Aged Care Nutrition: Fed Up and Inconveniently Alive
Jack Beattie-Bowers (Dietitian)
Ten dollars a day. That’s the figure discussed by dietitians as the likely amount spent by some aged care homes on each resident’s nutrition.
The basic daily fee paid by all residents living in Australian Government subsidised homes is $47.15 and is meant to cover the costs of meals, cleaning, laundry, heating and cooling. Yet operators are also in the market to make a profit, and the actual proportion of the fee going towards these services is unclear. The basic daily fee is set to rise on 20 March in line with changes to the aged pension.
Unsurprisingly, the figure leaves little room for managers “to inject soul into menu design, to put pleasure back into food service and to give older people joy through their palette”. That’s a quote from 2010 Senior Australian of the year, Maggie Beer who has campaigned for awareness over equal rights for people in residential aged care. Beer goes as far as to say ““I’d rather shoot myself than be in [some facilities] eating the food on offer”, and I’m inclined to agree.
Paradoxically, the most vulnerable people in our population, who would benefit most from an injection of fun onto their plate and into their lives, are being served boring, bland, processed and pre-packaged medically approved foods. What they need is food that is familiar but diverse, fun but nutritious. That is how I like my food anyway, and contrary to what you might think, the eating habits of 80 year olds are not all that different to younger people.
Although some aged care residents need their meals to be texture modified (that is, for their food to be softened or mashed), not all of them do; a variety of textures can and should typically be served.
The reality is far more disappointing.
If you thought hospital food is bad, think again; you’ll be craving it if you end up in an old folks home. Hospitals have tougher and clearer regulations around colour, variety, and enjoyment. Put simply, Australia’s residential aged care regulatory framework is weak and piecemeal when it comes to nutrition.
The current guidelines state expectations broadly and non-specifically, presumably to protect the bottom-line of struggling facilities. They also fail to provide a model on how to achieve their targets. Nutrition is just one of the many concerns for our elderly, and in my opinion, stakeholders would be better served with a national nutrition standard embedded in a greater framework for aged care health.
As the Dietitians’ Association of Australia reminds us, the problem then is how to achieve menus which focus on meeting the nutritional needs of individual in terms of local supply and the financial capacity of the facility.
While the choice appears to be one of morality, duty, and responsibility, without funds an excellent menu can only be implemented with excellent staff willing to work above their requirements. There is evidence that the current approach has been fairly unsuccessful with the prevalence of malnutrition in residential aged care facilities between 32-72%. It is apparent that these businesses would do better with clear succinct guidelines.
Currently, dietitians must create their own regulatory standards, and carry no legal might beyond their station as an Accredited Practicing Dietitian. We must hope that aged care homes see the sense in consulting with dietitians who may suggest a plethora of improvements and menu renovations, beyond the requirements of current regulations. Spending money in this way will have a direct influence on the happiness and end of life care of our elderly.
Two deaths reported in September 2014, one of which involved malnutrition and dehydration, prompted Alzheimer’s Australia and the Combined Pensioners and Superannuants’ Association to propose a royal commission into the accreditation process for residential aged care facilities. Despite these calls the facilities who have allegedly neglected their clients have retained their full accreditation and no action has been taken. Society has to decide what a human life is worth. It is certainly worth more than just being alive.