Maggie Beer’s Big Mission – Episode 2
Dysphagia and Texture Modification
One of the most important elements of cooking in aged care is to meet the needs of those residents affected by dysphagia (swallowing difficulty), as they may need the texture of their food and drinks modified. There are 5 different textures of food and 5 different fluid textures. Further information about the different textures can be found by clicking here.
Having different textures means that not all food is ready once it is cooked – it needs to be further converted into the correct texture. Failing to do this can put the resident at risk of choking or inhaling food or fluid, which may lead to significant, sometimes fatal outcomes.
The health experts in dysphagia and texture modification are speech pathologists. Surprisingly, a speech pathologist had not originally been included as part of Maggie Beer’s consultant team, but we were very fortunate that Elizabeth was able to connect us to Natalie – firstly to train clinical and kitchen staff, and then undertaking further consulting later in the project.
The effect of Natalie’s training was that staff in the kitchen and the dining room became very knowledgeable about dysphagia and would discuss this with each other. Natalie also worked with our cooks and the Maggie Beer Foundation chefs to trial texture modified versions of new foods.
Not all foods are able to be texture-modified, notably pasta, rice, noodles and similar. During the project we attempted to modify chips for residents requiring level 4 or 5 texture to enjoy with fish on a Friday, but unfortunately we did not succeed.
Menu Planning
In Episode 2, there is a short piece relating to menu planning in aged care which involved Maggie Beer, alongside our chef (Sas), a speech pathologist (Natalie) and a dietician (Emma). As was highlighted, devising a menu is extremely complex to ensure foods with sufficient nutrition are used to create a variety of different meals over a 28-day menu. This means that where you have a choice of 2 main meals at lunchtime, there must be a minimum of is 56 different lunches in a menu. That’s before you add in an evening meal or meals.
Distributing the meals into the menu is not always straightforward – you want to mix up the protein sources: beef, lamb, pork, chicken, fish, vegetarian. The easiest meals to allocate are roast meals twice a week (Wednesday and Sunday lunch at Meath Care), and fish for Friday lunch.
In the episode, Emma discusses eating the rainbow – having a variety of colours in the foods. It is especially important to ensure vegetables have different appearances. For example, the orange of pumpkin or carrots to contrast with green broccoli or beans.
Previously, our menus had been developed and then signed off as appropriate by a dietitian; we believe that involving a dietitian during the development stage was a huge benefit.
Training
During Episode 2 there are several training sequences shown. During the project there was initially leadership training to assist the change process, then there was dysphagia training for kitchen and clinical staff, before the holistic care model training.
The need for training and vocational development is relatively universal, but this is an essential area for aged care, and an area that has been limited in recent years. With the hands-on nature of aged care, as well as the linguistic diversity of workers, the best training has been observed as including in-person practical application.
Previously, up until 30 June 2014, there was a conditional adjustment payment available to aged care providers where certain undertakings are being met, which included a level of training. The conditions were removed on 1 July 2014 with the funds rolled into the care subsidies, which alongside an expanding workforce, may have contributed to the critical need for training we see today.
Communication
Good communication is paramount for success in many walks of life, but especially aged care. While this is consistently a challenge throughout the series, it is illustrated in Episode 2 in several ways. In an early scene where Maggie Beer is trialling her porridge with Merle there are a couple of examples where communication ought to have been better.
Firstly, additional prunes for the porridge have been cooked and supplied to the dining room, but not offered with the porridge when Merle is served. This highlighted the need for improved communication between the kitchen and dining room.
Secondly, Merle asks the carer to get Maggie “a bowl”, which the carer duly does returning with an empty bowl. Notwithstanding Maggie tapping her place setting and saying “some porridge” at the same time, Merle meant for a bowl of porridge. With staff diversity, many not having English as their first language, such miscommunications can occur.
The key to communication is that the message received should be the same as the message given. Within the workplace there are different ways in which such things are addressed.
Later in the episode there are residents who say that there has been no communication about what’s happening at the Centre. It is important to keep residents informed; at the very least it is a courtesy to them given that they live there. However, we also need to be mindful of cognitive deterioration and other accessibility issues. In a fast-paced situation such as this project, the only way to inform residents may be in person as schedule changes were happening each day.
Holistic Care Model
Episode 2 showed some training related to our holistic care model – “Partners in Care”. The training focused on how mealtimes are a great opportunity to place the resident at the centre of care, rather than routinely providing care as a way to complete tasks.
The essence of a holistic care model is that the person receiving care is central. Consequently, the focus is on care or service delivery in a manner that they as an individual prefer and desire, as opposed to providing all care recipients with a similar service. This doesn’t mean that there is any change in the standard or quality provided, but the focus is to the individual.
Meath Care adopted and trialled this care model in October 2022 following the development of a workforce strategy. The timing coincided with implementation of care minutes requirements in aged care, and crucially, the funding to achieve those requirements. Rather than just scale up the care and services in the way we have delivered these previously, we recognised that the additional staffing would allow for more meaningful episodes of care promoting the resident at the centre of those episodes.
While we had partly implemented the care model in some areas of the organisation in the months before the project, this was superficial when compared to what we were able to achieve during the project through the incredible training and support from Elizabeth and Julie.
All Images Copyright Artemis Media Pty Ltd 2024