Asking the essential questions to improve aged care food quality


Food has zero nutritional value if it isn’t eaten – which is why Flinders Caring Futures Institute is driving research that measures stakeholder satisfaction levels with food and dining being offered in residential aged care.

A program of research led by Professor Michelle Miller has produced the Flinders Aged Care food service satisfaction questionnaires, an innovative toolkit recording the views of all stakeholders – from cooks and chefs to residents and their families – which is now ready for use by Australia’s aged care sector.

These questionnaires will enable Aged Care organisations to gather service feedback for quality improvement activities, which is a requirement embedded in the Aged Care Quality Standards. It’s a matter that needs to be addressed with urgency, underlined by the Royal Commission into Aged Care Quality and Safety having received more than 10,000 submissions – with a quarter relating to food being served to aged care residents.

“The rate of malnutrition in residential aged care has been persistently high for decades, and recent Australian research suggests that between 30% and 50% of residents are malnourished,” says Professor Miller.

“A recent study suggests that when residents are unhappy with their meals, they are 20 times more likely to suffer malnutrition. Our research is therefore dedicated to improving the quality of food so that residents are satisfied with the meals being offered, thereby reducing the risk of unintentional weight loss.”

Professor Michelle Miller

Having recognised that there were no questionnaires suitable for measuring stakeholder satisfaction with food and dining in residential aged care, the Flinders University team developed a broader view by recognising that many people within aged care organisations (including cooks and chefs) influence food satisfaction outcomes and that staff satisfaction in their work can have a significant impact on resident satisfaction.

“Typically, satisfaction with the food service has only been measured from the perspective of the final consumer – the resident – but this is a downstream approach that does not consider the whole food service system,” says Professor Miller.

“The food in aged care has often been reported through a negative lens. Social media and the audience are often quick to condemn and lay blame without understanding the systems that are in place and the barriers that aged care homes encounter in delivering good quality food to their residents.”

The Flinders research team began this program of research in 2015, creating a questionnaire that measures the satisfaction of cooks and chefs working in residential aged care.

“The staff turnover rate in residential aged care is about 30%, so it is important that aged care providers are better equipped to change conditions that can help increase staff satisfaction, decrease burnout and increase staff retention,” says Professor Miller.

The Flinders research team then developed two additional questionnaires – a resident food service satisfaction questionnaire that measures opinions about the food and dining experience, including taste, temperature, appearance, variety, choice and the level of support available at mealtime; and another questionnaire for completion by families with loved ones in residential aged care, who are often required to be proxies on behalf of the resident.

This program of research has garnered the interest and support of aged care providers eager to have the tools to help them with quality improvement initiatives. More broadly, organisations such as the Maggie Beer Foundation and the Institute of Hospitality in HealthCare are supporting the program of research by raising the profile of this work.

The completed toolkit of three questionnaires will help aged care providers identify where issues are occurring, thereby providing the first step towards fixing problems. The questionnaires can then be used to measure change following the implementation of quality improvement initiatives.

“As an example of improvements arising from the questionnaires, one of our current projects is designing a photo-based menu for residents, so they can imagine what their meal choice will appear like,” says Professor Miller.

“Ultimately, we would like to see the questionnaires being used by every aged care home in Australia, placing a focus on measuring aged care food services so that residents receive the highest quality of food services possible and are satisfied with what they receive.”

Outcomes of this research will equip aged care providers with tools they need to understand the satisfaction of their stakeholders, help increase staff satisfaction to reduce their burnout – and ensure that residents receive nutritious and delicious food.

“It is our hope that this program of research can facilitate change,” says Professor Miller, “and ultimately improve quality by contributing to a national food service satisfaction benchmarking platform.”

All aged care organisations are being welcomed to express an interest in using the questionnaires by emailing

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Quality Aged Care