Managing Risk versus Choice in Aged Care kitchens

The first of the new Australian Aged Care Standards, which came into effect on July 1, 2019, is titled Consumer Dignity and Choice. It states:
“You are treated with dignity and respect and can maintain your identity. You can make informed choices about your care and services and live the life you choose.”

One of the areas of Aged Care this has impacted is food, dining and resident preferences versus clinical advice—particularly in the area of texture modification levels in Aged Care kitchens.

We recently spoke to Speech Pathologist Sophie Crouch from Loqui Speech Pathology in Queensland about the feedback they have received, as Aged Care Chefs have incorporated this important standard into their daily processes.

Resident preference is always the priority for both clinical staff and foodservice. However, the difficulty arises as the residents’ needs change to the extent that they have to move to a new texture modification level, and they perceive they no longer are able to make a choice about the food they can eat.

As changes in texture modification are mainly due to the individual’s decreased ability to chew and/or swallow food, there is more risk if the resident chooses to eat something which is no longer advisable to eat.

The biggest issue, says Sophie, is around the communication about the change—not the change itself.

Commonly, when a clinical change is made, the change itself (and often not the reason for the change) is documented and given to the Aged Care Chef to incorporate in their menu planning. The resident then receives a meal they may not have been expecting, and the complaint goes directly back to the Chef and kitchen staff.

What Sophie is seeing is an opportunity to create strong communication channels between clinical staff and the food and dining staff in Aged Care kitchens, so not only are the changes communicated, but the reasons for these changes are also clearly communicated to the Aged Care Chef. The Chef can in turn talk to the residents and discuss options, so they are able to make an informed choice about the food they want to eat.

This is the real crux of the issue, says Sophie,
“Choice is not choice—it is informed choice.”

When Chefs, dining, and mealtime care staff have all the relevant information, they are able to have a conversation with the resident and, where necessary, the residents’ families, so informed choices can be made.

It is as simple as being able to say a meal choice has changed because.... Simply being able to explain why there has been a change is very powerful, for both the Chef and the resident. It means everyone is in some way included in the decision-making process, and allows the Chef to then come up with innovative ways to give residents what they want, in a safe meal format.

Sophie went on to say that an additional challenge arises when a change in texture levels coincides with a decline in cognitive ability. This means even if the communication between clinical staff such as a speech pathologist and the Chef are very clear, often the resident is unable to understand or retain the information about why their meals are not what they expect. It then falls to the next of kin to be informed so the resident can continue to eat healthily and safely.

The resolution lies in the relationship between the clinical staff and the Chefs—something Loqui endeavours to nurture at every opportunity.

Experience shows that when clear communication between clinical staff, Chefs and residents is built into the process of assessing and updating a resident’s texture level, the number of complaints tends to drop.
When Chefs, dining, and mealtime care staff have all the relevant information, they are able to have a conversation with the resident and, where necessary, the residents’ families, so informed choices can be made.

It is as simple as being able to say a meal choice has changed because.... Simply being able to explain why there has been a change is very powerful, for both the Chef and the resident. It means everyone is in some way included in the decision-making process, and allows the Chef to then come up with innovative ways to give residents what they want, in a safe meal format.