Careful thought and creativity are as important to menu planning for home care clients as they are to the selection of our own daily meals – if not, more so, given the heightened health complications inherent with ageing, disability or illness.
One of the benefits of receiving care in the community or home setting is its personalised nature, and food and meal choice is one of the most personal choices a person can make.
For this reason, our clients not only expect but have a right to provide input into the type of meals they receive.
It is well known that food consumption and nutrition are closely linked to our overall quality of life. Furthermore, studies have shown that increased independence in food choice and active participation in food planning is associated with a reduced risk of malnutrition (Abbey 2015).
This article will provide broad nutritional advice and methods of effective meal planning for home care clients.
Malnutrition in Home Care
While malnutrition is difficult to measure, it’s estimated that 15% of clients receiving home care are malnourished (TAS DoH 2020).
In general, older adults are especially known to be at a disproportionate risk of malnutrition (Rossi 2017). There are many reasons for this, including:
Decreased food intake due to factors such as isolation and reduced ability to access food
Physical impairment such as disability, reduced appetite, reduced sense of taste or smell, difficulty chewing or swallowing, difficulty self-feeding and difficulty preparing food
Cognitive and psychological issues such as dementia, depression, anxiety, self-neglect and bereavement
Being unable to consume certain food groups due to difficulty chewing, swallowing or digesting
Polypharmacy, which may impair nutrient absorption or increase nutrient loss
Having a poor eating environment
Inflammation associated with disease, injury or illness
Requiring assistance with eating due to factors such as cognitive impairment
Being unable to consume sufficient amounts of food.
(TAS DoH 2020; Rossi 2017; Iuliano-Burns 2019)
People living with disabilities or chronic illness may be at increased risk of malnutrition due to factors such as:
Loss of appetite, nausea, vomiting or diarrhoea caused by chronic illness
Impaired mood and reduced desire to eat caused by mental illness
Impaired ability to digest food and absorb nutrients due to conditions such as Crohn's disease and ulcerative colitis
Increased energy requirements due to surgery or involuntary movements (e.g. tremor)
Taking certain medicines
Impaired ability to mobilise, cook or shop for food.
(NHS 2020)
Preventing and Treating Malnutrition
The following three methods are advised for preventing and treating malnutrition:
Dietary approaches:
Ensuring that sufficient energy and nutrient quality is met through meals and food between meals
Food fortification:
Improving the nutritional density in meals
Can be used as a vehicle for nutrients, for example adding Vitamin D to foods
Found to be particularly effective in hospital settings
Potentially less effective in aged care settings.
(Iuliano-Burns 2019)
Older adults and people living with disabilities or chronic illness are known to be at an increased risk of malnutrition.
Feeding Assistance
Feeding assistance is one method to curb malnutrition. The level of assistance required by clients will vary. Assistance can range from:
Supervision, prompting and encouragement
Setting up cutlery etc.
Cutting up meals
Full feeding assistance.
(Eat Well Nutrition 2014)
The style and manner of feeding assistance are important to get right. Staff must be trained to feed in a controlled manner, distractions should be minimised, altered utensils should be made available, and swallowing rehabilitation is to be encouraged if appropriate (Iuliano-Burns 2019).
A Dietary Guide for Home Care Clients
Foods to Avoid
Limit foods that are high in saturated fats, including cakes, pastries, processed meats, pizza, fried foods, potato chips etc.
Limit foods and drinks with added salt and avoid adding salt to food when eating
Limit foods and drinks high in sugar, such as confectionery, sugar-sweetened soft drinks, cordials and fruit drinks
Limit consumption of alcohol to no more than two standard drinks per day
Keep 'extras' such as lollies, cakes, biscuits, fried foods and pizza to a minimum - they should not feature regularly and are not part of a healthy diet.
(Better Health Channel 2017)
Foods to Embrace
Eat from each segment of the food group regularly:
Vegetables, fruit, legumes and beans:
Choose a variety of types and colours (e.g. green, orange, red, yellow, purple and white)
Lean meats and poultry, fish, eggs, tofu, nuts and seeds
Grain (cereal) foods (mostly wholegrain and high-fibre)
Dairy (milk, cheese and yoghurt), preferably reduced-fat varieties
Drink plenty of water (six to eight cups every day)
Swap foods that are high in saturated fat with foods containing polyunsaturated and monounsaturated fats
Switch foods such as butter, cream, cooking margarine, coconut and palm oil with unsaturated fats from oil, nut-based butters and pastes, and avocado
Eat fish regularly as it has been known to reduce the risk of heart disease, stroke, dementia and macular degeneration
Some older adults may benefit from vitamin or mineral supplements, however, these are not to be taken simply to compensate for a poor diet.
(Better Health Channel 2017; NHMRC 2013; Nutrition Australia 2013)
Increased intake of the following nutrients is recommended for older people. Keep these requirements in mind during all meal planning:
Calcium and Vitamin D
Vitamin B12
Fibre
Potassium
Fats (polyunsaturated and monounsaturated).
(Wolfram 2018; Better Health Channel 2017)
Meal Planning
We eat with our eyes first, which means that the visual appearance of a meal matters. Make sure to incorporate a wide variety of colours, textures, flavours and types of food to keep things interesting when planning meals.
While rotational meals are no doubt a more convenient option when providing home care, keep in mind the importance of meal variation for nutritional needs and meal enjoyment.
Meal Planning Considerations
Some clients have specific meal requirements. When planning meals, always take into account the following:
Medical needs
Allergies and intolerances
Dietary restrictions (e.g. vegetarian)
Eating and swallowing capabilities
Cultural customs
Religious food practices
Mental illness
Personal likes and dislikes
Medicines being taken
Additional energy requirements (e.g. due to unplanned weight loss, illness or injury)
Abbey, KL, Wright, OR and Capra, S 2015, ‘Menu Planning in Residential Aged Care-The Level of Choice and Quality of Planning of Meals Available to Residents’, Nutrients, vol. 7, no. 9, viewed 16 June 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586549/
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