Should residential aged care have mandatory nutrition standards?

As we face a burgeoning aging population, food quality in aged care has entered the limelight. After all, nutrition is pivotal for good health and healthy aging. Food also enhances quality of life through the joy of eating and the social interaction that it fosters.

Yet more than half of Australian aged care residents suffer or are at risk for malnutrition.

Malnutrition carries a host of negative outcomes like increased risk of falls, osteoporosis, arthritis, poor recovery from illness, delayed wound healing, depression and mortality. It lowers quality of life. And it is preventable.

It’s not just a matter of ensuring all nutritional needs are met, which include protein, energy and a variety of foods from each food group. Several other considerations factor in.

Improving older people’s nutrition status would need a multifactorial approach to address problems with swallowing, dentition, food packaging, eating support, appetite, food preferences, taste and environment.

Fundamentally, quality food needs higher priority in aged care budgets.

Even though people and organisations like Maggie Beer, Nutrition Australia, The Lantern Project and others are tackling this issue, systemic change may only come with mandatory guidelines.

Nutrition standards in aged care

Services provided at residential aged care facilities are regulated under the Aged Care Act, through the Aged Care Standards and Accreditation Agency. The standards include general nutrition information, but no mandatory guidelines for nutrition and menu planning. Hospitals have standards, so why doesn’t aged care?

To rectify this situation, mandatory nutrition standards would need to be created, implemented and enforced for all Australian aged care facilities.

Proposed recommendations

The new standards could contain the following recommendations:

  • Serve the minimum macronutrients (protein, fat, carbohydrates) at each daily meal.
  • Provide snacks twice daily.
  • Provide fluids at all meals; make fluids easily accessible throughout the day.
  • Specify portion size of all meals, snacks and fluids.
  • Provide texture modified meals and/or feeding equipment to people with dysphagia. (See information at IDDSI.)
  • Provide a variety of meal choices, including hot and cold options.
  • Cater to specific dietary requirements (e.g. allergies, vegetarian/vegan, different cultures and religions).
  • Rotate menu cycle (e.g. 7, 14 or 21 days, depending on the capability of the organisation), to avoid menu fatigue.
  • Monitor food intake, and regularly screen residents for malnutrition.
  • Provide menu planning suggestions and guides for implementing the standards to assist foodservice/dietetic staff to ensure compliance.

Rolling it out

The residential aged care landscape is fragmented. Cooperation among all stakeholders would be imperative for the successful creation, acceptance, adoption, rollout and continuation of new mandatory standards.

Stakeholders include the government’s Australian Aged Care Quality Agency, My Aged Care program, Residential Aged Care Facilities (RACFs), Leading Aged Services Australia, Dietitians Association of Australia, and Speech Pathology Australia.

Challenges would need to be ironed out. Thousands of aged care workers complain about cost cutting, understaffing and rationing in RACFs, resulting in “struggle to provide the most basic level of care and dignity for elderly people.”

Clearly, a cultural overhaul in aged care facilities would be essential for a new mandatory policy to succeed. This could be achieved through collaboration with stakeholders, priority budgeting, and a directive issued from above: the government body responsible for aged care quality.


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