service, lifestyle and volunteers - are familiar with the changes.
So, have you made the change to IDDSI?
About the Author Nutrition Professionals Australia is a team of Accredited Practising Dietitians who consult to aged care homes across Australia. They have more than 40 years of combined experience in a range of roles, as Advanced Accredited Practising Dietitians, Food Services Coordinator, Residential Site Manager, Author of Nutrition Manuals and Consultant Dietitian.
Have you implemented IDDSI yet? The date for implementation of the new IDDSI guidelines was 1st May. Key issues to consider include:
Our Meal Plans for Older People Manual has been revised for IDDSI. If you have purchased a version over the past 12 months, you will receive an updated version. For more information or to purchase the manual, click here.