Last week's topic covered seeking feedback from your clients. This week, I thought it would be good to look at an area that appears to make the biggest difference to client health and well-being in a remote context – meals and the choice we could be offering to clients. Many older clients find it difficult to maintain an adequate, nutritious intake. There may be many reasons for this, but accessing Meals on Wheels can assist a client to regain health and ward off illness. Eating is a basic need that allows us to survive, however, I’m sure I can speak for most people when I say that we would prefer to exercise choice when deciding on our meals and enjoy our food rather than simply surviving off it.
As we move to a CDC model of care, we need to look at ways of providing choice for clients; choice around what they want to eat and what service supports they are seeking.
Clients will soon have the option to decide what they want to eat. In some residential settings, clients already have choice. The residential service might provide a daily menu that clients can choose from or they may offer the option of wine or beer with the meal. I have also seen cafes popping up at some of the residential centres – families can choose to join the resident for a coffee or a meal at the centre, a great idea for those people who can no longer get out and about easily. Residents can enjoy a tea or coffee in a modern cafe setting and feel a part of the wider world, great for social and emotional well-being.
For the more remote centres, clients will not have as many options available to them for accessing different foods. If ensuring an adequate daily food supply is the most important goal for the client and there are problems with food security, remote aged care services may need to get a little creative.
Menu Options: Clients will appreciate that their likes and dislikes are being taken into consideration. I have heard feedback from clients about services delivering ‘too much sloppy food' or ‘not enough meat'. Using surveys, you can discover whether people prefer beef, fish or chicken. Do they prefer chunky or finely chopped vegetables? Is there too much spice in the current meals? What are their favourite meals? What about favourite desserts or special treats? What do they prefer to have for breakfast; cereal or hot scrambled eggs?
Finding out general client preferences and developing a rotating menu plan will assist to provide a balanced diet that is hopefully comprised of tasty meals that meet their dietary requirements and satisfy your clients.
Personalising menus: this is obviously going to be difficult in a remote setting, however there are ways this can be done. For example:
- If a client doesn't like tomato based meals, provide an alternative meal that has been frozen and reheated on the day.
- If a client requires a special diet, consult with the dietician about their specific needs.
- If you need to prepare food to meet a special diet, think about ways to make it easy on the cooking / preparation on a daily basis. For example, to accommodate a renal diet, soak a pot of potatoes overnight and cook separately and mash. Freeze into portion size servings for adding to their meal.
- If a client needs extra energy, but your meals are all based around a low energy, diabetic diet, add extra cream or butter to their meal and provide a high energy drink.
Menu options are just one aspect of Consumer Directed Care and choice. What about the timing of meals and service around this? What if clients want additional meals? How can you assist and provide a high quality service?
Breakfast: Dry breakfast ingredients can be delivered along with lunch as a meal pack, but what if the client wants a cooked breakfast? Many older aboriginal people on community may not have eaten since the previous day's lunch meal. They are hungry and cornflakes just don't cut it. Services may be able to provide a cooked breakfast two to three days a week, perhaps on other days they could drop off a boiled egg and a pack of toast as they run around to remind clients to take medication or pick up laundry.
Lunch: As this is the most important meal of the day for a lot of clients, make sure it is substantial and tasty. It is no use making a meal that is nutritious but most clients don't like. Your own personal preferences have to go out the window here. You might like fish, but if your clients throw it to their dogs, what is the use of cooking it?
Supper: Many older clients on a community have diabetes. A small evening meal can assist to even out blood sugar levels. Some remote services drop off a light salad or a ham and cheese sandwich to clients just before they knock off for the day, usually at the same time as dropping off washed blankets or clothes.
For some organisations, providing this level of service may be difficult due to staffing levels or distance from clients. We also need to acknowledge that people choose to live at home on their land and so there is an assumed level of competence in being able to do that and a desire for independence. It's worth thinking about what sort of choice you can provide in your setting. Perhaps you can work in with the local store, if there is one. They may be able to provide one meal each day. Perhaps you have someone who runs an after hours take-away on community; can they provide a cooked meal? Of course, don't overlook family members who are also happy to provide support to ensure the person receives meals. These options may not provide the healthiest of meals for the client, but that falls back to choice and availability.
Don't forget you can create surveys using Apps on your iPad or phone. I've been playing with the Pro version of Survey Master this week, creating some customised surveys. It's very easy and more interactive for clients and think of all that paper saved!