Speech pathologist Caitlin Zowtyj and dietitian Kylie Walton from Food Solutions have been working with St Vincent’s Care Executive Chef and Hotel Service Manager David Martin and his team to deliver innovative menus for the residents at St Vincent’s Care homes throughout Queensland, Victoria and NSW. It’s just one of many such collaborations between aged care chefs and expert consultants to ensure a multidisciplinary approach to menu creation. We spoke to Caitlin and Kylie, fresh from their presentation at the IHHC National Conference, to find out more about how the process works.

“Food Solutions has been around for over 20 years, we’re a national company but mostly focused on the eastern seaboard – Queensland, NSW, Victoria and SA,” Caitlin tells us. “We have speech pathologists and dietitians who work predominantly in residential aged care and our focus is on improving nutrition and hydration for residents while making food enjoyable for our older Australians.”

Food Solutions has had a dietitian working with St Vincent’s Care for more than a decade, and some three years ago added speech pathology to the collaboration. “The appeal for St Vincent’s in having both disciplines is that our speech pathologists and dietitians are able to work collaboratively to service each of their facilities,” Caitlin explains. The majority of such allied health services are outsourced – dietitians will typically visit a facility once a month based on referral need, whereas speech pathologists may come a little more frequently. Importantly, these teams are also in constant communication with kitchen and foodservice staff to consult on how to best meet residents’ needs.

Kylie and Caitlin have forged a strong working relationship with David Martin and his team at St Vincent’s Care. “If David has an idea for a particular recipe,” Kylie says, “we’ll typically have a look at it, undertake a nutritional analysis and see how much protein, see how much fat and so on is in it. Then we might suggest making some adjustments, so we’re getting a higher protein option for residents for example. When the team is creating menus we’re able to provide an extra pair of eyes – they might have a great fish recipe, but if there are residents who don’t like fish, and that’s the main choice, we can suggest a secondary option to ensure their needs are still being met. It’s a combination of applying nutritional knowledge and being another source of ideas.

“I think chefs are known for being quite creative, whereas dietitians and speech pathologists might be a little more methodical – David’s quite methodical himself, I have to say, but just to have that input from a different way of thinking about food can really improve the outputs for all residents.”

Caitlin adds: “We work with David across NSW and Victoria and his counterpart Chris in Queensland, and the process is similar for the other providers with whom we have a collaborative partnership.”

Kylie lays out the process step by step: “We might get a seasonal menu draft come in where the chef says, this is what I’m thinking about for summer, can you have a look at it? And our team will review and might say, that looks amazing but you’re not offering red meat three days a week, or the speech pathologist might look at it and say, this is great but these items aren’t really suitable for texture modification, can you swap this in – can we add an extra option for those on texture modified diets? So it’s a little bit of back and forth. We’ll also look at what’s happening in the kitchen and dining room – because a menu on paper can translate into

something very different in practice. So a big part of our job is providing feedback on things like portion sizes and presentation.”

Caitlin adds: “And that’s where we very much link back to our team who are in those facilities, to learn what’s happening with IDDSI compliance, in the dining rooms, in the mealtime experience. We can then say, for example, our last IDDSI review showed you’ve been delivering peas on an L6 soft and bite-sized diet. How are we going to improve that? Or, what have we seen in the dining room that we want to improve this time?”

Caitlin says while texture is the key focus of texture modified food, presentation, taste and variety also needs to be considered. “We work closely with our hospitality managers to ask, what can we doing to give our residents more variety in their texture modified diets? How can we make their food more enjoyable? We know that people on texture modified diets will most likely be on them for the rest of their lives, so how do we give them choice, flavour, make the food more interesting for them?

“Particularly for some residential aged care homes, it can be 50 to 70 per cent of residents who are on texture modified – so we need to look closely at the menu development process and make our meals with them in mind. That means looking at what can be modified and what’s available for everyone else to have as well. Sometimes it’s just about being a little bit clever – we’ve seen some amazing improvements in texture modified diets over the years, we’re now seeing more choice, the use of different sauces as opposed to plates covered in gravy. Using moulds is a wonderful thing but it’s not always the be-all and end-all – a mould in itself can actually take away choice if it becomes the only option given in the facility, even though it allows for consistency.

“I think it’s also important to have a talk with the dietitian and foodservice staff around how we can deliver flavours within texture modified food. Particularly when we’re looking at facilities with a strong multicultural contingent – for example, we’re currently working with a facility in NSW to develop a predominantly Vietnamese menu. The challenge then is how do we adapt that for texture modified diets – we’ve had to sit down with the hospitality team and ask, how are we going to modify rice noodles, how are we going to make congee appropriate for a texture modified diet?

“This is where we’re really lucky to have a multicultural speech pathologist and dietetic team, so we’re able to reach out to some of our colleagues and ask for their ideas and inspiration – we work to bring everyone in to get the best for the residents, even if those team members are not working across that particular facility.”

Kylie says, “Across Covid, we had a lot of chefs coming into aged care who had only ever worked in restaurants – I remember one who had only ever worked on superyachts and all of a sudden he was in aged care! So it can be a steep learning curve, and education is a big part of what we do. A lot of our speech pathologist teams will go in to aged care kitchens and work with the chefs to adapt their dishes to texture modified diets and I think it’s important to have that hands-on learning – yes, you can watch a webinar to get the basics, but our teams working right alongside the chefs can really help them understand how to modify these dishes for the residents they’re looking after. Historically a lot of texture modified would basically be composed of whatever was left in the bain marie at the end of service, which would be taken into the kitchen and pureed – and you would often not know what was coming out on the dish, and they wouldn’t necessarily be composed of flavours that went together well.”

Caitlin makes the point that “we know a large majority of residents on texture modified diets have some cognitive or communication deficits, and in the past there may have been this idea of ‘well, they can’t complain about it’. So I think we’ve really come a long way – as the focus on aged care food has increased over the past couple of years, the standards have risen when it comes to offering these options and that’s where I feel the ability to work collaboratively and start menu creation with texture modified in mind can make a big difference. That way it’s not just an afterthought.”

Food Solutions has just launched a new program, Menu Made by Food Solutions which supplies a full menu to those facilities without the resources to create their own – designed by dietitians, speech pathologists and chefs, it includes a range of recipes which can be bought in to support the relevant aged care nutritional standards. For more information visit www.foodsolutions.com.au