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Lack of clarity among aged care workers around the role of dietitians may be the root cause of their limited use in the sector, a new study says.
Practising dietitian Karly Bartrim says many people working within residential care don't fully understand what a dietitian does, influencing the number of referrals they receive from providers.
"Sometimes it takes six months before I get called to visit an aged care facility," says the lead researcher.
"We've just got a long way to go on using the full potential of dietitians in these settings.
"The role dietitians play in aged care is very limited at the moment."
After the Royal Commission's 2021 report unearthed alarming numbers of malnourished residents and poor-quality food, the watchdog advised more dietitians should be placed in aged care homes.
But Bartrim says the limited use of dietitians in aged care is linked to with a lack of mandated requirements for providers.
"Currently, Australia has no set requirements for a dietitian to attend a facility," she says.
"We might get called in if a resident has lost some weight or they have nutrition concerns.
"But the problem is that it's happening too late – it's either happening a month down the track, after they've gone to the hospital, or other issues have occurred."
Countries like Canada have mandated dietitian requirements of 30 minutes per resident every month so that residents will have regular reviews by dietitians.
While regulations might improve the uptake of dietitians in aged care, Bartrim's study also reveals dietitians themselves are hesitant to work in aged care.
"They recognise their contribution to the profession, but they did voice many challenges," she says.
"There was uncertainty around their role – they felt that all staff members in aged care facilities have a role to play in nutrition care, but not all parties acknowledge that.
"Dietitians also have some assumptions and biases about older adults and working with them, which I imagine comes down to ageing and our healthcare system."
Of over 1200 dietitians surveyed, only one-third perceived older people as capable of making wise dietary choices on their own.
But they also felt not everyone on staff supported the role of dietitians in providing nutritional advice.
Bartrim's study underlines that improving nutritional care for residents is a team effort.
"Some said that nutritionists are totally ineffective without nurses behind them," Bartrim says.
"But dietitians faced challenges, such as the timely provision of nutrition care or not feeling residents and staff respected them.
"Plus, if staff aren't trained, and they aren't able to feed a resident, then we can't get food into them."
When dietitians are called in, they often only have enough time to address a resident's symptoms but not to further enquire about their food practices.
The Maggie Beer Foundation Malnutrition research also found that screening is done in an ad-hoc way or sometimes not at all.
Bartrim agrees dietitians are not given the time and freedom to determine what led to the resident's nutrition-related health issues.
The government's Aged Care Amendment (implementing Reform) Bill 2022 that passed the lower house last week aims to enhance regulations around the sharing of data by providers to authorities.
"We've had more referrals with unplanned weight loss estimates because they're now mandating reporting standards about that," Bartrim says.
"But regarding the whole question about, 'how much protein are residents receiving?' – I'm not sure how facilities are answering that when they aren't regularly consulting dietitians."
Robert Hunt, chief of the peak body for dietetic and nutrition professionals, says that despite the major reform bills' passing, there's still much to do to save older people from malnutrition.
"The transparency bill under its current form is still allowing a situation where the fox is in charge of the henhouse," he says.
"It still relies on self-reporting by aged care providers."
Recent research estimates that 15 per cent of residents are malnourished, and between 25 and 50 per cent are at serious risk.
While Hunt welcomes the commitment of the Albanese government's five-point plan to improve food and nutrition, he says data coming out about what is being spent on food is unreliable.
"Receptionists or admin officers are doing templates being completed on the spend of food.
"If we're going to get this data done properly, we have to make it mandatory and give the homes support.
"Right now, there is no structured plan to support this vulnerable group to receive nutritious food. End of story."
Hunt recommends mandating malnutrition screening of providers and allocating a specific amount of minutes per resident to see a dietitian.
"The solution's quite straightforward – they need to engage the right health professionals in the homes working collaboratively.
"Because now, the number of malnourished residents in aged care is too high.
"Any malnourished resident is too high."
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I would like to see some research results on grain fed beef V grass fed beef
How many aged care facilities has Maggie Beer set foot in? Unless she has been to everyone maybe she should not be making sweeping statements and comments.
This article discusses the confusion the aged care sector has around the role of the dietician yet doesn’t provide an explanation as to what that role actually involves. Poor journalism.