Overview
"Eating and drinking is a big part of life for most people. Food can be comforting and enjoyable, and sharing meals is a way to connect with people. Not being able to eat and drink in the same way can be upsetting for people who are nearing the end of their life and for those around them." 2
Providing quality nutrition and hydration support for a person in the palliative phase can challenge our ideas about what we think constitutes good care. During this phase, the focus is quality of life, including comfort, symptom relief and enjoyment of food (while still possible) rather than adhering to specific dietary restrictions.3
Outcomes sought in relation to nutrition and hydration management at the end of life include:
- enabling the person to eat and drink for as long as they want
- ensuring the person has access to their choice of food and drink and has opportunities to share food with others e.g. their family and friends
- supporting family and friends to understand why the person might not be able to, or may choose not to, eat and drink at the end of life.
Each of these outcomes depends on good planning and effective communication between the resident, their family and friends, health professionals and aged care staff.
Managing nutrition and hydration for people nearing the end of life can be challenging and involve many considerations. This resource seeks to assist staff working in residential aged care to identity and address some of the key risks - be they legal, clinical, or communication risks - associated with nutrition and hydration during the palliative phase. It does not provide a comprehensive assessment of all risks, but rather prompts staff to apply risk-based thinking (noting that there will be different risks relevant to different people and aged care facilities).
This resource integrates principles and requirements of the Aged Care Quality Standards including person-centred and rights-based care, consumer dignity and choice, dignity of risk, quality of life, ongoing assessment and planning in line with a person’s needs, goals and preferences, and continuous improvement. It reflects the increased focus on improving food and nutrition following the Aged Care Royal Commission. This resource also draws on the National Palliative Care Standards including comprehensive assessment of need, care planning and quality improvement.
The Aged Care Quality Standards are currently being revised and strengthened.
The existing Standards [Standard 3(3c)] require ‘the needs, goals and preferences of consumers nearing the end of life are recognised and addressed, their comfort maximised and dignity preserved.’
The Consultation Paper: Aged Care Quality Standards Review signals the intent for a more detailed focus on end of life care. A new dedicated Standard on Food & Nutrition, and more detailed requirements for Clinical Care (e.g., choking and swallowing and malnutrition and dehydration risks) are foreshadowed. The strengthened Quality Standards are due to come into effect in mid-2024.