16 Aug Will the Royal Commission change aged care catering?
Aged care nutrition, menu management, training, food budgets and procurement practices were the focus of the Royal Commission hearing in Cairns. Three aged care chefs and celebrity chef Maggie Beer gave evidence, together with speech pathologists, dietitians and oral care specialists.
The hearing highlighted both ends of the spectrum in aged care catering – from the challenges chefs face preparing meals for residents on budgets as low as $6.50 a day, to what you can achieve on $16 a day, including working with ingredients such as fillet mignon, salt and pepper squid, seafood baskets and good quality meat.
We’ve worked through the transcript from the day and below is a summary of the key themes that impact food service delivery.
The flexibility of menu design was raised as a factor impacting how well care chefs can plan menus with suitable variety. Given most providers operate on a 4-week cycle and a seasonal menu that must satisfy dietetic nutrition standards, it stands to reason there will be some degree of repetition. Procurement systems in place will also dictate how much scope care chefs have to tailor recipes and ingredients.
Menu design flexibility will also be dictated by the food service operating model providers choose. For example, some larger aged care residential groups may implement a menu at head office level and give chefs some scope in execution. Others will give facility chefs full control over menu planning and procurement. One of the expert aged care chefs, Ms Lindy Twyford, Hospitality Manager at RFBI, not only plans her own menus, but surveys residents to ensure they have real input into menu design:
“When we do our menus we ask the residents, we have surveys, we have resident meetings. They have favourites like roast dinners and silverside and cutlets, and the party pies of an evening. It might be repetitive in some cases but it’s what they request. So we provide that for them.” [Lindy Twyford]
Fresh vs frozen and food safety
The Royal Commission examined evidence on how care chefs manage food budgets and the use of fresh vs frozen ingredients in meal preparation. Mr Nicholas Hall, a care chef who has worked in both residential facilities and for contract caterers, highlighted where corners are often cut to make ends meet:
“For $7.20 a day, you are having to cut corners, you are having to use frozen or processed foods just to feed the residents. So if you were making, say, rissoles for 80 people they would supply five kilos of mince. So you’ve got to extend that out with grated carrot, breadcrumbs, just to make sure every resident had two rissoles and there’s nothing left over.” [Nicholas Hall]
Conversely, Ms Twyford noted that while frozen products were used in combination with fresh, being able to use the right equipment, like combi ovens could really lift the quality of the finished product:
“We have a combination of fresh and frozen because there are some good products of frozen foods, but the utmost importance is the food.” [Lindy Twyford]
More concerning were instances of unsafe or substandard food preparation practices witnessed in residential aged care facilities:
“Reusing food that’s already been out served to residents and (have) come back to the kitchen. They use that for the texture modified diets. Reheating texture modified food in a cold bain-marie, which is high risk. Not storing food correctly. I’ve had one place where the fridge temperature was 14 degrees, where the food was in the danger zone for the whole day.” [Timothy Deverell]
A lack of appropriate food service equipment and food temperature were cited as major sources of complaints from residents:
“Without a proper hot box, by the time we’ve plated up the food and the resident gets it, could be 30, 40 minutes later, and by then, the food is cold.” [Timothy Deverell]
Lindy Twyford added that it’s not just food service equipment, having the right crockery with lids on them, comfort plates or crockery with higher lips to offer dignity to those residents who need assistance with eating, as well as serving residents in the dining room, just like a restaurant service are all key to improving the dining experience.
Food appeal and nutrition
Celebrity chef, Maggie Beer gave evidence focusing on her passion to see more ‘oomph’, ‘scent’ and ‘aroma’ in aged care cooking. She used the example of taking the time to prepare meals individually and pan-frying elements to highlight food appeal. Whilst wonderful in theory it becomes somewhat impractical when you’re catering for up to 80 to 100 residents at every service. To add to the complexity, layer in 80 to 100 individual dietary, clinical and cultural preferences and you can see the challenges care chefs face every day. However, an a la carte style meal service is certainly something the industry can aspire to, given the right technology, staffing, training and expertise.
Nutritional adequacy was another key area of discussion. Dietitians play an important role in providing guidance to chefs and cooks on good nutrition in the context of building recipes that meet minimum requirements around protein, for example. However, if the ingredients aren’t available, substitutions may result in a substandard meal:
“Sometimes there isn’t the right food to prepare the menu item, so you will substitute a food item, and normally it’s a cheaper or lesser option. So even though the menu has been approved by a dietitian, it’s not being followed by the chefs because they don’t have the stock.” [Timothy Deverell]
While good ingredients are critical to nutrition, there are other factors that can influence how well residents eat, with ingredients being just one contributor. A resident’s underlying wellness and appetite, medications, sleep quality, the food’s temperature, smell and appearance, even the ambience of the dining room, will all impact how well a resident eats. This is not to mention how much (or little) time carers have to assist residents if they need help eating their meal.
Care catering training
The care catering workforce is extremely mobile, with a high degree of staff movement and employment of agency staff. Care catering training has always been the poor cousin when compared to the investment in clinical training, which attracts substantial government subsidies. There is currently no formal TAFE or certified aged care catering courses available in Australia. Appropriate training was noted by all witnesses as key to delivering the best outcomes for residents:
“Quality training is very, very important. We have ongoing training all the time. Our staff are asked to know the residents, to talk with the residents after every meal, or when they can, to know every little thing about their likes and dislikes, their allergies. Get to know them as part of their family, not just as coming to work. The resident knows that they’re cared for, and that the staff genuinely want to do the right thing by their food.” [Lindy Twyford]
The importance of food for resident happiness
The Royal Commissioner, Ms Hutchins asked one key question of the aged care chefs: How important do you think food is to a resident’s happiness?
“It’s everything. It’s what they look forward to at the end of the day. It’s what they get up for in the morning. It’s what’s left after a lot of other things have been cut, their outings, games. At the end of the day, the food, it’s the number one thing for them.” [Nicholas Hall]
“The whole resident’s day is structured around their meal periods. It’s the one thing they get to look forward to every day. The bus outings, the shopping trips: those sorts of things are intermittent. But the meals are constant. So their happiness and getting a decent meal is huge.” [Timothy Deverell]
“The residents love the little things. We’re there to make the place their home. Nutrition is vitally important to both physical and emotional wellbeing because malnourishment will lead to wounds or bedsores. And to them – it’s a social site in the dining room… food is the one thing that gives them importance and independence.” [Lindy Twyford]
Will the Royal Commission change care catering?
There is currently a clear disconnect with consumer expectations around quality and choice. In the end though, it’s simple – we need to understand the power of food to create happiness and wellbeing.
What perhaps is missing from the Royal Commission’s scope is the focus on the positive changes that have occurred over the last 20 years. Yes, there are still a few rogue providers, however as a whole, the standards of food service across the aged care industry have come a long way. ‘Hospitality Managers’ are now the norm and extended choices are available for lunch and dinner. Restaurant chefs are flocking to the industry, in part because of the family-friendly hours, but also to make a difference. We now cater for eight different textures of food, four different fluid levels, 100 different allergies/intolerances/dislikes and 10 different cultures at any given meal service.
The industry is made up of passionate, hard-working people. While unintentional, the negativity of evidence presented at the Royal Commission may counter-intuitively deter those wanting to work in the industry.
The Australian aged care system is one that is clearly under pressure. It is likely the recommendations of the Royal Commission will only increase the pressure on providers and allied health services to do more. Ultimately, there is no silver bullet that will fix the systemic problems, although extra funding will help.
What is needed is a holistic approach.
The key to long-term improvement is the right training, more hours in the kitchen, a better understanding of food and produce, a fit for purpose procurement system and genuine investment in people, technology and processes. By creating a true career pathway for catering and care professionals, everyone will benefit.
At SoupedUp, we are privileged to work in a sector where we can contribute to improving the quality of life of our elderly Australians. And we are long-term players, committed to working with providers and contract caterers to bring care and catering together using innovation and technology.