Introduction

Decent Care management and team members ensure that all meals that are prepared for participants in line with the framework of the International Classification of Functioning, Disability and Health (World Health Organisation), that is incorporated into mealtime management practices. Decent Care recognise that people with disabilities frequently have associated disorders that interfere with nutrition in terms of intake, digestion or absorption of nutrients. They often require assistance from others for nutritional planning, and some are dependent on others for eating and drinking.

Scope

This policy applies to team members and any person representing Decent Care who are providing meals or supporting participants with meal preparation.

Principles

Decent Care is committed to ensuring they meet the NDIS Legislation Amendment Quality Indicators by ensuring that each participant requiring mealtime management receives meals that are nutritious, and of a texture that is appropriate to their individual needs, appropriately planned, and prepared in an environment and manner that meets their individual needs and preferences. Meals are delivered in a way that is appropriate to their individual needs and ensures meals are enjoyable. This is achieved through:

• • identifying each participant that requires mealtime management.
• • Ensuring each participant requiring mealtime management has their individual mealtime management needs assessed by appropriately qualified health practitioners, including by practitioners:
  • undertaking comprehensive assessments of their nutrition and swallowing; and
  • assessing their seating and positioning requirements for eating and drinking; and
  • providing mealtime management plans which outline their mealtime management needs, including for swallowing, eating and drinking; and
  • reviewing assessments and plans annually or in accordance with the professional advice of the participant’s practitioner, or more frequently if needs change or difficulty is observed.
• With their consent, each participant requiring mealtime management is involved in the assessment and development of their mealtime management plans. Each team member responsible for providing mealtime management to participants understands the mealtime management needs of those participants and the steps to take if safety incidents occur during meals, such as coughing or choking on food or fluids.

Procedure

Where it is identified that a participant may be experiencing difficulty or have specific nutritional requirements, Decent Care will seek a mealtime management plan. The assessment and planning will be conducted by an appropriately qualified practitioner and in partnership with the participant where consent is provided. Assessment and planning will include the following factors:

• Participant preferences including their likes and dislikes
• Specific nutritional requirements
• Positioning needs
• Food/fluid consistencies
• Equipment needs
• Communication needs
• Environmental needs
• Social connectedness opportunities
• Considerations when eating out
• Risks and management strategies

The Mealtime Management is included in participants files, which is easily accessible by all team members who administer the plan.

Team member Training in relation to individual participant mealtime plans:
Team members who provide mealtime management to participants are provided with information and understand the mealtime management needs of the individual participant. Team members will also understand the specific steps to take if safety incidents occur during meals, such as coughing or choking on food or fluids. This information will also be documented in the mealtime risk management plan. Where a participant has a mealtime plan, information regarding the requirements will be accessible to all team members who are administering the plan for easy reference at all times.

Preparation of texture modified foods:
Team members who are required to provide texture modified foods will ensure the appropriate equipment, including a temperature probe are available to them when undertaking this role. Texture modified meals are provided for participants that have difficulty chewing and swallowing. Texture modified foods may be thickened, minced or pureed. Due to the extra handling involved with the preparation of texture modified foods, there is an increased potential for cross contamination and cases of foodborne illness have been attributed to hygiene failure during this process. The following steps must be adhered to:

Cleaning and sanitising equipment

The equipment used will include a procedure or set of work instructions that outline the dismantling, cleaning and sanitising of equipment. Equipment used to homogenise food usually requires complete disassembly to fully clean. Contamination of blenders and mixers has been identified as a potential problem because they are difficult to clean.

Procedure for preparing texture modified foods

• All team members must wash hands thoroughly with soap and warm water and dry thoroughly – clean gloves may be used as an additional barrier.
• Texture modified foods should be prepared according to the directions for use of the thickening agent or recipe. In some cases a blender might be required to achieve an adequate mix.
• Any equipment such as blenders and stab mixers should be dismantled to enable thorough and effective cleaning and sanitising. /li>

Where food is modified or puréed without cooking:
For food that is texture modified and not intended to be cooked (e.g. puréed fruit)

• Use equipment dedicated to uncooked ready-to-eat foods only
• Ensure all equipment is clean and sanitised prior to modifying/puréeing
• Ensure these foods are processed before other foods that need to be cooked
• Ensure the equipment is cleaned and sanitised in between uses.

Where food is modified or puréed before cooking
For food that is texture modified prior to being cooked:

• Minimise the amount of time between texture modification and cooking (e.g. less than 1 hour)
• Thoroughly cook food to temperatures of at least 70°C for 2 minutes (or use an equivalent process)
• Ensure texture modified food remains above 60°C before serving.

Where food is modified or puréed after cooking:
For food that is intended to be texture modified after cooking:

• Thoroughly cook food to temperatures of at least 70°C for 2 minutes (or use an equivalent process).
• To limit the risk of contaminating foods that are thickened, puréed or cut up after cooking: – process food in an area away from raw meats and other non ready-to-eat foods on equipment dedicated to ready-to-eat foods only,
• Texture modify or purée food immediately after cooking
• Ensure food is cooled in compliance with Food Standards Code requirements (the ‘2- hour/4-hour cooling rule’) such that the food is cooled: – within two hours—from 60°C to 21°C – within a further four hours— from 21°C to 5°C – then modified once cooled.
• Ensure all equipment has been dismantled, cleaned and sanitised before use.
• Minimise the amount of time it takes to texture modify the food before chilling (e.g. place in cool room as soon as possible).
• Minimise the amount of time texture modified food is stored between cooking and reheating: – Refrigeration should be limited to 48 hours at 5°C or below – Frozen food should be used within 48 hours of being thawed
• Foods should be reheated to 70°C for 2 minutes (or equivalent) prior to serving.
• Serve reheated food above 60°C Texture modifying left-over food Left-over food from the plating line may be texture modified providing it is refrigerated during plating or processed within 2 hours of food temperature entering the danger zone. Reheating should allow for potential Listeria monocytogenes contamination (70C for 2 minutes).

On provision of meals:
When a team member is providing meals, the following procedures must be followed:

• Review the prepared food against the plan on each occasion
• Check with the participant that they are satisfied with the mealtime experience
• Document any expressed dislikes or issues that arise during mealtimes
• Ensure food is stored safely and identified as the specific participants requirement

When supporting a person to eat their food
If physically supporting a participant to eat, team members must be aware of the individual participants health risks (such as swallowing difficulties, diabetes, anaphylaxis, food allergies, obesity or being underweight) and manage those risks accordingly

• Always follow the person’s mealtime support plan including the risk management plan.
• Check that the person is alert and as upright as possible
• Make sure that small amounts of food are being offered
• Wait for food to clear from the person’s mouth before offering more

Complications during mealtime:
If the team member who is providing the food observes:

• Difficulty swallowing
• Choking or gagging
• Bringing food back up
• Wet ‘gurgly’ sound voice or breathing

Team members must:

• Follow management strategies outlined in the Mealtime Plan
• If necessary, contact the Ambulance
• Advise their Program Manager
• Wait with the participant until the participant has been assessed
• Document the event in the participant progress notes
• Seek a Practitioner Mealtime Management Plan review if the complication has not been previously identified.

Training and skills

Decent Care will support their team members and others involved in providing mealtime supports to:

• Read, interpret and implement mealtime management plans
• Follow food preparation procedures
• Deliver food and monitor eating to identify and respond to risks
• Arranging/supporting postural requirements.

Decent Care will ensure team members who are providing meals are trained in the following:

• Signs and symptoms of swallowing and feeding difficulties
• Risks associated with eating and swallowing
• Risks associated with not following the mealtime plan
• Food preparation requirements and methods for common conditions e.g. people with dysphagia
• Awareness of procedures and methods for including medication in food where this is required by the plan including an understanding of crushable/non-crushable medication
• Common terminology related to mealtime preparation and modified meals

Food Management Risks: (seek medical attention immediately)

Condition	Impact and Sign
Dysphagia occurs when a person experiences difficulty from swallowing	death from choking aspiration and its complications (see below) compromised nutrition (malnutrition and dehydration) changes to usual patterns of oral intake social isolation negative psychosocial effects, e.g., anxiety related to coughing and choking, depression
Aspiration	death from choking aspiration and its complications compromised nutrition (malnutrition and dehydration) changes to usual patterns of oral intake social isolation negative psychosocial effects, e.g., anxiety related to coughing and choking, depression
Undernutrition	occurs when the body does not get enough energy or nutrients for good health or is unable to utilise energy or nutrients because of digestive problems or illness. Undernutrition (malnutrition) may result in starvation
Medications are a risk factor for poor nutritional status.	They may influence food intake, as well as the digestion, absorption, and metabolism of nutrients.
Medications are a risk factor for poor nutritional status.	They may influence food intake, as well as the digestion, absorption, and metabolism of nutrients.
Overnutrition and obesity.	Overnutrition may result in overweight and obesity, as well as other disorders related to specific nutrients, such as cardiovascular disease (linked to high dietary fats) and type 2 diabetes (linked to excess refined carbohydrates).
Neurological impairments that affect eating and drinking will have an adverse impact on nutrition.	Neurological impairments may affect: muscle tone and movement – posture, hand grip, intentional movement, drooling oral-facial hypersensitivity chewing and swallowing problems – dysphagia and aspiration
Reflux and gastro oesophageal reflux disease (GORD) are common and have a significant impact on nutrition.	Oral and peptic ulcers are often associated. Pain and discomfort may cause loss of appetite or sometimes wanting to eat all the time
Physiological digestive disorders include:	irritable bowel syndrome (IBS) inflammatory bowel disease (IBD) – includes Crohn’s and ulcerative colitis. Weight loss and malnutrition can be dramatic
Communication problems and dependence on others lead to problems with the communication of hunger and thirst, as well as information about food preferences.	People with disability are dependent on others to a greater or lesser extent. Nutritional support may vary from guidance and assistance with healthy food choices and preparation to total dependence on others who need to ensure adequate nutrition and hydration.

Responsibilities

The Managing Directors are responsible for:

• Reviewing this policy on an annual basis to ensure that the policy is operating effectively
• Monitoring compliance with this policy.
• Reviewing incidents related to mealtime practice

Program Managers are responsible for:

• Ensuring team members source a professional medical assessment for participants that experience any challenges in managing food consumption
• Reviewing Mealtime Plans to ensure they are accurate, current and completed correctly
• Ensuring team members are trained in mealtime management planning
• Monitoring actions being undertaken to manage mealtime challenges
• Developing meal plans in partnership with participants

Team members are responsible for:

• Undertaking training and familiarising themselves in relation to mealtime management
• Recording any discrepancies between the mealtime plans and actual activity