“My stomach has really toughened up since working in aged care,” Nicole* told the ABC.
“I once saw a sign in the kitchen saying ‘essence of chicken’ in a big bucket … it is a disgrace. Ads showing ‘nutritionally balanced’ food are blatant lies.”
Describing a common dish known as “minced moist”, Nicole said: “It smells horrible and is truly disgusting.”
The ABC asked people involved with aged care to write about what is right and wrong about the system that looks after our most vulnerable community.
Four thousand people filled out the questionnaire and contacted the ABC. Many of them indicated they were worried about the food quantity and quality more than anything else.
We asked them to send in pictures.
In a suburban Melbourne facility, dinner was a chunk of store-bought garlic bread, a hotdog and tomato sauce.
A Perth home offers party pies – a classic staple for children’s birthday parties and, it seems, aged care facilities.
In Sydney, they’re serving a watery soup with a pale yellow creamy pasta.
$6 a day spent on food
In some homes, the meals are blobs – green, brown and white blobs smeared in gravy. It’s what’s known as a texture-modified meal, for people who have difficulty swallowing.According to a family member, one regional Queensland home hasn’t changed the dinner menu since September last year.
“My mother has dementia but still knows she is fed up with this meal and doesn’t like it,” a frustrated daughter told the ABC.
Dietician Dr Cherie Hugo led research on more than 800 aged care facilities in Australia and found on average, homes were only spending $6.08 a day on food per resident.
The dollar figure is far less than other adults in the community, who eat about $17 per day’s worth of food, and $2 less than is spent on Australian prisoners.
More worrying to Dr Hugo than the low spend was that the amount spent on food dropped by 31 cents per person per day in just one year, while facilities spent 50 cents a day more on nutrition supplements.
“We know that supplements don’t necessarily improve quality of life … they certainly provide calories and protein, but they’re not providing that social experience that food does,” she said.
“This is just a disgrace,” Health Services Union national secretary Gerard Hayes said of the low budgets for food.
Mr Hayes said Federal Government spending cuts to aged care had trickled down, particularly inside facilities run by not-for-profits.
“We have people that may not have a lot to look forward to in their life, when they could look forward to a warm meal during the evening,” he said.
It would be a small pleasure, but one that unfortunately in some areas is not achievable.”
Mr Hayes has been involved with aged care for more than three decades, first as an intensive care paramedic and now as a union leader.
He said the facilities had improved dramatically since the 1980s and 1990s but he was “fearful” about living in an aged care home himself.
“I don’t get fearful of too many things, but to lose that independence and then lose that ability to be able to enjoy some small issues within life is a concerning thing.”
Better quality food served to management
Elizabeth* works in aged care in Melbourne. She sent in the photo of the hot dog and garlic bread, taken in her former workplace.
At her last job, she said the standard of food declined in the years she worked there.
The manager pinned a selection of pictures of food to the noticeboard for family and friends of residents to see when they visited.
The food looks delicious: a stuffed lamb rack, profiteroles, tiramisu and salmon bruschetta.
“Admittedly [the residents] did get some of those things,” Elizabeth said.
However, most of the meals pictured were prepared for managers’ lunches, rather than for residents.
“The rack of lamb was served to the leadership team to impress the new regional manager,” she said.
“It was paraded through the residents’ dining room to the private dining room while the residents were given the meatloaf as per the other photo.”
The reality of the residents’ regular meals as described by the aged carer is much more difficult to swallow, with a budget Elizabeth estimated to be less than $10 each day per person.
“Vegetables not cooked properly, hard carrots and potatoes, tough meat because they didn’t have long slow cooking.
“Sadly, because of cutbacks it’s hard to retain good staff and the resident meals suffer, because no one really cares.”
The ‘minced moist’ and the blobs
The minced moist meal aged carer Nicole described as “disgusting” is one of the many compromises that are made when feeding people with health problems.
Nicole said she tries to spend proper time spoon feeding the residents in her care, but often she’s one of only two staff to 16 dementia patients at meal time and has to attend to others.
Not only does the food need to be easily digestible, the guidelines for presentation and consistency of the slop do not help, Dr Hugo explains.
“We’ve got a large proportion of residents who are requiring a pureed, or minced-type diet, and the presentation, the visual appeal of those diets is typically pretty poor,” she said.
“Typically you’ll see that same picture which shows what a pureed meal should look like, and a minced meal should look like and what a soft meal should look like and it’s just the blobs.”
Some aged care homes were moulding the food to make it more visually appetising, but the guideline poster would have to change, Dr Hugo said.
The party food
Another common complaint was about heat-and-serve foods, like party pies, sausage rolls and hot dogs, that were served as meals to residents.
Mr Hayes said this was often a result of catering staff cutbacks, with skilled staff only rostered in the kitchen for certain meal times.
Regular aged carers were then required by management to prepare meals, leading to simple foods served that could be easily heated up in the oven.
“We’re seeing 43 per cent of not-for-profit aged care facilities in New South Wales who are struggling to make ends meet, they’re struggling to make budgets, so looking at how they can minimise expenditure, particularly with staffing costs is something that is the forefront of many organisations,” he said.
“Not because they choose to, it’s because they have to.”
Nicole said she and the other staff tried to put a happy spin on the cheap, fast food she was forced to serve.
“The worst part is that you’d say to your residents ‘it’s like sausage rolls at the footy!'” she said.
Food is ‘the barometer’ for aged care quality
While not in the majority of pictures sent in, the ABC was also sent some pictures of appealing food.
“I visit mum every day around meal times and have found the quality and variety of food very acceptable,” said a Brisbane man.
“Roast corned silverside, chicken parmigiana, roast pork to name a few mains. All served with two or three vegetables and dessert.”
A marketing coordinator for a not-for-profit facility in regional Victoria said her facility moulded their pureed meals with care to make them more attractive.
“[The home] buys all its fresh produce from local butchers, greengrocers and bakeries,” she said.
Dr Hugo spoke to the ABC from a residency at an aged care facility in Sydney where she and her team were staying for two weeks to improve the food and lifestyle offerings at a provider who runs multiple homes.
She remained optimistic for change, and said she had seen improvements since starting The Lantern Project five years ago, which aims to make small changes to improve the quality of life for people in aged care homes.
“I know some people would rather die than move in to a nursing home, there are figures around that, but I think we’re going to shift that figure if we have more homes looking at that food and dining experience.”
Dr Hugo said she was continually emphasising the importance of quality food to aged care managers.
“One of the first things I’ll point out whenever I’m doing presentations is that food is used as a barometer of the quality of care of the whole organisation,” she said.
“So if we get the food right and your staff are trained and you’re really investing in really doing that food well, residents and family members will judge the entire organisation, including clinical care — everything — they’ll be much more forgiving and more receptive, and more positive about the home.”