AGED CARE QUALITY STANDARDS TOOLKIT FOR APDs

AGED CARE QUALITY STANDARDS TOOLKIT FOR APDs

December 2020

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TABLE OF CONTENTS

OVERVIEW 4

Standard 1 – Consumer Dignity and Choice 7

Standard 2 – Ongoing Assessment and Planning with Consumers 17

Standard 3 – Personal Care and Clinical Care 23

Standard 4 – Services and Supports for Daily Living 29

Standard 5 – Organisation’s Service Environment 37

Standard 6 – Feedback and Complaints 43

Standard 7 – Human Resources 48

Standard 8 – Organisational Governance 55

Helpful resources for APDs, aged care staff, carers and consumers 62

AGED CARE QUALITY STANDARDS TOOLKIT FOR APDs 3

Toolkit authors

Dr Cherie Hugo – APD, The Lantern Project and My Nutrition Clinic

Petra Salo – APD, My Nutrition Clinic

Anne Clark – APD, My Nutrition Clinic

Aloysa Hourigan – APD, My Nutrition Clinic

Acknowledgement of Toolkit reviewers

Yvonne Feeley – APD

Sharon Lawrence – APD

Vanessa Schuldt – APD

Dr Melanie Wroth – Aged Care Quality and Safety Commission

© Copyright 2020 Dietitians Australia

Dietitians Australia’s ‘Aged Care Quality Standards Toolkit for APDs’ - 1st edition. Month of publication – Dec 2020.

All rights reserved. No part of this toolkit may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without prior permission in writing from Dietitians Australia.


OVERVIEW

Commonwealth subsidised Aged Care Services are required to comply with the Aged Care Quality Standards. These services are assessed and must provide evidence of their compliance and performance against the Standards.

Food, nutrition and the mealtime experience are relevant across each of the eight Aged Care Quality Standards. Accredited Practising Dietitians (APDs) play a vital role in not only highlighting opportunities, but supporting aged care providers to ensure their organisations are compliant with the Aged Care Quality Standards (ACQS), especially with respect to food provision and nutrition care.

This Toolkit is designed to provide APDs with practical strategies to best support aged care organisations – in the community and residential aged care home settings – to be compliant with the eight ACQS and furthermore, to excel in the food, nutrition and mealtime experience space. It also reflects strategies for APDs to align their own consulting habits with consumers and the Standards. This Toolkit compliments the comprehensive guidance resource titled “Guidance and Resources for Providers to support the Aged Care Quality Standards” – which all APDs consulting in the Aged Care Sector should be familiar with.

Each of the Standards are interlinked across all of the focus areas, with the overarching “bookend” Standards 1 (Consumer Dignity and Choice) and 8 (Organisational Governance) integral across the interconnected standard themes.

The intent of this Toolkit is to provide a quick reference for APDs who are supporting aged care organisations with targeted strategies relevant to specific Quality Standards. Due to interconnected themes, there is, at times, overlap and repetition between the Quality Standard sections.

This Toolkit steps through Quality Standards 1 to 8 to provide:

A brief overview of each Standard Targeted example strategies APDs can take to support aged care providers to meet each

Standard Practical tips and quality improvement ideas

The Toolkit provides links to helpful resources for APDs in the final 3 sections: Available guidelines/tools and resources for APDs Practical resources in terms of handouts, online training and websites for aged care

providers and their staff Practical resources in terms of handouts and websites for consumers and their carers

https://www.agedcarequality.gov.au/sites/default/files/media/Guidance_%26_Resource_V11.pdf


Each Standard is considered from the perspective of Residential Aged Care (RAC) organisations and their consumers, as well as from the perspective of Community Care Organisations (Home Care and Community Care – including centre-based respite and cottage respite), their consumers and carers.

An overview of the role of APDs across aged care settings

Throughout the document, the example tables are divided into the 3 key aged care settings. These are:

1. Residential Aged Care setting – where food, nutrition and mealtime experiences occur

in a residential aged care facility (for permanent consumers and community respite

consumers)

2. Community Care setting – where food, nutrition and mealtime experiences occur in a

community setting outside of the home (e.g. centre based respite, cottage respite etc)

3. Home Care setting – where food, nutrition and mealtime experiences occur in the

consumer’s home

In Residential Aged Care, nutrition input from an APD can be across a number of areas including clinical care, food service and staff education. APDs can provide assistance and support by way of 1:1 consultations, menu design and review, meal planning and preparation, mealtime experience and environment, assistance with feeding/drinking, mealtime support options, clinical and food service audits, advisory services around nutrition governance, policies and procedures, in addition to staff and consumer education.

Community and Home Care Support programs include APD advice and assistance/support by way of 1:1 consultation, menu design and planning (including shopping, shopping lists), meal planning and preparation, mealtime experience and environment, assistance with feeding/drinking, mealtime support options, quality assurance, advisory services around nutrition governance, policies and procedures, in addition to staff, carer and consumer education, collaboration and nutrition assessment and planning. An APD involved in community care considers not only the consumer’s needs, but the needs and practical issues of the carers.

Under the Commonwealth Home Support Program (CHSP) there are a number of Community and Home Support sub-type programs, as well as Care Relationship and Carer Support sub-type programs where advice, assistance and provision of food and nutrition to an elderly person and/or their carer may be provided (but not necessarily have an APD involved). It is important for APDs in the community to understand the broader range of settings, programs and providers to ensure the nutritional quality and safety of the older person is maximised, and potential or actual risks are identified across each of the quality standards.

The relevant Community and Home Support sub-type programs that may provide advice, assistance and provision of food and nutrition to an elderly person include:

o Allied health and therapy services

o Domestic assistance

o Goods, equipment and assistive

technology

o Meals

o Nursing

o Other food service

o Social support – groups

o Social support – individuals

o Specialised Support Services


The relevant Care Relationship and Carer Support sub-type programs that may provide advice, assistance and provision of food and nutrition to an elderly person include:

o Centre-based respite

o Cottage respite

o Flexible respite

In all of these settings (Residential and Community Aged Care), it is important to consider the:

o 1:1 consultation

o menu design and planning (including

shopping, shopping lists)

o meal planning and preparation

o mealtime experience and

environment

o assistance with feeding / drinking

o mealtime support options

o quality assurance

o nutrition governance, policies and

procedures

o staff, carer and consumer education

o collaboration

o nutrition assessment and planning

The example tables in each Quality Standard Chapter within this Toolkit offer a few examples, not a definitive list, of the types of evidence an organisation may use relating to food, nutrition and mealtime experience to demonstrate that it is meeting the requirements for each consumer.


Standard 1 – Consumer Dignity and Choice

Standard 1 - Key Food/Nutrition Requirements Summary

There is significant opportunity for APD engagement and support to consumers and aged care organisations around Quality Standard 1. This standard is all about the individual consumer and threads through all of the other quality standards. When considering any aspect of care, this Quality Standard requires us to think about care from the shoes of the consumer. Has the consumer been shown dignity and been given choice in all aspects of care?

Food, Nutrition and the Mealtime Experience are prime ways for an organisation to demonstrate consumer choice, independence, inclusion and respect for consumer dignity.

Key requirements for APDs to consider with this Standard are:

a) Each consumer is treated with dignity and respect, with their identity, culture

and diversity valued.

b) Care and services are culturally safe.

c) Each consumer is supported to exercise choice and independence, including to: (i)

make decisions about their own care and the way care and services are delivered; and

(ii) make decisions about when family, friends, carers or others should be involved

in their care; and (iii) communicate their decisions; and (iv) make connections with

others and maintain relationships of choice, including intimate relationships.

d) Each consumer is supported to take risks to enable them to live the best life they can.

e) Information provided to each consumer is current, accurate and timely, and

communicated in a way that is clear, easy to understand and enables them to exercise

choice.

f) Each consumer’s privacy is respected and personal information kept confidential.

There are many touch points across the food, nutrition and mealtime experience for consumers where engagement can be displayed, such as in:

Standard 1 – Consumer Outcome

I am treated with dignity and respect, and can maintain my identity. I can make informed choices about my care and services, and live the life I choose.

Standard 1 – Organisation Outcome

The organisation:

(a) has a culture of inclusion and respect for consumers; and

(b) supports consumers to exercise choice and independence; and

(c) respects consumers’ privacy.


menu design, planning and review meal planning and preparation mealtime audits and feedback mealtime support options staff, carer and consumer education 1:1 consultations with consumers optimising collaborative communication between APD service and the aged care

organisation Nutrition governance, policies and procedures

As an APD consulting to aged care organisations, the checklists, resources and example tables over the following pages offer examples of how you can promote and support compliance with Quality Standard 1.

Checklist for consideration of Food/Nutrition across Quality Standard 1

Has consumer dignity and choice been considered when planning the menu/meal plan?

Do events involving food consider aspects of consumer dignity and choice?

Is consumer dignity and choice considered when preparing meals?

Is consumer dignity and choice considered at the mealtime?

Does the APD consultation prioritise, reflect and communicate consideration of

consumer dignity and choice?

Do the APD recommendations/plans reflect consumer dignity and choice?

Does current staff training include food and nutrition modules in relation to Quality

Standard 1 – Dignity and Choice?

Are there Nutrition Policies and Protocols in place? If so, do current Nutrition Policies

and Protocols within the organisation value and prioritise consumer dignity and choice?

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9

Quality Standard 1 Requirements

Examples Residential Aged Care

Community Care

Home Care

a) Each consumer is treated with dignity and respect, with their identity, culture and diversity valued.

Menu / Meal Planning Use easy to understand but descriptive written and verbal language on menus. Consider the use of pictures. Encourage the same to be used when menu orders are taken in the Residential Setting. Encourage well-presented meals (colours of foods, plating etc) and texture- modified meals; encourage the use of moulds/piping/quenelling to improve the visual presentation of texture modified meals.

Mealtime Experience Encourage description of meals for consumers upon serving, with special care taken to describe all components of the meals for those with vision and hearing disabilities and for those with limited literacy. Offer finger foods as an alternative choice and / or present food and drinks in creative ways to enhance the experience and assist those with dexterity issues and those who find it difficult to complete a meal. Offer snacks and drinks that can be enjoyed ‘when on the move’ (e.g. milkshakes, ice cream in a cone, yoghurt drinks and finger foods).

Consultation Show respect for, understanding of, and dietary recommendations that are mindful of a consumer’s cultural, ethnic and religious background (for English and non-English speaking consumers and their families).




Community Care

Home Care

b) Care and services are culturally safe.

Menu / Meal Planning Take into consideration the cultural backgrounds and literacy levels when designing menu surveys, questionnaires and new menus/meal plans. Discuss consumers’ culture and traditions related to food in consumer meetings.

Mealtime Experience Consider eating habits and preferences (e.g. dining location and timing of meals etc) of consumers of various backgrounds.

Consultation Discuss and consider consumer’s background, religion, cultural values in relation to food, eating pattern, meal choices, eating and food preparation.




Community Care

Home Care

c) Each consumer is supported to exercise choice and independence, including to: (i) make decisions about their own care and the way care and services are delivered; and (ii) make decisions about when family, friends, carers or others should be involved in their care; and (iii) communicate their decisions; and (iv) make connections with others and maintain relationships of choice, including intimate relationships.

Menu

Offer a choice of products (a variety of cereals, breads, type of milks, type of drinks, hot vs cold breakfast, finger foods) and ensure that consumers are aware of these options. Ensure that all choices of meals are offered when meal orders are taken. Offer a choice of flexible eating pattern. Offer finger foods as an option - particularly for those with hand dexterity issues to maintain independence and for those who find it difficult to complete a meal. Encourage the consumer to be involved in meal preparation and planning if they wish to do so. Provide options for meals according to the consumer’s preferences.

Mealtime Experience Support the consumer’s choice where to have her/his meal – with other consumers/with family/alone - if so desired.




Community Care

Home Care


Mealtime Experience (Continued) Ensure that seating preferences (location, position, company around table) are checked regularly and that there is flexibility for change in place. Encourage family and friends to bring in meals and snacks of the consumer’s choice, and to join in for meals regularly if the consumers wishes to do so. Enable independence by providing consumers a possibility to help themselves to safe food choices in between meals, if so wished for (e.g. by providing a fruit bowl, baked items, a variety of drinks in the communal area, or some snacks available in their personal fridge).

Consultation Seek permission from the consumer to speak with others (family members, GPs, nurse etc) about their nutrition. Respect consumer’s choice of whether to accept dietary input. Consider the functional ability of a consumer during the assessment when planning and preparing food and fluids to maximise independence.




Community Care

Home Care


Consultation (Continued) Ensure that dietary input is available regularly if consumers wish to access it. Make certain that choice is offered and respected when discussing strategies. Ensure that preferences and wishes are easy for carers to access and know. Ensure that the consumer has assistance with grocery shopping (if required) and that the consumer is encouraged to take part in shopping, if he/she wishes to do so. Ensure that the consumer has assistance with food preparation if he/she requires it. Offer finger foods as an option for those with hand dexterity issues to maintain independence. Provide recipes for the same. Discuss meal delivery options for maintaining independence and function.




Community Care

Home Care

d) Each consumer is supported to take risks to enable them to live the best life they can.

Meals/Mealtimes Support consumer’s choice (e.g. to choose a regular textured diet different to speech pathologist recommendations for a texture modified diet), provided the risks have been explained, information has been provided, the decision has been clearly documented and in line with the organisation’s policy and the consumer has capacity to make an informed decision.

e) Information provided to each consumer is current, accurate and timely, and communicated in a way that is clear, easy to understand and enables them to exercise choice.

Menu

Outline all meal options in a menu, including those on texture modified diets. Communicate any changes to the consumers in a clear manner.

Mealtime Experience Encourage staff to describe all meal options to clients upon serving in a clear manner so that the consumer is aware of their choice (including a family member and/or interpreter if required).

Consultation Provide strategies based on current evidence-based practice, explained in an easy to understand language, explaining the choices the consumer has. Ensure that all written material is up to date, clear and easy to understand, and supports and respects the consumers right for choice.




Community Care

Home Care

f) Each consumer’s privacy is respected and personal information kept confidential.

Consultation Always offer to conduct consultations in the consumer’s room or in another private area within the building. Seek permission from the consumer before sharing information about the consumer (i.e. health details, dietary information, preferences etc) with other staff/carers involved in caring for the consumer.

Keep all documents with information about the consumer securely stored when leaving the site (organisation/consumer’s home).


Quality Improvement ideas for APDs consulting to aged care organisations

Support organisations to capture consumer mealtime preferences routinely. This may be done by providing and/or reviewing their ‘mealtime preferences survey’ and recommending preferences are captured on admission into service and at regular intervals, as part of the organisation’s processes. Examples include monthly food focus meetings, quarterly consumer meetings and annual service satisfaction surveys.

Offer seasonal menu reviews, incorporating current consumer preferences, and advise on menu planning templates.

Engage with consumers and catering teams around menu language reviews.

Look for opportunities to advise and educate management, carers, clinical staff and catering staff on areas such as: special diets, medical nutrition therapy, mealtime experience, malnutrition, environment and service delivery, cost saving strategies, nutrition in palliative care, hospitality, maintaining dignity when feeding, healthy eating and various cultural diets, easy but healthy meals – assisting to stay independent, special diets, cost saving strategies/ nourishing meals on a budget. Deliver via presentations, workshops, written summaries or webinars.

Provide shopping guidance to consumers and their carers, personalised to consumer needs and preferences.

Work with organisations to develop programs to meet their consumer needs (e.g. supermarket tours, cooking classes).

Work with organisations to develop competency-based guidelines for their staff who are involved with shopping assistance, menu planning assistance, meal preparation assistance, cooking assistance, feeding assistance, weight monitoring etc.


Standard 2 – Ongoing Assessment and Planning with Consumers

Standard 2 - Key Food/Nutrition Requirements

Quality Standard 2 focuses on themes including consumer empowerment, involvement in assessment, care and planning and involves aspects from Quality Standard 1 around consumer goals and preferences/choice. This standard has a strong connection to the food, nutrition and mealtime experience, and the role of the APD.

This standard advocates for consumers to feel empowered and included in their food, drink, dietary care, personal care and healthcare decisions alongside organisation and healthcare staff and volunteers. It looks into aspects of whether consumers feel empowered and included in the development of personal care plans, and whether these care plans are flexible to the needs, goals and preferences of the consumer. APDs can support aged care organisations and consumers with this quality standard in a number of ways to demonstrate partnership with the consumer, the organisation and other supporting health care professionals.


a) Assessment and planning, including consideration of risks to the consumer’s health

and wellbeing, informs the delivery of safe and effective care and services.

b) Assessment and planning identifies and addresses the consumer’s current needs,

goals and preferences, including advance care planning and end of life planning if the

consumer wishes.

c) Assessment and planning: (i) is based on ongoing partnership with the consumer and

others that the consumer wishes to involve in assessment, planning and review of the

consumer’s care and services; and (ii) includes other organisations, and individuals and

providers of other care and services, that are involved in the care of the consumer.

d) The outcomes of assessment and planning are effectively communicated to the

consumer and documented in a care and services plan that is readily available to the

consumer, and where care and services are provided.


I am a partner in ongoing assessment and planning that helps me get the care and services I need for my health and well-being.


The organisation undertakes initial and ongoing assessment and planning for care and services in partnership with the consumer. Assessment and planning has a focus on optimising health and well-being in accordance with the consumer’s needs, goals and preferences.


e) Care and services are reviewed regularly for effectiveness, and when circumstances

change or when incidents impact on the needs, goals or preferences of the consumer.

There are many touch points across the food, nutrition and mealtime experience for consumers where engagement in assessment and planning for care can be displayed. Services such as:

menu design, planning and review meal planning and preparation mealtime audits and feedback mealtime support options staff, carer and consumer education 1:1 consultations with consumers optimising collaborative communication between APD services and the aged care

organisation nutrition governance, policies and procedures

As an APD consulting to aged care organisations, the checklists, resources and example tables over the following pages offer examples of how you can promote and support compliance with Quality Standard 2.

Checklist for consideration of Food/Nutrition across Quality Standard 2

Have consumers been involved in planning and feedback around the menu/meal plan?

Does the planning of mealtime events/activities specific to food involve consumers?

Is the organisation engaging with consumers when planning services and care needs?

Are consumer preferences checked regularly and options offered that are in line with

the consumer’s health, well-being and quality of life needs?

Does the APD consultation engage with the consumer to ensure their needs, goals and

preferences are reflected in care decisions to optimise health and wellbeing?

Does the APD consultation prioritise, reflect and communicate the consumer’s

identified needs, goals and preferences?

Do the APD recommendations/plans reflect the consumer’s identified needs, goals and

preferences?

Does current staff training include food and nutrition modules in relation to Quality

Standard 2 – Ongoing Assessment and Planning with Consumers?


and Protocols within the organisation value and prioritise the importance of ongoing

assessment and planning with consumers?




Community Care

Home Care

a) Assessment and planning, including consideration of risks to the consumer’s health and wellbeing, informs the delivery of safe and effective care and services.

Menu / Meal Planning Provide training and resources on food allergies /intolerances and texture modified diets/thickened fluids to staff when required. Consultation Consider consumer’s oral health status, along with their ability to chew and swallow as part of an assessment and arrange relevant dental or swallow assessments if required. Consider consumer’s risks related to pressure areas, falls, infections, aspiration and malnutrition. Menu / Meal Planning Assess satisfaction of menu and conduct a menu review (at least twice annually in RAC setting and annually in community care setting). Consultation Consider consumer’s health needs, goals and nutrition preferences during assessment and review consultations, and take into consideration how changing circumstances, such as moving into palliative care and incidents can impact these. Assist with menu planning and shopping lists, and prepare for different circumstances/occasions (e.g. return from hospital post operation, during isolation, or when family and friends are not able to assist).

b) Assessment and planning identifies and addresses the consumer’s current needs, goals and preferences, including advance care planning and end of life planning if the consumer wishes.




Community Care

Home Care

c) Assessment and planning: (i) is based on ongoing partnership with the consumer and others that the consumer wishes to involve in assessment, planning and review of the consumer’s care and services; and (ii) includes other organisations, and individuals and providers of other care and services, that are involved in the care of the consumer.

Menu Planning and Mealtimes Encourage family and carers to join consumer meetings with topics revolving around food, menu and mealtime.

Conduct meal, menu and mealtime satisfaction surveys. Encourage carers and family to be involved if consumer wishes so.

Consultation Involve family and carers in the assessment and planning of strategies if requested by the consumer. Ensure nutrition care goals are developed in conjunction with the consumer and documented in the consumer’s wording.

Involve other health professionals such as allied health (e.g. physiotherapist, occupational therapist, speech pathologist, dentist) in the care if the consumer wishes so.




Community Care

Home Care

d) The outcomes of assessment and planning are effectively communicated to the consumer and documented in a care and services plan that is readily available to the consumer, and where care and services are provided.

Menu Planning and Mealtimes Provide feedback regarding surveys and questionnaires in consumer meetings.

Consultation Document consultation notes in an accurately and timely manner in consumer’s notes. Communicate the result of your assessment and planning to the consumer, and to the family/carers (if the consumer so wishes).

e) Care and services are reviewed regularly for effectiveness, and when circumstances change or when incidents impact on the needs, goals or preferences of the consumer.

Menu Planning Conduct regular menu satisfaction questionnaires and incorporate responses in menu review assessment.

Mealtime Experience Encourage regular consumer meetings and suggest mealtime experience as a topic. Encourage regular consumer feedback on the mealtime experience to better inform carers.

Consultation Suggest a review timeframe and follow-up at the agreed time. Check there is a mechanism to review whenever the consumer requests a review. Check consumer preferences and changing needs regularly as part of the assessment.



Provide consumers and carers with information on how APDs can help with various conditions and nutrition related wellbeing issues.

Provide nutrition information in various formats and styles related to health priority in focus and health literacy.

Provide a printed nutrition care plan summary of strategies to the consumer and carers.

Provide recipes (e.g. HPHE milkshakes, recipes for texture modified diets) and food fortification tips.

Be available for team case conferences with the consumer and carers.

Engage consumers and carers in decision-making regarding dietary planning and also regarding suggested review timeframe.

Assist with the setup of a resident food committee.


Standard 3 – Personal Care and Clinical Care


Quality Standard 3 relates to Personal and Clinical Care. For the consulting APD, medical nutrition therapy and integrated APD care aligns directly with this Standard by providing Personal Care and Clinical Care that aligns with the consumer’s needs, goals and preferences to optimise health and wellbeing. ‘High impact’ or ‘high prevalence’ risks associated with care of each consumer are highlighted. These link to nutrition-related risks such as malnutrition, dysphagia, dehydration, pressure injury, diabetes, allergies, intolerances and dementia.


a) Individualised, safe, effective personal and clinical care related to food and nutrition

in line with best practice where possible.

b) Effective management of high impact or high-prevalence risks associated with the

care of each consumer.

c) The food and nutritional needs, goals and preferences of consumers nearing the end

of life are recognised and addressed, their comfort maximised and their

dignity preserved.

d) Deterioration or change of a consumer’s mental health, cognitive or physical

function, capacity or condition, related to nutrition and food provision, is recognised

and responded to in a timely manner.

e) Information about the consumer’s condition, needs and preferences is documented

and communicated within the organisation, and with others where responsibility for

care is shared.

f) Timely and appropriate referrals to individuals, other organisations and providers of

other care and services.

g) Minimisation of infection-related risks through implementing: (i) standard and

transmission-based precautions to prevent and control infection; and (ii) practices to

promote appropriate antibiotic prescribing and use to support optimal care and

reduce the risk of increasing resistance to antibiotics.


I get personal care, clinical care, or both personal care and clinical care, that is safe and right for me.


The organisation delivers safe and effective personal care, clinical care, or both personal care and clinical care, in accordance with the consumer’s needs, goals and preferences to optimise health and well-being.


There are many touch points across the food, nutrition and mealtime experience for consumers where Personal and Clinical Care can be displayed, including:



As an APD consulting to aged care organisations, the table below offers examples of how you can promote and support compliance with Quality Standard 3.

Checklist for consideration of Food/Nutrition across Quality Standard 3 –

Have Personal Care and Clinical Care been considered when planning the menu/meal

plan?

Do social events involving food consider aspects of Consumer Clinical Care and Personal

Care needs?

Is Personal Care and Clinical Care considered when preparing meals?

Is Personal Care and Clinical Care considered at the mealtime?

Does the APD consultation prioritise, reflect and communicate consideration of

Personal Care and Clinical Care?

Do the APD recommendations/plans reflect Personal Care and Clinical Care?

Does current staff training include Food and Nutrition Modules with relation to Quality

Standard 3 - Personal Care and Clinical Care?


and Protocols within the organisation value and prioritise the Personal Care and Clinical

Care of Consumers (including monitoring and early detection of nutrition risk)?

Does each consumer feel that their meals are contributing to the best

management of their nutrition-related health conditions, and add to overall

improved health and well-being?

Are the meals nutritious and meeting the consumer’s clinical needs?

Are the referral pathways connecting APD services in a timely and proactive


manner for consumers?

Are staff aware of the individual consumers and the total current number of

consumers that have allergies / intolerances in the organisation? How many

consumers have special diets (i.e. vegan, vegetarian, religious requirements)?

What training and strategies do the staff have to safely manage these allergies and

special diets and ensure the consumer receives the appropriate meals?

How frequently does an APD visit the organisation? How many visits from the APD

over the last six months and what proportion of consumers have been assessed /

seen? Are visits routine or on an as-needed basis?

How frequently does a speech pathologist visit to assess, and re-assess, consumers

on texture modified diets and thickened fluids? How do staff recognise when

referrals are required?




Community Care

Home Care

a) Individualised, safe, effective personal and clinical care related to food and nutrition in line with best practice where possible.

Consultation Consult with consumer and/or carer to create an individualised nutrition plan in line with best practice, where possible, and reflecting consumer preferences.

b) Effective management of high impact or high-prevalence risks associated with the care of each consumer.

Systems Put hydration and food intake monitoring measures in place. Conduct malnutrition screening on admission and then on a monthly basis in line with weight monitoring checks. Communicate malnutrition risk concerns and plans to mitigate risk to the consumer’s health care team. Assist with mandatory Quality Indicator Reporting for nutrition-related indicators – unplanned weight loss and pressure injuries.

Ensure APDs are included in relevant clinical care pathways (e.g. malnutrition, dysphagia, pressure injury, falls, infection etc).

Mealtime Environment Implement strategies to optimise all consumers’ food and hydration needs – including offering a range of hydrating fluid choices, timing of fluids over the day and positioning of fluids to optimise consumption.




Community Care

Home Care

b) Effective management of high impact or high-prevalence risks associated with the care of each consumer.

Audits Look at opportunities for nutrition input as part of medication reviews – such as for consumers on aperients, oral nutrition supplements, pain meds.

Education Prepare and present education sessions for staff, consumers and carers around Medical Nutrition Therapy to raise awareness and move towards preventative care.

c) The food and nutritional needs, goals and preferences of consumers nearing the end of life are recognised and addressed, their comfort maximised and their dignity preserved.

Education Facilitate education sessions with staff, carers and consumers around the role of APD support and practice in palliative care and end-of-life.

d) Deterioration or change in a consumer’s mental health, cognitive or physical function, capacity or condition, related to nutrition and food provision, is recognised and responded to in a timely manner.

Education Facilitate staff/carer education regarding nutrition and mood, dementia and medical nutrition therapy to assist staff to be aware of, and swiftly identify and respond to risks in a timely manner.



APD involvement in Unplanned Weight Loss Management within organisation.

Audit of the mealtime experience and staff mealtime support.

Provide ‘Nutrition Essentials’ and ‘Medical Nutrition Therapy’ Training to clinical, catering and care staff.

Education to aged care organisations to assist in the early identification of nutrition risks and timely referral to APDs and other relevant health professionals.


Standard 4 – Services and Supports for Daily Living


Quality Standard 4 focuses on the adequacy of services and supports for daily living to support consumer independence, health, well-being and quality of life. Services and supports for daily living include food services, shopping/cooking/mealtime assistance, recreation and social activities.

The provision of safe and effective services and supports connects in with the consumer food, nutrition and the mealtime experience. Accredited Practising Dietitians offer a valuable service which not only supports optimising health and wellness, but assists in preserving independence and improving the quality of life of consumers.


a) Each consumer gets safe and effective services and supports for daily living that meet

the consumer’s needs, goals and preferences and optimise their independence,

health, well-being and quality of life.

b) Services and supports for daily living promote each consumer’s emotional, spiritual

and psychological well-being.

c) Services and supports for daily living assist each consumer to: (i) participate in their

community within and outside the organisation’s service environment; and (ii) have

social and personal relationships; and (iii) do the things of interest to them.

d) Information about the consumer’s condition, needs and preferences is

communicated within the organisation and with others where responsibility for care is

shared.

e) Timely and appropriate referrals to individuals, other organisations and providers

of other care and services.

f) Where meals are provided, they are varied and of suitable quality and quantity.

g) Where equipment is provided, it is safe, suitable, clean and well maintained.


I get the services and supports for daily living that are important for my health and well-being and that enable me to do the things I want to do.


The organisation provides safe and effective services and supports for daily living that optimise the consumer’s independence, health, well-being and quality of life.


There are many touch points across the food, nutrition and mealtime experience for consumers where services and supports for daily living can be displayed, such as in:



As an APD consulting to aged care organisations, the checklists, resources and example tables over the following pages offer examples of how APDs can promote and support compliance with Quality Standard 4.


Have services and supports for daily living been considered when planning the

menu/meal plan?

Do events involving food consider appropriate services and supports for daily living to

optimise consumer independence, health, wellbeing and quality of life?

Have services and supports for daily living been considered when preparing meals?

Are services and supports for daily living considered at the mealtime?

Does the APD consultation prioritise, reflect and communicate consideration of the

aged care organisation’s services and supports for daily living?

Do the APD recommendations/plans reflect practical strategies that work with and

enhance the organisation’s current services and supports for daily living?

Does current staff training include food and nutrition modules with relation to Quality

Standard 4 – services and supports for daily living?


and Protocols within the organisation value and prioritise and highlight essential

services and supports for daily living that optimise the food, nutrition and mealtime

experience for consumers?




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a) Safe & Effective Services and Supports that meet consumer’s needs and goals.

Mealtime Experience Implement strategies to enable consumers to feel socially connected when eating/dining. Ensure consumers have access to adaptive feeding equipment.

Consultation Consider each consumer’s well-being and quality of life (QoL) aspirations as part of the consultation in all aspects of care, including food, nutrition and hydration.

Services Ensure Allied Health Services and supports are provided by qualified and suitably trained staff. Ensure consumers have access to:

o Domestic assistance o Food services – MOW etc o Meal preparation at the consumer’s home o Shopping support (e.g. transportation)




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b) Services & Supports that meet consumer’s emotional, psychological and spiritual needs.

Consultation Consider each consumer’s physical, mental, spiritual and emotional health needs, as well as their social and lifestyle needs/desires as part of the 1:1 consultation. Advocate the importance for social support/ social outings / social gatherings where meals are provided. Address the consumer’s (and carers) personal needs. Incorporate strategies to address identified needs related to:

o Social isolation o Grief management o Opportunities for spiritual/pastoral care o Cultural awareness/celebrations

c) Services & Supports for Daily Living to support consumers to feel connected.

Consultation Consider each consumer’s relationships and the influences of those around them, including carers, family and community when planning meals. Consider the consumer’s living conditions and quality of life and incorporate additional recommendations for support where issues have been identified (e.g. referrals to occupational therapist, social worker etc).




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d) Communication of consumers’ condition, needs & preferences.

Consultation Adapt services and supports when consumers situations change (e.g. health, mobility, dexterity). Communicate any significant change in consumer’s clinical condition to attending health providers. Provide coordination of care to the consumer (e.g. between the hospital and residential aged care home). Advocate the consumers nutritional needs and preferences to carers, health professionals and relevant others.

e) Timely & appropriate referrals

Service Delivery Put processes in place for staff/consumers to have flexible access to APD services (e.g. via telehealth, zoom consultations) when barriers are present (e.g. COVID restrictions).




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e) Timely & appropriate referrals (continued)

Referral procedures Work with providers to establish timely APD referrals for:

o malnutrition o unplanned weight loss o overweight/obesity o dysphagia/texture modification o wounds/pressure injuries o falls o chronic disease (e.g. diabetes, CVD) o food allergies/intolerances o reduced oral intake and/or observed appetite issues o other dietary issues as they arise

f) Provision of suitable food

Menu Reviews Review the aged care menu and mealtime experience on an ongoing basis using Dietitians Australia’s ‘Menu and Mealtime Quality Assessment for Residential Aged Care’, and the Meals on Wheels ‘National Nutrition Guidelines’ for home delivered and centre-based meal programs for older Australians. Adhere to the HACCP framework to ensure the organisation’s food safety protocols are in line with accepted standards and guidelines. Ensure food safety audits are current and maintained.




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f) Provision of suitable food (continued)

Audits Manage consumer risks within the organisation (RAC, Community Care Site, Respite Care Site, Community Meal Provider), including:

Food allergies and intolerances

Adherence to IDDSI framework (or comparable)

Response to cultural and spiritual food requirements – Halal, Kosher, Ramadan etc.

Nutritional support for: o Malnutrition (i.e. HPHE diets) o Special Diets o Diabetes Mellitus o Deficiencies (e.g. B12, Vitamin D)

g) Provision of suitable equipment

Mealtime Experience Ensure consumers have appropriate assistive devices, where required, to optimise independence and mealtime experience (e.g. Plate Guards, Modified Cutlery, Sippy Cups etc).



Policy review to ensure Nutrition Assessment is required for consumers identified with high nutritional risk issues such as oral health issues, dysphagia, dementia or pressure injuries.

Work with organisations to develop competency-based standards for their staff who are involved with shopping assistance, menu planning assistance, meal preparation assistance, cooking assistance, feeding assistance, mealtime assistance for consumers living with dementia etc.

Education for staff around mealtime support to optimise food intake.


Standard 5 – Organisation’s Service Environment


Quality Standard 5 relates to the organisation’s service environment. This standard is relevant for APDs as the ‘service environment’ in terms of food, nutrition and mealtime experience relates to physical areas of food preparation, dining and equipment involved in supporting the mealtime experience – specifically for residential aged care homes and community care services including centre-based respite, cottage respite and flexible respite. This Standard does not apply to an individual’s privately owned or occupied home.

Key requirements for APDs to consider with this standard are:

a) The dining room environment is welcoming, easy to understand and optimises the

consumer’s sense of belonging, independence, interaction and function.

b) The mealtime environment is safe, clean, well maintained, comfortable and enables

consumers to move freely.

c) Furniture, fittings and equipment within the dining area/s are safe, clean, well

maintained and suitable for the consumer.

There are many touch points across the food, nutrition and mealtime experience for consumers where a safe, effective and comfortable service environment can be displayed, such as:

meal planning and preparation mealtime audits and feedback mealtime support options staff, carer and consumer education 1:1 consultations with consumers optimising collaborative communication between APD service and the aged care



The organisation provides safe and effective services and supports for daily living that optimise the consumer’s independence, health, well-being and quality of life.


The organisation provides a safe and comfortable service environment that promotes the consumer’s independence, function and enjoyment.




Has the organisation’s service environment been considered when planning the

menu/meal plan?

Do events involving food consider the organisation’s service environment to optimise

consumer independence, health, wellbeing and quality of life?

Has the organisation’s service environment been considered when preparing meals?

Has the organisation’s service environment been considered at the mealtime?


aged care organisation’s service environment related to food, nutrition and mealtime

experience?


enhance the organisation’s service environment related to the consumer’s needs

around food and mealtimes?

Does current staff training include food and nutrition modules that relate to the

organisation’s service environment?


and Protocols within the organisation value and prioritise factors within the

organisation’s service environment that optimise the food, nutrition and mealtime

experience for consumers?

Does the organisation understand that food and mealtimes may be the most important

potential source of pleasure for consumers?




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a) The dining room environment is welcoming and easy to understand, and optimizes each consumer’s sense of belonging, independence, interaction and function.

Menu / Meal Planning Include menu items that are familiar, appropriate and desirable for the resident population. Include finger foods as an option for those with hand dexterity issues, and for those who are unable to complete a meal, to maintain independence.

Education Train care staff and catering staff on meal presentation, food description. Encourage particular attention around supporting consumers who are generally struggling with their meals or struggling due to sensory impairments (hearing impairment, vision impairment) to support and enhance the mealtime experience.

Mealtime Environment Review and update menus and menu boards to be easy to read, written in descriptive but concise language. Use menu images to engage and encourage independence and choice for consumers with literacy and/or cognitive impairments. Support ‘protected mealtimes’ by restricting non-essential mealtime activities (e.g. avoiding medication trolley use and medication dispensing within the dining room) to improve consumer engagement and enjoyment at mealtimes. Encourage the facility to provide welcoming environments for families and friends to share a meal with the consumers.




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a) The dining room environment is welcoming and easy to understand, and optimises each consumer’s sense of belonging, independence, interaction and function.

Mealtime Environment (Continued) Communicate with Diversional Therapist/Activities Coordinator, Catering and Care staff to ensure consumer preferences and choice around mealtime location/seating/company at the table is clear and supported to assist with optimising the mealtime experience.

b) The mealtime environment is safe, clean, well maintained and comfortable and enables consumers to move freely, both indoors and outdoors.

Consultation

Check and document (during 1:1 consultation) with consumer that mealtime arrangements – seating, chairs, positioning, assistive devices supplied (if required) and general ambiance of the dining room – are in line with consumer preferences and communicate with appropriate staff if any issues are identified in this space.

Audit Conduct a mealtime observation audit – ensuring the dining space is safe, clean, well maintained and comfortable. Ensure that there is adequate space around tables and chairs for the consumers to easily move around before, during and after a meal. Ensure there are private areas for those residents who prefer to sit apart from everyone else and not be facing others.




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c) Furniture, fittings and equipment within mealtime areas are safe, clean, well maintained and suitable for the consumer.

Mealtime Environment Provide assistive devices to promote independence for consumers requiring same (e.g. plate guards, modified cutlery, assistance with inserting dentures for meals where needed etc).

Audit Conduct a mealtime observation audit – ensuring that the furniture, crockery and cutlery are safe, clean, well maintained and comfortable.

Consultation Advocate and liaise with an OT for special cutlery and drinking cups (e.g. sippy cups, double handed cups etc) and plate guards for consumers with identified dexterity difficulties.


Quality Improvement Ideas for APDs consulting to aged care organisations

Conduct audits of the mealtime environment and dining area to provide improvement suggestions, taking into consideration the music, interaction, table settings, menu boards, crockery/cutlery, area between chairs/tables, lighting, colour contrast etc.

Assist with planning special events involving food and drinks.

Advocate for dining options incorporating outdoor areas.


Standard 6 – Feedback and Complaints


Quality Standard 6 relates to Feedback and Complaints. This standard is relevant for APDs as food, nutrition and mealtime experience generate a significant portion of the aged care complaints nationally.


a) Consumers, their family, friends, carers and others are encouraged and supported to

provide feedback and make complaints around the food service and mealtime

experience.

b) Consumers are made aware of and have access to APDs, advocates, language services

and other methods for raising and resolving food, nutrition and mealtime complaints.

c) Appropriate action is taken in response to food and nutrition complaints and an open

disclosure process is used when things go wrong.

d) Feedback and complaints related to food, nutrition and mealtime experience are

reviewed and used to improve the quality of care and services.

There are many touch points where effective systems can capture Food, Nutrition and Mealtime experience feedback and complaints can be displayed. These include:





I feel safe and am encouraged and supported to give feedback and make complaints. I am engaged in processes to address my feedback and complaints, and appropriate action is taken.


The organisation regularly seeks input and feedback from consumers, carers, the workforce and others and uses the input and feedback to inform continuous improvements for individual consumers and the whole organisation.



Have feedback and complaints been considered when planning the menu/meal plan?

Do events involving food consider consumer feedback and complaints when looking to

optimise consumer independence, health, wellbeing and quality of life?

Have feedback and complaints been considered when preparing meals?

Are feedback and complaints welcomed and considered at the mealtime?


aged care organisation’s feedback and complaints related to food, nutrition and

mealtime experience?


enhance the consumer feedback and complaints related to food and mealtimes?

Does current staff training include food and nutrition modules that relate to feedback

and complaints?


and Protocols within the organisation value and prioritise factors related to feedback

and complaints that optimise the food, nutrition and mealtime experience for

consumers?

If actions have been initiated as a result of a consumer food or mealtime complaint, has

the action actually solved the problem for the consumer and is the change sustained?




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a) Consumers, their family, friends, carers and others are encouraged and supported to provide feedback and make complaints.

Menu Planning Provide consumers with a feedback form (paper format or tablet-based) prior to each new menu development cycle. Offer consumers opportunities for verbal feedback, where this form of communication is preferred.

Mealtime Experience Provide consumers with a feedback form (paper format or tablet-based) in dining areas as well as in consumers’ rooms to assess the mealtime experience. Offer consumers opportunities for verbal feedback, where this form of communication is preferred.

Consultation Ask consumers and carers about their mealtime experience during 1:1 consultations and reflect on these when planning strategies. Ensure that the essential feedback is communicated to relevant members of the care team - clinical, catering, carers etc. Inform consumers of how to provide feedback or complaints about meals, snacks, beverages and the mealtime experience. If required, provide consumers and carers with contact details for the Aged Care Quality and Safety Commission.

b) Consumers are aware of/have access to advocates, language services etc for raising/ resolving complaints.

Consultation Liaise with carers, family members and interpreters (if required) due to cultural, cognitive or language barriers in providing feedback and complaints. Encourage them to be involved in providing feedback whether it is verbally or in writing.




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c) Appropriate action is taken in response to complaints & an open disclosure process is used when things go wrong.

Consultation Document consumers’ complaints and feedback around food or mealtimes received as part of your work and outline how these have been addressed and followed up.

d) Feedback and complaints are reviewed and used to improve the quality of care and services.

Menu Planning Attain complaints information/details and ask catering team for feedback prior to completing a menu review. Reflect on these when planning new strategies.

Mealtime Experience Discuss feedback and complaints with the management and plan improvements to the mealtime experience (e.g. more flexible mealtimes, managing background noise at mealtimes, offering condiments so consumers can flavour their meals as they wish, etc).

Consultation Ensure appropriate referrals are made to support health care professionals when issues have been identified within the consultation (e.g. swallowing difficulties – refer to SP, dental pain – refer to dentist etc). Seek feedback at review consultations around response and consumer satisfaction re: previous nutrition strategies, to assist in adapting and improving future strategies with the consumer. Use consumer feedback regarding difficulty in swallowing to arrange a swallowing assessment and therefore improve quality of care.



Advocate for menu satisfaction questionnaires and mealtime surveys and interviews.

Discuss with aged care organisations the different ways in which consumers can provide feedback or make a complaint so that the APD can advise consumers on how to do so, if an issue arises.

Attend consumer meetings regarding menu and mealtimes - assist with strategies and provide nutritional input.

Discuss feedback regarding menu, menu extras, mealtimes and food with RAC management and chefs regularly.

Offer menu planning templates and discuss these with the management and chefs prior to menu planning, in conjunction with a discussion about a previous feedback and complaints about the food.

Offer staff training relating to feedback and complaints about meals and the mealtime environment.

Advocate for the setup and running of a regular ‘resident food committee’ within the organisation.


Standard 7 – Human Resources


Quality Standard 7 relates to the organisation’s Human Resources. This standard is relevant for APDs as the ‘human resources’ in terms of food, nutrition and mealtime experience relates to provision of quality and timely care and services for consumers requiring nutrition support, in addition to an adequately skilled workforce to optimise safe, respectful and quality care and services around food and nutrition care provision.


a) The workforce deployed (number and mix of members) enables the delivery and

management of safe and quality care and services related to consumer’s nutritional

care.

b) Workforce interactions around food, nutrition and mealtimes with consumers are

kind, caring and respectful of each consumer’s identity, culture and diversity;

specifically in terms of dietary requirements, cultural and religious preferences and

nutritional needs.

c) The workforce is competent and members of the workforce have the qualifications

and knowledge to effectively perform their roles to support optimal nutritional care in

between APD visits.

d) The workforce is recruited, trained, equipped and supported to deliver the outcomes

required by these standards.

e) Regular assessments, monitoring and reviews of the nutritional knowledge of each

member of the workforce is undertaken.

There are many touch points across the food, nutrition and mealtime experience for consumers where optimal management of Human Resources can be displayed. These include:

menu design, planning and review planning and preparation mealtime audits and feedback


I get quality care and services when I need them from people who are knowledgeable, capable and caring.


The organisation has a workforce that is sufficient, and is skilled and qualified to provide safe, respectful and quality care and services.


mealtime support options staff, carer and consumer education 1:1 consultations with consumers optimising collaborative communication between APD service and the aged care




Does the organisation proactively engage an APD on a regular basis or know how to

access an APD? Can consumers request an APD review?

Have appropriately qualified staff been involved when planning the menu/meal plan?

Have care staff undertaken competency training to complete shopping assistance,

menu planning assistance, meal preparation assistance, cooking assistance, feeding

assistance etc?

Do events involving food consider an adequate level of staffing and use appropriately

qualified staff to optimise consumer independence, health, wellbeing and quality of

life?

Have workforce matters (staffing levels and use of suitably qualified staff) been

considered when preparing meals?

Does the APD consultation consider the aged care staff’s ability to implement and

support Nutrition Plans related to food, nutrition and mealtime experience?


enhance the organisation’s workforce supporting food and mealtimes?

Does current staff training re: food and nutrition modules reach all relevant staff

members within the organisation?


and Protocols within the organisation value and prioritise factors within their workforce

that optimise the food, nutrition and mealtime experience for consumers?

As an APD engaged to provide services in the aged care sector, do you undertake CPD

activities to ensure your knowledge and work practices are current?




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a) Enabling the workforce to deliver safe & quality care

Audits Check that suitably qualified staff, with required skills in adequate numbers, are provided to:

o Assist the consumer with feeding/drinking assistance. o Ensure the delivery of food services, including quality food choices,

to consumers in a timely manner and safe condition. o Maintain food services to consumers in the event of major issues or

pandemics (i.e. virus outbreaks) Check systems (staff contingency plans) are in place to provide continuity of care to consumers for unplanned staff absences (i.e. transport issues or sickness). Check systems are in place to provide continuity of care from professional and allied health services (i.e. doctors, dietitians, speech pathology) in events of major issues or heightened risks (e.g. lockdowns or virus outbreaks). Do current providers offer the option of remote consults/telehealth where required and does the organisation allow remote access to records if needed?

Consultation Provide communications/handover to the relevant bodies to maximise continuity of care of consumers.




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b) Workforce interactions around food, nutrition and mealtimes Are kind, caring & respectful of each consumer’s identity, culture & diversity

Education Provide education and training to ensure awareness and acknowledgement of diverse dietary requirements relevant to the cultural and religious preferences of individual consumers (e.g. halal, kosher, Ramadan etc).

Menu Ensure menu options consider the cultural and religious preferences of the consumer whilst meeting their nutritional needs.

Audits

Ensure respectful and caring feeding/drinking assistance is provided to consumers (e.g. staff engaging in conversation/explanation/encouragement when assisting with meals).

Mealtime Experiences Acknowledge and celebrate special occasions that relate to diverse cultural and religious backgrounds of consumers is provided (e.g. Chinese New Year).




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c) The workforce is competent and members of the workforce have the qualifications and knowledge to effectively perform their roles to support optimal nutritional care in between APD visits.

Education Provide education/training to the workforce to assist with identifying consumers that are malnourished or may require extra nutritional support (i.e. training on how to use a validated malnutrition screening tool like the MST).

Systems Implement systems to guide and support staff to identify and report consumers - for professional intervention - that may have complications that impact their nutritional status, for example:

o Nutrition impact symptoms - nausea, pain, diarrhoea, constipation. o Oral cares – denture issues, ulcers. o Nutritional deficiencies that impact appetite and sense of taste (e.g.

iron, zinc, B12) o Swallowing issues o Medications o Grief or loneliness o Poor wound healing

d) The workforce is recruited, trained, equipped and supported to deliver the outcomes required by these standards.

Audits Ensure the workforce is qualified to perform all specified duties. All attending professionals are specialists in their field of expertise:

o Wound care o Dental care o Podiatry o Psychology o Dietetics o Physiotherapy o Speech Pathology

Records of currency for membership to professional bodies is maintained by management.




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e) Regular assessment, monitoring and review of the performance of each member of the workforce

Education Ensure clinical, catering and care staff involved with food, mealtimes and/or nutrition screening attend mandatory nutrition education and complete assessment to confirm comprehension of key messages.



Conduct a ‘Dietary Records Audit’ of consumer’s current requirements against meals provided by organisation or home-delivered meal service.

Review ‘Nutrition Policies and Protocols’ within the organisation to optimise workforce impact on food, nutrition and mealtime experience for consumers.

Aged Care Organisations provide ongoing nutrition education and training to staff, carers and attendants.


Standard 8 – Organisational Governance


Quality Standard 8 relates to Organisational Governance. This Standard is relevant for APDs as the Organisational Governance in terms of food, nutrition and mealtime experience relates to the organisation’s governing body being accountable for the delivery of safe and quality care and services around the food, nutrition and mealtime experience.

Key requirements for APDs to consider with this standard are:

a) Consumers are engaged in the development, delivery and evaluation of nutrition care and food services and are supported in that engagement.

b) The organisation’s governing body promotes a culture of safe, inclusive and quality care and services and is accountable for their delivery.

c) Effective organisation wide governance systems relating to the following: (i) information management (ii) continuous improvement (iii) financial governance (iv) workforce governance, including the assignment of clear responsibilities and accountabilities (v) regulatory compliance (vi) feedback and complaints.

d) Effective risk management systems and practices, including but not limited to the following: (i) managing high-impact or high-prevalence risks associated with the care of consumers (ii) identifying and responding to abuse and neglect of consumers (iii) supporting consumers to live the best life they can.

e) Where clinical care is provided – a clinical governance framework, including but not limited to the following: (i) antimicrobial stewardship (ii) minimising the use of restraint (iii) open disclosure.

There are many touch points across the food, nutrition and mealtime experience for consumers where the Organisational Governance prioritises safe and quality nutritional care and services can be displayed. These include:

menu design, planning and review planning and preparation mealtime audits and feedback mealtime support options


I am confident the organisation is well run. I can partner in improving the delivery of care and services.


The organisations’ governing body is accountable for the delivery of safe and quality care and services.


staff, carer and consumer education 1:1 consultations with consumers optimising collaborative communication between APD service and the aged care




How does the health service organisation ensure that the planning, preparation and

distribution of food and fluids are safe and acceptable, and meet a consumer’s needs?

Does the organisation encourage feedback from all consumers and staff?

Does the organisation involve systems that allow all consumers, including those from

diverse backgrounds, to provide input in menu planning and mealtime experience?

Does the organisation’s governing body support and promote a culture within the

organisation that allows safe, inclusive and quality care and services?

Does the organisation allow consumers to access their records with regards to nutrition

care and services provided?

What dietary systems are in place to support quality and safety of care and services for

consumers within the organisation?

Are systems in place to ensure menus are rotated regularly and reviewed by an APD?

Are weight monitoring and malnutrition screening (using a validated malnutrition

screening tool) conducted regularly within the organisation?

Does the organisation have a weight management policy that adequately supports a

food-first approach to care?

Does the organisation promote open disclosure/communication with consumers in the

event of any food-related incident?




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8a) Consumer Engagement. Consumers are engaged in the development, delivery and evaluation of nutrition care and food services and are supported in that engagement.

Consumer Engagement Encourage feedback from consumers (e.g. satisfaction with service staff, APD advice, mealtimes etc) via food focus meetings, feedback forms, food preference forms, verbal feedback around events and activities involving foods.

Menu Planning Ensure all consumers – including those from diverse backgrounds – are involved in providing feedback re: menu planning, the mealtime experience and dining environment.

Mealtime Events Ensure activities staff, diversional staff, carers and catering staff involve consumers in the planning of, running of and/or feedback around food-related events and activities.

Audit Ensure consumers are aware of, and have access to, the organisation’s nutrition and mealtime policies and procedures.




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8 b) Governing Body Accountability.

The organisation’s governing body promotes a culture of safe, inclusive and quality care and services and is accountable for their delivery.

Audits Provide evidence to substantiate that members of the governing body have suitable experience to fulfil their roles within the organisation.

Nutritional Leadership Assist the organisation to achieve best-practice in proactively engaging with an APD in the provision of high quality care for consumers, education of staff and reviews/auditing of their food service.

8 c) Effective Governance Systems.

Relating to (i) information management (ii) continuous improvement (iii) financial governance (iv) workforce governance (v) regulatory compliance (vi) feedback and complaints.

Audits Implement systems to ensure consumers personal details (e.g. medical history), is stored safely and confidentially.

Quality Improvement Review Policies and Procedures relating to Nutrition and Hydration, Weight Monitoring and Malnutrition Screening regularly to ensure processes reflect best practice and are responsive to industry requirements, regulatory compliance and consumer feedback.




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8 c) Effective Governance Systems. Effective organisation wide governance systems relating to the following: (i) information management (ii) continuous improvement (iii) financial governance (iv) workforce governance, including the assignment of clear responsibilities and accountabilities (v) regulatory compliance (vi) feedback and complaints.

Menu Ensure menus are consistent with regulatory requirements, professional standards and guidelines.

Menu Planning Ensure consumers’ feedback is appropriately responded to regarding menu planning, mealtime experience and environment.

Provision

Ensure meals provided to consumers (within RAC, Community Care Centres, Respite Centres and via Home-Delivered Meal services) are consistent with regulatory requirements, professional standards and guidelines and reflective of menus displayed.




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8d) Effective Risk Management.

Including but not limited to: (i) managing high-impact or high-prevalence risks (ii) identifying and responding to abuse and neglect of consumers (iii) supporting consumers to live the best life they can.

Audits Implement effective risk management processes within the catering service (within RAC, Community Care Centres, Respite Centres and via Home-Delivered Meal services) in the event of major incidences or ‘near misses’ involving consumers, the workforce and organisational governance (e.g. food poisoning).

Weight Management Implement initial and ongoing malnutrition screening (using a validated malnutrition screening tool e.g. MST) and referral pathways to an APD for nutrition care.

8e) Effective Clinical Governance.

Including but not limited to the following: (i) antimicrobial stewardship (ii) minimising the use of restraint (iii) open disclosure.

Audits Apply effective communications with consumers in the event an incident has caused harm and take steps to ensure subsequent incidents are not repeated. Ensure that the staff responsible for incident management within the organisation are clearly identifiable.



Implement mandatory Malnutrition Screening across the organisation.

Advocate for management staff to be present at mealtimes and to occasionally share meals with consumers.

Advocate for there to be engagement of an APD in some capacity at all aged care organisations.


Helpful Resources for APDs, aged care

staff, carers and consumers


RESOURCES FOR APDS

AGED CARE QUALITY STANDARD

1 2 3 4 5 6 7 8

Guidelines / Policies / Procedures

Aged Care Quality Standards Guidance and Resources link QS1 - Consumer dignity and choice link QS2 - Ongoing assessment and planning with consumers link QS3 - Personal care and clinical care link QS4 - Services and supports for daily living link QS5 - Organisation’s service environment link QS6 - Feedback and complaints link QS7 - Human Resources link QS8 - Organisational Governance link

✓

✓ ✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓ Best Practice Food and Nutrition Manual for Aged Care Homes - link ✓ ✓ ✓ ✓ ✓ ✓

Dietitians Australia ‘Menu and Mealtime Quality Assessment for Residential Aged Care Homes’ (coming early 2021) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Meals on Wheels - National Meal Guidelines for Home Delivered and Centre-Based Meal Programs for Older Australians - link

✓ ✓ ✓ ✓ ✓ ✓ ✓

Nutrition Standards for Meals and Menus – Queensland Health link

✓ ✓

https://www.agedcarequality.gov.au/sites/default/files/media/Guidance_%26_Resource_V11.pdf

https://www.agedcarequality.gov.au/sites/default/files/media/Guidance%26Resources_Standard_1_v4.pdf

https://www.agedcarequality.gov.au/sites/default/files/media/Guidance%20and%20resources_Standard%202.pdf







https://x2x8z3r3.stackpathcdn.com/wp-content/uploads/BestPracticeFoodandNutritionManualforAgedCare.pdf

https://mealsonwheels.org.au/wp-content/uploads/2016/10/NationalMealsGuidelines2016.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0030/156288/qh-nutrition-standards.pdf


RESOURCES FOR APDs


1 2 3 4 5 6 7 8

Guidelines / Policies / Procedures continued…

International Dysphagia Diet Standardisation Initiative (IDDSI) framework - link

✓ ✓ ✓ ✓ ✓

A Kitchen Manual for Modified Texture Diets - link ✓ ✓ ✓ ✓ ✓

Diabetes Management in Aged Care: A Practical Handbook - link

✓ ✓ ✓ ✓

Healthy Eating and Diabetes: A Guide for Aged Care Facilities - link

✓ ✓ ✓ ✓

Resources for Health Professionals Working in Aged Care – Diabetes Australia link

✓ ✓ ✓ ✓

The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings - link

✓ ✓ ✓ ✓

Australian Commission on Safety and Quality in Health Care: Nutrition and Hydration - link

✓

Australian Commission on Safety and Quality in Health Care: Malnutrition - link ✓ ✓ ✓ ✓ ✓ ✓ ✓

NSW Health Nutrition Care Policy - link ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

ACI Nutrition Network – The Patient Nutrition Care Journey. A guide to support implementation of the NSW Health Nutrition Care Policy - link

✓ ✓ ✓ ✓ ✓ ✓ ✓

Dietitians Australia: Nutrition and Hydration Policy Support Handbook for Acute Adult Inpatient Setting - link ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

https://iddsi.org/framework/

https://member.dietitiansaustralia.org.au/Common/Uploaded%20files/DAA/Resource_Library/2020/A_Kitchen_Manual_For_Preparation_Of_Modified_Texture_Diets.pdf

https://www.ndss.com.au/about-diabetes/resources/find-a-resource/diabetes-management-in-aged-care/

https://www.chsa-diabetes.org.au/education/Aged%20Care%20Manual_Jan2012.pdf

https://www.ndss.com.au/health-professionals/resources/

https://adma.org.au/download/the-mckellar-guidelines/

https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard/minimising-patient-harm/action-527

https://www.safetyandquality.gov.au/sites/default/files/migrated/SAQ7730_HAC_Malnutrition_LongV2.pdf

https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_041.pdf

https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/172489/nutrition-care-policy-implementation-support-guide.pdf

https://dietitiansaustralia.org.au/wp-content/uploads/2019/03/Nutrition-and-Hydration-handbook-February-2019-APPROVED.pdf


RESOURCES FOR APDs


1 2 3 4 5 6 7 8

Guidelines / Policies / Procedures continued…

National Aged Care Mandatory Quality Indicator Program - link

✓ ✓ ✓

Palliative Care – A Shifting Paradigm - link

✓

Complaints Management Handbook for HealthCare Services, Australian Council for Safety and Quality in Health Care, 2005 - link

✓

✓

✓

Webinars

DA WEBINARS: Free webinars, Dietitian’s Australia membership required. In the member portal - link Locate using search terms such as “aged care”, “elderly”, “malnutrition”, “wound nutrition”, “dementia”, “dysphagia”

and “menu” (as examples) to identify webinar topics relevant to APDs across the Quality Standards related to dignity,

choice, ongoing assessment and planning with consumers, personal and clinical care and services and supports for daily

living.

✓

✓

✓

✓

Aged Care Interest Groups

Dietitians Australia Interest Groups: (for DA members only) – Access by logging into Share Plate

Rehabilitation and Aged Care IG

Food Service IG

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

The Lantern Project – Free Monthly Collaboration Meetings – meeting registrations via link (focused industry discussion around topical areas related to Aged Care Food, Nutrition and Mealtime Experience)

✓ ✓

✓

✓ ✓ ✓ ✓ ✓

https://www.health.gov.au/initiatives-and-programs/national-aged-care-mandatory-quality-indicator-program

https://www.nejm.org/doi/10.1056/NEJMe1004139?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

https://www.safetyandquality.gov.au/sites/default/files/migrated/complntmgmthbk.pdf

https://dietitiansaustralia.org.au/

http://www.thelanternproject.com.au/


RESOURCES FOR APDs


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Assessment Tools

Malnutrition Screening Tools – MST link, MNA link, MNA-short form link

✓ ✓ ✓ ✓ ✓

Subjective Global Assessment form (SGA) – SGA link, Patient Generated SGA link

✓ ✓ ✓ ✓ ✓

Food Diary (template) - link ✓ ✓ ✓ ✓

Dietitian Meal Plan (template) - link ✓

https://www.health.qld.gov.au/__data/assets/pdf_file/0029/148826/hphe_mst_pstr.pdf

https://www.mna-elderly.com/

https://www.mna-elderly.com/forms/mna_guide_english_sf.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0030/143877/hphe_sga.pdf

http://pt-global.org/wp-content/uploads/2016/07/PG-SGA-Metric-version-3.22.15-std-logo.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0025/150298/general_fooddiary.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0022/148432/general_mealplan.pdf


RESOURCE SUGGESTIONS FOR AGED CARE STAFF AND CARERS


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Factsheets and Handouts

Dietitians Australia factsheets - link Locate relevant factsheets using search terms such as “aged care”, “elderly”, “malnutrition”, “wound

nutrition”, “dementia”, “dysphagia” and “menu” that are suitable for aged care staff and carers.

✓

✓

✓

✓

✓

✓

Multicultural nutrition resources - link

✓ ✓ ✓

Dementia Australia factsheets – link

Topics relevant for aged care providers, staff, consumers and carers across the Quality Standards related to

dignity, choice, ongoing assessment and planning with consumers, personal and clinical care, services and

supports for daily living, feedback and complaints, human resources and organisational governance.

Eating and common behaviour challenges - Link

Eating issues - link

✓ ✓

✓

✓ ✓ ✓ ✓ ✓

Eating Well – a Nutrition Resource for Older People and their Carers

Eating Well Booklet - link

Eating Well Brochure - link

✓

https://member.dietitiansaustralia.org.au/Portal/Membership/Resource-Library/Search-Resources.aspx

https://metrosouth.health.qld.gov.au/multicultural-nutrition-resources

https://www.dementia.org.au/sites/default/files/helpsheets

https://www.alzheimers.org.uk/get-support/daily-living/eating-behaviour-challenges

https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend/personal-care/eating

https://x2x8z3r3.stackpathcdn.com/wp-content/uploads/EatingWellANutritionResourceforOlderPeople.pdf

https://x2x8z3r3.stackpathcdn.com/wp-content/uploads/EatingWellBrochure.pdf




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Nutrition Education Materials Online (NEMO) - link

Topics relevant for aged care providers, staff, consumers and carers related to dignity, choice, ongoing

assessment and planning with consumers, personal and clinical care, services and supports for daily living and

organisation’s service environment.

✓

✓

✓

✓

✓

Training, Tools and Reference Links

Malnutrition in Older People online training - link

✓ ✓ ✓ ✓ ✓

Food Allergy and Intolerance Menu Assessment Tool - link

✓ ✓ ✓ ✓ ✓

Mealtime Tips for Persons with Dementia video - link

✓ ✓ ✓ ✓ ✓

The Lantern Project – Free Monthly Collaboration Meetings: meeting registrations via link (focused industry discussion around topical areas related to Aged Care Food, Nutrition and Mealtime Experience)

✓ ✓

✓

✓ ✓ ✓ ✓ ✓

Lantern Little Things Videos - link ✓ ✓ ✓ ✓

Food & Heath Communication Across Cultures: Considerations for Health Professionals Working with Remote Aboriginal Communities - link

✓ ✓ ✓

Protocols for use of ‘Aboriginal’ & ‘Torres Strait Islander’ - link

✓ ✓ ✓

Malnutrition Screening Tools – MST link, MNA link, MNA-short form link

✓ ✓ ✓ ✓ ✓

https://www.health.qld.gov.au/nutrition

https://health.tas.gov.au/healthyageing/online_training

https://member.dietitiansaustralia.org.au/Common/Uploaded%20files/DAA/Resource_Library/2020/NAS_DAA_Food_allergy_intolerance_Menu_Assessment_Tool_2020.pdf

https://www.youtube.com/watch?v=tujTZK0s804


https://vimeo.com/user61898707

http://resources.menzies.edu.au/download/Food_and_%20health_%20communication_%20across_cultures.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0031/147919/terminology.pdf


https://www.mna-elderly.com/

https://www.mna-elderly.com/forms/mna_guide_english_sf.pdf




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Subjective Global Assessment form (SGA) - link

✓ ✓ ✓ ✓ ✓

Patient Generated Subjective Global Assessment (PGSGA) - link

✓ ✓ ✓ ✓ ✓

Quick and Easy Meals - link

✓ ✓

Food Diary (template) - link

✓ ✓ ✓ ✓

Top Tips for Service Providers for Managing Complaints - link

✓ ✓ ✓

Patient-Centred Care: Improving quality and safety through partnerships with patients and consumers. Australian Commission on Safety and Quality in Healthcare, 2011 - link

✓ ✓ ✓ ✓ ✓

Dignity in the Dining Room - tips for carers - link

✓ ✓ ✓ ✓

Aging and Aged Care: Dementia Friendly Environments – “Dining Areas, Kitchens and Eating” - link

✓ ✓ ✓ ✓ ✓


✓ ✓ ✓ ✓ ✓

Food Allergies - link

✓ ✓ ✓ ✓ ✓

https://www.health.qld.gov.au/__data/assets/pdf_file/0030/143877/hphe_sga.pdf


https://www.eatforhealth.gov.au/eating-well/tips-eating-well/quick-and-easy-meals


https://www.agedcarequality.gov.au/resources/top-tips-service-providers-managing-complaints-fact-sheet

https://www.safetyandquality.gov.au/sites/default/files/migrated/PCC_Paper_August.pdf

https://www.agedcareguide.com.au/talking-aged-care/dignity-in-the-dining-room

https://www2.health.vic.gov.au/ageing-and-aged-care/dementia-friendly-environments/dining-areas-kitchens


https://www.foodstandards.gov.au/consumer/foodallergies/Pages/default.aspx




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Food Standards Australia New Zealand (FSANZ) - link

✓

My Aged Care – Australian Government - link ✓

Meals on Wheels Australia - link

✓ ✓ ✓ ✓

Alzheimer Society of Canada: Meal time - link

✓

Hydration Health Literacy in the Aging - link

✓

Covid-19 and Food Service - link

✓

https://www.foodstandards.gov.au/Pages/default.aspx

https://www.myagedcare.gov.au/

https://mealsonwheels.org.au/we-nourish/

https://alzheimer.ca/en/help-support/im-caring-person-living-dementia/providing-day-day-care/meal-time

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734130/

https://member.dietitiansaustralia.org.au/ItemDetail?iProductCode=COVID2&Category=WEBINARS&WebsiteKey=03ff812d-ea2b-487f-936a-969228cc2690


RESOURCE SUGGESTIONS FOR CONSUMERS AND THEIR CARERS


1 2 3 4 5 6 7 8

Factsheets and Handouts

Dietitians Australia factsheets - link Locate relevant factsheets using search terms such as “aged care”, “elderly”, “malnutrition”, “wound

nutrition”, “dementia”, “dysphagia” and “menu” that are suitable for aged care staff and carers.

✓

✓

✓

✓

✓

✓

Multicultural nutrition resources - link

✓ ✓ ✓

Dementia Australia factsheets – link

Topics relevant for aged care providers, staff, consumers and carers across the Quality Standards related to

dignity, choice, ongoing assessment and planning with consumers, personal and clinical care, services and

supports for daily living, feedback and complaints, human resources and organisational governance.

Eating and common behaviour challenges - Link

Eating issues - link

✓ ✓

✓

✓ ✓ ✓ ✓ ✓

Nutrition Education Materials Online (NEMO) - link

Topics relevant for aged care providers, staff, consumers and carers related to dignity, choice, ongoing

assessment and planning with consumers, personal and clinical care, services and supports for daily living and

organisation’s service environment.

✓

✓

✓

✓

✓

https://member.dietitiansaustralia.org.au/Portal/Membership/Resource-Library/Search-Resources.aspx

https://metrosouth.health.qld.gov.au/multicultural-nutrition-resources

https://www.dementia.org.au/sites/default/files/helpsheets

https://www.alzheimers.org.uk/get-support/daily-living/eating-behaviour-challenges

https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend/personal-care/eating

https://www.health.qld.gov.au/nutrition




1 2 3 4 5 6 7 8

Eating Well – a Nutrition Resource for Older People and their Carers

Eating Well Booklet - link

Eating Well Brochure - link

✓


✓ ✓ ✓ ✓ ✓

Quick and Easy Meals - link

✓ ✓

Food Diary (template) - link

✓ ✓ ✓ ✓

Healthy Ageing – Department of Health Tasmania - link ✓ ✓ ✓

Training, Tools and Reference Links

Mealtime Tips for Persons with Dementia video - link ✓ ✓ ✓ ✓ ✓

The Lantern Project – Free Monthly Collaboration Meetings - – meeting registrations via link (focused industry discussion around topical areas related to Aged Care Food, Nutrition and Mealtime Experience)

✓ ✓

✓

✓ ✓ ✓ ✓ ✓

Lantern Little Things Videos - link ✓ ✓ ✓ ✓

Malnutrition Screening Tool (MST) - link ✓ ✓ ✓ ✓ ✓

Patient Generated Subjective Global Assessment (PGSGA) - link

✓ ✓ ✓ ✓ ✓

Dignity in the Dining Room - tips for carers - link ✓ ✓ ✓ ✓

https://x2x8z3r3.stackpathcdn.com/wp-content/uploads/EatingWellANutritionResourceforOlderPeople.pdf

https://x2x8z3r3.stackpathcdn.com/wp-content/uploads/EatingWellBrochure.pdf


https://www.eatforhealth.gov.au/eating-well/tips-eating-well/quick-and-easy-meals


http://www.health.tas.gov.au/healthyageing

https://www.youtube.com/watch?v=tujTZK0s804


https://vimeo.com/user61898707



https://www.agedcareguide.com.au/talking-aged-care/dignity-in-the-dining-room




1 2 3 4 5 6 7 8

Aging and Aged Care: Dementia Friendly Environments – “Dining Areas, Kitchens and Eating” - link

✓ ✓ ✓ ✓ ✓


✓ ✓ ✓ ✓ ✓

Food Allergies - link

✓ ✓ ✓ ✓ ✓

My Aged Care – Australian Government - link

✓

Meals on Wheels Australia - link

✓ ✓ ✓ ✓

Alzheimer Society of Canada: Meal time - link

✓

https://www2.health.vic.gov.au/ageing-and-aged-care/dementia-friendly-environments/dining-areas-kitchens


https://www.foodstandards.gov.au/consumer/foodallergies/Pages/default.aspx

https://www.myagedcare.gov.au/

https://mealsonwheels.org.au/we-nourish/

https://alzheimer.ca/en/help-support/im-caring-person-living-dementia/providing-day-day-care/meal-time
