Tài liệu Nutritional Care of the Housebound Elderly pptx

Members of the planning committee CNOA have been involved in writing and popularising NH and MRC’s Dietary Guidelines for Older Australians 1999 and researching and preparing the Best Pr

Nutritional Care of the Housebound Elderly

Notes from the Conference held at the

University of Sydney, 4 November 2005

The Conference was supported by the

Australian Nutrition Trust

and

Sydney University Nutrition Research Foundation

and

Gosford Hospital, Northern Sydney, Central Coast Area Health Service

If you have comments or would like to obtain further copies of this booklet, contact:-

Nutrition Department

Gosford Hospital

PO Box 361, GOSFORD NSW 2250, E-mail:rbartl@nsccahs.health.nsw.gov.au

Thanks to Rachel Moerman and

Marianne Alexander for help with this project

Committee on Nutrition for Older Australians

Sydney University Nutrition Research Foundation

This is the first conference on this topic to be held in Australia

Speakers include both experts and practical field workers (refer to the list on the next page for details)

Field workers and representatives of patients’ organisations are invited to attend

We expect to hear about the food and nutrition needs and problems of this growing section of the community; what different organisations of field workers are achieving, what challenges they see for the future and perhaps what research might help

This conference may help to remind the whole community of the importance of helping our housebound older people keep well fed and nourished

Members of the planning committee (CNOA) have been involved in writing and popularising NH and MRC’s Dietary Guidelines for Older Australians (1999) and researching and preparing the Best Practice Food and Nutrition Manual for Aged Care Facilities (2004) But Australia seems at present

to lack formal guidelines for nutrition of disabled and frail old people in their own homes

CNOA is part of the Nutrition Research Foundation of the University of Sydney The major funding for the Conference comes from the Australian Nutrition Trust (a small, entirely independent fund with no commercial or political affiliation or agenda)

Program

Registration and Morning Tea 8.30 - 9.30 am

9.30 am Chairman: Professor Stewart Truswell

Opening Remarks: Margaret Fulton Undernutrition in housebound elderly: Dr Peter Lipski

Importance of oral hygiene in older people: Dr Peter King

Dietitians work with older people: Sally James

The meaning of food: more than nutrients: Dr Susan Quine

Economic aspects: Dr Michael Fine

Consumer involvement in nutrition and health: Sheila Rimmer

Nutrition: is it on your training calendar? Janette Robinson

Nutrition screening: ACAT: Nicole Vos

Case study: an incident waiting to happen: Trish Devlin

MOW: More than just meals: Debra Tape

A practical approach to food issues: Carolyn Bunney

A consumers experience: Marlene Brell

Committee on Nutrition for Older Australians (CNOA)

Nutritional Care of the Housebound Elderly Conference

SPEAKERS

Stewart Truswell, AO, Emeritus Professor of Human Nutrition,

Chairman CNOA

Margaret Fulton, AM, Australia’s best known food writer

Dr Peter Lipski, MD FRACP, Staff Specialist in Geriatric Medicine,

Central Coast AHS

Dr Peter King, BDS, Staff Specialist, Special Care Dentistry, Hunter and New England AHS

Sally James, Dietician, Geriatric Ambulatory Care Service,

Newcastle, Hunter and Central Coast

Nicole Vos, Aged Care Community Dietician, Sydney South West AHS

Trisha Devlin, Program Coordinator, McKillop Community Care Central Coast

Debra Tape, General Manager, Meals on Wheels

Carolyn Bunney, Community Nutritionist/Home Economist,

Central Coast AHS

Marlene Brell, Consumer Advocate, Member CNOA

Rudi Bartl, Community Dietician, Central Coast AHS,

Honorary Secretary CNOA

The conference on NUTRITIONAL CARE FOR THE HOUSEBOUND ELDERLY at the University of Sydney on 4th November 2005 had a large enthusiastic audience and we said we intended to send them notes from the speakers after the conference We know

a number of other people were disappointed to miss our conference, either because they were at another geriatric conference in Sydney the same day or for other reasons

So Carolyn Bunney, Rudi Bartl and I have edited the notes that speakers gave us and/or their slides and/or notes we took, to produce this impression of the main points of what was said These are not definitive conference proceedings Speakers have not been asked to re-write these notes in a more formal way

We hope these notes will add to those our audience may have taken for themselves and give interested people who could not attend some idea of the experiences, advice and problems our speakers shared with us The conference was not tape-recorded and we have missed points that came up in Discussions

This was the first conference on this difficult subject in Australia and we haven’t seen any report of a comparable meeting elsewhere

The subject is difficult because there is no available estimate of numbers of people at risk or numerical analysis of the problems they have or how severe they are It is difficult too because the many thousands of housebound elderly are in private houses and flats, often alone and widely scattered across the streets and suburbs of Australia and there is

no register of who they are

We hope the meeting of 4 November 2005 will increase awareness of the community, of governments, NGOs and professionals so that Nutritional Care of the Housebound

Elderly will receive increasing attention, study, planning and work Our Committee on Nutrition for Older Australians will try and help this along We are sending copies of this set of notes to all who attended and hope to have it on a Website soon as well

Stewart Truswell, AO, MD, DSc, FRACP

NUTRITIONAL CARE OF HOUSEBOUND ELDERLY

preparation of food, soon to be a delicious meal to be shared My career choice seemed odd at this time and I was to be referred to as 'The Cook' with a sniff of dismissal by my contemporaries

From an early age I accepted that food was an important part of life It was the perfect way to start and finish a day, eating something good, with family and friends around a table

My first realisation that cooking was so important was in the early 1940's when I was asked to give cookery lessons for the blind Classes began, with me a sort of novice, but

I soon learned My excited students told me of the horrors of being blind at the time; being hidden, not allowed to touch anything, go anywhere, or do anything This was after baking a batch of scones, baking a cake, frying an egg We bonded over the food we had prepared together They were so proud of their new skills It may have been bedlam but we did it together The Royal Society for the Blind had addressed a serious problem, things had to change, and special cookery classes were on the way It was a brilliant approach and had a more far-reaching affect than anyone had imagined

Children respond enthusiastically to cooking and seeing what enjoyment there is in making a batch of pikelets, a jacket potato, a proper hamburger Understanding how to make salad, soup, wash, peel, grate a carrot or just eat one, raw or cooked It is great to

be able to look after yourself, and learn what helps you to feel better, stronger They are quick to realise what helps you be good at whatever outdoors activities call for - running, jumping, catching or throwing balls they soon learn good food makes you think better Throughout life food plays an important role in our well being, but what happens when things go wrong?

Today this group (CNOA) is interested in problems of the elderly and in being

housebound

Organisations, individuals, groups - church, charity, and ethnic are responding in

different ways

Examples:

 Kosher meals on wheels, available through the Jewish centre on ageing

 Hungarian catering based on Northside

 TLC catering - tender, loving cuisine offer meals that are National Heart Foundation approved, gluten-free, homemade dinners for diabetics and others

 Edith Models Pty Ltd offer a wide selection of dishes that could be used to compile an international cookbook

 Auntie Beryl's Kitchen - An elder of the Redfern community cooks and takes her caravan to the Hurstville area

 and of course Meals on Wheels

These are just a few examples of what is going on Hungarians like their rather stodgy but nonetheless delicious and comforting goulash, paprika, sour cream and cabbage dishes Jewish people have to have kosher foods, genuine, authentic I appreciate my porridge, it's the only way a Scot can start the day- with good organic oats And so it is with the rest of the world, we try other foods but we always return to what we call comfort foods Different countries, different customs, but based on good food, food that makes us what we are

While it is obvious that there are people and groups who are addressing the problems of those needing care, my concern is the increasing role of machines No matter how clever

or time and labour saving, they can't replace man Soups, cottage pies, vegetables etc, being whirred by those electric, clever magic wands - the trouble is everything becomes the same And this is only the beginning Clever technology and inventions invite the easy approach without giving the full human touch Steamers, chillers, freezers,

microwaves - there's every trick in the book Then there are powders, packets and so many things They are useful of course but we shouldn't let them take over, nor should

we allow anything but good foods to be used

I know what a difference mass production makes, so do the accountants For years we have seen the changes, in top institutions and hospitals Food is no longer always

cooked on the premises, much is farmed out It makes sense to all but the sick patient or person who has no say in the matter and often has to eat what no self-respecting

chimpanzee would choose

I am here to speak up for the home cook, the cook in the home, hospital, and factory kitchen What 'The Cook' does cannot be replaced with a machine, or powder no matter how clever the invention The cook who chops, stirs, notices, watches and cares is

irreplaceable

It is my aim that we should all remember the true importance of eating, the necessity of educating our cooks, accountants, nutritionists, indeed us all in treading the paths in which we should go, in what is the aim of this conference, the well-being and enjoyment

we can offer to the housebound elderly

UNDERNUTRITION IN HOUSEBOUND ELDERLY:

undernutrition At least 30% of independent community living elderly are

undernourished 80% of undernutrition goes unrecognised

The causes of undernutrition are multifactorial with common risk factors being

 gait and balance disorders,

 adverse drug reactions,

 chronic pain, depression,

Many older people eat food of low nutrient density Most critical nutrients include

Calcium, Iron, Zinc, Vitamin B12, B1, D, Folate

The complications of undernutrition include 30% increase in mortality within 1 year, recurrent infections, falls, pressure sores, adverse drug reactions, dehydration, early hospitalisation and nursing home entry, prolonged and complicated hospital stay and increased health care costs Many elderly people lose weight in hospital

“It is quite a paradox of modern medicine that most doctors pay little attention to the nutritional status of the elderly when it is such a common problem, leading to potentially catastrophic outcomes yet is potentially reversible” – Lipski 1997 Nutrition is regarded

as a non-core medical subject and most doctors pay little attention to it Nutrition needs

to be incorporated into medical student’s training

Early screening of high-risk groups is important for early intervention Screening tests include a good history, and screening tool such as the Mini-Nutritional Assessment Treatment includes:

 a holistic general medical assessment,

 diagnosis and treatment of underlying conditions, including managing chronic pain and depression,

 appropriate time to consume meals,

 safe swallowing techniques,

 medication reviews and drug holidays,

 early mobilisation and weight bearing exercises with rehabilitation where appropriate (Increased physical activity increases appetite)

 nutritional supplements including fortified milk and fruit drinks,

 eating at least 3 meals per day,

 avoiding restrictive diets,

 adequate fluid intake, and

 improved social contact

Better nutritional care has clearly been shown to improve health outcomes and quality of life for housebound, institutionalised and hospitalised undernourished elderly, and also reduces health care costs For every dollar spent on better nutrition care for the elderly,

$5 is saved in health care costs

ORAL DISEASE, A HIDDEN DISEASE OF THE FRAIL ELDERLY:

Peter Lloyd King BDS MDS FICD

Staff Specialist

Special Care Dentistry

Hunter and New England Area Health Service

There is a trend away from edentulousness (no remaining natural teeth) in the elderly In

1979, 60% of elderly Australians were edentulous By 1989 this figure had dropped to 44% and it is projected that by 2019 about 20% of Australians will be edentulous The combination of an ageing population that are retaining more natural teeth has created a phenomenon that has been effectively portrayed as growth in the pool of teeth requiring treatment

Predominant oral health problems of the elderly include dental caries, periodontal

disease, dry mouth and oral cancer The prevalence of periodontal disease appears to increase with age This may reflect an accumulation of disease over time rather than enhanced susceptibility The number of teeth that need to be extracted due to

periodontal disease increases with age

Dry mouth is a common complaint of elderly people, however, age does not significantly effect the salivary flow rate Medications commonly prescribed to elderly persons are the strongest influence on reducing salivary flow rates The progressive impact of smoking and drinking on the development of soft tissue lesions is more apparent in older adults The prevalence of oral cancer increases with age

The impact of oral health on the well being of elderly persons in Australia has been investigated in both the institutionalised elderly and functionally independent elderly Stockwell's study of 238 geriatric patients at the Mount Olivet Complex revealed that oral pain was a problem for 12 % of the group Functional problems including chewing,

swallowing and speaking were identified in 49% of the patients Loss of chewing

mechanisms can lead to the preference of soft bland food, which may be nutritionally dilute compared to the vitamins and fibre obtained from harder fruit and vegetables Undernutrition in the elderly is a significant problem and has a variety of effects ranging from the development of pressure sores to an increase in the incidence of fractured femurs

In South Australia, 1217 non-institutionalised persons aged 60 years and over completed

a questionnaire containing 49 questions about the effect of oral conditions on discomfort, dysfunction and disability Impacts such as difficulty chewing discomfort during eating and avoidance of foods 'fairly often 'or very often' was reported by over 5% of dentate persons and 10% of edentulous persons 5% of persons reported that their oral health had significant impact on their interpersonal relationships The correlation between oral disease and aspiration pneumonia is also well documented A correlation between oral disease and diabetes management as well as cardiovascular disease is under

investigation

Strategies need to be implemented to address the oral health needs of frail and

functionally dependent elderly people Carer education should focus on how to provide

oral hygiene in residents with challenging behaviours What products are available to address dry mouth and will prevent dental caries and periodontal disease? How diet effects oral disease and what sugar substitutes are available to reduce the risk of dental caries? Dental professionals require education in the oral health needs of the frail and functionally dependent elderly Finally, resources need to be allocated to public health facilities to manage complex needs of elderly patients requiring hospital admissions for dental care

Natural teeth for optimum health

In a Nutritional Status Survey at Tufts University which looked at 691 subjects aged 60 to

98, the three factors that were significantly associated with nutritional status were

income, education and denture status

For denture wearers males had significantly reduced levels of Vitamin A, C, B6, folate, proteins and calories Female denture wearers had significantly reduced levels of

calcium and protein As we would expect, there appears to be good evidence that the older adult with teeth is more likely to maintain a nutritious diet than an edentulous older adult

Ettinger (1998) explored the question: Does improvements in the quality of prosthesis effect nutrition? He found that while the masticatory function improves with improvement

in the quality of prosthesis, in the absence of dietary counselling significant changes in the choice of foods does not

Broken down dentitions

While there is little doubt that a healthy natural dentition is ideal to maintain optimum nutrition, for a functionally dependent older adult, this ideal may no longer be an option Patients with dementia frequently present with dentitions that are broken down and they require multiple extractions to stabilise their oral disease

Poor oral health is a known risk factor for undernutrition, chest infections, upper

respiratory tract infections, management of diabetes and possibly heart disease

If a broken down dentition is contributing to a patient's poor general health, an

appropriate treatment plan to remove painful stimuli from the mouth is essential

However, if the patient is undernourished and postoperative complications occur that prevent the patient from eating, there is a risk of "protein energy undernutrition" This syndrome occurs when an undernourished patient fails to eat well for four to five days and results in weight loss, peripheral oedema, and ultimately organ failure

Hence, the dentist managing a patient with a broken down dentition with risk factors of undernutrition should use the mini nutritional assessment to determine the nutritional status of the patient before treatment proceeds If the patient is undernourished or at risk

of undernutrition the dentist should arrange for the patient to be monitored by a dietitian over the course of treatment to ensure that dietary changes are implemented pre

operatively and that the patient's nutritional status is monitored postoperatively

Maintaining oral health in patients with dementia

The key areas to be addressed are:

Use of fluoride

Clients should be using a high fluoride regime Use a high fluoride toothpaste

Minimise sugary between meals snacks and drinks

Consider the use of sugar substitutes and reducing between meal snacks Nutritional requirements may over ride this objective If the client needs to snack throughout the day, more frequent use of fluoride is required Atomising a fluoride mouthrinse can effectively deliver a small dose of fluoride regularly throughout the day

Manage Xerostomia (dry mouth)

Reduce caffeine intake and consider the use of saliva substitutes for dry mouth

Train Staff

Direct care staff requires training in oral health care practices

Access dental services

Consider the use of the enhanced primary care program to access private services Make use of DVA privileges; understand the limitations and abilities of public health dentistry

Bibliography

Australian Bureau of Statistics 1999 Year book

NHMRC 1994 A Report of the Health Care Committee Oral health care for older adults

NHS National Health Strategy 1992 Improving Dental Health in Australia, Background paper No 9, NHS, Melbourne

Gift HC Issues of ageing and oral health promotion Gerodontics 1988, 4: 194-206

Katz RV, Stanley PH, Neal WC, Muma RD Prevalence and intraoral distribution of root caries in an adult population Caries Res 1982, 16:265-271

Pajukowski H Salivary flow and composition in elderly patients referred to an acute care geriatric ward Oral Surg Oral Med Oral Path Oral Radiol and Endo 1997, Sept: 84(3) 256-7

Stockwell Al Survey of the oral health needs of institutionalized elderly patients in

Western Australia Community Dent Oral Epidemiol 1987, 15:273-6

Mc Cormack P Undernutrition in the elderly population living at home in the community: a Review of the literature Journal of Advanced Nursing, 1997,26:856-863

Slade G Spencer AI, Social impact of oral conditions among older adults Australian Dental Journal 1994, 39(6):358-64

DSRU 1993 Dental Statistics and Research Unit, Australian Institute of Health and Welfare, A research data base on dental care in Australia, Adelaide

FDI Technical Report No.43 1986 Commission on Dental Education and Practice

Working group 10 Delivery of oral health care to the elderly patient London: Federation Dentaire

GOOD NUTRITION FOR THE HOUSEBOUND ELDERLY:

Sally James APD

Dietitian, Geriatric Ambulatory Care Service,

Westmead Hospital

Summary:

Weight loss and lack of appetite are common among older people who are housebound This frequently causes anxiety for family and carers It should not be regarded as an

inevitable part of ageing

Why does this happen?

 Physiological changes eg; taste, constipation diarrhoea, decreased thirst sensation, swallowing difficulties

 Early cognitive impairment This affects planning, making shopping and cooking difficult Later cognitive changes impact on remembering how, when and what to eat

 Depression is common, often unrecognised, and is treatable

 Dental problems People need to be encouraged to seek dental care earlier rather than later

What can be done?

 Treat the treatable

 Medical review by general practitioner or geriatrician Diagnosis and treatment of depression, medication review, diagnosis and treatment of early Alzheimer’s disease

as appropriate can improve appetite

 Dental review and regular oral care

 A speech pathologist can recommend appropriate consistency of meals for those with swallowing disorders

 Exercise – a physiotherapist can prescribe exercises which can be done at home Tai chi or seniors’ exercise group for those who can access these

 Regular exposure to sunlight for 10-20 minutes daily – without sunscreen and not through glass Avoid the middle of the day in summer This is essential to maintain vitamin D levels and can enhance mood

 Bowel care – fluid, fibre, exercise, regular habit Those on painkillers may need

laxatives

Assistance with meals

 Shopping

 Meal provision – Meals on Wheels, Tender Loving Cuisine, frozen supermarket

meals, in home preparation

 Take-aways

 Day Centres, clubs

 Ensure good food hygiene

Ways to encourage eating

 Offer a variety of attractive, tasty, good-smelling meals and snacks Use garnishes and sauces to enhance appearance

 Ensure meals are of appropriate consistency and that meat and vegetables can be easily chewed

 Meals should be culturally appropriate

 Small meals with snacks between meals usually result in better overall intake

 Guided choice – offer a choice of two or three foods rather than asking, “what would you like?”

 Relaxed environment – turn off the TV!

 Use plain plates & tablecloth for those who are confused

 Finger food for those having difficulty manipulating cutlery Eg mini quiche,

sandwiches, cut-up fruit, ice cream in cone, mug of nourishing soup

Make every mouthful count

No restrictive diets

Add extra energy (calories/kilojoules) – Oil, margarine, butter, powdered milk, cheese, avocado, and peanut butter

Offer small amounts of food and drinks often

Tea, coffee, salads are filling but low in energy

Vitamin-mineral supplements

Make up for lack of balanced diet

Do not provide energy (kilojoules) or help weight gain

May improve appetite

Nourishing snacks

Yoghurt, custard, Fruche®, rice desserts

Muffins, scones, pikelets, raisin bread

Muesli bars, breakfast bars, breakfast cereal – at any time!

Dried fruit, nuts, fruit snacks

Flavoured milk, Milo®, ice cream, smoothies

Baked beans, spaghetti, tuna, sardines

Sandwiches, biscuits and cheese, dips

Nutritional supplements

Used to help gain weight or as meal replacement

Most contain vitamins and minerals – e.g.Sustagen®, Ensure®, Fortisip®, Resource®.

Others are additives eg: Promod®, Polyjoule®, Polycose®, and Calogen®.

Can use Milo®, malted milk, powdered milk, cream etc instead or in addition

A dietitian can

Assess nutritional status

Estimate nutritional needs

Recommend foods which are practical and enjoyable

Advise on supplements

There are few dietitians working in the community

Carers are often in a better position to make well-informed changes

Refer early for best results!

Conclusion

Weight loss is not an inevitable part of ageing

Management is challenging for all those involved in the care of the individual

Requires time and resources

Early intervention will be most effective – it is difficult to regain a significant amount of lost weight

THE MEANING OF FOOD; MORE THAN NUTRIENTS:

Associate Professor Susan Quine

School Of Public Health

Faculty of Medicine, University of Sydney

My presentation is not specific to the housebound elderly, although it includes them, as this has not been the main focus of the research projects in which I have been involved

It presents findings, both quantitative and qualitative, from studies of older Australians (65+) These studies are based on older people living in the community (including the 'homeless), and does not include those older people living in institutional care The

studies, publications from which are listed below, are those in which I was a researcher and therefore about which I have first hand knowledge

The purpose of this presentation is to show that while it is important to identify the

quantity and nutritional quality of food eaten by older people, other aspects of nutrition should also be taken into consideration if we are to understand consumption patterns, and improve the nutritional status of older people Disability may reduce an individual's ability to shop for groceries and to prepare food, but older people who have no major disability may still not eat well Reasons for this are numerous Inadequate income is a major cause of food insecurity and poor nutrition Findings from the NSW state wide quantitative study (n=8,881) identified the characteristics of those older Australians who could not afford to purchase food They were four times as likely to be renters as home owners, five times less likely to have private health insurance, and 85 times more likely

to report that they ‘could not make ends meet’

Quantity rather than quality of food was emphasised in the qualitative studies Healthy food was recognised as important by some low socioeconomic participants: “I love fish, but I can’t afford it I have tinned fish, sardines, but it’s not the same as fresh fish” , while other participants were not concerned with quality as long as they had enough to eat:

“Healthy food is not important to me…as long as you get enough tucker into you, that’s all you worry about.”

The quantitative study also identified that older Australians who were food insecure were twice as likely to be living alone Findings from the qualitative studies emphasised the importance of motivation to shop for ingredients and to prepare a meal Older people living alone are less likely to cook for themselves, and this is particularly true of older men - many of whom have not learnt the skill of cooking “Because I live alone I don’t care what I eat If you’re cooking for others it’s different” Eating is a social activity, a way

of interacting with other human beings Findings from the study of soup kitchen clients emphasised the social component of eating While many came out of necessity to obtain food which they otherwise could not afford, the social component of visiting the soup kitchen was strongly emphasised “I come here for lunch every day Good meals, Get out

of my room for a couple of hours I’ve got lots of mates here We have a good yarn.”

Findings from both the quantitative and qualitative studies identified the impact of poor oral health on nutrition Oral health problems may reduce the range of foods eaten and the enjoyment of food, so while poorly fitting dentures and sore gums may not be classified as a 'disability', such problems can severely impact on the quality of food eaten, reducing the intake of healthy foods such as raw fruit and vegetables

Publications:

Quine S., Morrell S Food insecurity in community dwelling older

Australians Journal of Public Health Nutrition 2006; 9(2): 219-224

Wicks R., Trevena L., Quine S Experiences of food insecurity amongst

urban soup kitchen consumers: insights for improving nutrition and

well-being Journal of the American Dietetic Association (Accepted

2005, to be published late 2006/early 2007)

Quine S., Kendig H., Russell C., Touchard D

Health promotion for socially disadvantaged groups: the case of homeless older men in Australia Health Promotion International, 2004, 19(2): 157-165

Russell C., Touchard D., Kendig H., Quine S

Foodways of disadvantaged men growing old in the inner city:

policy issues from ethnographic research

Chapter 12, International Library of Ethics, Law and the New Medicine Kluwer, Netherlands, 2001, ppI91-215,

ECONOMIC AND SOCIAL ASPECTS:

Dr Michael Fine,

Department of Sociology,

Macquarie University

Care doesn’t feature in economics

Care is an essential aspect of social life

Without care none of us would exist

Food is a real embodiment of care

Food Services

Delivered meals organisations

Meals on wheels Other meals services (frozen meals)

Other home based meals

Help provided through Community Aged Care Packages (CACPs)

Other social food services

Care based meals (eg senior citizens centres)

Food clubs/groups (eg Balmain gourmets)

History of Meals on Wheels

MOW was established in Britain I World War II for old people who needed help In

Australia the first service was set up in Melbourne in 1952 It was soon taken over by the Red Cross MOW started in Sydney in 1957, provided by the Sydney City Council and prepared in their own kitchens In 1968 the Federal Meals on Wheels Act was passed and in 1985 the Home & Community Care Program (HACC) was set up

Organisation

s

Average clients per day

Meals per year Volunteers

Cost Per meal

Meals on Wheels, Australia 2004

Key Elements of MOW

Delivery is staffed by volunteers or ‘expenses paid’ volunteers They are both female and male, runners and drivers Organisations (2002 in NSW) are generally small, local community-based organisations, linked to local government

There used to be a hidden subsidy The food was prepared in hospital kitchens Now typically organisations have their own kitchens and paid kitchen staff The organisations provide care and social capital as well as meals The members are caring for strangers MOW is based on the Welfare model For volunteers it may be ‘clubby’ For clients there may be some feeling of shame in accepting charity How can MOW adapt to multicultural meals?

It is easy to forget the newness of community care

 Home nursing started in Australia in 1954

 Nursing homes started in 1962

 The Meals on Wheels Act in 1968

 1970 came Home Care

 1985 saw HACC and Aged Care Assessment Program and ‘Balance of Care’

 (Aged Care reform strategy) and residential care benchmarks

 1989 Case management: community options programs

 1991 CACPs (Community aged care packages)

 1996 Howard government – Aged Care

 1997 The Aged Care Act – user pays approach

 2004 ‘The Way Forward’

There has been over 50 years of Aged Care, 20 years of HACC

Carers are identified as a target group There is now a ‘hybrid’

approach of ‘shared care’

There have been 15 years of Case Management: ‘integrated’ and individualised’ care

Home and Community Care (HACC) has these characters It is a small-scale, service model with localised service, community governance It has possibilities of innovation,

eg home visiting, shopping, transport The problems for HACC seem to be task

specialisation, lack of standardisation and regional variations

Expenditures on Community Care

FUNDING 2002-2003 INCREASE 1996-2004

The Way Forward (2004) discusses

Assessing need and eligibility; access to services

A common approach determining ‘consumer’ fees; accountability and quality assurance Information management and data collection; planning

The Hogan report (2004) recommends that aged care is no more a cottage industry A

‘mature market’ has developed Corporates now provide 80% of child care Will they move into aged care? HACC federal/state partnership doesn’t work well Work for profit

is permitted but it’s marginal Will HACC become attractive to corporations?