Each day, we all make thousands of decisions that shape the way we live – one of those that commonly stumps us is deciding what to eat! Today, social media is flooded with memes, jokes and banter about the arguments and conundrums people go through when deciding where to eat for dinner, what takeaway to order in or what recipe to cook up… but have you ever stopped to think about menu planning on a large scale?
The hustle and bustle of family life, the time poor workaholics, the picky eaters and the single pringles who simply can’t be bothered cooking will often struggle with mealtimes and find menu planning a chore; ultimately dampening the fun of cooking and limiting the nutritional variety of our diets.
Hospitals, childcare centres (long stay), residential aged and disability care facilities, army bases, colleges, correctional facilities and even some schools are examples of institutions where food service runs 365-days of the year. Depending on the institution, residents and patrons can rely on these facilities to provide up to 100% of their daily food and nutrition requirements for tens to thousands of people at a time –now that’s some serious business! Food preparation is more than just cooking meat and 3 veg for dinner, it requires intricate and innovative planning to ensure food being offered is seasonal, shows variety, is culturally inclusive, adaptable for people with allergies/intolerances, food safe, texturally appropriate, pleasing to the eye, affordable, convenient and of course, nutritious. Tricky? Absolutely! Impossible? Not at all! Let’s take a look into menu planning and how Dietitians play a role in ensuring safe, delicious and nutritious food service for aged care and childcare centres.
Menus – the breakdown:
Why are menus important?
It is no secret that food and nutrition are associated with our overall quality of life. Food does not only offer nutrients to keep us healthy, but it is also nostalgic, encourages socialisation with others and can draw on cultural values and beliefs. Menu planning is an essential part of the food preparation process as it reflects on these concepts to create a meal service that suits the target audience. Menu planning provides an opportunity to plan meals which saves time in the kitchen, prevents food waste and promotes healthy eating.
Menus are designed to be aesthetically pleasing (having different colours, heights and shapes on the plate), diverse in ingredients (e.g. changing the protein source at each meal) and culture (e.g., offering Chinese at lunch and Mexican at dinner), offer variety to avoid taste fatigue (e.g. not having chocolate desserts on consecutive days), highlight seasonal produce to optimise nutritional value (e.g. citrus fruits in the winter months) and use appropriate cooking methods to suit the current climate (e.g. hot desserts, stews/bakes/casseroles for the winter, cold desserts and fresh, quick cook meals for the warmer months). Menus can also be planned around special occasions such as Melbourne Cup Day (having a long lunch), cultural celebrations (e.g., an Indian inspired feast to celebrate Diwali) and religious holidays (e.g., fish for Good Friday, roast turkey on Christmas etc.)
What is a menu review?
Menus in aged care and childcare are seasonal, (a 4-week cyclic menu that changes every 3 months) meaning a new menu is created at the start of each season. Summer menus for will commence on 1st December so now is the ideal time to start preparing the summer rotation to allow enough time for a menu review with an OSCAR Care Groups Accredited Practising Dietitian (APD).
APDs should conduct menu reviews for each seasonal menu. We can be called upon to provide recommendations and changes or improvements to existing menus or to create a new menu from scratch with different recipe ideas.
What does a menu review entail?
At current, the gold-standard for menu reviews is an onsite assessment which is highly recommended. The Menu and Mealtime Quality Assessment Tool has been developed by Dietitians Australia to provide care facilities with an expert assessment and recommendations, focusing on nutrition as well as the menu and mealtime experience which makes up the whole of food service. This assessment tool is based on the Aged Care Quality Standards to ensure food service is meeting compliance.
The APD will work in conjunction with chefs, healthcare staff, managers and residents/children of care facilities to obtain feedback from consumers on what they would like to see on the menu, identify trends in the food environment (e.g., there is a strong preference for Italian food or pudding based desserts) and ascertain the nutrition demand to and ensure menus and food ideas are appropriately meeting likes, dislikes and nutrient targets at each meal and across the day. In addition, we can provide recommendations and assistance in creating an appropriate and safe mealtime environment which encourages eating and positive relationships with food.
A desktop review is also offered as an alternative menu review assessment. Although not the gold-standard, this type of review is comprehensive and uses the same standards and guidelines to ensure compliance with menu planning guidelines is achieved. A desktop review is faster to complete and can be called upon when time constraints permit. As always, an onsite assessment is more thorough, looks at the food being served which is incredibly important and onsite menu reviews are the top recommendation.
Residential aged care menus
Food is one of the key influencers for residents when deciding on an aged care home. Choice of food is an important quality of life measure for residents as overall control of their food environment is lost upon entering a home. Residents in care are reliant on the food service system for 100% of their meals, including breakfast, lunch, dinner, mid meal snacks and fluids and therefore they need the opportunity to exercise choice and decision making to maintain independence.
The elderly have specific nutrient requirements that are essential to support their health and wellbeing. Compared to the younger adult population, older people need increased protein to maintain muscle mass, increased calcium for bone health, fibre to regulate bowel health and energy to support their poor appetites.
Menus in residential care are designed to meet Australian Dietary Guidelines and Nutrient Reference Values recommended for the population, are culturally diverse to appeal to the Australian demographic and use seasonal produce and food preparation methods to ensure variety. An important aspect of aged care menus is texture modification and Dietitians strive to maintain choice for residents who may require modified texture diets. OSCAR Care Group helps you in complying to the texture modified IDDSI levels on your menus as well.
Remember, mandatory Aged Care Menu & Mealtime Quality Assessments are coming.
Childcare menus (long-stay centres)
Early childhood educators and staff are pivotal in influencing a child's food and nutrition journey from an early age. Chefs/cooks and food service staff have the responsibility to plan, prepare and serve a menu in line with the guidelines and recommendations with support from APDs. Educators and care staff provide the resources children need to engage in mealtimes, learn about food and nutrition and encourage them to expand and develop their food repertoire. Long-stay day-care centres provide morning tea, lunch and afternoon tea which supplies children with half of their daily nutrition requirements. Some services will also offer breakfast and/or a late snack as required and therefore, their provision of food is greater.
Engaging a dietitian in menu planning – Dietitians, the Meal Planners that Care
Why should a dietitian conduct a menu review?
Nutrition is vital across all aspects of the human lifecycle; however, our need for nutrients at each stage can change (for example - infants and children require more iron whereas people >70 years of age require more calcium and protein). APDs are skilled in using evidenced-based clinical practice guidelines to meet these nutrient targets across a daily menu to ensure overall nutrition status is adequate.
As the elderly are more susceptible to illness and disease, the failure to provide adequate nutrition in aged care can lead to a rapid increase in morbidity and mortality such as delayed wound healing, increased risk of infection, unintentional weight loss and malnutrition, fatigue, poor immunity and can contribute to mortality. Not only is this negative for the resident, it also increases healthcare costs and pressures on staff. APDs use the Australian Dietary Guidelines and Dietitians Australia Menu and Mealtime Assessment Tool for Aged Care to create meal plans that are nutritionally adequate to ensure best health outcomes for residents.
Dietitian reviews for childcare menus are also vital. Little bodies rely on appropriate food and nutrition to support and promote adequate growth and development, as well as to foster healthy eating habits and positive relationships with food. APDs use recommendations from The Healthy Eating Advisory Service Menu Planning Guidelines to prepare menus for long-stay day-care centres which focus on providing adequate servings of the 5 core food groups for children aged 1-5 years, as well as food and drink recommendations for infants.
Tips for a smooth menu review
Plan ahead – menu reviews are a lengthy process so don’t leave it to the week before to get it done! A month before the start of the new seasonal menu is the perfect time to engage a Dietitian.
Communication - allow time to speak with the Dietitian when they start the review, chat through any recommendations and provide feedback to any possible changes.
Collaboration – involve everyone in the menu review process. Chefs/cooks, kitchen staff, carers, educators, managers and healthcare personnel all have an influence on the mealtime environment and should be consulted for feedback during the process. It is also vital to offer the residents or children the opportunity to enlist feedback about what they want to see on the menu, their likes/dislikes, preferences and goals and ask for feedback from them during the review process – after all, they are the ones who will be eating the food!
For more information on menu planning or to book in a menu review with an OSCAR Care Group APD by emailing dietitian@oscarcaregroup.com.au