Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study

Abstract

Aims and objectivesTo explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self‐determination and quality of life from the perspectives of both residents and staff.BackgroundGlobally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self‐determination, sense of autonomy and quality of life.DesignThis study used an exploratory descriptive qualitative approach guided by self‐determination theory.MethodA total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In‐depth, semi‐structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study.ResultsThree main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well‐being.ConclusionsThis study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities.Relevance to clinical practiceNurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

“…Despite all levels of TMDs being offered, the TMD menus had inadequate variability and food choices. Similar results were found in Australian aged care facilities, where the TMD menus offered fewer choices than regular menus and meals adhered poorly to the planned menus [ 46 , 47 , 48 ]. In Miles et al’s study, residents on TMDs reported that sweet snacks brought them the most pleasure [ 44 ].…”

How Are the Mealtime Experiences of People in Residential Aged Care Facilities Informed by Policy and Best Practice Guidelines? A Scoping Review

“…Furthermore, mealtime rules and practices lack transparency for residents, who are rarely consulted about foodservice processes (West, Ouellet et al 2003). Thus, residents' expectations of choice and control at mealtimes are not coherent with institutional processes that regulate mealtime practices and risk (Wang, Everett et al 2020). Collaborating to foster a common understanding of good mealtimes across residents, staff and policy makers will facilitate signi cation structures that improve RACF mealtime experiences.…”

“…There are several bene ts of positive mealtime experiences on the quality of life (QoL) and overall health for people who reside in residential aged care facilities (RACFs) (Carrier, West et al 2009). However, mealtimes are highly variable depending on local RACF practices (Lowndes, Daly et al 2018, Wang, Everett et al 2020, and are also informed by broader government regulatory processes, local policies and guidelines (Bundgaard 2005). Mealtime interventions designed to improve resident nutrition and/or mealtime enjoyment are often implemented in a 'bottom-up' format by staff, families or the residents themselves .…”

“…, Wang, Everett et al 2020. Residents value opportunities to exercise agency and have autonomy over preferred foods, location and timing of meals, and tablemates(Bailey, Bailey et al 2017), and to participate in preparing food (Grøndahl and Aagaard 2016).…”

“…Best practice assessment also requires multidisciplinary team input to develop appropriate care plans that generate new mealtime rules(Bennett, Ward et al 2015). Additionally, open and regular communication with residents provide staff direct feedback and gauge resident expectations and experiences of meals(Wang, Everett et al 2020).Best practice menu guidelines for resident nutrition have been developed in Australia, but these are not mandated, and do not provide guidance about improving mealtime experiences (Williams 2012, Abbey 2015). For example, whilst studies have recommended policy that protects mealtimes and deters non-mealtime related tasks during meals(Ullman 2009, Ullrich, Buckley et al 2014), these are not policy measures.…”