Maggie Beer’s Big Mission – Where We Are Now
July 2024 Update
While the series has only recently been broadcast, it has been 12 months from the start of the project and 6 months since the cameras left us. Therefore, we have now spent as much time without specialist advisors by our side as we did during the project. So where are we now?
Menu changes
When it came to the menu, the aim of the project was to implement more protein per serving, which was achieved through modification of existing recipes and incorporating a few new recipes. As we saw in the intermediate research results, this has had a positive outcome with the average protein per serving doubling and almost 2/3 of residents increasing their protein intake.
Since the end of the project, we have had to amend a few recipes which had achieved the higher protein by fortifying with dairy products such as cream, butter, and cheese. Unfortunately, since the end of the project we noted that there was a higher incidence of residents having digestive ailments which suggested that the diet was too high in fat, for example gall bladder or reflux issues.
However, equipped with his new skills learnt from the Maggie Beer Foundation chefs and the dietician, Sas has identified a few recipes that he feels can be fat reduced without losing protein levels; for example replacing cream in soups with coconut cream. Further to this, he has trialled his lower fat versions with small groups of residents for their feedback as part of the adjustment process.
OUTCOME AT JULY 2024: The enhanced menu remains in place, except for minor changes necessary for resident health. Sas has applied skills learnt in the project relating to nutritional analysis and resident focus groups to effectively and responsibly change a menu.
Buffet
While a buffet was not a new idea in aged care, nor at Meath Care, the buffet experience that was implemented in the project was much further reaching as it was available for all meals and went beyond just a meal choice for those who could utilise a buffet – it became a focus where residents are given the appropriate support of staff to access the buffet.
On Darch, all meals remain as a buffet style. On Perry, where there was a breakfast buffet in operation before the project, the food options have been increased for breakfast, although other meals are served from the kitchenette. Because the buffet depends on people undertaking their specific roles for this, there have been a few instances where things were noted to regress; for example, jams were provided in individual sachets rather than decanted into bowls for residents to serve themselves, or certain foods not set out.
This highlights the phenomenon of where changes are implemented, you need to keep monitoring to prevent old practices recurring.
OUTCOME AT JULY 2024: Buffet meals on Darch remain in place, although ongoing checks are needed to ensure that best practices are continuing.
Modified texture food equity
Before the project, our texture modified food did not always follow the menu. For example, some meals had texture modified foods were identical to what was being widely offered to residents who did not require modification, but there were other meals where the texture modified option was completely different.
A positive outcome of the project is that we can now always offer a meal to people who require a texture modified diet that is identical to what is offered to residents who do not require modification, except for the texture. This is what we refer to as food equity in aged care.
To achieve this food equity, 2 main interventions were needed: a menu review to ensure that food that can be texture modified is always a meal choice, and a review of kitchen processes to ensure that there is sufficient time for freshly cooked food to be modified for service at the next meal.
OUTCOME AT JULY 2024: At least one menu choice at mealtimes can be texture modified and made available to residents who require this.
Resident roles
The resident roles in the mealtime experience consisted of tasks such as ironing napkins, filling condiments, and setting tables. While the number of residents who took on these roles was lower than the number who initially expressed an interest in doing so (38% compared to 67% initially), this has consistently continued.
Since the conclusion of the project, the same residents have engaged in the same roles and this is generally now resident-initiated, so staff rarely need to remind them. This demonstrates that the roles have not only given residents a sense of purpose, but may have maintained a level of cognition, given that 92% were noted as having some form of cognitive deficit at the beginning.
The only shortfall we have currently is succession planning for these roles. Generally, a task is not completed by another resident where a resident is unable to perform their task, for example if they are in hospital. We have also had limited success in encouraging new residents to take on roles, so this is something we need to encourage in the future.
OUTCOME AT JULY 2024: The resident roles continue on Darch, although longer-term planning may be needed to encourage others to be involved.Â
Further research outcomes
The final research measures were conducted in April / May 2024. While these are being analysed and will be used for a final research paper by Associate Professor Jade Cartwright, there are some initial findings that show a degree of success:
- Resident weight: no discernible change overall.
- Depression: a reduction from 46% of residents showing signs of depression at the start of the project, to 22% of residents at the end (tool used was the short-form Psychogeriatric Depression Scale).
- Appetite: a reduction from 85% of residents being at risk of weight loss over the next 6 months at the start of the project, to 43% of residents at the end (tool used was the Comprehensive Nutrition Assessment Questionnaire).
- Mealtime satisfaction 1: 43% of residents were mostly or sometimes satisfied with the variety of meals at the start of the project; this increased to 100% at the end.
- Mealtime satisfaction 2: 29% of residents were mostly or sometimes offered food that they liked; this increased to 53% at the end.
In addition to these quantitative results, there were many positive qualitative outcomes noted about all aspects of mealtimes and care.
OUTCOME AT JULY 2024: While the research aspect is concluded, the final results have provided good insights into areas that need to continue to improve further.
What next?
Since the conclusion of the filming, we have implemented some of the aspects of the project into other residential care areas of within Meath Care. For example, the enhanced cooking techniques and new menu was implemented at the Michael Lee Centre in Como a few months ago. This was overseen by Sas as part of his role as Catering Services Manager, as well as all kitchen staff in the Michael Lee Centre receiving texture modification training and support from Natalie, the speech pathologist featured in the project.
Due to the success in maintaining food temperatures using plug-in hotboxes during the project, we have now acquired more of these for the other areas at the Dr Mary Surveyor Centre in Kingsley. We already used these at the Michael Lee Centre.
We have also implemented buffet breakfasts in other areas, although we have currently limited the use of buffets to breakfasts due to a few reasons. One is that we are yet to create second dining areas on the other floors of the Dr Mary Surveyor Centre or refurbish these. However, we are currently finalising the plans with Felice Burrows (architect) to allow for the additional space and refurbishments of all dining areas.
We do not believe that additional dining areas are required at the Michael Lee Centre due to the lower numbers of residents in each area, but the buffet meals cannot be expanded beyond breakfast here as only a few staff at the Centre have undertaken the care model training. We have engaged Elizabeth and Julie (care change consultants) to deliver this throughout the next year. This will also support the residents to take on meaningful and engaging roles.
One of the real successes of the project to build on is the provision of texture-modified food. With the correct training and kitchen role reviews, we were able to achieve food equity. This is yet to be fully implemented at the Michael Lee Centre, and our wider aim at both Centres is to be able to provide additional texture-modified choices. We may not be able to texture modify all items on the menu, but if we can provide equity on one main meal and nutritious alternatives to that meal, then we will have come a long way from before the project.
The table below shows our current situation as we roll out strategies from the project across all residential care areas at Meath Care.
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