A 1/8 Phipps Close, Deakin ACT 2600 | T 02 6189 1200 E [email protected]| W dietitiansaustralia.org.au Dietitians Association of Australia | ABN 34 008 521 480 Dietitians Australia and the associated logo is a trademark of the Dietitians Association of Australia. 1 The Reimagined Personal Care Worker July 2020 Dietitians Australia is the national association of the dietetic profession with over 7,500 members, and branches in each state and territory. Dietitians Australia is the leading voice in nutrition and dietetics and advocates for food and nutrition for healthier people and healthier communities. DA appreciates the opportunity to provide feedback to SkillsIQ regarding The Reimagined Personal Care Worker. Contact Person: Vanessa Schuldt Position: Senior Policy Officer Organisation: Dietitians Australia Address: 1/8 Phipps Close, Deakin ACT 2600 Telephone: 02 6189 1200 Email: [email protected]
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A 1/8 Phipps Close, Deakin ACT 2600 | T 02 6189 1200 E [email protected] | W dietitiansaustralia.org.au Dietitians Association of Australia | ABN 34 008 521 480 Dietitians Australia and the associated logo is a trademark of the Dietitians Association of Australia. 1
The Reimagined Personal Care Worker July 2020
Dietitians Australia is the national association of the dietetic profession with over 7,500 members, and branches in each state and territory. Dietitians Australia is the leading voice in nutrition and dietetics and advocates for food and nutrition for healthier people and healthier communities. DA appreciates the opportunity to provide feedback to SkillsIQ regarding The Reimagined Personal Care Worker.
Dietitians Australia interest in this consultation
As the leading organisation of nutrition and dietetic professionals in Australia, Dietitians Australia (DA) supports reforms to entry-level training for Personal Care Workers (PCW) so as to better meet the needs of clients in aged care. DA has an interest in fostering food and nutrition knowledge and skills across the community. It is important that workforce development for the aged care sector considers knowledge and skills in food and nutrition to support quality of life, health and wellbeing among elderly Australians living in the community and residential aged care homes.
The Accredited Practising Dietitian (APD) program provides an assurance of safety and quality and is the foundation of self-regulation of the dietetic profession in Australia. Accredited Practising Dietitians have an important role to play in aged care, such as in the assessment and dietary management of clients with chronic diseases and malnutrition, in the planning and coordination of food service within aged care homes and home delivered meal programs, and in the training of aged care sector staff.
KEY MESSAGES 1. Food, nutrition and hydration are considered core components of entry-level training and
continuous professional development (CPD) for all Personal Care Workers employed in
residential and community aged care.
2. Training providers are advised to develop the food and nutrition components of vocational
education training units and qualifications for Personal Care Workers in consultation with
Accredited Practising Dietitians (the nutrition experts) to ensure the material developed is
evidence-based and addresses the management of food and nutrition related risks
experienced by older people (e.g. malnutrition, chronic disease, pressure injuries/wounds,
dysphagia, dementia, falls and food allergy).
3. Training providers are advised to include Accredited Practising Dietitians in the delivery of
entry-level food and nutrition training and CPD for Personal Care Workers.
4. DA supports Personal Care Workers to work collaboratively as part of a multidisciplinary
team (with allied health professionals included), so as to support the health, wellbeing and
quality of life of elderly recipients.
DISCUSSION
The breadth of care recipients’ needs
Good nutrition is a core need of aged care recipients that cuts across diversity and key life stages, including healthy aging, re-ablement and palliation. When it comes to maintaining the physical health and wellbeing of aged care recipients for healthy aging, assistance with grocery shopping, meal preparation, cooking and safe eating all play a vital role in achieving and maintaining food intakes that are both enjoyable and nutritious. Assistance with these tasks from Personal Care Workers (PCWs) with no nutrition knowledge or skills can jeopardise the physical health and wellbeing of aged care recipients, as discussed later in this submission.
The Reimagined Personal Care Worker 3
Access to dietetic services (through prompt referrals to an Accredited Practising Dietitian, APD) is also a key need for aged care recipients so as to prevent and manage many of the diseases and conditions that plague elderly Australians including malnutrition, chronic disease (e.g. diabetes, renal disease, hypertension), pressure injuries/wounds, dysphagia, dementia, falls and food allergy. In the absence of no mandated minimum qualification or nutrition training for PWCs, APDs are rarely called on by PWCs to address dietary issues that are commonplace among the elderly. Malnutrition among elderly Australians is a particular concern with The World Health Organization (WHO) recognising malnutrition as one of six contributing factors to the declining physical and mental capacity of older people1. Malnutrition increases the risk of falls, osteoporosis and fractures, slow wound healing, morbidity, mortality and contributes to poor quality of life2. Malnutrition is an accelerator to entry to residential aged care.
A study published in 2012 identified that the prevalence of malnutrition in older Victorians receiving home nursing services was around 8% and approximately 35% were at risk of malnutrition3. In residential aged care, Australian studies have identified a prevalence of malnutrition from 22% up to 50% (see Appendix). There is obviously a failure in safety and quality systems for the prevention and management of malnutrition in older Australians, of which PCWs equipped with appropriate food and nutrition knowledge and skills, as part of a multidisciplinary team, can help to address.
The range and complexity of the skills and capabilities required to meet those needs
Nutrition knowledge and skills of Personal Care Workers in aged care: Older people have unique nutrition needs, so it is important that the aged care workforce has good quality training that encompasses the basics of nutrition and hydration for the elderly. Currently, aged care staff with vocational education training may have completed Certificate III in Individual Support or Certificate IV in Ageing Support level courses without studying any food or nutrition component. This impacts on quality of care when PWCs assisting aged care clients in the community with grocery shopping and meal preparation do not have a basic understanding of the food and nutrition needs of the elderly. Likewise, it compromises quality of care when staff working in residential aged care homes have little to no understanding of nutrition requirements and malnutrition risk.
Unsafe practice has been observed where the enteral nutrition care of elderly clients receiving a Home Care Program package has been provided by a PCW without appropriate training or supervision. In other cases, PCWs have been observed to order meals for residents without reference to their dietary needs, health condition, swallowing ability or food preferences.
For diet-related problems which arise after services at home have been initiated, the limited food and nutrition knowledge of in-home support teams, (including PCWs and registered nurses), limits appropriate basic support to older people. It is a barrier to identifying food and nutrition problems and the escalation of referral to an Accredited Practising Dietitian for higher level support. DA members have raised concerns that individuals with obvious weight loss or pressure ulcers are not routinely referred to an Accredited Practising Dietitian.
The Reimagined Personal Care Worker 4
The successful implementation of integrated nutrition care and the provision of nutritious enjoyable food is a complicated undertaking. It requires a trained workforce, working within their scope of practice and present in sufficient numbers who are guided by contemporary policies and procedures.
It is critical that there be a benchmark standard of consistent nutrition care provided to elderly Australians by PCWs. Therefore, DA considers it vital to include food, nutrition and hydration training, as well as malnutrition screening training, as a CORE component of entry level training and continuous professional development (CPD) for all PCWs working in residential and community aged care, so as to meet the nutrition and hydration needs of elderly clients living in these settings.
In addition to food, nutrition and hydration competencies as a CORE component of training for
PCWs, ELECTIVE units for training should include additional food and nutrition competencies for care
staff working in residential and community aged care. In the SkillsIQ consultation re: Certificate III in
Ageing support, DA recommended adding the following elective units to the list of eligible elective
units for Certificate III in Ageing Support:
HLTAHA018 - Assist with planning and evaluating meals and menus to meet recommended
dietary guidelines
SITHCCC201 - Produce dishes using basic methods of cookery
SITHCCC307 - Prepare food to meet special dietary requirements
CHCAGE006 - Provide food services
HLTAHA021 - Assist with screening & implementation of therapeutic diets
HLTFSE001 - Follow basic food safety practices
HLTOHC001 – Recognise and respond to oral health issues
HLTAHA013 – Provide support in dysphagia management
HLTAHA018 - Assist with planning and evaluating meals and menus to meet recommended
dietary guidelines
SITHCCC201 - Produce dishes using basic methods of cookery
SITHCCC307 - Prepare food to meet special dietary requirements
HLTAHA021 - Assist with screening & implementation of therapeutic diets
HLTFSE001 - Follow basic food safety practices
HLTOHC001 – Recognise and respond to oral health issues
HLTAHA013 – Provide support in dysphagia management
It is important to ensure the food and nutrition training material developed and delivered as part of
the course content for PCWs is evidence-based and provides course participants with clear referral
pathways for higher level dietary assessment and management (i.e. referral to an Accredited
Practising Dietitian for the management of food and nutrition related issues experienced by older
people, such as malnutrition, dysphagia, food allergy and intolerance, chronic disease, wounds and
falls).
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Training providers are advised to develop the food and nutrition components of vocational
education training units and qualifications for Personal Care Workers in consultation with
Accredited Practising Dietitians (the nutrition experts) to ensure the material developed is current,
evidence-based and addresses key food and nutrition related risks experienced by older people.
Training providers are further advised to include APDs in the delivery of entry-level food and
nutrition training and CPD for Personal Care Workers.
The extent to which an individual worker can meet those needs versus the scope of the role as part of multi-disciplinary team DA supports trained PCWs to work collaboratively as part of a multi-disciplinary team (with allied health professionals included), so as to support the health, wellbeing and quality of life of elderly recipients. Planning, implementing and monitoring food and nutrition services within residential and community aged care is best achieved as part of a multidisciplinary team that includes an Accredited Practising Dietitian, other allied health staff, food service staff, nursing staff, PCWs and family/carers. Nutrition skilled PCWs have an important role to play in delivering food, nutrition and hydration care to elderly recipients under the supervision of an APD. As part of the multidisciplinary team, APDs are professionally equipped to support PCWs with continuous professional development (CPD) specific to nutrition care for the elderly.
REFERENCES 1. World Health Organization (WHO) Guidelines, 2017. Integrated Care for Older People - Guidelines on
community-level interventions to manage declines in intrinsic capacity. Available from:
Older Australians in the community and in residential aged care represent a heterogeneous population i.e. some are well nourished, some are overweight or obese, some are malnourished. Research shows that up to 50% are either at risk of malnutrition or are malnourished. Malnutrition is defined as two or more of the following characteristics
insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation or diminished functional status1.
There are many contributors to the development of malnutrition. People with malnutrition are at higher risk of falls, infection and pressure wounds and they experience greater mortality than people who are well nourished. They also experience longer recovery from illness or injury and are less able to carry out activities of daily living.
There are a variety of tools available to screen and assess malnutrition in different care settings. These have been reviewed and summarised in ‘Nutrition Education Materials Online’ (NEMO) on the Queensland Health website.
While there is no single marker for malnutrition, unplanned weight loss is a key indicator of malnutrition risk. It is possible to be overweight or obese and also malnourished, as any weight loss at a later age can significantly impact lean body mass and therefore immune capacity, wound healing ability and more. Studies show also that there is an increased risk for older people with a Body Mass Index (BMI) <23.0 kgm2. Monitoring of body weight is essential in both residential and community aged care settings.
The involvement of Accredited Practising Dietitians is vital where unplanned weight loss is identified as they are uniquely qualified to lead integrated strategies for the prevention and management of malnutrition. Better outcomes in treating malnutrition and hydration are achieved when organisations implement proactive policies and when collaboration occurs with older people, carers, nursing, medical practitioners, allied health professionals, food service managers and staff, aged care workers and service managers.
1. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition
and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics
recommended for the identification and documentation of adult malnutrition (undernutrition).
A 1/8 Phipps Close, Deakin ACT 2600 | T 02 6189 1200 E [email protected] | W dietitiansaustralia.org.au Dietitians Association of Australia | ABN 34 008 521 480 Dietitians Australia and the associated logo is a trademark of the Dietitians Association of Australia. 7
Summary table showing prevalence of malnutrition in Australian studies
The table below is a summary of Australian studies in malnutrition. While the focus in this document is residential care and community settings, the prevalence of malnutrition in Australian hospitals is also of concern. Most hospital programs aim to screen and assess patients soon after admission, which reflects nutritional status prior to admission to hospital. This is not to say however that a great deal more needs to be done to address malnutrition in hospital, whether it is pre-existing or not.
-Most common nutrition risk factors: polypharmacy (47%), eating alone most of the time (45%) and dietary modification due to illness (35%).
Australian Nutrition Screening Initiative (ANSI)
Community living (Senior citizen’s centres)
NSW Regional
Cobiac & Syrette
1996 >70 yrs 1098 30% high risk
20.6% moderate risk
ANSI Community setting
A 1/8 Phipps Close, Deakin ACT 2600 | T 02 6189 1200 E [email protected] W dietitiansaustralia.org.au | ABN 34 008 521 480 Dietitians Australia and the associated logo is a trademark of the Dietitians Association of Australia.
References for malnutrition summary table
1. Ackerie A, Carroll E, McCray S, Hill J, Leveritt M. Malnutrition does not discriminate.
Nutr Diet 2012; 69: (Suppl. 1): 146
2. Adams NE, Bowie AJ, Simmance N, Murray M & Crowe TC. Recognition by medical
and nursing professionals of malnutrition and risk of malnutrition in elderly