Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders

Abstract

The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.

The challenges facing residential aged care homes to participate in quality food and nutrition research

“…Staffing issues can account for these differences and the results presented here show that if a particular individual leaves a system or changes position, then research can fail. Identifying food and nutrition champions at each home may be a potential solution to the challenges caused by staff turnover in the sector 4 …”

“…Data primarily consisted of in-depth interviews of foodservice managers, foodservice workers, dietitians, care staff and other managers from the aged care sector (n = 21) and the detailed methods (including the interview guide) have previously been reported. 4 Additionally, field notes written by the lead researcher and a research assistant across three studies and emails communications with aged care staff about recruitment and engagement in the research studies were included in the analysis. Purposive sampling was used across all three studies and potential participants were contacted through email by a member of the research team.…”

“…Qualitative research conducted across a four-month period in 2019 had a response rate of 45% from aged care workers with existing relationships with a member of the research team who were contacted to participate in the research, with 21 in-depth interviews being conducted. 4 It was more difficult to organise a time to interview foodservice staff (kitchen hands, cooks and chefs) who spent most of their work time completing tasks and often did not want to be interviewed in their free time outside of work. Managers within the sector, as well as dietitians who all worked as consultants appeared to have more flexibility in when they could complete an interview.…”

“…3 Providing meals for aged care residents is a complex task, requiring aged care homes to consider individual food preferences and dietary requirements. 4 The needs of residents entering residential aged care has become increasingly more complex over the past decades; however, the science of foodservice does not appear to have advanced to meet these needs. 5 The performance of the Australian aged care system has been repeatedly questioned over the last few decades.…”

Examining dietitians' knowledge, skills and attitudes regarding working with older adults in residential aged care facilities and home care services: An integrative review

“… 34 Furthermore, a 2020 systematic review on malnutrition practices in older adults revealed that other health professionals' time for, and knowledge of, screening policies is inadequate and negatively affects the impact of dietitians. 35 Cave et al 36 highlighted that teamwork between all staff is required to encourage adequate dietary intake in older adults. The lack of nutrition knowledge and prioritising nutrition care was also a key finding of the 2021 Royal Commission into Quality and Safety in Aged Care in Australia.…”