Is the food and nutrition hotline a costly solution?

In May 2023, the Federal Government announced that $12.9 million would help “deliver a range of meaningful measures to enhance the quality of food for older people.” 

This included the establishment of a dedicated food, nutrition and dining hotline. Older people receiving aged care, their families and carers could call this hotline to seek support, ask questions or raise concerns about the food, nutrition and dining experience. 

Of the $12.9 million dedicated to food and nutrition measures across the 2023-24 financial year, $7.4 million the established of a Food, Nutrition and Dining Advisory Unit and the Food, Nutrition and Dining hotline which they provide support for.

“The funding enabled the Commission to set up a dedicated Food, Nutrition and Dining Advisory Unit. This team of dietitians and speech pathologists provides expert advice for people receiving aged care, their representatives, and aged care workers and providers,” explained a spokesperson for the Aged Care Quality and Safety Commission. 

“They also support the Food, Nutrition and Dining Hotline and regulatory activities. These regulatory activities include the food, nutrition and dining targeted assessment visits. The Commission also offers education and support on this topic for the aged care sector as a whole.

“Since the Food, Nutrition and Dining hotline was launched in late July 2023, the Commission has received and dealt with nearly 600 calls from people receiving aged care, their family members and carers, aged care providers and their staff.”

The spokesperson also shared that calls to the hotline include general enquiries, specific questions, and concerns or complaints related to food, nutrition, and dining issues in aged care.

It’s important to note the figure of “nearly 600 calls” was provided to Hello Leaders in July, so it will have certainly increased by now.

At face value, it would appear that equates to just over $12,000 per call. However, further clarification from the Aged Care Quality and Safety Commission paints a clearer picture.

The $7.4 million is allocated to the Advisory Unit and hotline, meaning the funding is spread more evenly among staff wages (including dietitians and speech pathologists), the creation of education support resources, webinars, research and direct support for aged care providers.

With a range of critical issues in aged care that require attention and funding, is the overall cost a high price to pay? Or is it a meaningful investment that’s set to make a positive impact?

For Dietitians Australia, the hotline is a step in the right direction. Dietitians Australia Aged Care Interest Group Convenor, Accredited Practising Dietitian, Karly Bartim, explained to Hello Leaders that providing food and nutrition in residential aged care is a complex task due to the many unique nutritional needs. 

She said the Food, Nutrition and Dining Unit’s establishment within the Aged Care Quality and Safety Commission is a valuable initiative, so too is the hotline as it “empowers residents and their families to escalate menu and mealtime complaints and enable referrals to dietitians as required.”

But the real value will come in the long term, with the hotline being one of several pathways to improvement in food and nutrition. 

Ms Bartim said Dietitians Australia is excited to see the draft strengthened Quality Standards state that residential care menus must be reviewed at least annually through a menu and mealtime assessment conducted by an Accredited Practising Dietitian. The organisation has been advocating for this outcome for many years. 

“It will take time and a strong integrated approach, including cooks, chefs, dietitians, care workers, and more, to transform and lift the standard of food and nutrition in residential aged care,” Ms Bartim said.

“We are just getting started, but the impact of some of the foundational work being put in place to transform nutrition in aged care is starting to show light. 

“This is the start of real transformation, but there is a long journey ahead, and dietitians are committed to working closely with the sector to ensure older Australians are well supported to live and age well through good food and nutrition.”

She also highlighted the Quarterly Financial Report’s increased transparency of residential aged care expenditure on food and ingredients and dietetic care as another important initiative.

Bringing the focus back to allied health

The Commission recently highlighted food-related issues in its Sector Performance Report (April – March 2023), reporting that 10% of complaints related to food in residential care were linked to allied health assessment and services. Only three categories received more complaints with ‘Quality and variety’ being the standout problem comprising almost one-third of complaints. 

Industry leaders who strongly support allied health have been pleased to see the Interim Inspector General of Aged Care, Ian Yates, encourage the Department of Health and Aged Care to review the impact of AN-ACC and care minutes on the provision of allied health. 

Mr Yates said “The implementation of properly intentioned policies can have unintended consequences” and there’s a consensus that allied health deserves standalone recognition under AN-ACC or care minutes requirements. 

Ms Bartim said Dietitians Australia, alongside Allied Health Professions Australia, welcomed his comments and recommendations. 

“It is our view that allied health support, including support from dietitians, is chronically underrepresented in aged care, and residents and home care consumers deserve to be provided with services based on their individual needs,” she said. 

“We ultimately want to see every residential aged care home, and home care provider engaging regularly with a dietitian.”

“In addition to supporting residents’ nutrition needs one-on-one, it is so important for dietitians to work with the home to ensure the food served meets residents’ preferences as well as their nutritional, psychosocial, and cultural needs. 

“It is so important that dietitians are engaged onsite to support the food service teams to ensure the food, drink and dining experience is conducive to health, wellbeing and quality of life.”

Don’t argue with compliance 

Aged care is toeing the line with regulation and compliance. Some, like Dr Jonathan Foo, lead author of a recent study into malnutrition in aged care, are reluctant to see more regulation in the food and nutrition space. 

Right now, it’s all about balance. The strengthened Aged Care Quality Standards will bring a much-needed focus on food, nutrition and dining with a standalone Standard, highlighting its importance without overburdening providers. 

When it does come into effect, residential aged care facilities will be required to: 

• Implement processes to maintain an older person’s nutrition and hydration by conducting regular malnutrition screening, minimising the impact of chronic conditions, responding to the risk of malnutrition, and responding when an older person is malnourished or has unplanned weight loss or gain. 
• Develop menus with the input of chefs, cooks and an Accredited Practising Dietitian, including for older people with specialised dietary needs.
• Review the menu at least annually through a menu and mealtime assessment conducted by an Accredited Practising Dietitian.  

While these initiatives are a positive step forward, Dietitians Australia would also like to see mandatory malnutrition screening in aged care. Currently, older people are typically assessed upon entry to residential care but few are reassessed for malnutrition after that. 

Ms Bartim said routine malnutrition screening should occur at the assessment stage, at the beginning of care and at regular intervals thereafter, e.g. quarterly. 

“Malnutrition screening needs to be embedded in routine practices, to ensure residents at risk are promptly referred to a dietitian and given the nutrition support they need.”

She also said the current unplanned weight loss Quality Indicator should be replaced, with a malnutrition screening Quality Indicator to take its place, as it would be a more complete indicator of malnutrition. 

In conjunction with the Government’s other food and nutrition investments, this would allow for data collection of all indicators of poor nutrition – not just unplanned weight loss – and provide greater opportunities for early intervention.

Ultimately, time will tell on the true effectiveness of the funding for the Advisory Unit and hotline. If there is real impact on the ground in residential aged care, the outcomes will speak for themselves as providers improve the quality and variety of meals, or increase the influence of allied health professionals in the dining and nutrition space.