With the newly strengthened Aged Care Quality Standards coming into force from July 1, providers and staff are ramping up to working within this new framework. While many of us have familiarised ourselves with Standard 6 – Food and Nutrition, Nutrition Professionals Australia (NPA) Director Julie Dundon points out there are wider food and nutrition related implications which also need to be considered.

“Standard 6 is very important and a great step, but when you look at the other standards and how to apply them, you can see that food and nutrition sits within almost every other standard as well,” Julie says. “For example, when we talk about person-centred care, that includes catering for their cultural needs – so the menu will need to offer choices around cultural preferences, particularly regarding the Indigenous community.

“We also need to have policies and procedures devoted to food nutrition and hydration, and clinical care staff, as covered in Standard 3, will need to follow these.

“And of course Standard 6 in itself will have broad-reaching impacts. Of particular note for dietitians and foodservice managers is that under Standard 6.3.1 (b) residents are to have input to the menu along with an accredited practising dietitian (APD).

“That’s a big change, and it’s particularly going to impact those providers who operate multiple sites and are using the one menu – does the input from the dietitian come at the corporate level or at the individual site, because each site will likely tweak the menu slightly?

“I don’t think there are clear answers to these questions yet – but my view is that a dietitian should have input at each site, because that will best ensure the nutritional needs of the residents are being met. It could be done remotely, with guidance given about what needs to be on the menu.”

Standard 6.3.1 covers menu and mealtime assessments, which need to be conducted by a dietitian at least annually, but Julie points out: “I would think best practice would require this to be done each time a menu is changed, for example summer and winter menus would both need to be assessed.”

Julie says these kinds of questions are set to drive procedural changes across many providers and organisations. “The definition of a menu and mealtime assessment is partly informed by Dietitians Australia’s assessment process, which must be completed with a full day’s site visit – and many organisations have assumed that completing a paper menu assessment is appropriate, when we know that what’s on paper and what actually happens can be poles apart.

“These assessments are done on site from the first shift of the kitchen staff to well after the evening meal – they cover the whole process, looking at how much food is on the plate, how long does meal service run, what’s on the morning, afternoon and supper trolleys, how accurate the documentation is, whether there’s a good line of both formal and informal communication between clinical and kitchen staff and between the chef and the resident, and so on.

“I would really encourage providers not to be worried about menu and mealtime assessments – they provide guidance on how to improve your meals, they’re not intended as criticism but as constructive advice so you can move forward, which is why every menu and mealtime assessment has an action plan included.”

Julie made a significant contribution to the assessment process followed by Dietitians Australia, the national peak body for dietitians. Her own consultancy, Nutrition Professionals Australia (NPA), offers a more detailed analysis.

“You can follow the Dietitians Australia process and it’s OK, but you should know there are more extensive assessment tools available,” she emphasises. While acknowledging that the Standards are still in draft form until they’re passed on July 1, Julie says “There’s no point in waiting – you need to adopt best practice, starting now. That’s why NPA has developed and used our tool against the new standards for the past 12-18 months, so our clients will have their assessment processes reading for July 1. I think the penny is starting to drop for people that they need to have their menu and mealtime assessments completed ideally by July 1 – I’ve recently been to numerous sites across the country, both metropolitan and rural, and they’re all wanting them done before June 30.”

On the introduction of the new Standards as a whole, Julie says “It has taken a long time and I think in many ways it has been too slow – but to be fair, there have been a lot of changes and there’s only so much you can do all at once. These things do take time to embed – I personally think it’s a shame that the new Standards weren’t adopted on July 1 last year, but that shouldn’t stop anyone from forging ahead now with having dietitians contribute to the menu or looking at culturally appropriate foods, to use the two examples we’ve been talking about.”

A further challenge imposed by the new Standards is around resident choice. “Residents will need to have choice about where they eat, when they eat and who they eat with – and that’s a big change for the aged care sector, not only to implement it but to demonstrate it. At breakfast time you won’t be able to just flick the lights on and present someone with a meal tray – you’ll need to allow the person to wake, ask whether they want their breakfast in the dining room, in their own room, perhaps outside. Systems, processes and documentation will need to be put in place to allow those things to happen and most importantly, staff will need to read that documentation – not just kitchen staff but care staff as well.

“This is where there needs to be a combined team approach, with all staff aware of what residents’ preferences are, rather than just assuming they know. We all know preferences can change – and it’s no use having comprehensive documentation if it stays in a folder in the kitchen and no one takes it out and looks at it – that happens more often than some of us realise.

“Having said that, there are some fabulous providers and sites that are doing great work. But the systems and processes need to be there to support them, because they too can get weary and worn down, so they need the resources to help them perform at their best, and I think that’s often underestimated. And when staff become too jaded, they leave the industry and then we lose that wonderful experience and skillset.

“On the other hand, we often put people who are underskilled in the kitchen because we think they can cook and then we expect too much of them. Some cooks have been in aged care for 20 years but they haven’t been given much of an opportunity to grow and extend their skills. I think we should strive to do better than that.”