‘two dead frankfurts and a blob of sauce’: the serendipity of receiving nutrition and hydration...

ARTICLE IN PRESS+ModelCOLEGN-192; No. of Pages 7

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‘Two dead frankfurts and a blob of sauce’: Theserendipity of receiving nutrition and hydration inAustralian residential aged care

Maree Anne Bernoth, PhD, MEd(AdultEd&Training)(HonsClass1), RN ∗,Elaine Dietsch, PhD, RN, RM, Carmel Davies, RN, RM, BA, MTH

Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, Locked Bag 588, Wagga Wagga, NSW 2678, Australia

Received 17 April 2012; received in revised form 1 February 2013; accepted 11 February 2013

KEYWORDSNutrition;Hydration;Frail aged;Elderly care;Residential aged care

SummaryBackground: This paper explores the serendipity of residents accessing adequate food and fluidsin aged care facilities. It draws on the findings of two discrete but interrelated research projectsconducted in 2009 and 2011 relating to the experience of living in, or having a friend or familymember living in, residential aged care.Methods: Participants were recruited through media outlets. Indepth interviews with partici-pants were audiotaped, transcribed verbatim and thematically analysed.Findings: This paper discusses a theme that was iterated by participants in both projects that is,the difficulty residents in aged care facilities experienced in receiving adequate and acceptablefood and fluids. Unacceptable dining room experiences, poor quality food and excessive foodhygiene regulations contributed to iatrogenic malnutrition and dehydration. Implications forstaffing, clinical supervision, education of carers and the impact of negative attitudes to older
people are discussed.Conclusion: The inability of dependent residents in aged care facilities to receive adequatenourishment and hydration impacts on their health and their rights as a resident, and is anongoing issue in Australian residential aged care.
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Introduction

Please cite this article in press as: Bernoth, M. A., eThe serendipity of receiving nutrition and hydration inhttp://dx.doi.org/10.1016/j.colegn.2013.02.001

A theme related to nutrition and accessing adequate foodand fluids emerged from the thematic data analyses of

∗ Corresponding author. Tel.: +61 269332492; fax: +61 269332866.E-mail address: [email protected] (M.A. Bernoth).

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1322-7696/$ — see front matter © 2013 Australian College of Nursing Ltd. Published by Elsevier

http://dx.doi.org/10.1016/j.colegn.2013.02.001

rsing Ltd. Published by Elsevier Ltd.

wo research projects (Bernoth, 2009; Bernoth, Dietsch, &avies, 2012) which explored access issues in relation toged care services. In response to this finding, a litera-ure search was conducted using EBSCOhost (Health) andINAHL databases with the keywords aged care, nutrition,

t al. ‘Two dead frankfurts and a blob of sauce’: Australian residential aged care. Collegian (2013),

ealtimes, malnutrition, dehydration and starvation. Itemsublished in the preceding decade were accessed.

Background literature revealed that the companionshipf meal sharing enhances the nutritional status of older

Ltd.

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eople (Vesnaver & Keller, 2011). Furthermore, at a timehen our current older Australian-born population wasoung, their diet was based on bread, dripping (fat left in

cooking utensil from frying meat), lamb and tea, withorridge for breakfast with the oats soaked overnight. Anyrying was done with dripping from the dripping tin (addingxponentially to the fat consumed); there were slabs ofread and treacle or bread and dripping. The Sunday lunchas generally roast lamb followed by cold leftovers for mostf the week. When visitors arrived it was scones with creamnd homemade jam (Symons, 2007). During World War II, toeduce the impact of rationing, food was often grown in theackyard, eggs gathered from the fowl-yard and any excessas shared with neighbours, according to the Australianomen’s Weekly of the time (8 April, 1944 as cited in

ymons, 2007). Meals were prepared by women who stayedt home. The kitchen was the focal point of activity andhe smell of food being prepared and cooked pervaded theome, stimulating appetites. Meals were eaten together, at

set time, around the table (Symons, 2007).The outbreak of war in 1939 found Australia’s food indus-

ry ‘woefully unprepared’ (Farrer, 2001, p. 246) with theutcome being that, during and for some time after the war,ustralians experienced food rationing. They tolerated foodestrictions to contribute to the war effort. However, thend of World War II brought with it new food experiencesnd diversity in the people populating Australia. This meantiversity in the type of food eaten and the means by which itas prepared (Symons, 2007). Increasing affluence and cul-

ural diversity allowed Australians to be more adventurousnd they took advantage of the new restaurants, broadeningheir culinary experiences. It was possible to eat away fromhe home in affordable restaurants. Coffee and wine con-umption increased, oil replaced dripping, garlic and herbsnd spices came into common use and terms like stir-frynd pasta became familiar. New migrant cuisines producedxciting dishes (Dyson, 2002). Those who lived this historyre now in their seventies, eighties and nineties with someequiring residential aged care (RAC) (Australian Institute ofealth and Welfare, 2007).

Food has meaning, memories and traditions and theseecome more significant to those in residential aged care.ealtimes are one aspect of the day that residents shoulde able to anticipate. Chisholm, Jensen, and Field (2011)iscuss the link between a pleasant milieu and optimal nutri-ion. It is important that residents, including those fromulturally and linguistically diverse backgrounds, find com-ort and familiarity in their traditional food culture (Miller,009). The question needs to be asked: to what extentre we respecting food preferences when older Australiansnter residential aged care? Food preferences are signifi-ant (Miller, 2009) but enabling residents to access adequateutrition and hydration to avoid malnutrition is of evenreater significance.

The impact of malnutrition on the older person can haveultiple consequences. Age related changes to muscle mass,obility and circulation render the older person vulnerable

o increased morbidity and mortality when they are mal-


ourished (Koch, Hunter, & Nair, 2009). Malnutrition is aisk factor for pressure ulcers and associated pain (Dawson,elan, Pace, & Barone, 2012). Banks, Bauer, Graves, and Ash2010) state that pressure ulcers in 33% of patients in acute

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ospitals in Queensland are caused by malnutrition, costinghe health system more than $12 million dollars per annum.nadequate nutrition results in prolonged healing and recov-ry times from acute illness and longer hospital stays (Kocht al., 2009) which then have a declining, spiral effect onunctional capacity and quality of life.

The World Health Organization (1999) and the Australianovernment (National Centre for Classification in Health,008) utilise definitions of malnutrition focused on bodyass index, unintentional loss of weight, subcutaneous fat

nd moderate muscle wasting. While there is no universallyccepted definition of malnutrition, Elia (2000) argues that:. . . [it is] a state in which a deficiency, excess or imbalancef energy, protein and other nutrients causes measurabledverse effects on tissue/body form (body shape, size andomposition), function or clinical outcome’. This definitionas been amended by a number of government instrumen-alities (National Institute for Health & Clinical Excellence,006, p. 20; NSW Health, 2011, p. 2) and is particularlyseful in the context of RAC services.

Gaskill et al. (2008) found that almost half (49.5%) of theesidents in their study of south east Queensland RAC facili-ies were malnourished. Malnutrition screening tools, whichan quickly identify the risk of malnutrition have been devel-ped for residents in Australian aged care settings (Isenring,auer, Banks, & Gaskill, 2009). Even though policies andutritional guidelines are written regarding nutrition, themplementation of these is problematic for many reasonsncluding the skill mix of staff, time constraints and inade-uate staffing (Merrell, Philpin, Warring, Hobby, & Gregory,012).

ethods

esearch design and ethics approval

he purpose of the first research project informing thisaper was to explore the perspectives of family and friendsho have someone they love in residential aged care

Bernoth, 2009). The second project investigated the impactn family, friends and communities when the older per-on had to leave rural and remote communities to accessged care services (Bernoth et al., 2012). In both projects,he participants spoke of difficulties their loved ones expe-ienced in accessing adequate food and fluids; receivingourishment and hydration became a matter of chanceather than a basic human right. The accidental naturef receiving adequate food and fluids in residential agedare was perceived as serendipitous. The word serendipityas connotations of luck, chance and accidental discoveryHannan, 2006) and best describes in this context access tocceptable and adequate nourishment and hydration in agedare facilities. This was the implicit theme revealed in thewo research projects informing this paper (Bernoth, 2009;ernoth et al., 2012).

Both projects were phenomenological in nature and werepproved by the Charles Sturt University (CSU) Institutionalthics Committee (2010/011 and 2010/034 respectively).


egal and ethical principles related to research with vul-erable populations were adhered to at all times, includingeferral of participants to statutory authorities such as theomplaints Investigation Scheme, when appropriate.


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The serendipity of receiving nutrition and hydration in Austr

Participants

Participants were recruited following CSU media releasesalerting the public to the opportunity to take part inthe projects. Potential participants contacted the firstauthor who explained the nature of the respective researchto them, ascertained their level of interest in beinginterviewed and ensured their informed consent prior tointerview. A total of 43 participants (20 from the first projectand 23 from the second) from New South Wales, Victoria andthe Australian Capital Territory were interviewed.

Data collection

Interviews for both research projects were indepth andunstructured and lasted between one and two hours. Par-ticipants were advised of the purpose of the interviews andinvited to share their experiences. Interviews took the formof conversations as the interviewers followed the partici-pants’ lead at all times. All three authors were involvedin the interview process. Interviews took place in the par-ticipants’ homes with the exception of two, which wereconducted in an alternate site chosen by the participants. Allinterviews were audio-recorded and transcribed verbatim.

Data analysis

Transcriptions from the two projects were thematically ana-lysed. Nagy, Mills, Waters, and Birks (2010) discuss variationsof thematic analysis (narrative, content and discourse) usedin phenomenology. One single approach to thematic analysiswas considered inadequate to reveal the depth of meaningin the stories shared by participants. Therefore, a tieredapproach to thematic analysis was adopted. Narrative the-matic analysis was used to appreciate how the stories weretold; this was as important as the content of those storiesand to reveal the implicit themes evident in the experi-ences the participants shared. Content analysis was used todescribe and interpret the experiences shared and finally,discourse analysis was used to enable a critical lens to beapplied to the themes derived through narrative and con-tent analysis. This integrated approach to thematic analysismeant that themes could be revealed, described and inter-preted in a way that honoured participants telling of theirexperiences while exposing some of the contestation ofpower that was evident in RAC experiences shared.

It was noticed that there were some common themes inboth projects. To enhance the rigour of the study, trans-cripts were forwarded to participants to check the accuracyof the data. Themes were identified by the first and sec-ond authors individually, and then cross-checked. Only thosethemes agreed to by consensus of the research team mem-bers were included.

Findings


Participants disclosed that multiple factors led to the likeli-hood of a person becoming malnourished and/or dehydratedin RAC facilities, thereby impacting negatively on the resi-dents’ rights (Aged Care Standards & Accreditation Agency

PRESS residential aged care 3

td (ACSAA), 2012). Findings from the studies informing thisaper indicate that these factors include staff issues thatmpact the dining room experience for residents as wells the quality and appropriateness of the food served. Theevel of attention given to food hygiene to reduce the riskf food-borne diseases restricts the variety of food avail-ble to residents while at the same time, other aspects ofood hygiene such as dirty crockery and resident cleanlinessre ignored. Whether or not a resident has access to foodnd fluid contributes to the serendipitous nature of actuallyeceiving and ingesting the food that is served. The theme toe discussed in this paper was identified as the serendipityf receiving food and fluids and has four sub-themes: (i) theining room experience, (ii) quality of the food, (iii) foodygiene, and (iv) the outcome of iatrogenic malnutrition.

he dining room experience

ven though there may be many residents present in theommunal dining room of a residential aged care facility, itan be a lonely place; sitting at the table with no-one toalk to, just waiting. Residents are encouraged to be seatedn their place in the dining room up to an hour prior to theeal being served. Families perceive that it is organised thisay so that the few staff available can take the residents

o the toilet and then prepare those who remain in bed forheir meals. It was observed by some participants that whenhe meal is served:

There isn’t anyone in there while they are eating theirtea so if anything happened, there’s no one around. (Par-ticipant 7)

. . .very rare that they [care staff] were seen in the diningroom because normally they disappear and you just can’tfind a nurse. (Participant 2)

In an understaffed dining room, it was easy for resi-ent safety to be neglected. One family reported that theirother’s wheelchair was positioned by a staff member at

he table but the brakes were not engaged:

. . .I got a phone call saying Mum had a fall out of herwheelchair, sitting at the tea table. One of the residentssaw it happen. She [the other resident] said your Motherjust pushed the wheelchair back, the brakes weren’t on.She [the other resident] was yelling out to the girls out-side, they were smoking. (Participant 3)

As a result of falling backwards out of her wheelchair,he resident sustained extensive bruising to her face andkin tears to her legs and arms. Subsequently, the resident’samily felt they had no choice but to be present for all mealso ensure their mother’s safety.

Staffing levels are such that there are insufficient num-ers available in the dining room, especially at the eveningeal when fewer staff are rostered. Inadequate staffing can

esult in neglect of resident care. As related by one familyember:


. . .they took him to the dining room [in a wheelchair]with a broken hip and he would try to wriggle himselfaround because there was no one there to help him.(Participant 1)


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Irrespective of the staffing levels and the independencef the residents, a safe dining room environment is only onespect of a positive food experience of frail older people inesidential aged care.

uality of the food

especting the culture and food traditions of residents andhe quality of food provided could enhance or detract fromhe nutritional status of the older, dependent person. Theuality of food served in residential aged care was a domi-ant feature in many interviews:

What do they get to eat? . . .soup, watered down soup fortea and a sandwich, but the soup is always cold. I go andfeed Mum and I have to heat up the soup. The lunch isalright, they get a hot lunch. (Participant 5)

. . .he’s a self-funded retiree who’s paid $400,000 bondto be there and they give him two dead frankfurts and ablob of sauce or two party pies for dinner! It’s pathetic.(Participant 11)

Other aspects of concern included the paucity of cultur-lly appropriate food, the absence of fruit to snack on, theuantity of food and the lack of variety in the food available.hen families need to provide or supplement their relative’s

ood there are financial and social implications. There is thexpense of purchasing food and then having to be present atealtimes to ensure their family member is able to access

ood they enjoy:

Like Dad, like, if they brought their food to him, he’dsort of look at it and ‘Oh bloody this again!’ and hewouldn’t eat it. We’d go down and buy takeaway. (Par-ticipant 8)

The food is shit, shit! One night a week they used toget two little half sausage rolls and a little container oftomato sauce and a small container of orange juice thatyou had to pull the lid off and that was dinner. . .butshe loved food. It was her only joy left in life, the tasteof food. She was still tasting food but there [aged carefacility] she tried to eat something but there was never,never anything. She didn’t complain. (Participant 10)

While residential aged care facilities are required to have dietician evaluate the nutritional content of the menus,here is no assessment of the quality or the quantity ofhe food served. This is one of the paradoxes of standardsonitoring in aged care (Bernoth, 2009).

ood hygiene

nother enigma relating to food is the veracity of atten-ion paid to the prevention of food-borne pathogens buthe cleanliness of kitchens and serving implements are notffered the same attention. Participants spoke of organisa-ional concerns about listeriosis, which led to the prohibitionf lettuce and preserved meats being served in RAC facili-


ies. This restriction leads to limited food choices, whichmpact cultural traditions and residents’ food preferences.t was reported that foods such as tomatoes and apples areashed in diluted bleach so that residents are not at risk.

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owever, family members told us that other aspects of foodygiene do not get the same level of attention. One partic-pant even provided photographs illustrating the unhygienicitchen, crockery, cutlery and ground-in, spilt food on herother’s clothing.The dignity of the older person in care is negated and

heir family members suffer the trauma of seeing their lovedne left dirty and neglected and eating off utensils thatould never be considered acceptable in their home envi-

onment:

And then I noticed that the plates were dirty, alwaysdirty. The tea cups had stains in them that were obviouslythere for a long time. And I watched them put outthe dinners; the dinners were being put out on platesthat were dirty with dried food from soup that theyhad. Sometimes they used the cups for soup and thensometimes they’d be for cups of tea. The morning andafternoon tea trolley would come around with dried soupon the cups. (Participant 9)

he outcome of iatrogenic malnutrition

he quality and variety of food available may be question-ble but there is another challenge for the older residentnd that is the serendipity of accessing the food once it iserved. Those with co-morbidities are at greatest risk of mal-utrition and dehydration and this is compounded if they doot have a family member who can either be at the facilityt every mealtime to assist them or act as their advocate.n example would be the resident who is visually impairednd/or experiencing difficulties with mobility and dexter-ty, which can have serious consequences. One participant,ho was at the facility assisting her mother, described the

ollowing incidents:

Betty was blind, she was sitting in the corner. . .I neversaw anyone go over to Betty. I was ready to go afterfeeding Mum; it was an hour after tea time. I asked anurse ‘Has Betty been fed yet?’. ‘Oh my God, I forgother’. Another night I asked about Betty, they brought atray, put it on the end of the table and said ‘I’m goingon me break’ and left the tray there. While I was there,she did not get her meal. (Participant 1)

Facilities comply with the requirement to provide wateror residents and bottles are placed on the bedside tables.owever, the bottles are often not within reach of the resi-ent and many do not have the manual dexterity to removehe bottle top to access the water:

They’d put water bottles on the table near their bedsbut the residents in bed couldn’t reach them and even ifthey could, they couldn’t get the tops off. . . One familywas going away for a week. . .so they came and asked meif I would take the lid off their relative’s water bottlefor them because they knew they couldn’t rely on the


Palliative care is a significant feature of residential agedare. The following incident describes a participant’s beliefhat her dying mother would not receive food or fluids unlesshe was physically present to assist her:


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Everybody’s so busy, they didn’t even feed her. Near theend she couldn’t feed herself anymore, she couldn’t see.She was being handed these tubs of fruit, you have topeel off the top piece of plastic; she couldn’t see it andshe didn’t have the dexterity in her fingers. (Participant10)

The fact that the woman was blind and required assis-tance would have been in her care plan. However, theparticipants indicated that the staff who give the actual caremay not have accessed or read the care plans.

Management was not always privy to the decisions madeby staff to withhold food and/or fluids from residents asthese participants reported:

The staff decided that they were too busy to do the after-noon and morning tea trolley [rounds] so they stopped,just stopped. Management wasn’t even aware until we[relatives] spoke up. (Participant 6)

They used to take Dad’s dinner tray to him and they’dleave it there for him to eat and walk off. They’d comeback and he hadn’t eaten so they’d take the tray away.(Participant 7)

The inevitable outcome of inadequate fluid and foodintake is dehydration and malnutrition. Physiological, agedrelated changes add exponentially to the vulnerability of thefrail, elderly resident to make them especially susceptibleto both dehydration and malnutrition.

One family was concerned about their father’s healthbecause of his unresolved pain and his weight loss. Theyrequested a doctor to review his condition but this did nothappen even after a number of requests. Subsequently, theyordered a maxi taxi, wheeled him into it and took him to ageneral hospital. Their father was dehydrated, had multiplepressure ulcers, a urinary tract infection and an undiagnosedfractured femur. He died a few days later in intensive care.For this family, it meant their father suffered the ultimateinsult, the final outcome of iatrogenic malnutrition:

‘How did this man get into this state?’ [queried theadmitting doctor]. . .Well, Dad ended up. . .part of hisdeath certificate says he died of malnutrition; well, thedoctor in intensive care. . .that’s what he wrote, malnu-trition. (Participant 1)

Discussion

In Australia, residential aged care standards are monitoredby the Aged Care Standards and Accreditation Agency Ltdwith both announced and unannounced visits to facilitiesevery one to three years (ACSAA, 2012). There are forty-four standards but those relevant to this paper includeStandard 2.10 ‘Nutrition and hydration’ and Standard 4.8‘Catering, cleaning and laundry’. These standards mandatethat residents must be nourished and hydrated within aclean environment (ACSAA, 2012). However, findings fromthis study infer that standards are not being met and thisadds to the serendipity of residents in aged care facilities


accessing adequate nutrition and hydration.Staff require adequate time to provide the care that resi-

dents need (Gaskill et al., 2008). The lonely, unsafe diningroom will continue to exist while there are too few staff to

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ssist the residents. Residents are most vulnerable duringhe evening meal as fewer staff are rostered on duty andnformal support such as activity staff, visitors, families andatering staff are less likely to be available. At that time,here is a larger number of residents in bed so care staff areorced to prioritise where their presence is most needed.or some staff, the task of prioritising may be too onerousnd, as participants identified, a few choose to escape for

cigarette rather than being with residents.Clinical expertise, supervision and support are required

y staff to enable them to provide appropriate care for theesident who is most in need (Kayser-Jones, 2002). Priori-isation of tasks can be complex for staff when older, fraileople who have co-morbidities are involved. Semi-skilledtaff are responsible for making these complex decisions,ften without adequate supervision (Bernoth, 2009; Deellis, 2006). Age related changes and pathophysiology canredispose the older person to dysphagia and aspirationneumonia (Miller, 2009) yet there is inadequate staffingo spend the time necessary with these residents to ensurehey are positioned correctly and adequate time is allowedor the person to effectively swallow.

Findings from this study indicate that the culture in res-dential aged care facilities mirrors the pervading culturend societal attitudes towards the dependent, older person.lder people are seen as being incapable of making theirwn choices and decisions, including those about food anduid intake, and this leads to others making decisions forhem. Nearly 40 years ago, Gresham (1976) described thisotion as infantalisation whereby the pervading culture ofhe RAC facility was one where the older person is deemedo be childlike and this impacts staff interactions with resi-ents. In residential aged care, infantalisation often worksynergistically with institutionalisation (Walsh & Waldmann,008). The outcome is that the residents’ food is served at

time convenient to the institution, the menu is chosen forhem and food they may like but which has a degree of risks eliminated.

Chisholm et al. (2011) emphasise the role of compul-ory education and express disappointment at the lack ofptake of education related to nutrition by residential agedare staff. Gaskill et al. (2008) also recommend increasedtaff awareness of the issue of malnutrition. However, whilegeist attitudes persist and the older person’s humanity isevalued, education related to nutrition and improving theuality of food is irrelevant as practices are unlikely tohange. Ullrich, McCutcheon, and Parker (2011) suggest thattaff skills in creating change and problem solving may beore effective than education about nutrition but this cane problematic and dangerous for the staff member who isulnerable when challenging the dominant culture (Bernoth,009).

The participants in this study perceived that too muchmphasis was placed on food-borne pathogens while inad-quate attention was placed on cleanliness of crockery,utlery, residents and the kitchen/dining room environment.his not only contravenes Standard 4.8 (ACSAA, 2012) butlso causes distress to the resident and family as they see


heir dignity negated.Residents entering a RAC facility are required to be

ssessed for nutritional needs. This assessment is part ofhe facility’s claim for funds under the Aged Care Funding


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nstrument and their assessed needs are documented in theare plan for auditors (Department of Health and Ageing,010). However, as previously stated, the participants indi-ated that the staff who give the actual care may not haveccessed or read the care plans. This theory/praxis gap is notnique to Australian RAC as research in the UK also indicateshe disparity between clinical practice, policy directives andational standards (Merrell et al., 2012), thereby adding tohe serendipity of residents actually accessing the food anduids as documented in their care plans. Furthermore, cur-ent methods of food preparation and delivery, includingater bottle tops and food seals, add to the precariousnessf residents receiving adequate hydration and nourishment.

Unacceptable dining room experiences, poor quality ofood, inadequate or excessive food hygiene requirementsn RAC facilities can occur along a continuum with a poten-ial outcome being iatrogenic malnutrition and dehydration.vents along this continuum can occur in isolation or inombination. Environments that are founded on appropriatekill mix (De Bellis, 2006), focus on resident needs (Nay &arratt, 2009) and provide quality experiences around nutri-

ion and hydration are more likely to have positive outcomesor residents (Bernoth, 2011; Gaskill et al., 2008; Miller,009).

The Nutrition Care Policy Directive (NSW Health, 2011)dentifies the consequences of malnutrition and dehydra-ion and recognises the potential adverse outcomes for thendividual but falls short of mentioning death. For one par-icipant, the ultimate adverse outcome for her father waseath by malnutrition and this occurred, despite the family’sleas for him to receive medical assistance.

imitations

here are some limitations to this paper and the studieshich inform it. Only one participant chose to relay positivexperiences and it could be argued that only participantsho had negative experiences and who felt strongly enoughbout them would participate in being interviewed. Theature of the two studies informing this paper means thathe experiences described are based on the experiences ofhe family members and carers rather than the aged personshemselves.

onclusion

hemes revealed by the participants related to the experi-nce of the resident in the dining room, the quality of theood provided, the impact of both inadequate and excessiveood hygiene practices and finally iatrogenic malnutritionnd dehydration of the older person in RAC facilities. Nutri-ional neglect of residents in aged care facilities occurredlong a continuum. At the beginning of the continuum isisregard for the food cultures of these elderly residentshen they are admitted to residential aged care. Along

he continuum are deficits found in the quality of food andhe dining room experience. These impact resident safety


s well as nourishment and hydration. By implication, thiss a violation of residents’ human rights and the rightsf residents in aged care. Even when food and fluids arellocated to the resident, they are not always acceptable

I


nd accessible to them due to co-morbidities relating toision, manual dexterity and cognitive deficits. Such is theerendipity of receiving adequate nutrition and hydrations a resident of an Australian aged care facility.

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awson, B., Nelan, S., Pace, K., & Barone, L. (2012). Good eatingcan improve healing. Aged Care INsite, 69, 32. Retrieved from:.http://www.agedcareinsite.com.au/pages/section/article.php?s=Clinical&idArticle=23114

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‘two dead frankfurts and a blob of sauce’: the serendipity of receiving nutrition and hydration...

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