Catering in aged care

Catering is one of the most important functions in aged care. Human beings are food driven and each day catering services across the nation strive to achieve the perfect meal where residents are satisfied with the quality and have enjoyed the dining experience. This is by no means an easy task.

To look after every resident and get it right day after day takes a lot of planning and organisation. The perfect meal situation does not depend solely on the food being well cooked and presented. It also depends on how the food is produced, how the food is delivered to the residents through the meal delivery system, and finally to the dining room where all the hard work comes together. Each stage along the catering pathway is crucial to ensure its success and that residents enjoy their meal.

The following diagram outlines the pathway in which food goes from its purchase to the consumption by residents. Aged care facilities all walk a very similar path.

Menu  >  Production of meals  >  Meal delivery  >  Dining room

Menu

Previously I spoke about the nutritional aspects of menu planning in aged care and how the menu is more than just what will be cooked each day. It actually defines how catering systems are set up and how the menu can be limited by the catering equipment. Kitchen design needs to be carefully planned to maximise production opportunities that will ensure the menu has a freshness which allows residents the flexibility of choice and variety. Part of the development of menus is gathering food preferences from residents and understanding the types of foods residents like to eat. Food preferences gathered from Nambucca Valley Care indicated that desserts, soups and the traditional foods associated with an older generation like roasts, stews, pudding, baked custards are still very much part of the menu.

Production

Production is the process whereby food is transformed into a meal. Production can be essentially divided between two main systems, ‘fresh cook’ and ‘cook chill’. Data collected from the National Menu Survey for Residential Aged Care, conducted by the University of Queensland, suggests that aged care facilities across Australia are predominately ‘fresh cook’. Cooking fresh is having food cooked on the day it is served, which means that facilities have kitchens operating seven days a week. There is some variation on the ‘fresh cook’ theme where facilities do use some ‘cook chill’ technology, so that they can re-thermalise food over weekend periods and reduce their labour costs. These facilities can also produce batches of products like porridge, soups and gravies only a few times a week and hence free up time to concentrate on other areas of catering.

‘Cook chill’ is the process whereby food is produced and rapidly chilled thus enabling an increased shelf-life of anywhere between five to 28 days. One of the advantages of ‘cook chill’ is that it reduces the operational times of a kitchen. The difference between food services in a ‘cook fresh’ and ‘cook chill’ kitchen depends on the type of service you are marketing for your organisation. There is little to suggest a significant nutritional difference between the systems, and in aged care the focus of food production should be to deliver a meal which the residents like and will eat.

Food delivery

No matter how food is produced – whether in a centralised off-site kitchen or on premises – one of the key areas of food services is moving the food to residents. Again the National Menu Survey indicated that facilities use a wide variety of methods to do this, from kitchens that served straight to a dining room, smaller kitchens where food is delivered and kept warm to be served into dining rooms, kitchens which received bulk foods that require reheating to serve to a dining room, and finally tray meal services in which food is preplated and then heated in carts adjacent to dining rooms or thermally supported and delivered to resident areas.

In aged care the preferred model is to serve food into a dining area from an adjacent kitchen or kitchenette. It does not matter if the food is being cooked and hot held, delivered and hot held, or re-thermalised, as either of these systems allows the smell of the food to permeate through the dining area. One of the primary functions to stimulate the appetite is the smell of food so meal delivery systems need this function so that at meal time residents have the opportunity smell the food they are about to consume. Using trays and heating tray carts reduces this effect and hence also reduces a resident’s ability to change their mind about their food choice. Another important point with plated meal delivery systems is to ensure that they keep the food warm and have the ability to hot hold if required. This is especially important when residents require assistance to feed and meals are left on the tray waiting for care staff to provide assistance. In these incidences the meal support requires a thermal dome or base, or a heated base and cover.

Dining room service

When it comes to dining rooms this is the piece in the catering pathway which is the maker or breaker. The dining room is where the most important functions occur, when all the hard work in producing a meal getting that meal to the residents hot and looking spectacular is put to the test. Dining rooms need to be set up so that the resident feels at home, that they focus on the meal and feel comfortable. A dining room needs to be a nice welcoming space.

Below is a list of areas which need to be considered for a dining room:

• The set up – no clutter and plenty of space to move around.


• Appropriate furniture.


• Table settings.


• Background music.


• Lighting.


• Resident and staff interaction.


• Enough seats for staff to sit down and assist residents.


• Minimum disruption to residents from mediation trolley or visiting health professionals.

The other important function of the dining room is to ensure that residents are social and not being isolated by eating in their rooms. There will be times where a resident will need to stay in their room for meals due to clinical reasons. However, the dining room is a social place where residents can interact with staff and visitors. Having residents in the dining room helps to reduce social isolation and keeps residents engaged. Dining rooms also allow staff to monitor what residents are eating which is essential to prevent unintentional weight loss. As the population gets more frail it is important to ensure residents eat adequate amounts of food daily.

How do you know if your catering system is functioning well? Firstly, as food is such a hot topic for residents, the amount of complaints, complements and feedback from resident meetings is a good guide. Another measure is the use of a food service resident satisfaction survey. Tools such as these ask residents to rate the quality of the food, service from staff, dining room and menu. We have used a food service resident satisfaction tool at our facility and the one area which residents thought could do with some improvement was the dining room. They thought that the food was of good quality though at times the vegetables were too hard, the service from the staff was excellent and that the menu provided a good variety of foods. These surveys, though time consuming to implement and collect the data, do show where areas of improvement can be made and where the service is working well.

Catering for residents is not simple. It is a complex process whereby food is transformed into meals that our residents enjoy and want to eat. There is no perfect system and it is amazing what you can do to really enhance the meal experience by changing simple things. But one important fact is that if any part of the catering pathway is not functioning well then this can seriously compromise catering to residents.

What we are looking for in aged care is to have meals which are enjoyed and eaten and residents looking forward to meal times.

Karen Abbey

Bachelor of Science, Honours in Human Nutrition, Graduate Diploma in Nutrition and Dietetics, Masters in Health Science Management.

Dietitian/Manager Resident Support Services

Nambucca Valley Care

Karen is a food service and aged care specialist dietitian and has worked in the aged care industry for over 15 years. Karen has presented at conferences nationally and internationally on topics ranging from menu design, nutrition specification in food service, and nutrition for the elderly. Karen has worked for Queensland Health as a rural aged care dietitian, with the Rural Allied Health Team and done extensive work for Queensland Meals on Wheels delivering training in nutrition and menu design. Karen is currently the Resident Support Services Manager and Dietitian working for Nambucca Valley Care an aged care facility on the Mid-North Coast of New South Wales and is currently undertaking a PhD with the University of Queensland examining menu design and delivery of optimal nutritional care in residential aged care.

Karen can be contacted at: karen.abbey@nvcl.org.au