Menu Planning in Residential Aged Care—The Level of Choice and Quality of Planning of Meals Available to Residents

Abstract

Background: Choice of food is an imperative aspect of quality of life for residents in Residential Aged Care Homes (RACHs), where overall choice and control is diminished upon entering a home to receive care. The purpose of this study was to examine the current strategies of menu planning in a range of RACHs in Australia, and whether this facilitated appropriate levels of choice for residents receiving texture modified and general diets. Methods: The study comprised a National Menu Survey using a new survey instrument collecting general information about the RACH and foodservice system, menu information and staffing information (n = 247); a national menu analysis (n = 161) and an observational case study of 36 meal environments. Results: Choice was low for the entire sample, but particularly for those receiving pureed texture modified diets. Evidence of menu planning to facilitate the inclusion of choice and alternatives was limited. Discussion: Regulation and monitoring of the Australian Aged Care Accreditation Standards needs to be strengthened to mandate improvement of the choice and variety offered to residents, particularly those on pureed texture modified diets. Further research on how menu choice and a lack of variety in meals affects the quality of life residents is needed in this context, but current evidence suggests the effect would be detrimental and undermine resident autonomy and nutritional status.

Resident and family member perceptions of cultural diversity in aged care homes

“…The study supports the view that residents and their family members rank food choices as a high priority, but elaborates this care concern in the context of cultural diversity in aged care homes (Runci et al, ; Abbey et al, ). The literature recognizes that accommodating individualized food preferences is challenging for residential aged care homes because of the implications on resources, budget, and staffing (Chisholm et al, ; Abbey et al, ).…”

Optimising nutrition in residential aged care: A narrative review

“…The goals of managing the nutritional status of long term RAC residents include not only the treatment of malnutrition but also the prevention of decline in nutritional status (85,86). Although mealtimes are recognized as 'the highlight of the day' for many RAC residents (87) admission to RAC is known to come with challenges for residents including adjusting to specific meal times and choices, and dining companions and environments; and depending on RAC menus solely for their nutritional intake (88). It has been suggested that malnutrition may be caused iatrogenically by dietary accreditation standards that are either inadequate at meeting nutritional requirements of elderly residents (89) or extremely limited in offered choices related to menu selection (90,91).…”

“…It has been suggested that malnutrition may be caused iatrogenically by dietary accreditation standards that are either inadequate at meeting nutritional requirements of elderly residents (89) or extremely limited in offered choices related to menu selection (90,91). Therefore, to alleviate the issue of malnutrition in the RAC setting, there is increasing recognition for (a) revising existing menu guidelines to address nutritional requirements of elderly residents likely to have limited food intake (89); (b) accommodating residents' preferences based on cultural diversity and special dietary requirements (92); (c) improving mealtime choices and variety offered to residents (88). Furthermore, staff education, regular monitoring for nutritional risk and weight, with prompt and individualised triage for malnourished residents is crucial in the management of malnutrition (93)(94)(95).…”

“…Texture modified diets are therefore often prescribed to residents with dysphagia and/or poor dentition (108,109). However, texture modified diets are known to be nutritionally dilute due to the addition of fluid to achieve desired consistency, are limited in choice, and visually unappetizing thereby contributing towards reduced intake and thus malnutrition (88,(109)(110)(111). To manage these issues, Germain et al used a technology that reformed the appearance of smoot homogenous pureed food to look like its natural form, without altering the nutritional content of the food (108).…”

Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes

“…However, traditional, large‐scale hospital models of food service (characterized by residents pre‐ordering meals that are pre‐plated and taken to residents at a predetermined mealtime) remain strongly represented in the sector (Abbey, Wright, & Capra, ; Winterburn, ). The reasons for the overwhelming continued use of this model could include actual and perceived costs associated with changing from one food service system to an alternative system.…”