Managing nutritional issues and malnourishment
This month we’ll be hearing from Lisa Peterson, Deputy Commissioner, Sector Capability and Regulatory Strategy.
Part of my role at the Commission is to develop strategies to manage sector risks. This led me to reflect on some research by Monash and Griffith Universities that attracted media attention in July. The resulting concern is understandable as the researchers found that 40% of the people included in the study (all living in residential aged care) were malnourished. This sort of research is important in highlighting why aged care providers must be vigilant in their management of nutritional issues. The first prerequisite for providers is to have suitable systems in place to detect when a person is malnourished or is vulnerable to developing the condition.
Although weight loss can be an indicator of malnutrition, the Commission’s Chief Clinical Advisor and Geriatrician Dr Mandy Callary advises that a person can be malnourished or at risk of malnutrition without weight loss. This means it can go undetected, so providers need to make sure they are regularly using evidence-based screening tools to identify people who need more nutritional support. That’s because if left untreated, malnourishment will harm a person’s health, wellbeing and quality of life.
A contributing factor to poor nutrition is food quality and the overall dining experience. This is why the Commission invests heavily in making sure that providers are taking seriously their responsibilities to provide high-quality food. For example, in the 2023–24 financial year we conducted unannounced site visits at 608 services across the country, with a focus on food, nutrition and dining. Many of these site visits included a dietitian or speech pathologist from our Food, Nutrition and Dining Advisory Support Unit.
The purpose of these visits is to monitor the quality of care and services provided in residential aged care with a focus on the service provider’s management of food and nutrition, which are priority areas for the Commission. Visits also consider how people living with dementia are supported to eat and drink well, and what account is taken of cultural considerations for individual residents. Reassuringly, our visits showed that most providers are doing a good job. That’s not to say we didn’t find some problems. However, where we did, most providers were quick to make changes in response to our feedback. Where a provider is unwilling or unable to address risks or non-compliance, the Commission can and will take further regulatory actions including monitoring, investigation, compliance and enforcement actions.
Unannounced visits are just one way the Commission identifies food quality issues and poor dining practices. We also provide the opportunity for people to bring any concerns to our attention by making a complaint. For 2023–24, complaints about food quality and variety ranked 7 out of the top 10 issues complained about. We always encourage people to first raise concerns with their provider because complaints are usually resolved more quickly and easily at the service level. When people do raise concerns about food quality and dining with the Commission, we connect them with experienced complaints officers who will work with the provider and the person making the complaint to resolve the issue. Complaints also give us a valuable opportunity to hear first-hand about the kinds of issues that are concerning older Australians and their representatives. We analyse food-related complaint trends over time, which informs where we decide to conduct unannounced food and dining site visits or other regulatory activities to lift quality.
The Commission also has a dedicated Food, Nutrition and Dining Hotline staffed by professionals to support both people receiving care and providers to contact us with any issues or questions about food, nutrition and dining. Callers can speak with a dietitian or speech pathologist from our food, nutrition and dining advisory support unit for expert guidance and advice.
Now, back to the research that inspired this post. We’re continuing our complaints resolution and monitoring activities because we know this is an important issue, and we believe there is more work to be done across the sector. The level of malnutrition identified in the research is completely unacceptable – but fixing the problem is more complex than just making sure that providers are making good-quality food available to their residents. So, what does it look like in practice?
Dr Callary advised that as people age, they are more likely to develop frailty and medical conditions including dementia, which provide additional challenges to maintaining adequate nutrition. Supporting an older person’s nutrition becomes much more than just making sure a person’s food preferences are known and the food offered is high quality and attractive to eat. It involves consideration of a wider number of well-recognised possible contributing factors that allow the identification of all opportunities to support each person’s unique nutritional needs.
For some people this might be as simple as encouraging them to eat and drink in the dining room, where socialising supports improved nutritional intake. For others it might involve flexibility and a level of monitoring to identify and address if a person is not eating and drinking enough. More often than not, multiple targeted approaches are needed. If a person’s level of malnutrition is severe and/or weight loss continues after initial remedies, a thorough medical review (including medication review) with the general practitioner is important. In short, Dr Callary advises there is no one-size-fits-all approach – it’s about knowing the person, understanding their nutritional challenges and needs, and then developing a fit-for-purpose care plan to meet those needs.
For more information on this important topic, call our Food, Nutrition and Dining Hotline on 1800 844 044 or visit our resources on our website.
Until next time ….
