Bring on the baby boomers

The Aged Care Quality Standards are being rejigged and, at first glance, they appear pretty sexy -  but are they really? To understand these changes first let me first talk about the existing Quality of Care Principles (2014) and the current accreditation standards.

The existing Quality of Care Principles (2014) can be divided into two parts, the stuff relevant to aged care homes and the stuff relevant to community care. We’re going to discuss the stuff relevant to aged care homes which are (1) Care and services for residential care services (the stuff that aged care homes should provide to their residents); (2) Accreditation Standards (the stuff that aged care homes need to do if they want to stay in business.

In this entire document, meals are mentioned six times and food is mentioned twice. Colour me underwhelmed.

Schedule 1.10 states:

• that recipients must be offered meals of adequate variety, quality and quantity served each day at times generally acceptable to both recipients and management and generally consisting of three meals and three snacks
• that cultural, religious or special dietary requirements should be respected
• food, including fruit of adequate variety, quality and quantity and non alcoholic beverages be provided.

These sound lovely, but they are quality standards and not necessarily accreditation standards. There are currently four standards that Residental Aged Care homes must meet in order to stay in business and only one of these mentions meals:

2.10 Nutrition and hydration states:

• that care recipients (people living in aged care homes) receive adequate nourishment and hydration, this includes assistance with special diets (for health, religious or cultural reasons) and assistance to eat meals if necessary.

There are also a bunch of food safety requirements that have to be taken into consideration. Older people are more vulnerable to food borne pathogens and so extra care must be taken when preparing their food…. (but that’s a post for another time).

So, there’s what you should do (Quality of Care Principles) and what you have to do (Accreditation Standards).

The new and shiny draft Aged Care Standards Guidance Material mentions meals 41 times and food 25 times. Clearly, there has been a much greater focus in this iteration of the Standards. But what do they actually say?

Meals have their own section now, and requirement 4.5 states that ‘Where meals are provided, they are varied and of adequate quality and quantity’. The standard goes on to acknowledge that if meals are tasty, residents are given choice and the overall dining experience is positive that consumers (residents) are more likely to eat. So far, so good.

There follows a list of supporting strategies; actionable things that homes can do to help achieve the standard. There’s also a bunch of reflective questions that aged care providers can ask themselves to self-evaluation whether or not they are doing a good job. This is where I flipped an eyebrow.

If aged care facilities were capable of self-reflecting we wouldn’t have a Facebook group dedicated to 'The unacceptable food served in aged care' where photographs like the one below are shared.

Last year I was asked to give study tips to third-year dietetics students; I started with “Those of you with good study tips probably won’t learn anything new and those of you who need good study tips probably won’t listen to me anyway”. Self-reflection is a little like that. But I digress…

The supporting strategies are excellent. They include things like ensuring residents have access to food 24/7, engaging residents in meal preparation and cooking and consulting with dietitians. But these are just suggestions, not mandates.

The current generation of aged care residents is very polite and compliant, they don't like to complain. Despite paying 85% of their aged care pension for the 'privilege' of staying in an aged care home, many residents will suffer in silence. Indeed they have been dubbed the 'silent generation', discouraged against political activism and encouraged to conform with social norms.

I think aged care CEO's have a rude awakening coming. The baby boomers are coming! I think it's very exciting because it will mean an increase in the quality of care being demanded and therefore being offered.

God's Waiting Room

The world elderly is typically used to describe a person aged 65 years or more. It’s not a great word because it conjures images of frailty and the need for constant care. More recently the terms ‘robust aging’ and 'active aging' have been coined because they better reflect the vitality (e.g. mental, physical and social health) of many older adults.

People aged 60-79 are now referred to as ‘young-old’ and choose to remain employed or otherwise continue their normal daily activities well beyond the ‘accepted’ age of retirement (1). Indeed, the age for eligibility for the Aged Pension in Australia was 65 years but increased to 65.5 years in 2017 and is intended to increase by six months every two years to 67 years (2). This suggests that our government believes that we should continue actively contributing to the workforce.

The term ‘old-old’ is now used to describe people aged 80+ as often the final years of life are accompanied by the illness, disability and frailty we typically associate with the term ‘elderly’. Personally, I prefer the term elder. It can refer to any older person, regardless of age, and it confers wisdom and experience. It also demands respect.

In Australia, there are over 2,700 aged care homes providing 185,482 beds. During the 2015-2016 financial year 234,931 elders lived in this setting. As the population of Australia ages and the age profile changes, this number is projected to rise.

The average length of stay is 2.8 years and for the vast majority (91%) of older adults living in an age care home, it will be the last home they reside in. I read one article recently that referred to aged care homes as ‘God’s waiting room’, a place where we store old people while they are waiting to die (3).

Paints a pretty grim picture, doesn’t it? Imagine being stuck in your doctor’s waiting room for the last few years of your life. Or worse, the waiting room of any government agency *shudder* such as Centrelink. I think our elders deserve better.

What if, rather than a dull, drab waiting room, our elders' days were filled with activities they wanted to participate in and served food they actually enjoyed eating? What if life in an aged care home was designed to make the last few years an enjoyable transition? A fantastic 'So long and thanks for all the fish' celebration of life (4).

Sadly, there are aspects about institutionalised care that I can’t change. Luckily, the one thing I can address (the food) is something that can have a huge impact on resident enjoyment and quality of life. Have I mentioned that food service dietitians are superheroes in disguise?  

(1) Ansah, John P. et al. “Projection of Young-Old and Old-Old with Functional Disability: Does Accounting for the Changing Educational Composition of the Elderly Population Make a Difference?” Ed. Giuseppe Sergi. PLoS ONE 10.5 (2015): e0126471. PMC. Web. 27 Apr. 2018.

(2) https://www.humanservices.gov.au/individuals/services/centrelink/age-pension

(3) https://theconversation.com/gods-waiting-room-life-needs-to-be-valued-in-nursing-homes-59980

(4) https://en.wikipedia.org/wiki/So_Long,_and_Thanks_for_All_the_Fish

Hey now, you're a rockstar! (The importance of industry engagement during your PhD)

Clinical dietetics is perceived to be the most glamorous area for dietitians to work in and no doubt it is fun. There is a sense of urgency and adrenaline that you only find in a hospital setting that can be invigorating.

Community dietetics involves dealing with groups of people to empower them to make important changes to their health and wellbeing. That's pretty cool and important.

Foodservice dietitians are the least visible and perceived as the least glamorous, a rare few want to spend their days dealing with food safety plans. In fact just recently, at an industry event, someone asked me why, after going to University for four years, would I go into *that* side of things.

But that's kind of my bag. I like problem-solving.

When people have nutritional problems it's complex and multifactorial. Often the solution is to address something out of their control and that just makes me feel powerless. Conversely, foodservice systems are like a puzzle wherein problems often have a practical, and actionable, solution.

Research dietitians land in among that hierarchy depending on their field of expertise. I'm researching foodservice so I'm right at the bottom. Most people find my project to be terribly dull. Even other researchers glaze over and appear disinterested (you mean you're not solving the obesity epidemic)? *sigh* No. No, I'm not.

Recently I had the pleasure of attending an industry event hosted by the Maggie Beer Foundation. I was shocked and amazed at the reaction I received from the twenty cooks and chefs that were present at her Masterclass. When I explained my project to them I saw their faces light up. To them, I was a rockstar.

One chef said with enthusiasm, "Finally, someone who gets it!".

Don't get me wrong, I'm thrilled to be researching in the field that I am but it was so nice to see first hand the impact that my research will have on the people that it is relevant too.

For the first time, I felt a little less like this...

and a little more like this...

This is why industry engagement is so important during your PhD process. It's very easy to get lost in the dry dusty world of data but, if you do, there is a danger of losing your perspective. Of losing sight of your own value. Of losing your enthusiasm and that, my friends is how you end up in the valley of sh*t.

There are people out there who think you are a rockstar. There are people who value your work, who will be impacted by your work, whose lives will be changed by your work.

The PhD wife

This morning I conducted last-minute luggage checks in preparation for my trip to Brisbane. My partner showed me how to use the locks on my new luggage. Generally, I think he was just trying to spend as much time with me as he could before I left.

I asked him what I should blog about this week. He jokingly said, “why don’t you write about the support networks that make a trip like this possible.” I laughed and said, “you want me to write about your experience as a Ph.D. wife?” Honestly, I think he has the rough end of the pineapple.

We had lunch together at the airport and shared a beer at the Cooper’s Ale House. I had been battling a sense of anxiety and dread all morning but I couldn’t pinpoint the underlying cause. I love to travel, especially flying. I love visiting new places, although I am a bit unsettled at the prospect of going alone. I enjoy having a security blanket, someone by my side to navigate the unknown with me.

Then I realised, it wasn’t just that I like *someone* with me, I like my partner with me. There is a unique sense of comfort, security and strength I get from him that I don’t get from other relationships.

We talked a little about the circle of security (1). For the unfamiliar, this theory connects our adult patterns of attachment with our experiences as an infant.

As adults, we all inevitably face new situations. The new and unexplored can be exciting for some and frightening for others. I fall into the latter category. Indeed simply attending work for eight hours a day falls into the exciting but exhausting category. Engaging with other people, polite conversation, the activities of everyday life; these can be exhausting.

Extroverts, I am envious of your ability to recharge through social connection (2).

When I come home at the end of each day I take a deep sigh of relief and begin to relax. I kick off my shoes, put on my bunny slippers, make a cup of tea and start to recharge my battery for the following day.

When I travel alone, I can’t return to my circle of security. I don’t have my family, my partner, my dog or my pillow. I don’t have any of those fundamental supports that recharge me. My partner is my portable battery.

Although he is the most visible support in my life, he isn’t the only one. My family is a little (lot) unorthodox and every member has unconditionally and unselfishly supported me over the past four years.

They didn’t blink an eyelid when I said I was signing up for another three years.

When I came home with a weeks’ notice that I would be travelling to Brisbane, they took it in their stride. They all, including my teenage son, take on the lion's share of household chores to lighten my load.

In a few short days I will be graduating. I found out last week that I will be awarded the University medal for academic excellence.

I receive a lot of praise as a PhD candidate. I’m told that what I am doing is remarkable.

These accolades, these acknowledgements for effort and excellence, they belong as much to my family as they do to me because I couldn't do it without them.

(1) https://www.circleofsecurityinternational.com/

(2) https://yourworkplace.ca/recharging-for-introverts-extroverts/