Issue 10, May 2013
“Talk with” Series
Rest and Residential Care Facilities
Welcome to the tenth edition of the Dietitians NZ e-Bulletin for aged care facilities. This e-bulletin is brought to you
by Dietitians NZ special interest group in Nutrition and Gerontology (SING). SING members are dietitians working with
older people in the community, aged care facilities and in the hospital system. We aim to provide you with up to date
information on nutritional issues relevant to the older person.
THE MENU AUDIT: AN OPPORTUNITY TO IMPROVE YOUR FOOD SERVICE
The residents were seated well before the meal, the hum of pleasant
conversation in the background, staff moving quietly around,
pouring drinks and sharing in the comradery. A mouth watering
aroma of savoury mince and mushroom pie and vegetables and
apple crumble wafted from the kitchen. Plates - with just the right
amounts of food, and catering for individual preferences - were
placed in front of each resident, one table at a time. A hush fell
on the room, punctuated by the clink of knife and fork and quiet
conversation from carers assisting folk with their meals. Yes, these
are signs of a tasty meal, anticipated and enjoyed by the residents.
But most importantly, they are signs of a well organised meal
service that is able to deliver quality meals that meet the needs of
their consumers.
Central to achieving a good meal service is the menu. This is
recognised in the NZS Health and Disability Services Standards
Guidance statements and input into the menu by a New Zealand
Registered Dietitian is given as an important way of ensuring
that consumers’ needs in nutrition and food preferences are met.
To assist Dietitians in evaluating the menus of long term care
facilities for older adults a menu audit tool was developed. This
not only checks the menu for compliance with the Health and
Disability Services Standards but also provides the facility with
a useful independent assessment of their menu and related
foodservice factors. The menu audit tool was developed by
Dietitians NZ Special Interest Group for Gerontology (SING) and
was first released in 2006. It is reviewed every two years, with the
latest revision now available for use by New Zealand Registered
Dietitian members of Dietitians NZ from May 2013.
No 3,NoAugust
10, May2011
2013
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The Dietitians NZ menu audit tool
has been revised this year.
The audit tool is used by New
Zealand Registered Dietitians to
check the menu meets expected
standards in nutrition and food
choices appropriate to the elderly
in residential care.
An audit at least every two years
and whenever there is significant
change in the menu, is expected.
The menu audit helps ensure
Health and Disability Services
Standards are met, but also gives
the care facility an opportunity to
make quality improvements that
can make a significant difference
to the quality of life of their
residents.
The information in this bulletin is of a general nature and
should not take the place of a dietetic consultation. If you
would like to find a dietitian in your area, visit Dietitians
New Zealand website – www.dietitians.org.nz, and follow
the links to ‘Find a Dietitian’.
Scope of Menu Audit
The menu audit tool is intended to assess the
potential of the menu to meet standards of nutrition
and dietary variety for the residents in an aged
care facility, but cannot be used to guarantee the
intakes of individual residents. The auditing of food
hygiene/safety is also beyond the scope of the menu
audit tool.
A menu audit requires the dietitian to collect a
copy of the menu and additional information.
The additional information helps corroborate the
nutritional adequacy of the menu and answer the
question - does the menu reflect what is actually
served? Policies and practices around nutrition and
food service are also reviewed.
It is strongly recommended that a dietitian visit
the facility to gather the necessary information, if
possible. Ideally, this visit should coincide with a
meal being served so that a plated meal is viewed,
tasted and its components weighed. This also
provides the facility with an opportunity to get ‘on
the spot’ feedback and support from the dietitian.
It is important to recognise that the menu audit has
limitations, and is assessing the potential for the
menu to meet the requisite standards of nutrition
and dietary variety.
Menu standards and principles underpinning the
menu audit
1.
The menu follows the recommendations of
the Ministry of Health Food and Nutrition Guidelines
for Healthy Older People 2013, and maximises
the opportunities for residents to consume the
recommended number of serves from each of the
four food groups. The National Health and Medical
Research Council (NHMRC) Nutrient reference values
for Australia and New Zealand are used for reference
to specific nutrients where applicable, e.g. calcium.
2.
The menu/meal service allows residents
who have higher nutrient needs or special dietary
needs due to their age, morbidities or treatments,
to have access to adequate amounts and types of
appropriate foods and fluids.
3.
The menu is planned around the preferred
food choices of the resident group. When food
choices that are appealing and enjoyed are offered,
residents are more likely to meet their nutritional
requirements.
4.
The menu is planned using best practice
principles for menu planning that also take into
account the psychosocial, religious and cultural
needs of the residents.
The Menu Audit Report
The menu audit has four sections:
• Section A: checks quantities of key food
items purchased and compares these against
recommended serving sizes or daily quantities.
• Section B: checks the ability of the menu to provide
the recommended number of serves of each food
group plus appropriate fat, sugar and salt intakes
for all residents, whether they eat a normal diet or
have special dietary needs. This section also includes
the opportunity to check the weight of the different
components of an average size serve of a main meal
against recognised quantities.
• Section C: checks dietary variety
• Section D: checks foodservice and nutrition policies
Check lists are used to determine whether
compliance has been achieved. Comments may be
made and recommended actions listed to achieve
compliance. A summary section provides a userfriendly reference of recommended actions across
the whole audit, with space for the facility to note
corrective actions taken.
Following the menu audit, some facilities have
welcomed the opportunity to engage the dietitian in
staff training, to focus on nutrition and food service.
Individual resident needs
To determine the nutritional adequacy of the dietary
intake for individuals, the regular monitoring of
residents weight and observation of food intake is
recommended.
Where a resident has special dietary requirements
or their nutritional intake is of concern, engaging
the services of a registered dietitian is strongly
recommended.
Dietitians NZ SING members are committed to
supporting long term aged care facilities to provide
the best possible nutrition and food service for their
residents. The Menu Audit Tool aims to provide
feedback on how well the facility is doing and
recommendations to achieve the best possible meal
service and nutritional care of residents.
Finding a New Zealand Registered Dietitian for your menu audit.
Go to http://dietitians.org.nz/find-a-dietitian/ to find a dietitian working in aged care in your region.
Alternatively, look up Dietitian in the yellow pages of your local phone book or www.yellow.co.nz
10, May2011
2013
No 3,No
August
A 5-POINT PLAN FOR DEVELOPING YOUR MENU
Develop a systematic method of menu planning to
ensure the best outcome:• Use a template for writing your menu. This will
ensure you remember to include everything.
• Plan each menu-item category for the whole
cycle, whatever its length.
• Check each day as a unit on its own, compare it
with the days preceding and following, and with the
same day the previous week – to avoid repetition of
menu items or main ingredients.
• Plan in as much detail as possible: include the
vegetables, sauces and other accompaniments to
main meals, and snacks if these are part of your
menu.
Peach Streusel Cake: see page 4 for recipe
• Check that you have met the standard nutrition
guidelines, especially when you are designing
a menu for people who depend solely on your
organisation to meet all their nutritional needs.
What is more familiar than the sights, sounds, aromas and actions associated with meals? These are the cues to which
people have learned to respond over a lifetime. Food is a major part of our sensory stimulation and can continue to bring
satisfaction and pleasure when other sensory pleasures reduce:
How I hate this food!
My name is Angela; I’m 86 and I grew up on the farm. I was called a tomboy and my jobs included collecting eggs, feeding
animals (chooks, pigs and my lamb Anny), and picking ripe fruit and vegetables from the orchard and vegetable garden.
When I arrived here, staff filled in a form with my daughter’s help. They have followed it ever since. Meals follow a routine
I could set my clock to. No freshly baked bread now, just that thin sliced stuff. I’m sure it’s good for you but it’s just not
the same. I will get luke-warm tea in a minute so I can drink it fast and they can get me into bed. My daughter said I liked
black tea when they filled in that form, but after two years of drinking it warm from a plastic mug I would love a hot black
coffee in a proper cup.
I sit here in a track suit and that box in the corner talks and smiles but I can’t really hear what they say. It looks like staff
are enjoying it as they chat and laugh with each other, but they don’t smile like that at me or see the longing in my eyes.
They seem so busy and it must be hard with so many of us to feed.
(from: http://www.health.vic.gov.au/dementia/changes/dining.htm )
FUTURE ISSUES
The next issue is due in August 2013.
Please email your requests for topics or questions about food and nutrition issues for older people to
admin@dietitians.org.nz.
If you wish to unsubscribe, please let us know at the same address, and put Unsubscribe SING Bulletin in the
subject line.
No 3,NoAugust
10, May2011
2013
RECIPE CORNER
These two recipes are traditional baked puddings, the sort of recipe that when being baked allows nice homely smells to waft from
your kitchen! They are based on fruit, and when served with custard or ice cream, make a good contribution to the nutritional profile
of the menu.
GINGER PEAR SPONGE
PEACH STREUSEL CAKE
No 3,No
August
10, May2011
2013