“Moving into a care facility marks a major turning point in the everyday lives of older persons,” says Ombudsperson Bernhard Achitz on the occasion of the International Day of Older Persons (1 October): “Diet does not merely affect the health of care facility residents. Meals provide structure to the day, facilitate interaction with fellow residents and reflect customs, culture or religion. This makes it all the more important that consideration is given to their likes and dislikes, as well as to their dietary and eating habits.” The Austrian Ombudsman Board and its commissions are therefore currently conducting a monitoring priority for nutrition management in long-term care. The results will be published next spring.
Nutritional management reduces mortality rates
As people age, the demands on adequate nutrition and fluid intake increase. It has been proven that nutritional and therapeutic measures can improve functional parameters such as muscle strength, enhance quality of life and reduce rates of readmission to hospital as well as mortality rates. “Unfortunately, however, malnutrition was already an issue during the Commission’s visits to retirement and nursing homes in the context of the COVID-19 pandemic response,” says Achitz.
Often too few staff to assist with meals
One reason for this monitoring priority was that, during their visits conducted as part of the preventive human rights monitoring programme, the commissions repeatedly made critical observations: in many facilities, meal times remain rigid or unusually early. Nursing staff have too little time to assist people with reduced independence. In one facility, due to the outdated building layout, meals had to be eaten in the corridor, next to the waste trolleys. However, there are also examples of best practice, such as the ‘Dysphagia Project’ (swallowing disorder) at a care home in Lower Austria and care facilities that comply swiftly and comprehensively with the recommendations of the Austrian Ombudsman Board regarding nutrition and catering.
Standardised nutritional screening must take place upon admission to the care home
One of the key demands of the Austrian Ombudsman Boards and their commissions is that “all individuals admitted as inpatients to a care facility must undergo standardised nutritional screening upon admission”. This requires nursing staff who are competent in recognising signs of impending or existing malnutrition (screening) and who are able to carry out an in-depth evaluation of the nutritional situation and the factors influencing it (assessment).
Dementia increases the risk of malnutrition
The large number of people with dementia in nursing homes and the associated increased risk of malnutrition were key factors in determining the monitoring priority for this review. This is also against the backdrop of critical commission reports, which indicate that the creation of dietary histories, regular weight checks and risk screenings are not always carried out as a matter of course, and that the actual amounts of food and drink consumed by residents with dementia are sometimes overestimated.
Ombudsperson Bernhard Achitz: “The monitoring priority is to raise awareness amongst facility and care managers that eating can be an enjoyable experience, even though nutritional requirements change with age, and that appropriate nutritional therapy must be initiated at an early stage.”
Key term: Preventive human rights monitoring
The Austrian Ombudsman Board has a constitutional mandate to investigate public and private institutions where people’s freedom is restricted or may be restricted, with a view to protecting and promoting human rights. In addition to correctional institutions, these include, amongst others, psychiatric institutions, retirement and nursing homes, and facilities for persons with disabilities.
Multidisciplinary commissions set up by the Austrian Ombudsman Board monitor around 500 facilities each year without any specific cause and independently of complaints, in the vast majority of cases unannounced. This work is based on two United Nations conventions: the UN Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) and the UN Convention on the Rights of Persons with Disabilities (CRPD).
The aim of this preventive human rights monitoring is to identify conditions that are likely to contribute to human rights violations. Institutions are supported in focusing on precautions and measures that prevent human rights violations.
Photo: Pixabay/congerdesign