Food and nutrition | Aged Care Quality and Safety Commission

Intent of Standard 6

Access to nutritionally adequate food is a fundamental human right. Food, drink and the dining experience can have a huge impact on a person’s quality of life. As people age, they may lose their appetite or experience conditions that impact on their ability to eat and drink. As such, it is particularly important that providers engage with older people about what and how they like to eat and drink, deliver choice and meals that are full of flavour, appetising and nutritious (including for older people with texture modified diets), and support older people to consume as much as they want and exercise dignity of risk.

In many cultures, food also plays a large role in fostering feelings of inclusion and belonging. The experience of sharing food and drink with other older people and their supporters is important for many older people.

Providers must draw on Standard 3 in delivering food services to ensure this is informed by robust assessment and planning and funded aged care services are delivered in line with the needs, goals and preferences of older people. It is also critical for providers to monitor older people for malnutrition and dehydration and respond appropriately where concerns are identified – this is addressed as part of Standard 5.

Standard 6 is intended to apply only to residential care homes.

Updates to guidance

The Commission is currently updating our guidance content to reflect these changes. Please ensure you check back regularly.

Governing body

Information for governing bodies* in residential care homes

This guidance should be read in conjunction with Quality Standard 2 which relates directly to the governing body*.

The governing body* plays an important role in aged care and services. They’re responsible for an organisation delivering quality care* and services (Outcomes 2.2 and 2.3).

The governing body* needs to:

supervise provider activities
lead a culture of safety, inclusion and quality
help identify and address issues.

It is important the governing body* puts in place processes* to check the organisation’s strategies for delivering tailored care and services meet each older person’s needs, goals and preferences*. This includes monitoring the organisation’s performance, such as by reviewing reports on:

how they’re delivering care and services
how they’re managing complaints*, feedback* and incidents* (Outcomes 2.5 and 2.6)
the quality of care and services workers* are delivering. For example, through quality assurance or system* reviews (Outcome 2.8).

Make sure the organisation has a culture of safety, inclusion and quality by monitoring and investigating areas you find in the organisation’s reports you can improve. Identify opportunities and make recommendations to your organisation to improve its culture of safety, including quality care*. Provide feedback* and support to the provider.

You also need to monitor the performance of any associated providers*.

If you find any issues or ways you can improve, you need to address them. If things go wrong, you need to:

practise open disclosure*. This means being open about what has gone wrong. Share this information with older people, their supporters and others they may want to involve, such as family and carers*
have strategies to reduce the risk of things going wrong again.

The provider guidance for Outcome 2.3 has more information on open disclosure*.

Standard 2 provides detailed information for governing bodies*.

Key tasks:

Track how the organisation assesses the nutritional needs, goals and preferences* of older people.

This includes the nutritional, hydration and dining needs* and preferences of older people. Providing nutritious* and suitable food and drink is an important part of providing quality care*.

The governing body* needs to oversee the organisation’s activities. This includes reviewing reports on:

assessment and planning of older people’s nutrition, hydration and dining needs* and preferences
food, drinks and dining experiences* for older people.

Track how well the organisation designs and prepares food and drinks.

The governing body* needs to oversee the organisation’s activities and review reports on the:

strategies they use to provide food and drink to older people. Providers need to develop menus that meet older people’s needs and preferences
food, drinks and dining experiences* of older people
systems they use to monitor and continuously improve the food service

Track how well the organisation supports older people to eat and drink.

Organisations should support older people to eat and drink in a dining environment which meets their needs and preferences. The dining environment should support older people’s social engagement, function and quality of life*. You need to review how well the provider partners with older people to make the dining experience* enjoyable for them. 

You can find more resources about the role of the governing body* and governance* in the Quality Standards Resource Centre.

The Commission developed the Governing for Reform in Aged Care Program to support the key recommendations of the Royal Commission into Aged Care Quality and Safety. The Program supports governing body* members, leaders and emerging leaders to strengthen corporate and clinical governance* capabilities and enact critical reform.

Workers

What does this Standard mean for workers*?

Standard 6 describes requirements for providing older people in the residential care home with nutritious, appetising and safe food and drink and enjoyable dining experiences*.

Tips for workers*

Workers* involved in assessment and planning

You should find out the older person’s needs, goals and preferences* in relation to food, nutrition, drink and the dining experience* and manage any associated risks.

Risks may include:

clinical and other physical issues that impact an older person’s ability to eat, including:
- oral health
- ability to chew and swallow
- the impact of medications on appetite
- the impact dementia* can have on appetite
- dysphagia and dexterity
dietary needs and modifications (including nutritional needs, allergies and intolerances, texture, and cultural and religious needs)
preferences, including what they like and dislike, and favourite foods
the level and type of support an older person needs to eat or drink, including:
- seating and positioning needs
- dexterity
- needing physical help to eat and drink
- needing to be reminded to eat
- needing help cutting up their food for them
- specialised mealtime assistance.

Older people who require enteral nutrition (nutrition and hydration that is delivered via a tube) will need careful and specific planning in line with contemporary, evidence-based practices* and guidelines, and in consultation with relevant health professionals*. This includes consideration of:

the timing, temperature, and volume of enteral formula and water flushes, with consideration of any food or drink they may consume orally
safe administration, including the skills of the person administering enteral nutrition, positioning, and cleaning of equipment
the environment, such as temperature of the room and location in which it is provided
regular ongoing monitoring and reassessment of nutritional requirements and tolerance

Workers* involved in menu development and cooking

Your organisation should have processes* for actively involving older people in designing menus. This includes finding out what foods and drinks should be on offer to create an enjoyable dining experience*.

You should assist your organisation with getting feedback*on a regular basis from older people about the menu, meal quality and dining experience*. Use feedback* to shape menu offerings, make sure meals meet the preferences of older people, and improve the overall dining experience*.

You should follow the food safety principles outlined by your organisation. You should make sure the food prepared and served to older people meets their individual care and services plan*, as required by legislation.

You should think about how to present food and drink to older people in an appealing and appetising way. This may include, thinking about:

presentation
temperature
plating
presentation of texture modified foods (including through use of moulds, piping or scoops).

You should offer choice and variety for older people. For example, by:

offering a variety of options for every meal
having different condiments or sides available to accompany meals
changing the menu regularly*
having meals for special occasions, such as themed events
supporting older people to make their own basic snacks and meals when they want to
offering choice in the serving size.

You should have nutritious snacks or alternative meals available for older people who:

want to eat between meals
may have missed the regular meal service
don’t want to eat what is on the menu.

You should provide opportunities for older people to share food and drinks with their loved ones. Allow loved ones to join meals at the residential care home.

Workers* involved in supporting older people to eat and drink

You should know and support each older person’s needs, goals and preferences* in relation to food, nutrition, drink and the dining experience* and manage any associated risks. This includes being aware of any allergies, food intolerances, dietary requirements and additional support the older person may need. These should be documented in their care and services plan*. For example, you could consider:

if they need to be reminded and encouraged to eat and drink if they need to be supported to safely eat or drink, and what physical support they need to safety eat and drink at their preferred pace
if they have particular seating requirements or need certain utensils
where they like to eat and who they like to eat with
what makes a positive dining experience* for the older person.

It’s important older people get the help they need to eat and drink, otherwise they can be at risk of malnutrition or dehydration. Your organisation should make sure sufficient workers* are available to support older people to eat and drink in a way that meets their needs, goals and preferences* and at a pace that suits them.

You should recognise and seek feedback* when an older person has not eaten much and ask them why. It could be because:

they didn’t like the food
the serving size was too large
it wasn’t served at the right temperature or in an appealing way
they didn’t have the support they needed to eat or drink
there are other issues (for example, where they are not feeling well or they are upset).

It’s important to monitor and document when older people are not finishing their meals. Let management know so such issues can be addressed.

Your organisation should support processes* for getting regular feedback* from older people about their food, drink and dining experiences*.

It’s important to check how satisfied older people are with the quality, temperature, and presentation of their meals, as well as their preferences for dining arrangements and support. Workers* should create opportunities for feedback* and conversations, record any concerns, and bring them to management to help improve the dining experience*, to support Standard 2 and Standard 6.

Key concepts

Dignity of risk*

Dignity of risk* supports an older person’s independence and right to make their own choices, even if those choices involve some risk. If an older person’s choices are possibly harmful to them, you are expected to help them understand the risk and how it could be managed to help them live the way they choose (linked to Standard 1).

Some older people may choose to consume food and drink that has been identified as a risk to them. For example, these risks could be:

certain ingredients (such as sugar, salt or fat)
the serving size, texture and consistency of food and drink
fast food
food cooked by family
food that could be difficult to swallow or could lead to choking*. Choosing to eat and drink things that have a health risk is known as eating and drinking with acknowledged risk (EDAR)*.

Older people can choose to accept these risks so they can enjoy their meal. You must respect their decision. Where an older person’s decision-making capacity is impaired, use supported decision-making* to help them make informed decisions about their eating and drinking. This includes involving the older person’s supporters, family, carers* and loved ones they want engaged in their care to help with their decision-making.

Supporting older people to make informed choices* about all aspects of their food, drink and the dining experience* is a key part of maintaining their quality of life* in residential aged care.

Creating appetising foods

The food, drink and the dining experience* can have a huge impact on an older person’s quality of life*.

As older people age, they may lose their appetite and become less sensitive to flavour or experience conditions that impact on their ability to eat and drink. As such, creating nutritious, flavourful and appetising meals that meet older peoples’ diverse needs can be a challenge. Food is personal and preferences are complex. What is appealing to one older person may not be appealing to another.

It’s important to engage with older people to understand their likes and dislikes, and ways you can improve their enjoyment of food.

The dining experience*

The dining experience* is a combination of the food and drinks provided, the service, and the atmosphere. This experience impacts on an older person’s quality of life* and wellbeing*.

You should make sure food and drinks are accessible to older people with mobility or access needs. Meals should be easy to reach and seating or table arrangements should accommodate all physical abilities.

To support a positive dining experience*, you may think about:

table and seating arrangements and opportunities for social interaction
music, temperature, lighting and ambience
how the food is presented, including plating, serving size, temperature and smell
how workers* interact with older people to help them eat
opportunities to promote an older person’s independence and reablement*.

An enjoyable dining experience* can bring pleasure to an older person, improve their wellbeing* and quality of life* and increase the chance of them eating their meals.