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Read a plate like a book

The secrets of monitoring food intake in aged care.

One of the most important aspects of aged care meal services is to ensure that residents are eating sufficient food and drinking enough fluids. This is important so they do not lose weight or become dehydrated.

Monitoring food intake or reviewing what is left on plates and in cups is a useful way to measure how residents are coping with the meal service. This can be done by either weighing what is left on the plate or by observing the left over meals.

Plate waste is an interesting aspect to study when reviewing food services. It can indicate the following:

  • the popularity of the menu
  • resident’s intake
  • resident’s personal likes and dislikes (this is highly important for residents who are unable to communicate)
  • the meal delivery system
  • how the dining room affects the resident.

The menu

Menu planning in residential care homes is not easy and this area of healthcare should be given the resources and respect it deserves. Being able to cater for a group of residents whilst also meeting the needs of the individual is challenging. This must be done for every meal service, every day. The menu must provide meals residents like to eat, whilst also meeting clinical and nutritional needs. So, menu planning takes on a key role to ensure that plate waste is minimal and residents are enjoying the meals they are provided.

Menu planning can contribute to plate waste when:

  • the menu is predictable and highly repetitive and therefore residents refuse to eat what is provided
  • the menu does not have seasonal variation
  • standard recipes are not used, therefore the quality of meals produced fluctuates and leads to disappointing meal services
  • menu planning is not based on resident preferences or residents have not been involved in the planning process.

Residents’ intake

What is left on the plate is a quick and easy way to examine how much a resident is eating and drinking.

Plate waste can provide the following insight into nutritional care:

  • the resident is not receiving enough assistance to eat and drink
  • the food components left by a resident may indicate certain gaps in nutritional intake; for example, high fluid waste may indicate dehydration
  • small meal sizes where very little is eaten could suggest poor energy and nutrient intake
  • residents may look like they are coping with eating but are eating very little
  • texture-modified meals can be off-putting and require special care in preparation to ensure enough is eaten.

It is important to also understand that a clean plate with minimal waste may not be a good sign either. What is important is to make sure a resident is not losing weight for any clinical reason, and if they are losing weight and their plates are empty, then that could be a sign that not enough food is being provided. It is always important to monitor a resident’s intake and ask residents if they would like any more food or drink.

Residents’ personal likes and dislikes

Plate waste from the resident perspective comes from the following:

  • the resident did not enjoy the meal and therefore did not want to eat it, or was looking forward to the meal and the recipe changes and the quality of the product was not what the resident was expecting, and therefore disappointed
  • the resident did not get a choice and therefore felt disempowered with the meal service
  • the meal presentation was poor or food was unrecognisable, such as with texture-modified meals
  • the meal temperature was unsatisfactory and therefore the pleasure of eating a hot meal hot was ruined, or the dessert was warm when it was supposed to be cold. The beginning of a meal is crucial for a resident to enjoy what they are eating and meal temperature plays a critical role.

Meal delivery system

This is an interesting aspect when addressing issues surrounding plate waste. How a meal is delivered to a resident is crucial:

  • presentation is crucial for eye appeal and for making the meal appetising
  • the meal’s temperature is essential in order to provide the sensory properties to ensure that the food is enjoyed
  • the type of system used – tray services tend to have higher plate waste then those of bulk services. This is due to the inability to adjust portion sizes.

Dining room set up

The dining room is an important place for the meal service and the set up requires some consideration. Aged-care homes are unique in the aspect of social dining. The social area of the dining room forms one of the key home spaces and facilities attempt to ensure that all residents feel comfortable and their needs are met.

Plate waste can be affected by the dining room space in the following ways:

  • crowded dining rooms make the space uninviting
  • dining room appearance, in terms of furnishing, lighting, table settings and room temperature, is important for making a comfortable space that is inviting and pleasant to eat in.
  • the smell of food is essential in any dining room. And therefore how the meal delivery system operates to support this important function requires planning. The best dining room design is when the space is off the kitchen or kitchenette. However, the meal delivery system that heats up food in the service area can also help in creating a homely dining room.

Aged-care homes are the guardians of every resident and need to ensure that enough food and fluids are consumed daily. It’s an important task that is bestowed upon all staff as part of working in the residents’ home. The goal is to get residents enjoying the food they eat and drink. When staff members notice plate waste, some of the points above could be reasons for this and are worth exploring.

Karen Abbey is an Accredited Practising Dietitian working in aged care and food service with Nutrition and Catering Consultancy.

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