Survey assessing food quality in aged care launched

A new questionnaire has been launched by Flinders University to assess perceptions of food quality in aged care and enable aged care providers to make quality improvements.

Targeting family members of aged care residents, dietitians at the South Australian university are seeking 400 participants to complete the online Food Service Satisfaction Questionnaire consisting of 40 questions about food service, meal options and the dining experience. 

The research will be shared with aged care providers, offering insight into how food and meals are perceived to assist with improving food services and meeting necessary Aged Care Quality Standards and Aged Care Quality and Safety Commission auditing requirements. 

The survey questions are based on several major themes, including:

• The food on the plate (appearance, temperature, taste, etc)
• Choice and variety (e.g. is the food culturally appropriate)
• Food autonomy (does the resident have access to food 24/7)
• Participation (can they be involved in food preparation, or fold napkins, to feel helpful)
• Staff support (is there enough staff to help at meal times)
• Reliability (is your loved one receiving the meals they order)

Participants also have the opportunity to provide open-ended feedback at the very end.

Flinders University has conducted two other research studies linked to the current project; the first focused on the experiences of chefs and cooks in aged care kitchens, while the second surveyed 400 residents.

Dr Morgan Pankhurst, Accredited Practising Dietitian and Research Associate, said the previous research highlighted the importance of family insight and perspective.

“It became clear that there are residents who cannot advocate for themselves for various reasons,” said Dr Pankhurst

“Sometimes it’s cognitive impairment, sometimes it’s fear of repercussions; they’re the silent generation, they were raised not to speak out.

“When we interviewed residents and asked whether they were served something they didn’t like, if there was an alternative? Overwhelmingly they said ‘oh dear that would be rude’ or ‘I wouldn’t do that [send the food back]’. 

“They don’t want to speak up to staff, but many of these residents will speak to their families to express their concerns. 

“That puts the family member in a position where they need to be a proxy or advocate but there was no formalised way to capture their feedback.” 

Dr Pankhurst said providers can also benefit from the external perspective of family members as their interactions with staff members are going to be completely different.

“There are also questions about how staff interact with family members,” added Dr Pankhurst.

“How does the site manager or the corporation respond to feedback, too? Are staff listening, are they acting or treating family members with respect? 

“Family members provide a lot of unpaid labour in supporting residents but there’s been no way for them to have a formal voice.” 

Providers will benefit from research

While family members of residents are at the centre of the survey, the feedback and research are intended to benefit both aged care providers and residents. 

It aims to support aged care providers by gathering appropriate feedback that can be used for continuous improvement, a requirement of the Aged Care Quality Standards.

Key stakeholders, including both providers and family members, have been involved in the creation of the questionnaire. Many providers have already expressed their interest in adopting the template for use nationally, one of the major goals for Dr Pankhurst.

“Our dream is if we can get these questionnaires mandated in every home then there’s a national benchmarking platform so administrators, organisations and consumers can see which homes are performing really well on the services that matter, including food,” said Dr Pankhurst.

“We believe this research can provide a lot of information to the dietary services manager or the hospitality manager to help them target what they’re doing to make appropriate changes with meals and food quality.”

Dr Parkhurst said a nationally adopted questionnaire would allow providers to accurately seek feedback required under the Aged Care Quality Standards.

Because providers don’t have the tools to assess where food service improvements need to be made, ineffective changes are more likely to occur. 

Dr Pankhurst said they’re often stuck between a rock and a hard place when trying to implement new ideas.

“These homes are so well-intended and are trying to do the right thing but they don’t have any way of understanding the impact of their changes other than the verbal feedback,” said Dr Pankhurst.

“One provider introduced a visual menu that had an ice cream sundae. The image was a beautiful parfait glass from the internet that was Instagram-worthy but what the residents received was a scoop of ice cream in a plastic bowl with some topping. 

“We know that our satisfaction with the meal often depends on our expectations and if we’re expecting a beautiful parfait glass and get a hospital [quality] service then that’s setting the residents up to be disappointed with the food.”

The data collected could also be used for rating providers under the new aged care Star Ratings system.

Introduced as a tool for consumers to make informed decisions on aged care providers, information for the Star Ratings has been collected through Consumer Experience Interviews (CEIs).

CEIs were conducted with roughly 10% of the residents with 14 questions asked. Only one was focused on food and nutrition, and Dr Pankhurst said that does not benefit providers.

“There’s only one question about the food which is ‘do you like the food here?’,” explained Dr Pankhurst.

“We know that 38% of residents are saying ‘all of the time’ which means 62% think there’s room for improvement, but how do you identify where the improvements need to be made when it’s a yes or no question?

“We believe with more detailed questionnaires from chefs, residents and family members can inform the accreditation process, and inform the provider to easily identify where they’re doing well and where they need to improve.”

The Food Service Satisfaction Questionnaire is currently open for input and Flinders University expects the research to be publicly available for providers in the early part of 2023. More information is available through the Flinders University Website.