Meal Service in Aged Care

Attentive meal service combined with healthy and flavoursome food can be a high point in the day of aged care residents.

Dining in aged care is a topic worthy of consideration, as about half of all aged care residents in Australia are either malnourished or at risk of malnutrition (DAA 2019).

It would be unwise to underestimate the effect food presentation and service has on appetite and an individual’s eagerness to participate in mealtime.

This article will provide tips for providing high-quality meal service in aged care facilities. See previous Ausmed articles on food handling and meal assistance.

Meal service relates to Standard 4 of the Aged Care Quality Standards: Services and Supports for Daily Living.

Meal Times

Always provide three main meals, morning tea, afternoon tea and supper. These meals should be appropriately spaced out, however, it may be beneficial to allow residents flexibility (e.g. having a late breakfast if they wish to do so) (Bartl 2015).

Before Service

• Before the meal is served, it is important to ensure everything is correctly set up and accessible for the resident. Tables should have appropriate table cloths or mats, cloth napkins and/or clothing protectors
• Sufficient staffing is integral to being able to offer satisfactory meal service. It is difficult to anticipate how many residents will need help and it is impossible to predict mealtime complications that could require immediate attention
• To facilitate this, it may be worth holding two sittings for the midday meal. For example, the first sitting could be for residents requiring full assistance and the second sitting for residents requiring minimal assistance. Spread staff between these two sittings with a scheduled break in the middle.

(Bartl 2015)

Atmosphere

Ensure that the dining environment is welcoming, open and facilitates socialisation. It should be well-lit and pleasantly decorated.

Considerations should include:

• Room colour - pale walls are more calming
• Maintaining a comfortable, draught-free room temperature
• Background music, depending on residents’ preferences
• Preventing distractions such as loud music, televisions and unfamiliar people
• Ensuring chairs are comfortable, sturdy and well-balanced and having cushions or foam wedges available
• Cooking smells, which may stimulate appetite (however, keep in mind that some residents may be put off by cooking smells).

(Bartl 2015)

Using tablecloths, cloth napkins and small flower arrangements may make the dining environment feel more pleasant. Consider allowing residents to help set the table if they wish to do so (Bartl 2015).

It is important that tables and chairs are arranged in a way that permits residents to move around freely, including residents who use a wheelchair or another mobility aid (Bartl 2015).

Consider holding a ‘special service’ on occasion, for example, employing a chef to come to the facility to cook onsite. This means that at least once a month, the atmosphere, the type of meal and the meal service is novel for residents. Other ideas include themed days, barbecues and cupcake decorating. Eating outside from time to time may help to stimulate residents’ appetites (Bartl 2015).

Other ideas for optimising meal service include:

• Buffet-style service where residents can choose the amount and type of food they want to eat
• Taking around food platters containing vegetables, bread, cheese, biscuits, fruits etc.
• Providing condiment trolleys or trays
• Using name cards and menus
• Providing restaurant-style service with waiters.

(Bartl 2015)

Positive socialisation during mealtime has been found to increase appetite, as people generally eat more when in the company of others. Consider using tables that more easily facilitate conversation (e.g. round or square tables) and encouraging interaction between residents (Bartl 2015).

Note that some residents may feel uncomfortable eating in a dining room with others and may find it an anxiety-provoking experience. Furthermore, some people are naturally less sociable than others and may prefer to eat some meals alone (Bartl 2015).

Mealtime should be relaxed and never rushed. This is particularly important in the case of residents who may eat slowly but wish to remain independent. It is important to notice when an independent resident becomes tired, or needs assistance or support to finish their meal (Cater Care 2018; Bartl 2015).

Furthermore, note that removing plates and serving the next course too quickly may be off-putting for residents who are still eating (Bartl 2015).

Attention to Detail

It’s crucial to serve food in a way that looks appealing and satisfying, and to arrange food with the same level of detail that you would serve your own meals.

It only takes a few small thoughtful additions to drastically improve the appearance of a meal. For example, adding herbs such as a sprig of parsley or basil will add colour to a dish. Offering condiment options is relatively easy to incorporate into meal service and may offer residents a sense of agency (Unilever Food Solutions 2019).

Presenting food in an appealing way can prove challenging when catering for residents who experience difficulty eating solid foods and require pureed or modified foods. Texture modified foods can look unsightly, so it is important to pay extra attention to these meals and to come up with creative ways of presenting them.

While pureed food is a solution to choking hazards and caters to people with chewing and swallowing difficulties, it may be so unrecognisable from its original source that residents might refuse to eat it. A solution to this is to reshape the pureed food with a food mould, for example, a carrot shaped mould for orange puree (Egan 2019).

Always ensure that you provide appropriate cutlery and eating utensils and serve food in a manageable form. This is particularly important for residents who may feel embarrassed about spilling or dribbling food in front of others (Bartl 2015).

Crockery plates and cups are generally better than plasticware, as they are more homely and less childlike (Bartl 2015).

There’s no need to go overboard, but consider serving meals on colourful crockery and utensils. This will:

• Instantly liven up the meal, and
• Assist residents who are living with visual/cognitive impairments.

(Unilever Food Solutions 2019)

(Note: monochromatic cutlery and crockery are known to be confusing for people living with dementia.)

Cultural Considerations

Avoid a one-size-fits-all approach to food service.

Take the time to find out what the residents prefer. Beyond catering to their dietary restrictions or preferences, familiarise yourself with cultural needs in regards to food preparation, for example, if a resident requires their meal to be kosher or halal certified.

Sharing food and coming together during mealtime bears great importance in certain cultures. Visiting family and friends should be encouraged to bring and share food, but they will need to be briefed on food safety guidelines (Cater Care 2018; Bartl 2015).

After Service

There’s a good chance residents will have feedback for the way meals are served and how mealtime is carried out. It’s important to take this on board and make sure that this feedback is relayed to any others who may be involved in meal planning and preparation.

Take into consideration residents who may be reluctant to share their feedback openly and consider anonymous surveys or questionnaires (Cater Care 2018)

Malnutrition

Malnutrition is rife in Australian aged care facilities. Recent media reports have shone light on the poor state of food, leaving little doubt as to why residents might be reluctant to eat regular meals.

Malnutrition presents a major risk factor for sarcopenia and related issues such as an increased risk of falls, arthritis, depression, fractures, pressure injuries, poor quality of life and hospitalisation (Rossi 2017; ProPortion Foods 2018).

Access to adequate food and nutrition in a form that is enjoyable is a fundamental right that should be observed for all residents in aged care facilities (ProPortion Foods 2018).

It is well understood that meal appearance, smell, flavour and a relaxed eating environment all contribute towards appetite stimulation. Consider, for example, the difference careful food presentation could make for a resident in the process of adjusting to a diet of only pureed food.

Conclusion

Meal service is a crucial component of high-quality care. Your manner of service could greatly influence a client’s enjoyment of mealtime and directly result in them receiving the nutrition they require to be healthy and happy.

Additional Resources

• Standard 4: Services and Supports for Daily Living | ACQSC
• Best Practice Food and Nutrition Manual for Aged Care Homes Edition 2.2 | Central Coast Local Health District
• Food Handling Basics | Ausmed Article
• Meal Assistance in Aged Care | Ausmed Article
• Meal Planning in Aged Care | Ausmed Article

References

• Bartl, R and Bunney, C 2015, ‘Best Practice Food and Nutrition Manual for Aged Care Homes Edition 2.1’, Central Coast Local Health District, viewed 2 September 2019, https://www.cclhd.health.nsw.gov.au/wp-content/uploads/BestPracticeFoodandNutritionManualforAgedCareEdition2.1.pdf
• Blumer, C 2018, ‘Would You Eat This? The Real Food Inside Aged Care Facilities in Australia’, ABC Investigations, viewed 30 August 2019, https://www.abc.net.au/news/2018-09-17/food-in-aged-care/10212880
• Cater Care 2018, Top 5 Tips to Improve the Nutritional Outcomes in Your Aged Care Facility, Cater Care, viewed 2 September 2019, https://www.catercare.com.au/top-5-tips-improve-nutritional-outcomes-aged-care-facility/
• Dietitians Association of Australia 2019, Malnutrition in Older Australians, DAA, viewed 21 June 2021, https://agedcare.royalcommission.gov.au/system/files/2020-06/DAA.0001.0001.0079.pdf
• Egan, C 2019, ‘We Eat with Our Eyes’: Getting Food Right in Aged Care, Hello Care viewed 2 September 2019, https://hellocaremail.com.au/eat-eyes-getting-food-right-aged-care/
• Hugo, C, Isenring, E, Sinclair, D and Agarwal, E 2018, ‘What Does it Cost to Feed Aged Care Residents in Australia?’, Nutrition and Dietetics, 75, pp. 6-10
• ProPortion Foods 2018, Enhancing Nutrition and Flavour in Aged Care Food, ProPortion Foods, viewed 2 September 2019, http://www.proportionfoods.com.au/enhancing-nutrition-and-flavour-in-aged-care-food/
• Rossi, A 2017, Older People at Disproportionate Risk of Malnutrition, Aged Care Guide, viewed 2 September 2019, https://www.agedcareguide.com.au/talking-aged-care/older-people-are-often-at-disproportionate-risk-of-malnutrition
• Unilever Food Solutions 2019, Food Plating and Meal Presentation Tips for Aged Care, viewed 2 September 2019, https://www.unileverfoodsolutions.com.au