Food and nutrition funding may go cold despite demand for help

Food and nutrition in residential care remain a top priority for the Aged Care Quality and Safety Commission. However, the Food, Nutrition and Dining Unit potentially faces months of uncertainty as its current funding allocation nears the end of its cycle – while the 2025 Budget hinges on federal election results. 

Key points

• The most recent sector performance report indicated that food, nutrition and dining related visits constituted the majority of targeted assessment contact activities in residential care
• This included 275 site visits across the first quarter of 2024-25, up from 203 the previous quarter
• With just four months until the end of the current financial year, the initial two-year funding commitment to strengthen the Food, Nutrition and Dining Unit is due to run its course
• The Unit’s funding supports a team of dietitians and speech pathologists who provide expert advice for people receiving aged care, their representatives, and aged care workers and providers

While it is unclear how much money is required for the Unit’s ongoing operation, providers risk being left without a dedicated support unit for a critical piece of the aged care puzzle. 

Alternatively, it presents an opportunity for either government to address whether the funds are being utilised to the best of their ability or if additional funding can provide further widespread benefits.

Reflecting on the hotline’s impact

Last year, Hello Leaders contacted the Aged Care Quality and Safety Commission about the Unit’s impact, particularly through the Food, Nutrition and Dining Hotline. As of September 2024, the hotline had received roughly 600 calls.

In a statement provided to Hello Leaders this week, a spokesperson for the Commission said the hotline remains busy with figures suggesting it handles 50 calls per month.

“Since the Food, Nutrition and Dining hotline was launched in July 2023, the Commission has received and dealt with over 800 calls from people receiving aged care, their family members and carers, aged care providers and their staff,” the Commission spokesperson told Hello Leaders.

“Calls to the hotline include general enquiries, specific questions, and concerns or complaints related to food, nutrition, and dining issues in aged care.”

Additional complaints and enquiries are also fielded through the Commission’s website, emails, letters, and calls to the Commission’s general number.

The Commission’s spokesperson also revealed that many of the concerns and issues raised by aged care providers are linked to everyday challenges, including: 

• Special events, including cultural celebrations, theme days and ways people receiving care can be involved in cooking and dining
• How they can provide variety and ask people about their preferences
• Processes to keep improving and learning from mistakes
• Around-the-clock snack options and flexibility with eating times
• How to make dining environments calmer, quieter, more inviting and homelike

These requests indicate that providers want to improve service delivery and resident experiences with the dedicated hotline and unit offering effective insights.

“An enjoyable food and dining experience is important for the health, wellbeing and quality of life of people in residential aged care. People who enjoy their mealtimes are more likely to eat and drink well,” the Commission’s spokesperson added.

“This reduces their risks of malnutrition, dehydration and weight loss. Poor quality food can lead to more falls, lower quality of life, more pressure injuries, more frailty and less independence.”

However, a minority of issues remain. Roughly 2% of Serious Incident Response Scheme (SIRS) reported incidents are linked to nutrition. Quality indicator compliance remains strong overall, although food-related complaints still made up almost 15% of all complaints to the Commission in 2023-24.

Strengthened standards and a new way forward

The Commission’s targeted risk-based monitoring campaigns focus on three areas of risk: COVID-19/infection prevention and control, workforce responsibilities and food, nutrition and dining.

The priority is to address scenarios with a higher risk of harm for older people receiving care. Data and information are typically collected from several sources to inform these visits, including complaints and feedback pathways, site and non-site monitoring activities, and compulsory provider reporting. 

“Through our regulatory activities, the Commission has found examples of both good practice and poor resident experience in relation to food, nutrition and dining. Good practice includes understanding what people receiving care need and using both clinical and food service expertise to deliver it,” the Commission’s spokesperson explained.

“Examples of poor care include not modifying the food and drinks correctly, unappetising meals, and not offering choice. Many providers show that they understand what the people in their care need and listen and respond to their feedback.

“When we find problems with a service’s food, nutrition or dining arrangements, we draw this to the provider’s attention and seek their undertaking to fix them. Most providers we engage with take the necessary action to improve their performance. 

“However, in the rare instance where a provider is unwilling or slow to act and they have other areas of risk or non-compliance, under our provider supervision model we case manage them intensively and use our regulatory powers to compel them to act.”

Key areas for improvement highlighted by the Commission include:

• Providing familiar or favourite foods
• Improving the food delivery and processes that make sure food is delivered quickly and at a good temperature
• Holding regular events and occasions
• Providing homelike and social dining environments
• Maintaining staff quantity and quality
• Co-designing meals, menus and experiences with people receiving care

The new Aged Care Act will pressure providers to perform well in this area. The Strengthened Quality Standards will be implemented with the Act from July 1, bringing into effect a standalone Food and Nutrition standard. 

This standard features four outcomes: partnering with older people on food and nutrition, assessment of nutritional needs and preferences, provision of food and drink, and dining experience. 

All outcomes touch on the areas that providers are concerned about and require additional help. This includes recognising how to embrace diversity and culturally safe care in the dining experience, providing appropriate access to food and drink and ensuring older people have choices and are involved in food and nutrition-related decisions. 

Moving forward, providers must step up to ensure they go above and beyond minimum expectations. 

“While compliance with the Aged Care Quality Standards is essential, we encourage providers to strive for excellence beyond meeting what is required,” the Commission stated. 

“Our targeted food, nutrition and dining monitoring campaign uses preventive and responsive approaches aimed at intervening early to prevent harms associated with food, nutrition and dining from occurring, or reoccurring.”

Providers looking for additional information and support can utilise resources such as the Commission’s Food for Thought articles, an analysis of food and dining experiences in residential aged care services, or apply for a free Menu and Mealtime Review. 

The Commission also urged providers to continue engaging with residents, their families and advocates to understand their experiences and preferences.