Australian Federal Government Report: Nutritious Food in Aged Care

This ministerial briefing paper, prepared for the Australian Federal Government Department of Health, addresses the critical issue of nutritious food in aged care facilities. The paper highlights the problems of malnutrition and dehydration among elderly residents, along with the background of these issues, pre-existing policies, and standards. It discusses the signs of malnutrition, including oral, muscle, and eye symptoms, and reviews current policies such as the Quality of Care Principles and various practices for preventing malnutrition. The report also considers recommendations for improving food choices, timing, and variety to enhance the quality of life for residents, and suggests developments of better standards, guidelines, and training, along with regular monitoring of recruitment relations. The report emphasizes the need to address malnutrition to ensure the best care results for aging inhabitants in residential aged care facilities (RACFs).

RUNNING HEAD: NUTRITIOUS FOOD IN AGED CARE FACILITIES
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NUTRITIOUS FOOD IN AGED CARE FACILITIES 1
Executive Summary
Recently, I have been employed by the “Australian Federal Government Department of Health”
by Australia and the Mr. Hon Greg Hunt who is a Minister of Health has requested a series of
paper on Nutritious food and aged care facilities in Australia by focusing on health issues,
recommended actions, policies, service deliveries related to these issues. As the minister of
health recently become aware regarding increased complaints of quality of food delivered in
aged care facilities in recent months. Therefore, this ministerial briefing assignment covers the
issues and problems related to healthful food in old care accommodations, background of the
essential facts, pre-existing policies regarding nourishing food in elderly care services,
considerations and recommendations covering these ongoing issues in aged care facilities of
Australia.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 2
1. Issues and problems related to Nutritious Food in aged care facilities
As recently, we came across that thousands of aged Australians are at a danger of development
of undernourishment or already suffering with this issue. We have received many complaints that
elderly people who are living in homes are not getting sufficient nutritional good. Therefore, we
should take steps to fix these problems otherwise all the elderly residents who are residing in
aged care facilities of Australia will be suffering from malnutrition and consecutively improper
diet can also trigger other chronic diseases (Kollmorgen, 2016).
2. Background
Malnourishment in the severe hospice background is expected as high as about 40% of all
patients who were admitted recently. Furthermore, in 2015-16, the degree of infirmary developed
malnutrition in hospital was 12 each 10,000 hospitalizations (Lederman, 2012). The major
concern outlining the issues and problems related to nutritious food in adult aged care facilities
are mentioned below:
2.1 Dehydration
Undernourishment in “residential aged care facilities (RACFs)” is produced by a diversity of
issues in counting insufficient consideration from staff of inhabitants who require support in
consumption, lack of adapted care, not provided that oral fitness apparatus prior to mealtimes,
and an absence of diversity of mealtimes or food that is unpleasant or served stale. Liquid
consumption is frequently inadequately checked and inhabitants might not have prepared
admission to fresh water or juice through the day which can reason for the collapse as the liquid
consumption is little.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 3
Consecutively, inhabitants also frequently sleep concluded chosen feeding periods due to an
absence of management by supervise or whether mealtimes helped are really bothered; numerous
inhabitants miss mealtimes on an unvarying basis and develop undernourishment. Anecdotally,
wherever there is an absence of near nursing of dryness and food consumption, numerous aging
quickly yield to poor fitness and are at danger of early demise (JAY Cichero, 2013).
2.2 Indications of unattended early in care services
Separately from undernourished and malnourished inhabitants, there are numerous other tell-tale
emblems that care ability is missing in backing or is defectively observed by establishments.
Furthermore, owing to an absence of supervise enthusiastic to nourishing inhabitants at mealtime
periods, numerous inhabitants who shortage the forte or suppleness to feed them are fortified by
elderly care services organization to receive peg nourishing as a supernumerary for consumption
nourishment generally (LJ Ross, 2011).
2.3 Insufficiencies in the present Australian regulatory outline of food and water
delivery in inhabited aged care amenities
It must be renowned that all housing elderly care services must obligate support worker position
and obey with the governmental responsibilities customary available in the “Aged Care Act
1997” in instruction to be qualified for administration backing. Obedience with the legislature is
checked by the “Aged care Standards and Accreditation Agency (ACSAA)”. In January 2014,
the activity has been retitled to the “Australian Aged Care Quality Agency (AACQA)”
(Hampson, 2018).

NUTRITIOUS FOOD IN AGED CARE FACILITIES 4
2.4 Signs of elder malnutrition
Corporal and cerebral problems might seem if the elder is not appropriately nurtured. Family
associates of elders breathing in nursing home amenities should take a near appearance at
conceivable telltale emblems of elderly undernourishment (Flanagan, 2012). Certain of the signs
of elderly undernourishment may comprise, nonetheless are not incomplete to:
2.4.1 Oral Symptoms
Household memberships might discover evil sores and extreme soreness in the mouth of the
enduring. Also, thrush and maybe a mold contagion could be offender of the bleached patches in
cheeks and tongue of the underweight enduring.
2.4.2 Debilitate muscles
When the figure runs out of nutrition’s that are carried in the tissues, the muscles might develop
strikingly limp. Another sign of incapacitating strengths due to undernourishment is protracted
exhaustion.
2.4.2 Eye symptoms
If the enduring practices like eye redness or distended corneas, starvation could be the offender.
This can be the reason for elder’s image to also become worsened.
3. Pre-existing policies
There are numerous policies and guidelines for proper nutrition and assessment of malnutrition
in aged care facilities and hospitals. Numerous policies and strategies which are already
introduced are mentioned below by the hospitals and aged care facilities.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 5
3.1 Quality of Care principles
The ACSAA starts infrequent appointments to amenities to consider their presentation in
contradiction of the Accreditation Values, which are enacted under “Quality of Care Principles
Act”. The Accreditations covers a specification of 44 predictable consequences connecting to the
eminence of upkeep RACFs deliver and the privileges of the persons to whom they deliver
carefulness (Federal Register of Legislation, 2014).
The Accreditation Regular insurances four main parts:
3.1.1 organization schemes, recruitment and organizational expansion
3.1.2 health and individual conservation
3.1.3 housing existence
3.1.4 physical atmosphere and safe organizations
3.2 Practices for the prevention of malnutrition
The health service organization delivers facilities to patients at risk of malnutrition (care, 2015):
3.2.1 Implemented systems to prevent and manage malnutrition which are reliable with
best practice strategies.
3.2.2 Ensured availability of apparatus and plans to reduce the threat and effective
organization of compression wounds.
3.3 Clinicians practices
3.3.1 Screening for malnutrition, conduction of comprehensive nutritional status assessment
according to best practices in time frames and proper frequency.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 6
3.3.2 Delivery of malnutrition preventive strategies and proper care according within best
practice guidelines.
3.4 Comprehensive care standard
The “National Safety and Quality Health service (NSQHS) Standards (second edition)”, in
specific the “Comprehensive care standard”, provision the distribution of harmless enduring
upkeep (Healthcare, 2016). The information limited in infirmary learned difficulty fact pages
bring into line with the standards in this standard which are as monitors:
3.4.1 Clinical government constructions and excellence development procedures subsidiary
patient upkeep
3.4.2 Development of the comprehensive care plan
3.4.3 Providing the comprehensive care plan
3.4.4 Minimization of particular patient harms.
3.5 Nutrition Standards for Menu items in Victorian Hospitals and Residential Aged
Care Facilities
The values cover necessities for full district diet and additional foods that can be provided for by
the chief list of options through respect to (Department of Human Services (Victoria), 2009):
3.5.1 Nutritious arrangement of separate menu substances
3.5.2 An organization scheme for list of options item thoughtful absolute and comparative
nutritious worth
3.5.3 Serving dimensions

NUTRITIOUS FOOD IN AGED CARE FACILITIES 7
3.5.4 Strategies for emerging list of options
3.6 Royal commission into aged care Quality and Safety
The rule is industrialized to speech the dangerous characteristics for the development nutrition
older individuals (Royal Commission, 2019):
3.6.1 A community fitness attentiveness operation for the increment of understanding in
nutritious requirements.
3.6.2 A steady undernourishment testing by GPs, public care and inhabited elderly care facilities.
3.6.3 Satisfactory transfer trails and admission to safeguard delivery of nutritious care
3.6.4 Nourishment education as a core capable of aged care preparation, integrating and ongoing
professional expansion distributed by credited working dietitians.
3.6.5 Preparation and distribution of meals, counting suitable a calculation by an APD, to ensure
nourishment requirements are met.
3.6.5 Importance specified to meal times, counting suitable provision, help and modifications
desirable to aid meal ingestion, to exploit food and fluid consumption.
4. Consideration
Being capable to select what one provisions is an important right of each neighborhood alive in
“Residential Aged Care Homes (RACHs)” in Australia. This is predominantly significant
assumed the tall charges of under nourishment of among 30%-65% in the extended period
upkeep subdivision globally, which inclines inhabitants to a superior risk of disease and useful

NUTRITIOUS FOOD IN AGED CARE FACILITIES 8
weakening. The below mentioned are the recommendations of course of actions along with
advantage and disadvantage of actions (Karen L. Abbey, 2015).
4.1 Autonomy in food choice
The environment of admittance to aged care amenities demonstrates stimulating for inhabitants,
as they are obligatory to speedily adjust to current meal constructions and organizations.
Therefore, delivering a variety of another meal selections is vital to deliver adequate nourishment
and for the reassurance of meal ingesting.
Augmented ranks of foodservice gratification up to 30% have happened when inhabitants have
the control to select from the list of options. It was also originate when requested to amount the
position of regulator and select over convinced parts of their ordinary lifespan in a home,
populaces ordered consuming select ended their nourishments as the greatest significant.
 Advantage: This upsurges together pleasure and satisfaction, which in turn influences the
eminence of lifetime.
 Disadvantage: If old people will select the menu of their choice, it can impact the digestion and
will increase the obesity.
4.2 Timing of meal choice
The mealtime atmosphere is well-defined as the organization which reinforces the menu,
mealtime manufacture and meal distribution. It requires to provision food selection in rapports of
the effectiveness when inhabitants can handpick food substances from the list of options.
 Advantage: no boundation in time limit
 Disadvantage: unscheduled meal intake which can cause corpulence.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 9
4.3 Variety in meal choice
In the aged maintenance amenities, list of options are often recurring with limited substitute
selections. Revolving list of options may be used as a plan for the preferment of assortment by
altering the food menu regularly.
 Advantage: optimistic possessions on meal ingesting and pleasure can be attained
through the deliverance of meals and avoid of limitations of nutrients like sugar and fat.
 Disadvantage: if the old age people will consume high fat and sugary foods, there are
chances of increased obesity among the inhabitants in aged care facilities.
Example of Assortment and planning of food recommendation:
 Use of culinary methods like sweltering, grilling and boiling more often than frying in oil
 Meat and fowl will have cartilage, gristle and noticeable fat elimination
 Boneless fishes
 Abridged fat and low fat dairy foodstuffs
 Decrease of additional fat in procedures
 Monounsaturated and polyunsaturated oils in culinary
 Low fat salad dressings
 Wholegrain breakfast cereals and breads
 No added sugar fruit juices
 Evade protracted cooking of fruits and vegetables
 Usage of abridged sodium foodstuffs
 Consumption of unsweetened preserved fruits (R Shrimpton, 2012)

NUTRITIOUS FOOD IN AGED CARE FACILITIES 10
5 Recommendation
An answer to the undernourishment problematic in RACFs is an essential which has to be
absorbed on the finish unbiased of delivering aging inhabitants with best care results, somewhat
than just conference bare specks of distribution.
5. A Developments of better standards, guidelines and training
There are no exact nationwide strategies on how RACFs must do this or plan their list of options
to best encounter the nutritious obligation of inhabitants. Moreover, nursing of allergens and
nourishment compassions should also be lectured in an unchanging regular. There are likewise
requirements to be improved sympathetic and exercise to make a philosophy of refining the end
outcomes of elderly care, somewhat than reception of low stage maintenance.
5. B Regular on recruitment relations and enhanced observing
A standard must be advanced specifying a set supervise to neighborhood relation in imperative to
safeguard suitable care is specified to separate inhabitants. Lack of importance assumed to
incapacitate inhabitants necessities to be lectured. Separately from supplementary recruitment,
care values ought to necessitate preparation approaches that assign exact responsibilities to staff
memberships, particularly overseeing beverage and dietetic consumption at all periods.
Therefore, there is a need to create strategies and plans in accordance to benefit the aged care
population of Australia. Below mentioned are some recommendations for the improvement:
5.1 Deliver prevention plan
Clinicians must cooperate with patients, carers and relations in valuation of threat, in provided
that suitable info to provision shared conclusion creation, and in preparing care which encounter
the requirements of patients and their carers (J Crilly, 2012).

NUTRITIOUS FOOD IN AGED CARE FACILITIES 11
Wherever clinically designated, distribution of undernourishment deterrence plans like:
5.1.1 Community events to safeguard delivery of meals
5.1.2 Assistance with nourishing
5.1.3 Nourishment and fluid consumption histories
5.1.4 Adapted menus
5.1.5 Nutritional information and oral nourishment additions and/or artificial nutritious support
5.1.6 Enduring and family input where possible.
5.1.7 Nursing the efficiency of any undernourishment precautionary plans, and reconsiders the
enduring if undernourishment occurs
5.1.8 Assessment and inform the care strategy if is not actual or is instigating adverse effects
5.1.9 Appointment in studying clinical consequences, recognizing gaps and chances for
enhancement
5.2 Nourishment and Hydration
Clinicians must effort self-possessed to safeguard the nutritious and liquid supplies of the
enduring are (EA Isenring, 2012):
5.2.1 Scheduled
5.2.2 Distributed and accustomed as suitable
5.2.3 The patient’s consumption and production are examined

NUTRITIOUS FOOD IN AGED CARE FACILITIES 12
5.3 Revising Accreditation plan
Addition of required nourishments in the diet planning of elderly is recommended for more
enhancements in aged care facilities.
5.3.1 Meals of acceptable diversity, eminence and amount for each occupant, assisted each day at
periods usually satisfactory to both inhabitants and organization, and usually containing of 3
meals per day.
5.3.2 Superior nutritional necessity, having respect to either medicinal requirement or spiritual or
cultural compliance
5.3.3 Nourishment, counting fruit of satisfactory diversity, eminence and capacity, and non-
alcoholic infusions, including fruit liquid (S Iuliano, 2013).

NUTRITIOUS FOOD IN AGED CARE FACILITIES 13
Bibliography
care, A. C. o. S. a. Q. a. H., 2015. Selected best practices and suggestions for. [Online]
Available at: https://www.safetyandquality.gov.au/sites/default/files/migrated/Malnutrition-
detailed-fact-sheet
[Accessed 30 08 2019].
Department of Human Services (Victoria), 2009. Nutrition Standards. [Online]
Available at: file:///C:/Users/SystemJP/Downloads/nutrition_standards.pdf
[Accessed 30 08 2019].
EA Isenring, M. B. M. F. J. B., 2012. Beyond malnutrition screening: appropriate methods to
guide nutrition care for aged care residents. Journal of the Academy of Nutrition and Dietetics,
112(3), pp. 376-381.
Federal Register of Legislation, 2014. Quality of Care Principles 2014. [Online]
Available at: https://www.legislation.gov.au/Details/F2014L00830
[Accessed 30 08 2019].
Flanagan, D., 2012. Managing undernutrition in the elderly. Psychological strategies, 41(9), pp.
695-699.
Hampson, R., 2018. Australia’s residential aged care facilities are getting bigger and less home-
like. [Online]
Available at: http://theconversation.com/australias-residential-aged-care-facilities-are-getting-
bigger-and-less-home-like-103521
[Accessed 30 08 2019].
Healthcare, A. C. o. S. a. Q. i., 2016. Comprehensive Care Standard. [Online]
Available at: https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-
care-standard
[Accessed 30 08 2019].
J Crilly, W. C. M. W., 2012. A structure and process evaluation of an Australian hospital
admission avoidance programme for aged care facility residents. Journal of advanced nursing,
68(2), pp. 322-334.
JAY Cichero, C. S. J. D. P. C., 2013. The need for international terminology and definitions for
texture-modified foods and thickened liquids used in dysphagia management: foundations of a
…. Current physical medicine and rehabilitation reports, 1(4), pp. 280-291.

NUTRITIOUS FOOD IN AGED CARE FACILITIES 14
Karen L. Abbey, O. R. L. W. a. O. R. L. W., 2015. Menu Planning in Residential Aged Care—
The Level of Choice and Quality of Planning of Meals Available to Residents. Nutrients, 7(9),
pp. 7580-7592.
Kollmorgen, A., 2016. Failing standards in nursing homes and aged care. [Online]
Available at: https://www.choice.com.au/health-and-body/healthy-ageing/ageing-and-
retirement/articles/nursing-home-problems
[Accessed 30 8 2019].
Lederman, J., 2012. Elderly at risk: Food deficiencies of Australia's aged population. [Online]
Available at: https://www.agedcarecrisis.com/care-issues/malnutrition-dehydration/food-
deficiencies
[Accessed 30 08 2019].
LJ Ross, A. M. A. Y. M. B., 2011. Everyone's problem but nobody's job: staff perceptions and
explanations for poor nutritional intake in older medical patients. Nutrition & Dietetics, 68(1),
pp. 41-46.
R Shrimpton, C. R., 2012. The double burden of malnutrition: a review of global evidence.
Nutrition.
Royal Commission, 2019. Royal Commission into Aged Care Quality and Safety. [Online]
Available at: https://agedcare.royalcommission.gov.au/Pages/default.aspx
[Accessed 30 08 2019].
S Iuliano, J. W. J. R., 2013. Consuming two additional serves of dairy food a day significantly
improves energy and nutrient intakes in ambulatory aged care residents: a feasibility study. The
journal of nutrition, health & aging, 17(6), pp. 509-513.