Inquiry into the provision and regulation of supported accommodation in Queensland

• Submission No: 1
• Submitted by: Supported Accommodation Providers Association (SAPA)
• Publication: Making the submission and your name public
• Attachments: See attachment
• Submitter Comments:

Supported Accommodation Providers Association (SAPA).

Submission to the Inquiry into the Provision & Regulation of Supported Accommodation Services in Queensland

Submitted 11/12/2023

Contents

• 1. Executive Summary
• 2. Issues facing Residents and the Sector
  • 2.1. Residents’ views
  • 2.2. Viability & Urgent Need for Support to the Sector
  • 2.3. Urgent Need for Government Investment in Improved Models of Care
  • 2.4. Underinvestment leads to worse outcomes and increased cost to Government
  • 2.5. Complex and Overlapping Regulatory Frameworks
  • 2.6. Cost Benefit Analysis
  • 2.7. Access to Primary Health Care ………………………………………………………………………———–– 12
  • 2.8. Ongoing Funding for SAPA

3. Industry Viability …………………………………………………………………………………………………..––––– 13
   • 3.1. Limitation to Annual Rental Increases

• 4. Who is SAPA?
• 5. Sector Background & Regulations
  • 5.1. Accreditation
• 6. Who Lives in Supported Accommodation
  • 6.1. Forms of Disability
  • 6.2. How Residents Came to Live in Supported Accommodation
  • 6.3. Case Studies

7. Resident Views …………………………………………………………………………………………………..———–– 29

• 8. What Supported Accommodation Provides
  • 8.1. Rates charged
  • 8.2. Unfunded supports
  • 8.3. Comparative of Industry Service Offerings
  • 8.4. Cost Benefits and Saving the Queensland Taxpayer ……………. Error! Bookmark not defined.
  • 8.5. Conflicts of Interest and the NDIS

9. Provider Views …………………………………………………………………………………………………..———–– 41

• 10. A Mental Health System in Crisis
  • 10.1. Common Barriers to Recovery and Independence for our Resident Cohort
  • 10.2. Residents and the NDIS
  • 10.3. Community Mental Health Programs
  • 10.4. Acute Hospital Beds for Mental Health
  • 10.5. Entrenched Cycle of Homelessness and mental health
  • 10.6. Poor Mental Health Leads to Poor Physical Health
  • 10.7. Underinvestment Leads to Worse Outcomes and Increased Cost

• 11. Supported Accommodation as Part of Bigger System
  • 11.1. A place of last resort for many
  • 11.2. Residents of Supported Accommodation & Government
  • 11.3. Exiting of Supported Accommodation
• 12. Restrictive Practices
  • 12.1. Safety For All Residents and Staff
  • 12.2. Unintended Consequences and Red Tape
• 13. A Vision for the Future
  • 13.1. Urgent call for immediate funding and Regulatory Review
  • 13.2. We need an Integrated Approach to Break the Cycle
    • In order to get the desired outcomes, the Queensland Government must invest into the sector and the vulnerable people it homes.
  • 13.3. Improved models of care - What we can provide with funding
  • 13.4. A new model - Step up / step down model (Level 4)
• 14. Response to Specific Questions posed in the Public Advocate Report

List of Attachments

• Attachment A SAPA Participants VISPDATs
• Attachment B MP 2.1 - Fire safety accommodation
• Attachment C MP 5.7 - Residential services building standard
• Attachment D Healthy Eating Toolkit
• Attachment E Guideline for Medication Assistance
• Attachment F Micah Projects Report 2023

1. Executive Summary

SAPA welcomes the inquiry into the provision and regulation of Supported Accommodation in Queensland as we seek to work with the Community Support and Services Committee (CSSC) to improve our services and better provide for the care and accommodation needs of some Queensland’s most vulnerable people.

Supported Accommodation providers are private providers of accommodation who have improved the lives of thousands of vulnerable Queenslanders for decades with no cost to government. Providers didn’t wait for government or Non-Government Organisations (NGOs) to help; they actively took steps to do so.

This submission seeks to provide the CSSC with information from providers, those who are on the ground providing services. It is not written from a theoretical perspective or from a lofty CBD office, but by those who live and work in these environments every day. The language will be direct as we seek to draw the CSSC’s attention to issues and possible areas where we can improve the system.

Overall, the sector does an admirable job. Supported Accommodation plays a crucial role by filling the gap between hospital and independent community accommodation, a space that the Not-for-Profit (NFP) sector has abandoned. The sector continues to play a vital role in providing safe, secure, affordable homes to some of Queensland’s most vulnerable residents.

The Supported Accommodation sector plays a crucial role in Queensland to reduce both homelessness and hospital admissions by supporting people to have a safe, stable place to live. A home that provides them with dignity, community and basic care, including medication management.

Notwithstanding, the sector has been coming under increased pressure in recent years. SAPA has been calling attention to the sector; requesting for regulatory reform and funding to help Supported Accommodation facilities better cater to the increasing needs of our residents.

The mental health system in Queensland is in crisis for multiple reasons including:

• Hospital capacity;
• Lack of investment in community mental health;
• Poor outreach programs;
• Psychosocial Disabilities (PSD) not properly working within the framework of the NDIS; and
• Barriers to combined with a lack of suitable housing options.

The sector is unfunded and it is now at a tipping point with many providers continued losses forcing them to close their doors and reducing available beds during an ongoing housing crisis.

With proper government support and funding the sector can raise the floor of the minimum service levels, providing better care for some of Queensland’s most vulnerable residents and leading the way in future models of care.

This submission does not propose to solve the highly complex issues in the broader mental health sector but is a call to arms to support the sector and the vulnerable Queenslanders we look after. With the right investment, Queensland can improve the model of care and accommodation to some of our most vulnerable, giving our residents their best chance of living their best life.

If thoughtfully constructed and implemented, reform and investment has the potential to save the Queensland taxpayer significant funds through a reduction in resident interactions with government services (such as health, police, ambulance, justice, housing, disabilities)

We call on the CSSC to work with the sector to rethink how we can provide support and accommodation to our vulnerable. To work with the sector to develop appropriate funding models to support the improvement of services and outcomes.

2. Issues facing Residents and the Sector

2.1. Residents’ views

For many residents Supported Accommodation is their home of choice. A safe place amongst their peers where they are supported to live free from judgement and many day-to-day pressures.

Our residents have spoken they have told us that they are desirous of improved service levels and facilities, but many wish to remain in their home of choice.

• Likes single room and the privacy this provides
• Likes the quality of the food
• Enjoys living in a diverse community
• Likes the location and that its walking distance essential amenities

Con:

• Desires more personal space — single rooms and ensuites

• The rental costs are too high

• Better access to digital devices, internet / Wi-Fi | | Services | Pro:

• Assistance with laundry

• The Supported Accommodation assist to provide daily activities like community access (bank, Supermarkets)

Con:

• Wants more support for community access, particularly on weekends
• Friends getting NDIS services, but they are ineligible as they are >65 years old
• Prefer a greater range of food and to better cater to individual preferences
• House mates needing support for toileting and leaving the bathrooms soiled
• General cleaning concerns
• Confusion by some on who provides their supports — the Supported Accommodation facility or the NDIS
• Not able to engage with their support coordinator in person |

| Broader Mental Health / Health Sector | Pro:

• Assistance with medication
• Supporting moderating behaviour and promoting appropriate socialisation |

See section 7 for further information.

2.2. Viability & Urgent Need for Support to the Sector

With rents linked to DSP and spiralling costs, many Supported Accommodation providers are running at a loss, with residents unable to pay more and providers unable to provide more we are requiring urgent assistance from Government.

The pressure on industry is being driven by a confluence of factors including:

• Facilities becoming a dumping ground for hospitals and NGOs for individuals with complex mental health issues and insufficient supports
• Provider burnout – over stretched and have insufficient resources to efficiently look after complex residents
• Effective cap on revenue as rents charged are linked to Disability Support Pension (DSP)
  • Services provided are linked to the revenue that facilities can generate
  • No government support or funding
• Increasing cost pressures (wages, property, food and other supplies) growing faster than rents (linked to DSP)
• Increasingly complex and overlapping regulatory and legislative frameworks, at all levels of government (see section 5.1.7)
• Inability to find primary health care providers – a lack of GPs servicing health needs
• Increasing society expectations on care and accommodation delivery models
• Aging facilities in need of capital works programs

Our members are for purpose companies, seeking to make a positive difference to the lives of our residents while also returning an adequate return on their investment. No different to Residential Aged Care, NDIS, Childcare or many Hospitals.

However, providers are running at a loss and without urgent government support many are unlikely to be able to continue to provide services into the future.

There are very limited alternative options for our residents to go to in the event of a facility closure. Many are likely to end up homeless.

2.2.1. Staff costs vs income

The high cost of wages (particularly for Saturday, Sunday and Public Holidays) relative to the rents charged limits the amount of services that can be delivered

• Residents are charged ~$60 a day
• Staff costs at $60 - $80 per hour.

The high cost of wages vs the income a facility can earn means that services (staff) are limited.

2.3. Urgent Need for Government Investment in Improved Models of Care

The sector recognises the needs to improve the models of care and accommodation. The sector stands ready, willing and able, but is limited by the means at its disposal.

We call upon the CSSC and the Queensland government to work with the sector to jointly develop and suitably fund a new model of care and accommodation to give our residents the best chance of living their best lives in the environment of their choosing.

However; prescribed changes to the model of care without government investment will accelerate the closure of facilities. This will creating an unintended consequence of closures and worsening the outcomes for those the changes were intended to benefit.

Our residents are vulnerable, complex and often without the supports that they need to live outside of Supported Accommodation.

Simply put, increasing obligations without significant government support is likely to lead to a shutting of more facilities and a reduction in available beds. Many residents would lose their home.

There are no alternative places for our residents to go. This will drive residents from safe, secure and regulated facilities into unregulated environments and homelessness. This will ultimately lead to increased hospitalisation rates and / or justice interventions.

2.3.1. Proposed Models for Funding

SAPA advocates for funding to be looked at under 3 separate frameworks

1. Immediate and urgent needs to support sector viability and improve service delivery
2. Study and roll out an improved model of care
3. Study and consider implementing a new level of accreditation — Step up / step down model (Level 4)

See table below

Summary of Models of Funding

• Fire system upgrades / modernisation
• Air conditioning | - Further facility upgrades
• Ensuites
• Single rooms
• Improved breakout and community spaces
• Air conditioning | - Smaller purpose-built facilities
• Private but connected community spaces
• Clinical rooms
• Landscaped gardens and chill out zones
• Facilities for resident upskilling and community activities
• Staff areas and safe zones | | Operations | - Funding supplement to support operations and enhance service levels
• A per day rate based on number of registered beds in a facility
• Providing financial support to GPs to provide in reach clinics | - Direct sector funding in line with Residential Aged Care models to support service delivery
  • Case Management
  • Increased staffing ratios and immediate supports for residents without NDIS / upon discharge
  • Counselling services
  • Improved care and health supports
  • Occupational therapists and other allied health
  • Access to dentists
• Funding sufficient to facilitate reduced rents to residents
• Resident support programs | - Triaging of those experiencing psychosis
• Integrated with hospital and clinical supports
• A higher level of sub clinical and rehab services to supervisor and care for people in transition
• Case management
• Recovery programs
• Intended for short term stays
• Mental health RN and other clinical team members on staff |

| HR and Staff | - Staff training

• Owner management training | - Staged roll out and provider education | - A qualified and experienced leadership team on fulltime staff
• MH RN
• Support workers and surge workforce | | Other | - Remove state payroll taxes
• Reinstate CPI rent increases in line with pension increases
• Ongoing funding for SAPA
• Support SAPA to undertake a Cost Benefit Analysis of the models of care to the QLD taxpayer
• Establish cross government collaboration with the sector to address systemic and ongoing resident issues
• Government wide education initiative to dispel myths and provide information on what the sector does and does not provide | - Remove duplication between overlapping regulatory frameworks | |

2.4. Underinvestment leads to worse outcomes and increased cost to Government

When any individual resident has a crisis it not only has a profound impact to them personally, but significant costs are also socialised across multiple government services.

Chronic underinvestment in accommodation and in home support to residents has led to:

• Increased cost to government across multiple agencies
• Hospital bed blockages
• Unnecessary ambulance call outs
• Potentially preventable police (QPS) interventions
• Worse outcomes for individual residents as a result

2.5. Complex and Overlapping Regulatory Frameworks

The sector is already highly regulated which many prescribed obligations far outstripping the requirements in the Aged and NDIS sectors.

Supported Accommodation must report to and work with multiple overlapping government agencies in areas of safeguards, food safety, accommodation, personal care and complaints. Often with conflicting and differing requirements for the same standard areas.

Our staff have mandated training requirements that are higher than the NDIS

Our facilities must comply with high levels of building compliance.

2.6. Cost Benefit Analysis

SAPAs recommends that the CSSC investigate and support a cost benefit analysis (CBA) for the following proposed models of care:

1. The industry today and its benefits to the state of Queensland
2. The industry with a new model of care for Supported Accommodation
3. The introduction of a level 4 model of step up / step down semi clinical settings

SAPA postulates that the sector saves the state of Queensland tens of millions of dollars each year in direct service costs by providing safe, stable, accommodation and thereby diverting residents away from the alternative overloaded services.

SAPA has been advocating for financial support to undertake a cost benefit analysis of the sector and call of the CSSC to support this initiative

See section 13

We seek CSSC’s support in this undertaking.

2.7. Access to Primary Health Care

Our residents require regular in-house GP clinics without any gap fees. Our residents are unable to transport themselves to GP clinics and do not have the funds to pay gap fees.

Until recently many facilities were serviced by long running GPs; however, there are now significant gaps in coverage across both the Sunshine Coast and Brisbane

The recent retirement of a Brisbane based GP, who at one stage visited 9 Supported Accommodation facilities which capacity for ~400 residents, has left a chasm in the availability of primary care to our residents.

This has increased the risk to the health of our residents.

A shortage of bulk billing GPs on the Sunshine Coast has led to providers needing to call ambulances or transport residents to emergency wards to attend to their primary health care needs (in some cases simply to renew scripts).

This is terrible waste of time, money, resources and is a significantly worse outcome for all.

2.8. Ongoing Funding for SAPA

SAPA is a volunteer run organisation which until recently was funded solely by member contributions.

SAPA holds monthly meetings, provides support to members and an information line for enquiries.

SAPA advocates for and represents the sector in many intergovernmental committees and in other bodies on a regular and ad hoc basis.

• Health and Disability Interface Advisory Group
• RTA Stakeholder Working Group
• Residential Services Quarterly Stakeholder meeting
• Disaster planning

SAPA has successfully obtained several grants in the recent past to undertake 3 key initiatives including commissioning:

• Micah Projects:
  • Client needs-Level 3 Supported Accommodation
  • Resident case studies and videos
  • Limited assessment through the Vulnerability Index — Service Prioritisation Decision Assistance Tool (VI-SPDAT)
• Industry Development
  • Staff Induction and Training
  • Peak Body services, including undertaking
    • Queensland Disability Network (QDN) — SAPA Report: Issues Impacting Residents
    • Queensland Level Three Support Accommodation Facilities

• Industry conference
• Establishment of a non-clinical assessment for the sector
  • Work commencing Jan 2024

SAPA needs to assist and represent the industry as we navigate this inquiry, the subsequent regulatory review and the period of design and transition.

SAPA requires stable peak body funding to employ qualified staff to assist the industry with the transition.

We call upon CSSC to recommend the ongoing peak body funding of SAPA.

3. Industry Viability

The Supported Accommodation sector in QLD is not commercially viable. Low revenue, highly complex operating environment, and high fixed (and rapidly increasing) cost base combine to leave the sector in a precarious position. Unlike NDIS, My Aged Care, and other funded sectors, due to the absence of comparable funding the Supported Accommodation sector struggles to sustain its operations.

The industry is currently operated by both for purpose private enterprises (For Purpose) and the Not for Profit (NFP) sector. Historically, the NFPs have been unable to sustain their operations without grants, therefore leaving the For Purpose sector providers to fill the void. Repeated comment

To sustain their operations, the For Purpose service providers receive very low returns, often running at a loss and/or the individual operators themselves receive a very low wage. Many operators work in their facilities for a very little rate of return.

The sector is facing increasing viability pressure, driven by a confluence of factors including:

• Increasing numbers of complexity clients being referred with insufficient supports
• Effective cap on revenue as they are currently linked to Disability Support Pension (DSP)
  • Services provided are linked to the revenue that facilities can generate
  • No government support or funding
• Increasing cost pressures (wages, property, food and other supplies) growing faster than rents (linked to DSP)
• Increasingly complex and overlapping regulatory and legislative frameworks, at all levels of government
• Increased costs due to infection control and COVID safe practices
• Cost to ensure Workplace Health and Safety procedures are in place and all residents, staff and visitors to the site are inducted and completed emergency evacuation training
• Inability to find primary health care providers – a lack of GPs servicing health needs
• Increasing society expectations on care and accommodation delivery models
• Aging facilities in need of capital works programs

NGO’s have withdrawn from the space because of a lack of funding and industry knowledge and skills.

However; SAPA members are these on the front lines providing essential services. They are for purpose providers who seek to make a positive difference to the lives of our residents while also

returning an adequate return on their investment. No different to Residential Aged Care, NDIS, Childcare or many Hospitals.

Without the urgent provision of support many providers will be forced to close their doors leaving many residents without a home or supports.

3.1. Limitation to Annual Rental Increases

The recent changes to the tenancy laws in Queensland to restrict operators to annual rental increases has imposed an increased administrative burden on the sector and has increased the stress and anxiety placed on residents.

Rents are typically linked to the DSP which is increased twice per annum.

For example, if Mary comes in on 01/02/2023 her rent is due on 01/02/2024; if John comes in on 01/06/2023 his rent is due on 01/06/2024. Everyone will be paying different rates at different times depending on when they are due.

When the annual rental increases are imposed, the rental increases will likely be higher than the most recent increase in the DSP.

The residents with cognitive disability don’t understand the increase in rents is annualised and why they might be paying more than the next resident, even when we explain the dates are different. It’s confusing for the residents.

Before Board and Lodgings were raised twice per year in line with the DSP increases. All residents board and lodgings went up at the same time, in line with the pension increase. No one was disadvantaged, everyone understood the routine and how it worked. Now it not only is confusing for everyone, but it is also an administrative burden

This has put further strain on providers as rental increases are not able to keep pace with the rising costs of wages and services.

4. Who is SAPA?

The Supported Accommodation Providers Association (SAPA) is a not-for-profit, volunteer run and until recently solely member-funded, peak industry organisation advocating for the future of the residents of accredited Residential Services in Queensland.

We are committed to advocate for both Supported Accommodation providers and their residents, working collaboratively with all stakeholders, striving to elevate industry standards and ensure vulnerable individuals have access to safe, secure, and affordable accommodation throughout Queensland.

SAPA has extensive experience in the supported accommodation sector and the needs, aspirations and rights of the residents its serves. It also has extensive experience in how government policy, legislation and programs impact on the sector, its residents and their families.

SAPA represents 18 Supported Accommodation facilities with capacity for 683 number of residents from across the state.

5. Sector Background & Regulations

L3 Residential Services (Supported Accommodation) form an important part of the Queensland residential rental sector, providing vulnerable members of our community have a safe place to live.

Supported Accommodation provide services to residents at no costs to government, but this is no longer sustainable.

Supported Accommodation providers often fill the accommodation and care gap between NDIS (disability) and Health (hospitals). *“Supported Accommodation facilities are considered to be ‘quasi-hospitals’ by hospitals and other Government and non-Government support providers”*¹

We provide a home for people facing various challenges in life who are desirous to live in the community, by providing them a safe, stable and dynamic environment.

Our residents come to us with many different needs, including: acquired brain injuries, mental health issues, and intellectual disabilities.

Supported Accommodation’s seek to maximise both the health and the wellbeing of our residents. Not only do we work closely with various medical and allied health professionals, but we also collaborate closely with multiple community groups and NGOs to facilitate our residents’ participation in community access activities.

The residents have complex behaviours and many lack sufficient supports. While they may meet the functional definitions to register with the NDIS, many are not on the scheme. This includes individuals living with various challenges in life, usually across the spectrum of lived experience of mental illness and/or other forms of disability (see section 6 Who Lives in Supported Accommodation below)

Without facilities such as ours, the most vulnerable people in our society are often lost in the cycle between Queensland Health, crisis accommodation, government provided housing and homelessness. Through no fault of their own these people are left circling around the system as they are provided unsustainable or inadequate accommodation and support and therefore any housing solution, no matter how well intended, fails to address their long-term needs.

Supported Accommodation facilities break the cycle of homelessness for people who are out of options. They are both economically and socially sustainable and service the needs of some of the most vulnerable people in our society.

Providers, like our SAPA members, are set up to break this cycle by providing a housing solution with supports to keep residents safe, stable and cared for. Many residents move in because they are often looking to join an understanding and supportive community in the absence of other support networks. While there may be some difficulties at times, our residents feel comfortable and accepted by their peer group. They are often shunned or mistreated by people in mainstream society.

Supported accommodation facilities are not quasi hospitals, but a home for vulnerable residents with a base level of support provided across the facility (See the supported provided in section 5.1 Accreditation below). Supported Accommodation take the pressure off emergency services,

¹ Client needs-Level 3 Supported Accommodation (SAPA report), Micah Projects, 2023

hospitals, and the justice system by giving residents short- and long-term alternatives to transition to us through various pathways.

Residents may stay anywhere between the period of a few months, few years or for many they regard the facility as their long-term home of choice.

Generally, those with a Level 3 agreements are on a limited income, most often the Disability Support Pension.

5.1. Accreditation

All accredited Supported Accommodation (level 3) must also meet level 1 accreditation standards. A level 3 (personal care / Supported Accommodation) service provider may elect not to be accredited for level 2 (food service).

Prior to meeting the standards of the Residential Services (Accreditation) Act 2002, providers must first provide:

• Building Compliance Notice MP 5.7 – Residential Services Building Standard
• Fire Compliance Notice – MP 2.1 - Fire safety in budget accommodation buildings
• Food Licence (for those applying for Level 2 certification)

5.1.1. Accommodation service – Level 1 (compulsory)

• Communal Area Cleaning
• Electricity
• Water/Utilities
• Building and Grounds Maintenance
• Access to onsite facilities, unassisted e.g. Tennis Court, Swimming Pool, Pool Table, Table Tennis etc.
• Room Cleaning (Personal space) generally once per week
• Clean set of Bed Linen and Towels
• Generally, a single staff member onsite for emergencies 24 hours, 7 days
• Telephone access | - privacy and confidentiality
• agreement for residency
• prevention of abuse and neglect
• grievance mechanisms
• access to external service providers
• entitlement of residents to independence and freedom of choice
• living environment
• security and emergencies
• business management
• human resource management. |

5.1.2. Food service – Level 2

• Meal Preparation and Delivery - As per the Menu displayed in the dining room each day. (Breakfast, Morning Tea, Lunch, afternoon tea, Dinner and supper)
• All other food/meals/snacks are at the Customers expense | - food and nutrition
• kitchens
• food handling and storage |

5.1.3. Personal care service – Level 3

Accredited Level 3 services are able to offer the following services. Individual facilities offer varying models of inclusions and fee structures for services.

• Assistance with regular medication and PRN often completed at no charge
• Help with finances and clerical tasks
• Assistance with Tobacco Management
• Reminders and coordination of appointments
• Liaison with health providers, including hairdressers, podiatrists, dental, etc
• Assessment and ordering of personal care products
• Aid in sustaining relationships and social engagement
• Assistance in behaviour moderation and socialisation | - human resource management
• access to externally provided support services
• financial and clerical support
• assistance with medication
• health care
• clothing
• hygiene management
• preservation of social networks
• choice and decision making. |

5.1.4. Other Regulations to Meet Accreditation Requirements

As part of the accreditation process, facilities must also comply with

• Healthy eating in supported accommodation toolkit
• Guideline for Medication Assistance

5.1.5. Staff Training

In order to meet accreditation requirements, Supported Accommodation providers must ensure that their staff are suitably trained in

• Annual First Aid and CPR training
• Self-Assistance in Medication, consistent with HLTHPS006 Assist clients with medication
• At least 2 food safety supervisors compliant with Food Safety Legislation 3.2.2A
• Food Handler Certificate compliant with Food Safety Legislation 3.2.2A
• Healthy Eating in Supported Accommodation Modules
• Registered associates (under the act) must hold current National Police Check
• Fire Safety Training for staff annually

SAPA recently rolled out industry wide training and materials for staff induction and training. This is an 8-model toolkit designed to introduce new workers to the sector

https://sapa.org.au/resources/residential-services-induction-toolkit/

Industry Certifications

Even though not mandatory, providers may encourage staff to obtain the following additional training. Usually, staff pay for this themselves. Please note, even under NDIS it is not mandatory to hold any of the qualifications listed, including the mandatory training above.

a) CHC33021 – Certificate III Individual Support (Disability and Aged Care Units) b) CHC43315 Certificate IV in Mental Health c) Mental Health First Aid

In House Training – Non-Accredited

It is commonplace for Supported Accommodation providers to provide pre-start, ongoing and on-the-job training for employees. This is to ensure that all employees have a consistent skill and are set up to succeed in the sector.

a) Corporate Induction – Policy and Procedures etc. b) Site Inductions c) Buddy shifts d) Fire Safety onsite induction e) Assistance in Medication f) Infection Control g) Managing Challenging Behaviours / de-escalation h) Understanding Mental Health i) Documentation and Reporting j) Feedback and Complaint Handling k) Sexual harassment l) Whistleblower

5.1.6. Staff Costs

The industry standard for staff wages is guided by Fair work Australia and most employers in the sector are linked to the Social, Community, Home Care and Disability Services Award MA000100 (SCHADS Award). Some providers use Enterprise Bargaining Agreements which are generally linked to the SCHADS award.

The high cost of wages, particularly penalty rates for weekends / overnight is a key determining factor of the level of services that a facility can provide.

5.1.7. Regulatory and legislative frameworks

The sector is subject to increasingly complex and overlapping regulatory and legislative frameworks across all levels of government. Compliance with the independent processes takes considerable staff resources away from font line services.

It is difficult for providers to stay on top of these obligations while focusing on their primary care responsibilities without any funding or government support.

SUPPORTED ACCOMMODATION

5.1.8. Regulation and Inspections

Supported Accommodation providers are subject to compliance and regulatory obligations, which may include both announced and unannounced inspections, from the following agencies:

• Safeguards
  • Residential Services Unit (Dept Housing)
  • Community Visitor (Office Public Guardian)
  • Residential Tenancy Authorities (RTA)
  • NDIA Safeguards Commission (where a NDIS service is carried out)
  • Representative members (council ward members, state members, federal members)
• Food
  • Residential Services Unit (Dept Housing)
  • Local council – food safety
  • Community Visitor (Office Public Guardian)
• Accommodation
  • Residential Services Unit (Dept Housing)
  • Local council – building compliance.
  • Fire safety inspectors (independently contracted by providers to ensure compliance)
  • QLD Fire and Emergency (QFES)
  • Services Australia (Centrelink)
  • Residential Tenancy Authorities (RTA)
  • Office of the Public Trustee
  • Community Visitor (Office Public Guardian)
  • Representative members (council ward members, state members, federal members)

6. Who Lives in Supported Accommodation

Residents living in Level 3 Residential Services generally have some form of disability².

Many residents are living with a combination of mental health and physical health illnesses. A limited study recently commissioned by SAPA and undertaken by Micah Projects into the needs of the sector found the following:

Demographics

• Average age is 50 (ranging from 18-72yo)
• 5% indigenous
• 75% male
• 50% resided there >5 years
• 90% are on the Disability Pension

Health

• 100% have Mental Health issues (70% diagnosed with schizophrenia)
• 73% dual / tri morbidity issues
• 91% disclosed a history of chronic health issues
• 85% smokers

NDIS / Other Supports

• ~50% have NDIS (typically personal care, daily living and community access)
• Significant barriers exist to getting access to or appropriate levels of support
• Limited other supports currently available

Other

60% finances managed by Public Trustee

6.1. Forms of Disability

Generally speaking, residents may be living with one or more of the following:

• Psychosocial Disability, including: Schizophrenia, Paranoia, Anxiety, Depression, Bi-Polar, low Emotional IQ;
• Intellectual Disability, including: ADHD, Autism, Down Syndrome, Foetal Alcohol Spectrum Disorder, Developmental delay. (Consistently score below 70 to 75 on a standardized IQ test.);
• Cognitive Impairment, including: a person who has trouble remembering, learning new things, concentrating or making decisions that affect their everyday life (which may not affect or be indicated by a person’s IQ score);
• Alcohol-Related Brain Injury (ARBI), including: Korsakoffs

² Client needs-Level 3 Supported Accommodation (SAPA report), Micah Projects, 2023

• Acquired Brain Injury (ABI)
• Neurological Disease, including: Huntington’s Disease, Cerebral Palsy, Epilepsy, Dementia;
• Health Disease, including: Diabetes, Allergies, Cancer, Parkinsons Disease, High and Low Blood Pressure, Dysphagia requiring specialised diets, Dental
• Physical Disability, including: requiring a physical aid to be mobile e.g. Wheelchair, Wheelie Walker
• Sensory Impairment, including: hearing, visual, touch, taste, smell; and
• Addictive Behaviours such as alcohol and other drugs (AOD)

6.2. How Residents Came to Live in Supported Accommodation

Many residents of diverse backgrounds actively choose to call Supported Accommodation their home. Some of which have lived in their chosen facility for many years.

While for some, Supported Accommodation is transitional, they may be recovering from a crisis or a health episode and need a little extra support while they take stock and rebuilt. They may be referred to Supported Accommodation by a professional advocate or health professional and their length of stay may vary depending on their complexity and the ability to find longer term accommodation.

While for a small minority, they have limited choice due to health and guardian requirements and do not actively choose to live in Supported Accommodation. These are generally complex residents with an extensive history of behaviours of concern and often have overlapping medical requirements. They are placed in Supported Accommodation by their legal guardians, often the Office of the Public Guardian (OPG).

Flow chart of referrals

Into our facilities

The following chart highlights some of the common referrers to Supported Accommodation. The sector plays an important part of the Queensland residential rental sector, providing vulnerable members of our community have a safe place to live.

6.3. Case Studies

Janet redacted: s47F - Personal privacy

Janet’s life has been marked by a series of relocations and challenges, navigating a complex web of health issues and social circumstances. Diagnosed with schizophrenia at the age of 20, she has been on a Disability Support Pension for many years. Despite facing rejection from the National Disability Insurance Scheme (NDIS) in North Queensland, she is determined to reapply while residing in Supported Accommodation . Originally from Sydney, she moved to North Queensland in her 40s to

be closer to her sister, her primary caregiver, and spent two decades in public housing in Inala. Recently relocating to Brisbane to be near her daughter and grandson, Janet battles cardio-obstructive pulmonary disease, limiting her ability to walk. Her history includes a period of heroin use, initiated at 18 by a former partner, and she turned to sex work to fund her drug habit. Over the past few decades, she has shifted from needle use to methadone. Janet faces challenges accessing healthcare, struggling to find a GP for methadone prescriptions and facing a 12-month waiting list for an in-patient detox program. While appreciating the freedom in Supported Accommodation , she grapples with the trade-off of limited privacy and a concrete, noisy environment. Despite these difficulties, Janet remains resilient and relies on her daughter for support, recently obtaining a taxi subsidy card to assist with transportation.

Watch a video about ‘Janet’

Ben redacted: s47F - Personal privacy

Ben’s journey with schizophrenia began at 25 while working independently as a mechanic in NSW. The diagnosis brought a sense of relief, acknowledging the presence of ‘hearing voices.’ Before this revelation, he faced involuntary mental health admissions, job loss, and a transition to public housing. Living with his mother in public housing proved temporary, as he was eventually asked to leave due to his use of marijuana and alcohol, substances he relied on to cope with anxiety. Currently residing in Queensland since his mid-30s, Ben has been in Supported Accommodation since 2007.

Despite being on a disability support pension since his mid-20s, Ben initially resisted schizophrenia medication, finding it made him ‘dopey and tired.’ A trial with a medication depot, though painful, shifted his perspective, leading to a willingness to take medication that now keeps him settled and aids in sleep. Although he experiences side effects with clozapine, such as drooling, dizziness, and constipation, he expresses overall contentment with its impact.

Securing NDIS support two years ago marked a positive turning point for Ben, enabling him to engage in outings, attend the gym, and access various forms of counselling and support services. He sees NDIS as a transformative and socially positive change, enhancing his overall well-being.

In his Supported Accommodation , Ben finds a supportive community, considering fellow residents as his best friends. He values the excellent food and the relief from the stress of bill payments. While expressing a desire for improved room amenities like air-conditioning and fans, he acknowledges potential challenges with increased power bills. Looking ahead, Ben hopes for a structured NDIS plan with a weekly roster of outings and a focus on trauma-informed counselling.

Watch a video about ‘Ben’

Chris redacted: s47F - Personal privacy

Chris has been in Supported Accommodation for two weeks, previously spending two months in the same home and visiting family in redacted: s47F - Personal privacy. redacted: s47F - Personal privacy native, he moved to Brisbane in 2003 to distance himself from family, living in public housing. Diagnosed with paranoid schizophrenia in 2010 while working as a boilermaker, he has been on disability support pension since 2011.

After losing his job, Chris experienced homelessness due to struggles with his flat. In 2010, he spent six months in a Brisbane mental health unit after using drugs and alcohol to cope with auditory hallucinations. Following this, he spent four years in a community care unit’s group home and another four years in public housing with his brother before finding it overwhelming.

Receiving NDIS support two years ago, Chris has enjoyed participating in art-related activities, art festivals, and classes, enhancing his social engagement. Recently diagnosed with kidney disease and diabetes risk, he collaborates with NDIS to secure increased funding for a move to supported independent living (SIL) for more privacy.

Although he no longer uses drugs, Chris drinks at least weekly for relaxation. He visits his sister fortnightly for shared activities like drinking and listening to music. While content with his own room, he desires a larger one with a fan and air-conditioning, noting reduced stress in Supported Accommodation.

Expressing a need for Supported Accommodation tailored for Aboriginals, Chris emphasizes the importance of increased focus on mental health.

Watch a video about ‘Chris’

Nancy redacted: s47F - Personal privacy

Nancy has been in Supported Accommodation for 7 months since August 2022 after a relationship breakdown left her unable to afford rent. On a disability support pension since age 27, she was diagnosed with autism, borderline personality disorder, and attention deficit and hyperactivity disorder, finding it a relief.

Having received NDIS funding in 2019, Nancy is awaiting reassessment for increased funding to move into a supported independent living facility. Funding covers an occupational therapist, administration, psychology, and psychiatrist. She’s in the process of reassessment for a SIL home with residents her own age.

Nancy, with a degree in education/linguistics, worked as a language teacher for 15 years but couldn’t continue due to mental health issues. She dispenses her own medications.

Expressing a sense of unsafety at her current facility due to age and sexuality, Nancy feels bullied by the manager for raising concerns. She believes the facility is failing in its duty of care and finds the bullying triggering due to childhood trauma associated with her mother and undiagnosed mental health issues.

Watch a Video about ‘Nancy’

7. Resident Views

SAPA advocates for the rights and views of residents living in our sector to government and providers.

The range of individual circumstances for each resident gives differing perspectives of the sector and the services offered.

Resident feedback can be broadly broken down into several categories

Feedback

| Accommodation | Pro:

• Likes single room and the privacy this provides
• Likes the quality of the food
• Enjoys living in a diverse community
• Likes the location and that its walking distance essential amenities

Con:

• Desires more personal space — single rooms and ensuites

• The rental costs are too high

• Better access to digital devices, internet / Wi-Fi | | Services | Pro:

• Assistance with laundry

• The Supported Accommodation assist to provide daily activities like community access (bank, Supermarkets)

Con:

• Wants more support for community access, particularly on weekends
• Friends getting NDIS services, but they are ineligible as they are >65 years old
• Prefer a greater range of food and to better cater to individual preferences
• House mates needing support for toileting and leaving the bathrooms soiled
• General cleaning concerns
• Confusion by some on who provides their supports — the Supported Accommodation facility or the NDIS
• Not able to engage with their support coordinator in person |

| Broader Mental Health / Health Sector | Pro:

• Assistance with medication
• Supporting moderating behaviour and promoting appropriate socialisation |

Residents are asking for:

Karen indicates a desire for more opportunities to go out, including drives and attending church on Sundays. Limited transport options on Sundays poses a challenge.

Karen mentions not having access to NDIS due to being over 65, limiting the funding options available to her for additional support or activities.

Craig values his content living environment, appreciates support for daily activities and NDIS assistance, yet notes a recurring issue with toilet facilities and a limited 8-hour weekly support, without specifying additional concerns during his five-year residence.

Other Comments Received

• “My NDIS support coordinator won’t come out to meet me because they say it’s too far for them.” (Resident feedback)
• “One time I fell out of my mobility scooter and was waiting on the floor for 45 minutes for the ambulance to come and I was butt crawling my way around.” (Resident feedback)
• “When our support workers are sick, and they don’t show up we can’t go anywhere” (Resident feedback).
• “There is only so much that they can do and assist with, as well as balancing all the other responsibilities of their role. There needs to be a service through the NDIS to step in and support residents with appointments and outings when facility staff are not able to” (Resident feedback).
• “I’m not sure who funds my supports or who is funded to do what in assisting me!” (Resident feedback)
• “Staff members already know residents and their support needs, and the service is time and cost effective, supporting several people on-site at the one time.” (Resident feedback)
• “I have no money left to pay for a coffee with my friend” (Resident feedback).
• “I can’t afford medical care on the DSP, even with bulk billing” (Resident feedback).
• “The increases automatically happen whether justified or not” (Resident feedback).
• “As a woman I didn’t always feel safe and confident to raise some personal needs” (Resident feedback).
• “It would be good to have a home environment, not just a boarding house.” (Resident feedback).
• “It would be good to have a peer group where we have technology and study…I want computer help and to be able to use technology such as tablets.” (Resident feedback).
• “There is no Wi-Fi here, it would be good to have it here for people to be able to make free phone calls to services, access online services, for example, you can’t access Centrelink and other essential services now without connection.” (Resident feedback).
• “I would jump at the chance to live on my own” (Resident feedback).

• “Some people don’t follow the rules here.” (Resident feedback); or anxiety around repercussions around their stay or worry about not being understood.

8. What Supported Accommodation Provides

The Supported Accommodation Industry in Queensland saves the Federal and State Governments millions of dollars per year, supporting vulnerable Queenslanders in the community. A full cost benefit analysis/viability study would be required to accurately gauge exact costings, but when you consider the funding as listed below in the comparison table you will see the difference government funding has made to other sectors.

8.1. Rates charged

Supported Accommodation is unfunded and all income and service levels is determined by the rents charged to residents.

Resident Income

A resident over the age of 21 on the Disability Support Pension (DSP) receives a fortnightly income of $1,281.50 (including rental assistance and supplements – Total DSP). All residents of Supported Accommodation are eligible for rental assistance and supplements.

Typical Board and Lodging fees:

Residential Services generally charge a percentage of the Disability/Aged Pension, including allowances, for all three levels, however this can change between services.

As an example:

Level 1, Level 2 and Level 3 Services

a. up to 85% of the Disability/Aged Pension including allowances. b. up to 85% of the Disability/Aged Pension plus 100% of Rent Assistance

Some services charge per level e.g. (This will vary between operators)

a. Level 1 – Accommodation may be 45% of DSP including allowances b. Level 2 – Food may be 25% of DSP including allowances c. Level 3 – Personal Care 15% of DSP including allowances

Residents typically have approximately $200 per fortnight left over for personal expenses such as clothing, medication, outings, tobacco products etc.

Cost to Residents

A breakdown of the cost to the resident’s vs the Total DSP income, including allowances, they receive clearly dispels any myths that the sector is unaffordable. It is simply untrue to assert that residents have “very little money being available to spend on other goods or services.”

In fact, the sector provides very good value for money for residents when compared to renting in the private market. The figures above are usually inclusive of all levels (1, 2 and 3). See the breakdown of levels on the next page.

Supported Accommodation Inclusions

There a different service and fee models across the sector, but these rates typically include:

• Board and lodgings (including all utilities)
• All meals
• Cleaning of common areas
• Weekly room clean and linen change
• Internet / Wi-Fi services
• 24/7 onsite staffing
• Assistance with medication (a high risk support)*
• Weekly GP visits
• Financial and clerical assistance, including arranging of supports and coordinating with clinical carers
• Emergency / ad hoc supports in the event of incident

* May be charged separately by some facilities – often under NDIS

Additional services, such as regular daily living supports (shower and hygiene services) have never been provided within this cost structure by the sector.

There is a lack of knowledge and understanding within the community sector of what services are provided within Supported Accommodation and at what cost. This drives a negative perception of the industry by some advocates.

While it may be desirous for accommodation rates to be reduced, Service Providers are unable to do so and keep their doors open and continue to provide this invaluable service to an underserved and vulnerable cohort.

8.2. Unfunded supports

Supported Accommodation facilities are providing various essential unfunded supports. The cost of these are crippling the industry, but providers are unable to withdraw these due to safety concerns.

In effect, Supported Accommodation keeps people safe and off the streets. Diverting them from government services.

We give people a home and provide support at all times, when no body else is there, we are.

8.2.1. Care for complex residents without funding

Facilities are being referred residents with levels of complexity not seen previously in these spaces. Facilities are providing various supports in order to keep residents safe.

Many of these residents have:

• No NDIS support
• Insufficient NDIS support (i.e. not covering after hours or weekends)

Our residents require access to support on a 24 hour continuous basis, their needs do not cease after business hours or nights or weekends.

Those residents with NDIS supports have limited hours of support. This does not allow for support when they need it after hours or on weekends. It fails to consider that people with mental illness have cyclical escalations.

Supported Accommodation staff are there to monitor and mentor these residents and assist in de-escalation strategies when required. The staff have a good relationship and understanding of their residents As they work with them 24/7. Residential staff are well placed to note changes and coordinate with health and allied health professionals.

8.2.2. Case management

Supported Accommodation provides unfunded case management for their residents, these services generally include:

• Transitions into the facility
• Coordinating and organise health supports – health, allied health, blood checks, appointments
• Coordinate GP access
• Medication services – ordering, payment, , delivery and safe storage
• Community access and travel cards and other supports to ensure residents are able to safely access the community
• Coordination of external activities such as music, church and other community based services
• Assisting to gather evidence and coordinate assessments to access the NDIS
• Assisting to coordinate NDIS supports in the absence of effective support coordination
• Assisting to coordinate money and cigarettes
• Transitioning out of the facility

8.3. Comparative of Industry Service Offerings

Currently our sector is accredited by the Department of Housing — Residential Services. The accreditation is split into three levels (Please note, each registered provider offers slightly different options to each level. This usually depends on geographical location, or resourcing):

Comparison Table — Summary of comparable business services to L3

Accommodation (MTA) | Accommodation is not intended to go for more than 6 months however sometimes is extended due to individual circumstances.

MTA covers the cost of rent, electricity, water, gas only. It does not cover food or support services.

Comparison to L3 – MTA is only for accommodation so is comparable to the L1 part of a residential service only. It does not cover food (L2) or personal care (L3). As you will see from the table the daily rate is double that of a Residential Service offering all 3 levels. MTA is 100% NDIS funded.

| NDIS – Short Term Accommodation (STA) | This funding is available to approved NDIS participants who require a break from home for up to 14 days. It is only for a short break, but it covers all the same costs that a L3 does, so can be used for comparison purposes.

STA includes accommodation, food, personal care for the time that a participant is away from their home.

Comparison to L3 – Provides all the same services as L3 and STA is 100% NDIS funded. | | Public Housing | Public Housing is available to approved applicants. There is currently a waiting list for over 2+ years for anyone to be able to gain this approval. When approved, residents of government housing are not entitled to the Centrelink Rent Assistance, but usually they will be in receipt of a Centrelink Pension.

They are required to pay 25% of their pension as rent contribution plus electricity, gas, excess water, grounds maintenance if applicable.

There is no support service included with public housing.

Comparison to L3 – Public Housing only covers the cost of accommodation. A lot of residents entering L3 have come from Public Housing because they were unable to maintain a standard of living that isn’t detrimental to their health. They have been a failed placement in public housing. |

COMPARISON TABLE

This comparison table shows estimated pricing and funding lines for each style of comparable accommodation. Please see where we have referenced the source of the pricing listed at the bottom of the table.

NB: The following Comparison Table is for 14-day period for each line of service, so it is comparative.

³ https://www.myagedcare.gov.au/aged-care-homes

https://www.health.gov.au/our-work/residential-aged-care/funding/subsidy

⁴ https://www.ndis.gov.au/media/6130/download?attachment

https://www.ndis.gov.au/participants/home-and-living/specialist-disability-accommodation- explained#:~:text=Specialist%20Disability%20Accommodation%20(SDA)%20is,impairment%20oor%20very%20high%20needs

https://www.ndis.gov.au/participants/home-and-living/supported-independent-living-participants

https://www.ndis.gov.au/providers/pricing-arrangements

⁶ https://ourguidelines.ndis.gov.au/supports-you-can-access-menu/home-and-living-supports/medium-term-accommodation/what-medium-term-accommodation

https://www.ndis.gov.au/providers/pricing-arrangements

⁷ https://ourguidelines.ndis.gov.au/supports-you-can-access-menu/home-and-living-supports/short-term-accommodation-or-respite

8.4. Conflicts of Interest and the NDIS

8.4.1. Related NDIS Businesses

Some facilities provide NDIS services either through their Supported Accommodation entity or through a related entity.

There are many benefits to residents using an in house NDIS provider, including

• Existing relationships, trust and a feeling of security
• Efficiencies
  • Short appointments
  • No travel time
• Enhances choice and control
• Consistency and continuity of care
• Ease of management of resident conditions
  • Appointment coordination
  • Communication and working towards common goals
• Advocacy for residents not receiving the standard of care from other agencies that they require

8.4.2. Transparency and Potential Conflicts of Interest

The potential for conflicts of interest is something that all registered providers are familiar with and must be addressed during their NDIS accreditation.

Supported Accommodation Providers have clear Fee Schedule’s outlining their costs. If a Supported Accommodation Provider (or related entity) is also a NDIS Provider, then the provider must employ clear fee schedules and Conflict of Interest policies. It is the residents choice and control to be able to choose a suitable provider.

As part of the NDIS accreditation process all NDIS providers must have a robust Conflict of Interest policy. Any Supported Accommodation Provider operating across both spaces will have been audited and need to follow both the NDIS and Regulatory Services regulations.

Before commencement, all service agreements must be agreed to by the provider, resident, and their stakeholders, which often include their EPOA, Support Coordinators, the Office of the Public Guardian, and the Public Trust. All charges are clearly broken down with separate invoicing and service agreements.

9. Provider Views

Our members have provided consistent feedback on what they want to see in future industry reform.

Provider Feedback

10. A Mental Health System in Crisis

Supported Accommodation forms part of a broader ecosystem of support and accommodation for vulnerable Queenslanders.

To fully appreciate Supported Accommodation, the CSSC must understand the broader role it plays and its interactions within the system.

10.1. Common Barriers to Recovery and Independence for our Resident Cohort

ACCESS TO PREVENTATIVE & HOLISTIC HEALTH & CARE SERVICES

• Stretched systems not designed for psychosocial disability (PSD)
• Reactionary acute treatment as the norm

ACCESS TO HOUSING

• Affordability
• Stigma
• Housing crisis
• Suitable housing is out of reach

LACK OF DEFINED PATHWAYS

• Improved ecosystem needed
• Ability to step up / step down in their journey
• Limited integration of services from hospital into community

ENTRENCHED CYCLE OF HOMELESSNESS

Roadblocks to recovery leading to

• Justice interventions
• Health stays
• Loss of housing

Time with insufficient support increases risks & Roadblocks

10.2. Residents and the NDIS

Many residents are often given “the run around” between the NDIS and Queensland Health while their level of disability is discussed to be deemed profound or otherwise, many having their need for support grossly underestimated and not receiving the required support as a result.

The cyclical and varying nature of PSD is widely known as not working well within the NDIS system and the future of the NDIS and PSD is being assessed as part of the ongoing NDIS review.

On the ground this has translated to:

1. Accessing the system for residents is becoming increasingly difficult and is taking longer. Many “Access Met” applications are being rejected or sent back on endless requests for supporting information when comparable applications were granted access just 12 months ago. Many are being informed that it is a “health” condition and being outright rejected.
2. For those lucky enough to get onto the scheme, plan sizes are coming back smaller and smaller compared to plans for those preexisting on the scheme with similar disabilities.

3. Home and Living applications are taking upwards of 12 months to be approved, reducing the ability for those with the desire and suitability to be funded to move into alternative models of accommodation.

This is leaving more and more vulnerable Queenslanders residing in Supported Accommodation without any or insufficient support, despite clear evidence demonstrating their needs.

This is putting increases strain on Supported Accommodation providers who are having to support complex residents needs without funding.

10.3. Community Mental Health Programs

Queensland Health community mental health programs are overstretched and generally operate in reaction to crisis. Early or preventative care is increasingly rarely available to residents.

In practice, case managers are only assigned after an inpatient stay, meaning a resident needs to slide into psychosis and be admitted before they can be seen in the community.

MH Case Managers for those residents on the program are often over stretched and advise Supported Accommodation providers that they cannot attend to a resident’s needs, to wait until they slide to the point where an ambulance needs to be called.

While waiting for this to happen the resident will generally slide into psychosis, often over a period of days, causing increasing disruption to the other residents, staff and neighbours. Supported Accommodation facilities are left in extremely challenging position as residents slowly decline.

When deemed unwell enough for an ambulance and hospital to take them, often QPS support are need to be called to assist the QAS.

10.4. Acute Hospital Beds for Mental Health

Too often when unwell residents are taken to hospital for MH issues, they are not admitted and left to find their own way back to the Supported Accommodation facility.

This leaves Supported Accommodation providers to pick up the pieces and manage residents as they decline further. Sometimes sending them to emergency time and time again, only to have them return because there are insufficient beds in the MH wards.

10.5. Entrenched Cycle of Homelessness and mental health

Too often our residents are the forgotten ones

• Insufficient supports often lead to roadblocks →
• Interacting with multiple government agencies →

• Often leads to hospital admissions, QPS interactions and occasionally interventions from the Justice system.

When under supported our residents can interact with multiple government agencies resulting in high costs to the tax payer. These costs are poorly understood

Time spent with insufficient support increases risks

An anecdotal take on the resident homeless cycle in QLD today

UNABLE TO MAINTAIN HOUSING

ROADBLOCKS TO RECOVERY: Emergency Services (QPS / QAS)

POVERTY AND SOCIAL EXCLUSION | TRAUMATIC EVENTS | INEFFECTIVE SERVICES | BEHAVIOURS OF CONCERN

The Journey

• A resident may be discharged into inappropriate setting or into a setting without sufficient supports
• They are regularly lost between health and disability sectors (large and widening gap)
• They get lost between disability organisations
  • No ongoing case management
  • Organisational KPIs too narrow → lack of accountability in long term outcomes
  • Residents need to move organisations as they progress / regress in their journey
• Problems arise

• Lack of contact with previous organisation → resistance to any step back
• Delayed and reactive interventions
• Unavailable of supports after hours
• Often resulting in
  • Poor health
  • Social isolation
  • Increased emergency service usage
  • High rates of Health (hospital) readmission
  • Justice (prison) outcomes

10.6. Poor Mental Health Leads to Poor Physical Health

Studies have found that poor mental health MH has a direct link to poor physical health⁸

Those living chronic mental health conditions live with higher rates of diabetes, cardiovascular diseases, weight, high blood pressure, diet, smoking and low levels of physical activity

• 15-20 year shorter life expectancy for those living with a long-term MH condition
• 2/3 deaths are related to physical illness and could have been prevented
• 12-18% of total health costs linked to poor MH*
• 45% increase in health costs to treat physical illnesses for those living long-term MH conditions

⁸ The Kings Fund, Mental Health and New Models of Care, Lessons from the Vanguards, May 2017 & Homelessness Australia, Creating a Framework for ending homeless, Nov 2011

10.7. Underinvestment Leads to Worse Outcomes and Increased Cost

Each crisis socialises costs across government.

It is the firm belief of SAPA that underinvestment in accommodation and support to residents in their home, leads to

• Increased cost to government across multiple agencies
• Worse outcomes for residents

11. Supported Accommodation as Part of Bigger System

The Supported Accommodation sector and residents are part of a bigger health and community sector.

Each has multiple interactions with various agencies, departments and providers. Residents in facilities, due to their complex needs, require a lot of interaction with many Government Agencies. They are often very confused and anxious about what they need to do.

Service Providers are also required to interact with many government agencies in order to remain operational and provide services to residents living in Supported Accommodation.

The cost and the resource drain of poorly planned and reactionary interactions is not well understood.

Just a small part of the resident’s touch points with government includes Health and ambulance services. These alone cost the QLD taxpayer per night / trip on average:

• Acute metro hospital care $7,180^9$
• Long stay metro hospital care ~$2,000 per night^10^
• Ambulance per incident cost $877^11$

Targeted investment into inhouse supports and accommodation in Supported Accommodation will seek to

• Reduce resident interactions with government services (e.g. QPS, QAS, QHealth)
• Reduce overall government expenditure
• Increasing resident quality of life.

11.1. A place of last resort for many

Supported Accommodation has been described as a quasi hospital for discharge^12

Due to the complexity of behaviour and lack of supports, there is typically limited appetite from NDIS / NGO’s to take on clients transitioning out of clinical settings because of :

• Complicated and challenging behaviours
• Insufficient funding to be viable for them

As a result, many prospective residents have little options available to them for accommodation.

^9^ WorkCover Queensland, Public Health Services Table of Costs, Effective 1 July 2023

^10^ WorkCover Queensland, Public Health Services Table of Costs, Effective 1 July 2023

^11^ Queensland Ambulance Service, Public Performance Indicators, Facts, November 2023

^12^ Client needs-Level 3 Supported Accommodation (SAPA report), Micah Projects, 2023

11.2. Residents of Supported Accommodation & Government

Our residents have extensive interaction across multiple government agencies. Providers work to keep residents safe; but are limited in their ability to support all residents needs.

Many residents are known to Queensland Health as “frequent fliers” and many have been long stay patients in the past. Frequent trips to hospital are often via over stretched ambulance services.

Please see the following table for a more extensive list of the state and commonwealth government agencies that our residents have common interactions with.

[Diagram showing residents connected to multiple state and commonwealth government agencies, departments, and services including Corrective Services, Centrelink, Medicare, Dept Veterans’ Affairs, NDIS, My Aged Care, Hospitals, Community MH, Drug & Alcohol Services, Allied Health, Dental, QCAT, Courts, Legal Assistance, Office of the Public Guardian, Community Visitor, Public Trustee, QLD Police, QLD Ambulance, Dept Disabilities, Dept Aboriginal and Torres Strait Islander Partnerships, Dept Housing, and Taxi Subsidy.]

Queensland Department [] Commonwealth departments

11.3. Exiting of Supported Accommodation

The following chart highlights some of the common avenues / groups which Supported Accommodation providers work with when assisting to transition residents on from their service

Far from being a close system, providers work with may NFPs, NDIS, advocates, government and other workers in the sector to assist residents to transition out of Supported Accommodation.

[Diagram showing Supported Accommodation centrally connected to Hospital, NDIS - SIL / ILO, Community Housing, Public & Community Housing, Affordable Housing, Other Supported Accom, Alternative low cost accom, Recovery Programs, Crisis Accom, and QPS / Justice, with a legend indicating Planned, Semi - Planned, and Unplanned transition types.]

12. Restrictive Practices

Currently Restrictive Practice does not apply to any Residential Service in Queensland. This is solely a requirement under the NDIS. If an NDIS participant, living in Supported Accommodation, requires a Positive Behaviour Support Plan (PBSP), we are only required to report any incident of Restrictive Practice to the NDIS Commission if that person is currently receiving NDIS supports at the time of the incident . It is worth noting that complex residents residing Supported Accommodation would generally only receive supports for several hours a day, being unsupported and otherwise outside of the NDIS reporting requirements for the majority of the time.

The cost of obtaining a professional PBSP is approximately $3500, which NDIS usually fund through a participants plan. Then there is the ongoing mandatory reporting around approved and non-approved restrictive practices with mandatory monthly reporting to the Commission. The time for staff to complete the necessary documentation is costly and time consuming depending on the level of Restrictive Practices used throughout the month. If the participant does not have an approved PBSP and a restrictive practice is used to keep them safe in the course of providing their NDIS services, this is considered a non-approved restrictive practice and requires reporting within 24 hours to the NDIS Commission.

12.1. Safety For All Residents and Staff

Please note, due to the complexity of resident behaviours within the Supported Accommodation sector, it is important that providers have the autonomy to evict, in a timely manner, or remove from site, a resident who is threatening themselves or the safety of others. We must retain to ability to keep other residents and staff safe when a crisis occurs. If our industry is to fall under restrictive practices, especially non approved restrictive practices, it would increase the risk to others if we cannot remove the threat. Providers should not be penalised for keeping others safe. The result of resident threatening others creates a ripple effect that negatively impacts others causing others to escalate at the same time, which makes it extremely difficult to manage. The only way we could manage Restrictive Practices lawfully within the Residential Setting is to have sufficient funding to cover the additional costs for staffing, training, documentation and reporting etc.

It is also important to note that due to the diagnosis of many residents, house rules have been put in place to inhibit alcohol, weapons, and drugs on site. Any person intoxicated onsite or threatening behaviours adds to the risks during an evacuation. Intoxicated people may be aggressive, be at high risk of injury, interferes with medication interaction and puts staff under excessive pressure. Relationships with other people become affected, fights commence and before you know it there is a crisis which emergency services would be called.

12.2. Unintended Consequences and Red Tape

There are other complexities and unintended consequences of well-meaning regulations that need to be considered. For example, the Healthy Eating in Supported Accommodation guide (which has been mandated by the Residential Series Unit) is in itself a restrictive practices. It stipulates the types

of food that must be provided, reducing residents choice and control of foods. Additionally, many residents have mental health illnesses taking psychotropic medications, this induces an increase in appetite and decrease their ability to know when they are full. Therefore, many residents have eating disorders, which require support, guidance, and management.

This guideline does not fit modern day practices around choice and control, it should be used as a guideline only and not be mandatory.

Restrictive Practices are complex, need to be duly considered and appropriate funding needs to be provided to ensure that they can be complied with appropriately.

Rushed or ill-considered changes will not be achievable without support.

13. A Vision for the Future

We need to rethink how Supported Accommodation can continue to play a critical role in supporting many vulnerable Queenslanders.

Supported Accommodation should be funded with clearer outcomes developed.

The standards of services provided can be raised commensurately with the levels of funding provided to the sector.

Regulatory overlap should be simplified and overlapping regulations either removed or made consistent.

CSSC and the Queensland Government should work with sector, experienced hands-on operators, building on their decades of experience. This will lead to the most optimal and practical outcomes.

The Queensland Government investment into the sector will lead to life changing outcomes and ultimately save the taxpayer money by reducing the drain on other government services by residents

13.1. Urgent call for immediate funding and Regulatory Review

With rents linked to DSP and spiralling costs, many Supported Accommodation providers are running at a loss, with residents unable to pay more and providers unable to provide more we are requiring urgent assistance from Government.

SAPA advocates for funding to be looked at under 3 separate frameworks

4. Immediate and urgent needs to support sector viability and improve service delivery
5. Study and roll out an improved models of care
6. Study and consider implementing a new level of accreditation — Step up / step down model (Level 4)

Summary of Funding & Regulatory Requirements

13.2. We need an Integrated Approach to Break the Cycle

[Diagram showing a continuum from Acute Care through Boarding Houses, L3 and other housing (varying levels of oversight & residential support) -> Semi Independent (live-in supports) -> Independent Living (drop-in supports) -> Fully Independent Living, spanning across Health and Disability (NDIS) domains.]

We need an integrated approach to bridge between

• Health
• Community services; and
• Housing

A holistic model to break the cycle of homelessness and disadvantage for our residents

In order to get the desired outcomes, the Queensland Government must invest into the sector and the vulnerable people it homes.

13.3. Improved models of care- What we can provide with funding

Funding at the facility level can improve quality of life and reduce the drain on mainstream government services through

• Investment in staff, facilities, resources, supports
  • Training key
    • Provider level training — SAPA to undertake on industry level
    • Staff
• Improved models of support
  • Formalised case management (at the facility level)
    • NDIS access met, H&L / ILO & SIL applications (outside of scope & budgets for support coordinators)
    • Navigating housing (out of scope of support coordinators)
    • Working with residents during transitions (high risk periods for roadblocks)
    • Coordinating regular stakeholder coordination sessions (health, mental health, allied health, guardians, supports, housing etc)
    • Ongoing check-ins / collaboration with care providers
    • Recommendation supported by Micah Projects recent study into resident needs^13
  • Support work for unfunded residents
    • Immediate supports for new residents daily and social needs
    • After hours and ad hoc care for when outside of NDIS funded periods
    • Provide wrap around supports and stabilise residents.
    • Includes:
      • Newly discharged
      • Insufficient evidence
      • Not engaging

^13^ Client needs-Level 3 Supported Accommodation (SAPA report), Micah Projects, 2023

• 65

• Non Australian
  • Ability to provide facility level groups and physical activity
  • Funded access to occupational therapists and other allied health
  • Funded access to dentists
• Reduce rents paid by residents
• Capital
  • Modernisation
  • Private room / ensuite
  • Improved and modernised fire systems
  • Airconditioning
  • Improved living spaces
• In line with govt and contemporary expectations
• Resident support programs

13.3.1. Bridging Health & Community

Removing barriers to discharge

• Close coordination and planning
• Stakeholder approach
• Staged discharges
• Supported facilities

13.3.2. Facilitated Pathways

• Providing stepping stones on the path to independent living
• Affordable, available housing
• Step up and down processes
• Integrated approach
• Use of various funding models on the journey (DSP, Flex Core / Concierge, SIL, H&L)
• Coordinators to plan processes

13.3.3. Consistent Care Teams

“Many residents of level three SA have no existing family support network or are estranged from family members. The prioritising and continuity of support from carers, staff and NDIS workers is therefore crucial for their ongoing wellbeing.”^14

• Walking the journey alongside
• Person centred focus
• Trust and rapport

^14^ Client needs-Level 3 Supported Accommodation (SAPA report), Micah Projects, 2023

• Earlier identification of issues
  • 2-way communication with stakeholders
  • Health teams, allied health, disability, NDIS, guardian etc

13.3.4. Holistic Model of Care

The support the new model of care, a holistic approach to support and housing should be considered

A model of care that takes into account all facets of a residents needs so as to give them the best chance of living their best lift, limiting roadblocks and thereby reducing health and justice interventions

[Diagram showing a cycle between Housing, Social, Mental Health, and Physical Health]

13.3.5. The Ideal Future

• Reduction in barriers to entry to treatment of physical health a key priority
• Health checks / screenings
• Improved 2-way collaboration between mental health and other physicians, treating teams, community supports housing (not simply a referral process without follow up)
• Increased treatment in safe spaces (home)
• Increased focus on prevention (sub threshold symptoms / early intervention)
• Rapid access to mental health services when needed

13.3.6. Keys to this Success

• A comprehensive care model → MH / Allied Health / Wellness
• Scalable
• Sustainable funding
• Strong systems with focus on quality, compliance and outcomes
• Comprehensive staff training throughout
• Good data with strong feedback loops → Regular / coordinated cross team dialogue
• Consistent staffing → Good organisational memory

13.4. A new model - Step up / step down model (Level 4)

There is a gap in the system between clinical hospital settings and the community, such as Supported Accommodation.

SAPA advocates that CSSC should look at an additional model of care, a Step up / step down facility (Level 4).

This facility is envisaged to a semi-clinical and act as

• A point for earlier discharge from hospital
• A diversion facility to keep those with declining mental heath out of hospital

What an improved sub clinical level of care model of care might look like

13.4.1. Operations

• Onsite staffing to include
  • Team Leader
  • MH Nurse
  • Case worker
  • Support Workers
    • Surge workers
  • Admin
  • Facility management (cooking, cleaning, maintenance, landscaping etc)
• Supported by
  • External
    • Clinical psychologist (QHealth stakeholder group)
    • GP
    • OT
    • NDIS liaison
    • Other allied health professionals
  • Internal
    • Snr management and governance
    • Quality & Compliance
    • Training
    • HR / Recruitment
• Case management role to include
  • Ensuring smooth transitions (in / out)
  • Driving processes
    • Functional assessments
    • regular client stakeholder groups (health, allied health, NDIS, mental health, guardians etc)
    • NDIS applications (access met, reviews, Home & Living)
  • Coordinating capacity building / community access
  • Individual reporting
• Rehabilitation/Recovery Programs
• Triaging opportunity

13.4.2. Facilities

• Independent living spaces (up to 20 residents)
• Single level - multiple small buildings connected to a central cluster
  • Separate but connected
  • Ensuite
  • Courtyard
• Multiple break out / chill out areas
• Community areas
  • Encouraging and facilitating community
  • BBQ
  • Games and amenities
• Capacity building facilities
  • Cooking
  • Gardening
  • Other life skills
• Landscaped outdoor areas
  • Privacy / serenity
  • Promoting physical activity / Exercise
• Clinical facilities
  • Consult rooms
  • Medication storage
  • Nurse station
• Commercial areas
  • Admin
  • Kitchen
  • Laundry
  • Staff areas

13.4.3. Consistent Care and Plugging the Gaps

[Diagram showing a progression from Step Up / Down (sub acute clinical) through Transitional Housing (Integrated provider of accommodation, health & supports (L3, STA, MTA)), H&L / SIL Housing, Affordable Facilitated Housing, to Independent Community Living, with a banner stating ‘Consistent care team through the journey’]

14. Response to Specific Questions posed in the Public Advocate Report

The level 3 residential services model

1. Is the current model by which level 3 residential services are provided – which typically sees private providers delivering accommodation and support services at the cost of a majority of a resident’s Disability Support Pension – an appropriate one for Queensland into the future?

The costs align with other models of care including public housing when you consider everything that is covered in the Board and Lodgings fee. Please see SAPA report – Comparison table.

SAPA would welcome a government funded CBA into the costs and benefits of Supported Accommodation, then utilize this information to fund the industry directly.

The existing model of Level 3 residential services has developed in response to resident needs, addressing gaps in total care not covered by agencies funded for specific aspects of 24/7 care. It is regulated and monitored by state and local government. While some non-government organizations may replicate this model, it proves costly to the government.

2. Should new models of service delivery that meet the needs of particular cohorts of residents (e.g., residents with significant mental health concerns or with significant drug and alcohol use) be trialled?

SAPA advocates that the CSSC should investigate 3 further models of care to increase funded service delivery. Please refer to response in Section 13 - A Vision for the Future

SAPA does not believe segregation of disabilities is a good idea, safe community living is more about personalities and individual behaviours than disability conflicts.

Costs and charges

3. Are current charges for level 3 residential services reasonable?
   • a) Do they enable residents to have sufficient disposable income to ensure a reasonable quality of life?
   • b) Do they enable providers to deliver quality services on a financially viable basis?
   • c) Should a cap be placed on the amount that residents are able to be charged?

Please refer to responses in comparison table in section 8.3. for comparative analysis between sectors and section 8.1 for the breakdown of disposable income residents have after the payment for all board and lodgings.

As outlined in the submission above, the sector requires urgent financial assistance to remain viable in its current state and further funding levels to increase service levels.

Any rental cap would need to be accompanied by direct support for providers to ensure that they can remain open.

4. Should greater transparency be required of level 3 residential service providers concerning the fees charged for accommodation, food, and personal care services?

• The RTA Form R18 rooming agreement service agreement comprehensively outlines fees and charges, including NDIS charges. SAPA has collaborated closely with RTA to address transparency concerns, and this collaborative effort is ongoing.
• Confusion may arise for residents in Supported Accommodation as they encounter familiar faces providing support from both the accommodation and NDIS-funded services. This generally isn’t an issue with transparency per se, but often with capacity of residents.
• Any staff member acting in a dual role must acknowledge this change of service provision and clients sign for each episode of NDIS care provision.
• Residents have expressed their preferences and choices regarding who they prefer to provide their services, often preferring in house providers due to reasons outlined in section 8.4.1

Service standards

5. Do current service standards establish appropriate benchmarks for the provision of level 3 residential services, especially concerning personal care?

Personal Care definition needs to be altered to reflect current practice and viability for providers. Supported Accommodation does not have the capacity and never has carried out 1:1 resident care beyond ad-hoc emergencies.

6. Should the assessment of whether level 3 residential services meet particular standards require more comprehensive evidence, including increased on-site monitoring and more direct engagement with residents and relevant representative agencies?

Supported Accommodation already navigates a complex regulatory overlap between local and state government agencies – please see section 5.1.7 and 5.1.8 for an overview of the regulatory obligations of providers.

A change of the method of assessment is not required to meet accreditation standards. If anything, the regulations are very prescriptive in nature and give limited scope of service innovation.

However, a change in regulatory approach would be welcomed by the sector. The Residential Services Unit who oversees the sector is reactive in nature and compliance focused. There is little support or education provided to the sector.

Visits to sites are infrequent and often driven by complaints or 3 yearly accreditation audits

7. Should the residential services regulator be required to publicly report on the compliance of service providers with accreditation standards?

Residential Services already publishes the public register which includes and conditions placed on a service.

Any public naming and shaming must be carefully considered. It is not appropriate for regulator communication, quality improvement plans or other compliance actions to be made public. These are permanent in nature and may irreparably harm the reputation of a facility that may be quickly rectified.

Other care industry sectors do not publish this information unless in severe cases

Staff

8. Are current minimum qualification and training requirements for staff of level 3 residential services appropriate?

Refer to section 0 Staff Training. The sector already has higher levels of staff requirements than the NDIS. Training of staff to meet these requirements is unfunded.

The industry would benefit from funded training and development programs; however increasing the requirements is not feasible without funding.

9. How can greater assistance be provided to Level 3 residential services to manage difficult scenarios, including those that occur outside business hours?

With comprehensive government support the sector can provide additional levels of service and more staff after hours to deal with incidents, particularly after hours.

Most Supported Accommodation facilities run a 24/7 staffing model, with member of the team sleeping over to monitor for any overnight incidents.

The cost of providing this service is very high and prohibitive. Without funding it is simply not achievable to providers to provide additional supports.

Conflicts of interest and transparency

10. Further to question 4, should greater transparency be required concerning the fees that are charged to residents when their level 3 residential service provider, or a closely related entity, also provides them with NDIS-funded services?

The RTA Form R18 rooming agreement service agreement comprehensively outlines fees and charges, including NDIS charges. SAPA has collaborated closely with RTA to address transparency concerns.

Providers must disclose the rents and the services being entered into prior to entering into a leasing agreement.

Any NDIS services can only be provided after entering into a service agreement with a participant through their support coordinator (an independent advisor who assist participants to secure the supports that they need). NDIS rates are generally in line with the NDIS price guide and providers have little ability to alter these.

11. When a resident in a level 3 residential service selects their accommodation provider or a closely related entity as their NDIS service provider, what evidence should the service provider be required to provide to demonstrate that the resident has exercised an independent choice?

This is governed by the NDIS regulations and the Safeguards Commission.

Providers must adhere to policies on conflicts of interest and are audited on this during their NDIS accreditation.

Almost all Supported Accommodation residents who have NIDS packages have support coordination as part of their plan. It is the role of the support coordinator to assess to appropriateness and quality of the services provided.

Additionally, for those residents under the Office of the Public Guardian service providers must also justify their services to another independent government body. It is the Public Guardians default position to separate housing and supports and providers must pass this high bar in order to have any service agreements approved.

The Public Guardians, Public Trustee and the support coordinators are all independent avenues for residents to complain if they are unhappy with the services that they are receiving.

12. Is the monitoring of NDIS-funded services provided to residents of level 3 residential services adequate?

Supported Accommodation providers who provide NDIS services are registered providers and must adhere to the standards of the NDIS.

They are already subject to multiple, overlapping safeguard checks on their Supported Accommodation and associated NDIS service delivery.

Residents/NDIS clients and their significant others are provided with information and documentation regarding the comprehensive complaints process.

Supported Accommodation facilities are subject to spot checks from the Community Visitor program, Residential Services and council.

Support coordinators are in regular contact with their clients and the Public Trustee ensures that resident expenses are kept within budget.

Oversight and safeguards

13. How can existing safeguards be improved to provide better protections for residents living in level 3 residential services?

With direct funding to Supported Accommodation the sector can strengthen its mandatory reporting in line with other sectors – see section 13 – Vision for the Future

Without funding, this is simply not possible

Promoting skills and independence

14. Are there unintended consequences from the participation of residents of level 3 residential services in the NDIS that warrant regulatory reforms?

Those without NDIS funding miss out on the care and support they need. Daily care services, community access and group activities. This creates a haves and have nots within the residents.

Residents see others going out and receiving support services and don’t understand why they can’t as well.

With direct funding the sector can provide services to all residents – see section 13 – Vision for the Future

Complaints mechanism.

15. Should a ‘no wrong door’ approach be established under which residents of level 3 residential services are assisted to lodge complaints about service provision across a range of service sectors, including the accommodation, NDIS, and aged care sectors?

SAPA supports this initiative so long as the complaints are centrally managed through Residential Services. Having multiple complaints processes is a drain on staff resources, cumbersome and leads to confusion.

Rooming agreements

16. Do current regulatory requirements regarding rooming agreements sufficiently safeguard the rights of residents in level 3 residential services?

Yes, however they disadvantage providers by capturing them in the annual rent increase instead of aligning with pension increases twice per year. This is not sustainable for the Residential Services sector and changes to the legislation needs to be actioned immediately.

Any tenancy breaches or evictions are a serious matter. Providers must balance the rights of the individual resident and those of the other residents and staff.

Eviction is a very serious consideration by providers and a lot of thought and effort goes into preventing this happening. Ultimately providers want to maintain their residents.

Immediate eviction may be required in extreme situations to ensure the safety of other residents or staff.

While other avenues are explored, sometimes in practice the threat of an eviction is the only trigger that operators have to prompt Health and other agencies to respond to calls for assistance.

Providers typically deal with multiple incidents and ongoing behaviours of concern before any eviction is enacted.

Informal safeguards and capacity building

17. What additional steps should be taken to ensure that residents of level 3 residential services understand and are able to exercise their rights?

SAPA is committed to improving facilitating residents to exercise their rights and willing to engage with the CSSC on positive solutions to improve the existing mechanisms.

Residents are actively encouraged to exercise their rights and many do so frequently. Providers already facilitate this through their:

Internal

• Complaints handling procedures,
• Surveys / feedback forms
• Posters and communications
• Resident meetings
• Supportive staff advocating for residents

External

• Community Visitor Program
• Support coordinators and the NDIS safeguards commission

18. How can the voice of residents become more central to the regulation of level 3 residential services?

SAPA has a funded a project through QND to identify a client advisory framework/process and with government support this can be operationalised.

A part of any Residential Service accreditation, the auditors engage with residents to get an understanding of their views and of the facility.

The suitability of personal care services

19. Should a standardised intake assessment process be developed and implemented for potential residents of level 3 residential services to ensure that their accommodation and support needs will be able to be met in this setting?

SAPA provides members standard intake assessment forms. Issues arise when referrers provide incomplete or inaccurate information to providers in order to downplay the risks and ensure that they are discharge or “someone else’s problem”.

Additional funding has been received and SAPA is developing a standardized non-clinical assessment tool. This tool will assess the needs and the gaps in supports to residents; however the results for new residents will be less certain.

The use of this tool is not intended to be mandatory and providers will need ongoing funding to fully utilise and benefit from these tools.

20. How might the service and support needs of residents of level 3 residential services be reliably and regularly assessed?

At present Supported Accommodation providers do not have the resources for staff to constantly review resident needs. They are reliant upon external services such as Queensland Health and the NDIS to assess and provide for these needs.

Providers will update their records when there is a change to a resident’s accommodation or health needs.

SAPA is advocating for the introduction of funding to Supported Accommodation services in order to provide more support workers and case management. It would be the role of the case manager to

monitor their clients and coordinate external health, allied health, community and accommodation services in order to assess and provide for a residents need. Please see section 13 Vision for the Future.

Access to funding

21. Should greater assistance be provided to residents of level 3 residential services who need to navigate and engage with multiple service systems (including in the fields of housing, NDIS, aged care, mental health, alcohol and other drugs, and the justice system)?

Yes, the Supported Accommodation sector requires urgent funding but for costs associated administrative and coordination of residents.

SAPA is advocating for the introduction of funding to Supported Accommodation services in order to provide more support workers and case management. It would be the role of the case manager to monitor their clients and coordinate external health, allied health, community and accommodation services in order to assess and provide for a residents need. Please see section 13 Vision for the Future.

External service providers

22. What changes are required to ensure that residents of level 3 residential services are able to access external services, including advocacy services?

It is an existing regulatory requirement that all Supported Accommodation facilities are required to have a policy and procedures that demonstrate that residents have access to externally provided support services and that personal care services for residents are delivered.

A participant’s choice and control is a key feature underpinning the NDIS. Residents have the ability to choose who provides their services. Residents all have support coordination who assists them

Additionally, providers must adhere to policies on conflicts of interest and are audited on this during their NDIS accreditation.

Almost all Supported Accommodation residents who have NIDS packages have support coordination as part of their plan. It is the role of the support coordinator to assess to appropriateness and quality of the services provided.

Additionally, for those residents under the Office of the Public Guardian service providers must also justify their services to another independent government body. It is the Public Guardians default position to separate housing and supports and providers must pass this high bar in order to have any service agreements approved.

Unregistered residential services

23. How might unregistered services that meet the current level 3 residential services criteria, and that are therefore required to obtain registration and accreditation, be more reliably identified?

SAPA supports increased surveillance to identified unregistered Supported Accommodation facilities.

Emerging, unregulated models of accommodation

24. What regulatory steps should be taken to better protect residents of level 3 residential services from predatory provider behaviour?

Queensland government must ensure that providers are meeting their requirements and that all residents have true choice in control.

Existing frameworks of support coordination must be strengthened to ensure that the independent advocates that exist within the current system are acting in their clients best interests.

Effective, funded case management will assist to bring a larger stakeholder group for residents together more frequently. This will strengthen existing frameworks and provide more and broader pathways for concerns to be raised and shared.

Decision-making

25. How might residents, and potential residents, of level 3 residential services be better supported to make their own accommodation and service-related decisions?

Most residents often need assistance and information in decision-making processes. Providers will often show prospect residents around their facility who are accompanied by discharge coordinators (or similar) when coming from a clinical setting. Improved funding of the hospital discharge settings will assist residents to have better supports at this transition.

Better funded and functioning Office and Public Guardian and the Pubic Trust will assist residents to engage with their decision makers and provide their feedback in any transition.

A supported decision making template could be developed, which could assist potential residents to weigh up the pro’s and con’s of any future move.

Zero tolerance policies

26. Has the adoption of ‘zero tolerance’ policies by some level 3 residential service providers had unintended consequences that require a regulatory response?

With increased levels of supports in house (see section 13 Vision for the Future). Providers will be better placed to intervene early and initiate more harm reduction supports.

House Rules typically specify that, as a condition of accommodation, the facility will not tolerate the use of drugs, alcohol or weapons on-site. Approaches to this issue may vary, incorporating both harm minimization and zero tolerance. It is the responsibility of the Supported Accommodation provider to assess and estimate the potential impact on their specific setting.

In a communal setting, drug and alcohol use is not solely an individual choice. The rights of other residents and staff in the house to a safe environment must also be considered.

• Such behaviour can serve as a model for others
• The use of tobacco, drugs, and alcohol can significantly disrupt the uptake and management of a resident’s medication regime
• It poses a safety risk to other vulnerable residents and to staff
• The ability to evacuate in the event of an emergency can be severely impacted

It is essential for providers to consider these factors when determining their approach to drug and alcohol policies.

However, SAPA strongly advocates for the right of providers to evict residents so that can maintain a safe environment for all.

Restrictive practices

27. How should the use of restrictive practices in level 3 residential services be minimised and more effectively regulated?

Implementation of any restrictive practice regime costs significant time and money to implement properly.

The sector cannot afford to carry the costs of increased compliance and regulation without significant ongoing government funding.

Please see section 12 – Restrictive Practices

Additional regulation costs money to manage. Our sector cannot afford to carry any further costs. Funding from state government would be required for training and administration costs if the sector were to report on Restrictive Practices. Please see SAPA report on this issue.

Emergency and disaster planning

28. Are current disaster planning measures adequate across level 3 residential services?

Queensland remains susceptible to various disasters, including storms, power outages, floods, and fires, all of which can significantly impact the health and well-being of residents and staff in residential facilities. Given the increasing frequency of extreme weather events globally, SAPA acknowledges and advocates that disaster management should be an integral part of best practice business plans.

SAPA recognizes that their cohort of people may not integrate successfully with mainstream evacuees during emergencies. Emergency evacuations may involve large numbers of people requiring transport and suitable rehousing. Securing key stakeholder support and engagement is crucial in such situations.

SAPA actively participates in disaster management workshops.

Current regulations require Fire Management Plans in the event of a fire or evacuation of the facility.

More can be done to support the sector and to provide information to responders in the event of an emergency.

These initiatives will require support and funding from government to service providers.

Pathways out of level 3 residential services

29. How might residents of level 3 residential services be assisted to develop skills that will enable them to move into other accommodation settings, where this is their preference?

Not all residents are desirous to move out of Supported Accommodation, for many it is their chosen home. Imposing mainstream values and housing experiences on people living in Supported Accommodation might not be suitable, especially considering that many have chosen such arrangements for specific reasons. Some individuals may have severed ties with other housing situations due to the complexity of their mental health needs, which may outweigh the benefits of alternative accommodation.

While there may be those who express a desire to move, they might not be fully aware of their lack of capacity and may take for granted the services and support they receive.

Work needs to be done to develop better pathways for those who wish to move on from Supported Accommodation.

Funded services to capacity build / upskill residents can rolled out to residents but it is not possibly under the current funding. This approach can also help prepare those who may have the capability to move into less communal settings, providing them with the necessary skills and support for such a transition.

Brisbane Zero

Unlocking systems to end homelessness

Participants living in Support Accommodation

Unlocking systems to end homelessness

BRISBANE ZERO

Demographics and Acuity Scores

All Participants (n=11)

First Nations Identification

• 1 person identifies as Aboriginal (9% identify as Aboriginal)
• 91% identify as non-Indigenous (implied by chart/stats)

Gender

• 73% identify as Male ♂
• 27% identify as Female ♀

Country of Birth

• 8 born in Australia
• 1 born in Samoa
• 1 born in England
• 1 born in Fiji

Average Age

• Youngest: 21 years old
• Average Age: 50 years old
• Oldest: 72 years old

Income and Money Management

Form of Income:

• Aged Pension: 1
• Disability Support Pension: 8
• Any other pension/allowance: 2

Are Finances Administered by Someone Else?

• N/A: 3
• Public Trustee: 7
• Relative: 1

Data reported as of 02/02/2023

VI-SPDAT Scores, Risks and Socialisation

All Participants (n=11)

VI-SPDAT Acuity Score Breakdown

• High: 36%
• Medium: 55%
• Low: 9%

The acuity scores derived from the VI-SPDAT identifies participants that will require long term, permanent support to maintain tenancy (High needs category) or short term support to maintain tenancy (Medium needs category).

For Level 3 support accommodation residents, their acuity takes into account the fact that they are already housed and have ongoing support.

Engagement with Emergency Services in the last 6 months prior to being surveyed

• History of Custody Occurance: 9%

• Have Spoken to Police because they were the…: 9%

• Used a Crisis Hotline to see help: 27%

• Been admitted as an inpatient for a mental health reason: 27%

• Been admitted as an Inpatient for a non-mental health…: 18%

• Been taken by Ambulance to Hospital: 27%

• Received Healthcare at Accidents and Emergency: 9%

• 82% of participants surveyed disclosed that they are usually bored of on most days lacking planned things that they enjoy

• 45% of participants felt that they have been discriminated against by housing or homelessness services because of things like age, race, appearance, disabilities, gender identity or sexual orientation

• 36% of participants surveyed disclosed that they have thought they could be a danger to other people’s safety

• 36% of participants surveyed disclosed that they are currently being harmed by another person such as a spouse, parent, relative or friend

Wellness — Health Summary

All Participants (n=11)

Complex Health Issues & Dual/Tri-Morbidity

• Chronic Health: 10

• Mental Health: 11

• Substance Use: 8

• Dual-Morbidity*: 8

• Tri-Morbidity**: 8

• 36% of participants surveyed disclosed that they do not seek or are unable to go for care when feeling unwell

The participants who met the criteria for dual morbidity also met the criteria for tri-morbidity and comprised of 73% of the participants surveyed.

*Dual Morbidity is characterised by having both a history of mental health and substance use

**Tri-morbidity is characterised by having a chronic health condition, history of mental health and a history of substance use

Wellness — Chronic Health Conditions

All Participants (n=11)

The following chart depicts the Chronic Health Conditions that participants self-reported.

In addition to this, Participants surveyed disclosed:

• 18% Have ever been told they have a learning disability or developmental/intellectual disability
• 9% Have ever had a serious brain injury (ABI) or head trauma?
• 45% Have a physical disability that would limit the type of housing you could access, or make it hard to live independently
• 18% Have ever had to leave housing, crisis accommodation or other place they were staying because their physical health

Chronic Health Conditions Disclosed:

• 91% of participants surveyed disclosed a history of chronic health conditions

• Cellulitis: 1

• Kidney disease/end-stage renal disease or dialysis: 2

• Heart Disease: 4

• Emphysema / COPD: 1

• Diabetes: 1

• Hepatitis C: 1

• Chronic digestive condition: 1

• Dental Problems: 7

• Foot/Skin infections: 1

Wellness — Mental Health Disclosure

All Participants (n=11)

The following depicts self-reported Mental Health diagnosis

Mental Health Disclosure:

• 100% of participants surveyed disclosed having a history of mental health diagnosis

• Anxiety (other than PTSD): 8

• Depression: 5

• Post-Traumatic Stress Disorder (PTSD): 2

• Schizophrenia: 4

• Borderline Personality Disorder: 1

• Other mental health condition (specify): 2

Mental Health and Accessing Care:

• Do you have any mental health or brain issues that would make it hard for you to live independently because you’d need help?: 6
• Have you voluntarily spoken with a psychiatrist, psychologist or other mental health professional in the last 6 months because of your mental health?: 7
• Have you ever gone to the Accident and Emergency at the hospital because you weren’t feeling 100% well emotionally or because of your nerves?: 6
• Have you ever been taken to a hospital against your will for a mental health reason?: 4

Wellness — Substance Use History

All Participants (n=11)

The following depicts self-reported Substance Use History

Substance Use Disclosure:

• Will drinking or drug use make it difficult for you to stay housed or afford your housing?: 5
• Has your drinking or drug use led you to being kicked out of any housing, accommodation or program you were staying at in the past?: 3
• Have you ever been treated for drug or alcohol problems and returned to drinking or using drugs?: 5
• Have you ever blacked out because of your alcohol or drug use in the past month?: 2
• Have you injected drugs in the last 6 months?: 2
• Have you consumed alcohol and/or drugs almost every day or every day for the past month?: 7
• Have you ever had problematic drug or alcohol use, abused drugs or alcohol, or been told you do - including any issues with using medicines in a way you weren’t supposed to or using over-the-counter medications to get high?: 7

73% of participants surveyed disclosed that they do not seek or are unable to go for care when feeling unwell

MP 2.1 - FIRE SAFETY IN BUDGET ACCOMMODATION BUILDINGS

Index

Purpose………………………………………………………………………………………………………………2

Commencement and Application…………………………………………………………………………….2

Referral agency……………………………………………………………………………………………………2

Associated requirements……………………………………………………………………………………….2

Referenced standards …………………………………………………………………………………………..2

Definitions……………………………………………………………………………………………………………2

Early warning system ……………………………………………………………………………………………7

Emergency lighting……………………………………………………………………………………………….8

Occupant density………………………………………………………………………………………………..10

Travel distances …………………………………………………………………………………………………10

Emergency escape……………………………………………………………………………………………..11

Protection of exit paths………………………………………………………………………………………..13

Exit signage……………………………………………………………………………………………………….14

Portable fire extinguishers……………………………………………………………………………………15

Fire hose reels……………………………………………………………………………………………………15

Fire fighting water supply …………………………………………………………………………………….16

Smoke hazard management ………………………………………………………………………………..16

Maintenance of fire safety systems (omitted 22 August 2005) …………………………………..17

Building Code of Australia performance …………………………………………………………………17

Specification 2.01 – Sprinkler systems…………………………………………………………………..17

Schedule 1 - Schedule of maintenance options for fire safety systems (omitted 22 August 2005) …………………………………………………………………………………………………….18

Schedule 2 - Fire resisting construction …………………………………………………………………18

Schedule 3 - Maximum exit distances (m) for supported budget accommodation buildings ……………………………………………………………………………………………………………19

Schedule 4 - Maximum exit distances (m) for budget accommodation buildings with a floor area greater than 300 m^2^……………………………………………………………………………20

Schedule 5 - Evacuation impairment assessment checklist ………………………………………21

Part 2.1 – FIRE SAFETY IN BUDGET ACCOMMODATION BUILDINGS

Purpose

To ensure budget accommodation buildings, to which this code applies, provide for the safe evacuation of occupants.

Commencement

This version of MP 2.1 commences on 4 April 2008 and replaces the version of MP 2.1 published on 1 January 2008.

Application

This code is the fire safety standard applicable to budget accommodation buildings as prescribed by Part 3 of Chapter 7 of the Building Act 1975.

Referral agency

The Queensland Fire and Rescue Service is an advice agency for special fire services under Schedule 2 of the Integrated Planning Regulation 1998.

Associated requirements

• Building Act 1975
• Building Regulation 2006
• Fire and Rescue Service Act 1990
• Building Fire Safety Regulation 1991
• Building Code of Australia (BCA)
• Fire safety standard guidelines
• Fire safety management plan guidelines

Referenced standards

• AS/NZS 1668.1-1998: The use of mechanical ventilation and air conditioning in buildings – Fire and smoke control in multi-compartment buildings
• AS 1670.1-1995: Fire detection, warning control and intercom systems–System design, installation and commissioning – Part 1: Fire
• AS 2118.4-1995: Automatic fire sprinkler systems – Residential
• AS 2118.5-1995: Automatic fire sprinkler systems – Domestic
• AS/NZS 2293.1-1998: Emergency evacuation lighting for buildings – System design, installation and operation
• AS/NZS 2293.3-1995: Emergency evacuation lighting for buildings Part 3: Emergency luminaries and exit signs
• AS/NZS 2444-2000: Portable fire extinguishers and fire blankets – Selection and location
• AS 3786-1993: Smoke alarms

Definitions

Note: Italicised words within the body of the text are defined.

Acceptable solutions mean solutions which are deemed to satisfy the performance criteria.

Automatic means designed to operate when activated by a heat, smoke or fire sensing device.

Bedroom means a space or part of a space used for sleeping purposes excluding corridors, passageways and evacuation routes.

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Budget accommodation building means the definition in the application of this code.

Common areas means areas such as entertainment rooms, foyers, lounge rooms and dining rooms but do not include kitchens, laundries or sanitary areas.

Effective height means the height to the floor of the topmost storey (excluding the topmost storey if it contains only heating, ventilating, lift or other equipment, water tanks or similar service units) from the floor of the lowest storey providing direct egress to a road or open space.

Evacuation impairment^1^ means impairment or a combination of impairments which reduces the capacity of a person to evacuate a building in an emergency, and includes any impairment that restricts mobility or the ability to understand or independently respond to an emergency evacuation.

Evacuation route means the continuous path of travel (including exits, corridors, hallways and the like) from any part of a building to a road or open space.

Exit means any or any combination of, the following if they provide egress to a road or open space:

(i) An internal or external stairway. (ii) A ramp. (iii) A fire-isolated passageway. (iv) A doorway opening to a road or open space.

External wall means an outer wall of a building which is not a common wall.

Fire door means a complete door assembly having the same fire resistance level as the surrounding wall and has a certification tag fixed to the door and frame on the hinge side at 1500mm.

Fire hazard means the danger in terms of potential harm and degree of exposure arising from the start and spread of fire and the smoke and gases that are thereby generated.

Fire-isolated passageway means a corridor or passageway within a fire-resisting enclosure and includes the floor and roof or top enclosing structure that provides direct egress to a road or open space.

Fire-isolated ramp means a ramp within a fire-resisting enclosure which provides egress from a storey and that provides direct egress to a road or open space.

Fire-isolated stairway means a stairway within a fire-resisting enclosure and includes the floor and roof or top enclosing structure that provides direct egress to a road or open space.

Fire-resisting enclosure means an enclosed space within which a person will be adequately protected from the effects of a fire external to the enclosure for a period of not less than 60 minutes.

Fire safety management plan means the plan required to be prepared by the Building Act 1975 or the Fire and Rescue Service Act 1990

Fire safety system means one or any combination of the methods used in a building to:

(i) warn people of an emergency; or (ii) provide for safe evacuation; or

^1^ For the purpose of assessing whether a person has an evacuation impairment under the Standard, a checklist is provided in Schedule 5.

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(iii) restrict the spread of fire; or (iv) extinguish a fire, and includes both active and passive systems.

Fire service means a statutory authority or service constituted under an Act of Parliament and having as one of its functions, the protection of life and property from fire and other emergencies.

Floor area means:

(a) in relation to a building - the total area of all storeys excluding areas used to accommodate vehicles; and (b) in relation to a storey - the area of all floors of that storey measured over the enclosing walls, and includes (i) the area of a mezzanine within the storey, measured within the finished surfaces of any external walls; and (ii) the area occupied by any internal walls or partitions, any cupboard, or other built-in furniture, fixture or fitting; and (iii) if there is no enclosing wall, an area which has a use that- (A) contributes to the fire load; or (B) impacts on the safety, health or amenity of the occupants in relation to the provisions of the BCA; and (c) in relation to a room - the area of the room measured within the finished surfaces of the walls, and includes the area occupied by any cupboard or other built-in furniture, fixture or fitting.

Mezzanine means an intermediate floor within a room.

Minimum support ratio means the ratio obtained by:

(i) comparing the lowest number of responsible persons in the building at any time to the number of persons accommodated with an evacuation impairment in the building; or (ii) for the purposes of compliance with Schedule 3, option (B) in buildings divided into smoke compartments, comparing the lowest number of responsible persons in the building at any time to the number of persons with an evacuation impairment accommodated in smoke compartments.

Non-combustible means a construction of the following material type:

(i) reinforced or prestressed concrete; or (ii) steel in no part less than 6 mm thick.

Non-itinerant means a person who uses the building as a residence and is not traveling from place to place.

Open space means a space on an allotment, or a roof or similar part of a building adequately protected from fire, open to the sky and connected directly with a public road.

Path of travel means that part of an evacuation route that starts in a public corridor, passageway, hallway, stairway, landing, ramp or required exit.

Performance criteria mean the outcome that must be achieved for an element of a building or part of a building.

Personal care service means any of the following:

(a) Assistance or supervision in- (i) bathing, showering or personal hygiene; or (ii) toileting or continence management; or (iii) dressing or undressing; or (iv) consuming food. (b) The provision of direct physical assistance to a person with mobility problems.

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(c) The management of medication. (d) The provision of substantial rehabilitative or development assistance.

Public corridor means a space that serves as a means of egress from 2 or more rooms.

Required means required to satisfy a performance criteria or an acceptable solution of this code.

Responsible person means a person without an evacuation impairment who is the manager or agent for the manager of a supported budget accommodation building.

Sanitary compartment means a room or space containing a closet pan or urinal.

Self closing door means doors which are fitted with a device:

(a) with an automatic-closing operation initiated by the activation of the building’s interconnected smoke alarms or smoke detection system; or (b) with a free-arm action closing operation which closes the door or causes the door to remain closed (without preventing manual re-opening), upon the detection of smoke by the building’s interconnected smoke alarms or smoke detection system; or (c) that returns the door to the fully closed position immediately after each opening.

Smoke alarm means a device containing a smoke detector and an alarm sounding device.

Smoke compartment means a compartment that prevents the flow of smoke from the compartment into another part of the building.

Smoke detection system means a system of fixed apparatus, normally part of an automatic fire alarm system, in which smoke and/or fire detectors, control equipment and indicating equipment are employed for automatically detecting smoke and/or fire and initiating other action as arranged.

Storey means a space within a building which is situated between one floor level and the floor level next above, or if there is no floor above, the ceiling or roof above, but not-

(a) a space that contains only- (i) a lift shaft, stairway or meter room; or (ii) a bathroom, shower room, laundry, water closet, or other sanitary compartment; or (iii) accommodation intended for not more than 3 vehicles; or (iv) a combination of the above; or (b) a mezzanine.

Support means, for the purposes of minimum support ratio, immediate on-site evacuation assistance, able to be provided by a responsible person to a person with an evacuation impairment.

Supported budget accommodation building means a budget accommodation building:

(a) in which non-itinerant persons with an evacuation impairment are accommodated; and (b) in which a personal care service is provided to persons in association with accommodation within the building as part of the usual business or practice that is carried on within the building.

Type A construction means a building where all external walls, columns, common walls, internal walls, floors, and lift shafts, each have a fire resistance level in accordance with Schedule 2 of this code.

Type B construction means a building where all external walls, columns, and common walls each have a fire resistance level in accordance with Schedule 2 of this code.

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Type C construction means a building where all building elements have minimal fire resistance levels and is other than Type A or B construction.

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Note: If P13 is used to comply then P1, P2 and P4-P11 of this standard do not apply to the building. | For budget accommodation buildings, other than supported budget accommodation buildings, that have a current certificate of classification for the whole of the building that was issued- | (a) in relation to an application for a change of classification; or | (b) in relation to a development application for building work, other than building work required to ensure the building conforms with the fire safety standard

the whole building complies with the Building Code of Australia as applicable at the time of the application.

For buildings less than 4 storeys in height, buildings comply with Australian Standard AS 2118.5-1995 Automatic fire sprinkler systems - Domestic

For buildings of 4 or more storeys in height, buildings comply with Australian Standard AS 2118.4-1999 Automatic fire sprinkler systems - Residential

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Schedule 1 — Schedule of maintenance options for fire safety systems

Omitted 22 August 2005

Schedule 2 — Fire resisting construction

Note: The fire resistance levels (FRL) are extracted from the Building Code of Australia.

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Schedule 3 — Maximum exit distances (m) for all supported budget accommodation buildings

Compliance with A4 (a) may be achieved using the following options

(A) Table A

Supported accommodation buildings Maximum travel distance (m) (see also Notes below)

Notes to Table A:

1. Additional travel distance is allowed by using the following compliance options where indicated as applicable in Table A.

In single storey buildings in which travel in different directions to alternative exits is available from bedroom doorways and the building’s fire safety management plan requires monthly evacuation drills, travel distances may be increased:

(a) up to a maximum of 15 m if all smoke alarms are interconnected; or (b) up to a maximum of 15 m if a smoke detection system is installed that complies with A1(a)(ii) of this code; or (c) up to a maximum of 20 m where a smoke detection system is installed to AS 1670.1 requirements.

2. For the purposes of Columns 2 and 3, a bedroom with self-closing doors must be a smoke compartment.

OR

(B)

In buildings of two storeys or less, sprinklered in accordance with Specification 2.01 of this code, and where;

A. all smoke alarms are interconnected or the building has a smoke detection system that complies with A1 (a) (ii) of this code; and B. the minimum support ratio is (a) at least 1:10 in one storey buildings or across smoke compartments in buildings over 500 m²; and (b) in two storey buildings, at least 1:5; and

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C. the building’s fire safety management plan requires a monthly evacuation drill; and D. the maximum travel distance from bedroom doorways to a point from which travel in different directions to alternative exits is available does not exceed 10 m;

the building’s maximum travel distance is 25 m and can be extended;

(i) by an additional 3 m if the building is less than 500 m² in floor area or it is divided into smoke compartments of 500 m² or less; (ii) by an additional 5 m if the smoke detection system is installed to AS 1670.1 requirements; or (iii) by an additional 8 m if the building complies with both (i) and (ii)

Schedule 4 — Maximum exit distances (m) for budget accommodation buildings with a floor area greater than 300 m²

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Schedule 5 — Evacuation impairment assessment checklist

Supported accommodation EVACUATION IMPAIRMENT ASSESSMENT FORM

This form may be used to assess whether a person who is a non-itinerant occupant of the building has an evacuation impairment.

Use this form for the purposes of compliance with A4(a) of the Fire Safety Standard only.

Note 1: An occupant does not have an evacuation impairment when ALL answers on the form are ticked with Yes. Do not answer “Yes” to any question unless the occupant is able to meet the criterion at all times of the day or night.

Note 2: If this form is being used to exclude occupants from the need for evacuation support, the excluded person must be reassessed when the person’s evacuation ability changes or otherwise monthly. Monthly evacuation drills should be used to determine the ability of a person to safely evacuate the building in the event of fire.

Note 3: If the occupant has an evacuation impairment, you MUST include him/her in your minimum support ratio calculations. If the occupant does not have an evacuation impairment, you do not need to include him/her in your minimum support ratio calculations.

Note 4: The evacuation plan mentioned in the above assessment table forms part of the building’s fire safety management plan.

Note 5: If this form is used to exclude an occupant from the requirement that they be provided with evacuation support, a copy must be available in the building for inspection by authorised persons under the Local Government Act 1993 or authorised fire officers of the Queensland Fire and Rescue Service at any time the building is occupied.

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MP 5.7 – RESIDENTIAL SERVICES BUILDING STANDARD

Index

Purpose …………………………………………………………………………………………………… 3 Commencement ………………………………………………………………………….3 Application………………………………………………………………………………………………….3 Compliance………………………………………………………………………………..3 Associated Requirements…………………………………………………………………………… 3 Definitions………………………………………………………………………………………………… 4 Kitchen Facilities ………………………………………………………………………………………. 6 Laundry Facilities ……………………………………………………………………………………. 7 Common Areas ……………………………………………………………………………………. 9 Bedrooms ………………………………………………………………………………………………… 9 Storage Facilities …………………………………………………………………………………….. 10 Dining Room …………………………………………………………………………………………… 10 Sanitary Facilities ……………………………………………………………………………………. 11 Vermin Control ……………………………………………………………………………………. 12 Ventilation………………………………………………………………………………………………. 13 Early Warning System ……………………………………………………………………… 14 Emergency Lighting ……………………………………………………………………… 15 Emergency Telephone Access ……………………………………………………….. 15

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

Foreword

The Residential Services (Accreditation) Act 2002 requires residential service providers to register their residential service with the Residential Services Accreditation Branch of the Office of Fair Trading, Department of Justice and Attorney-General.

Registration requirements include demonstrating that the premises in which the residential service is offered complies with the mandatory building requirements contained in this document and that new building work also meets the requirements of the Building Code of Australia.

The building requirements focus on objectives and outcomes. They are presented as performance based requirements. A number of acceptable solutions are identified and listed for each outcome. Premises may need to use some or all solutions depending on the nature of the premises and business. Alternatively, you may be able to meet an outcome using a solution or method not listed in this standard. This allows for service providers to put forward alternative solutions to meeting the requirements thus supporting innovation and flexibility.

Before implementing alternatives, seek advice from local government. Local government officers will assess if a premises meets the acceptable solution given or if alternative solutions proposed are sufficient to meet the performance criteria.

MP 5.7 Page 2 Queensland Development Code Residential Services Building Standard Publication Date: 16 November 2007

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

Purpose

To ensure premises being used for residential services accommodation provide suitable standards of health, safety and amenity for residents.

Commencement

This version of MP 5.7 commences on 1 January 2008 and replaces Part 20 published on 23 August 2002.

Application

This standard applies to all premises at which residential services are provided. Residential services are defined in section 4 of the Residential Services (Accreditation) Act 2002. The requirements do not apply to premises at which exempted services are provided. Exemptions can be found in section 4(5) of the Residential Services (Accreditation) Act 2002. Premises may also be required to comply with the Building Code of Australia.

Compliance

Premises in which a residential service is provided will comply with the requirements if they satisfy the performance criteria. Compliance with the performance criteria can only be achieved by -

(a) Complying with the acceptable solutions; or (b) Formulating an alternative solution which complies with the performance criteria or is shown to be at least equivalent to the acceptable solutions; or (c) A combination of (a) and (b).

Where an alternative solution is utilised, the building compliance notice issued by local government should highlight the solution and how this demonstrates that the relevant performance criterion is met.

Associated Requirements

Compliance with this standard may not be the only requirement for premises in which a residential service is provided. Other legislation including State Acts and Local Government planning schemes may impose additional requirements. Designers, builders and owners should satisfy themselves that they will achieve compliance with all legislative requirements including:

• Residential Services (Accreditation) Act 2002.
• Residential Services (Accommodation) Act 2002.
• Building Act 1975 incorporating the Building Code of Australia.

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

• Food Act 1981 & ANZFA National Food Safety Standards 3.1.1; 3.2.2 and 3.2.3.
• Fire and Rescue Authority Act 1990, Section 104E.
• Plumbing and Drainage Act 2002, Standard Plumbing and Drainage Regulation 2003 and Clause 1.6.2 of AS/NZ 3500.4.2 – 1997 – National Plumbing and Drainage Code – Hot Water Supply Systems – Acceptable Solutions.
• Health Regulation 1996, Part 17 – Vermin Proofing.
• Environmental Protection (Waste Management) Regulation 2000.
• National Code of Practice for the Storage and Handling of Dangerous Goods: www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/cp2001storageandhanding
• Integrated Planning Act 1997.

Definitions

Note: - italicised words within the body of the text are defined.

ANZFA - Australian and New Zealand Food Authority.

Bedroom - a room used for sleeping accommodation only.

Building compliance notice - defined in schedule 2 of the Residential Services (Accreditation) Act 2002.

Common areas - areas such as lounge rooms, recreation rooms, verandahs, and covered outdoor relaxation areas.

Dining room - where meals are eaten at a table or a designated area used for dining.

Exit - means any, or any combination of the following if they provide egress to a road or open space: (i) An internal or external stairway. (ii) A ramp. (iii) A fire-isolated passageway. (iv) A doorway opening to a road or open space.

Fire Hazard - means the danger in terms of potential harm and degree of exposure arising from the start and spread of fire and the smoke and gases that are thereby generated.

Floor area - area measured within walls of a room or space.

Food service - as defined by Schedule 2 of the Residential Services (Accreditation) Act 2002.

Kitchen - where meals are prepared for or by residents.

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

Open space - means a space on the allotment, or a roof or similar part of a building adequately protected from fire, open to the sky and connected directly with a public road.

Personal care service - as defined by Schedule 2 of the Residential Services (Accreditation) Act 2002.

Protective hanging space – means an enclosed cupboard.

Property - the building and external common areas.

Resident - as defined by section 5 of the Residential Services (Accreditation) Act 2002.

Residential service - as defined by section 4 of the Residential Services (Accreditation) Act 2002.

Residential service accommodation buildings - are premises or complexes, including parts of premises or complexes, where a residential service is provided.

Sanitary facilities - means toilets, basins, showers, kitchen sinks, laundry tubs, and the like.

Storage facilities - storage of cleaning equipment and cleaning agents.

Travel distance - means the distance between a bedroom or any part of the premises to open space.

Unencumbered area - means a clear circulation space with no fixtures or fittings intruding within the space. Loose furniture can be included in the unencumbered areas.

Window - includes a roof light, glass panel, glass block or brick, glass louvre, glazed sash, glazed door, or other device which transmits natural light directly from outside a building to the room concerned when in the closed position.

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) adequate food preparation areas; and (b) suitable capacity to cater for the number of residents expected to prepare meals; and (c) unencumbered area and safe access to the kitchen at all times; and (d) fixtures and finishes which maintain the safety and wholesomeness of food; and (e) suitable cooking appliances and refrigerator space sufficient for the number of meals being prepared; and (f) suitable cleaning-up facilities for washing and cleaning of utensils; and (g) adequate storage facilities to prevent contamination of food and utensils. | A1

(a) Where residents prepare their own meals, a kitchen—

(i) has a minimum floor area of-

(A) 0.65 m² per person; or (B) where combined with a dining room — 1 m² per person; and in any case, not less than 16 m²; and

(ii) has the floor covered with a durable, impervious material finished to a smooth even surface free of cracks and crevices; and

(iii) has walls and ceilings finished with a durable light coloured impervious material, having a smooth even surface free of cracks and crevices; and

(iv) has walls behind each stove and cooking appliance ceramic tiled or lined with a smooth impervious material; and

(v) has food storage facilities and cupboards of 0.06 m³ per resident adequate to prevent contamination of food, and cooking or eating utensils, by dirt, dust, flies or the like; and

(vi) has a space of-

(A) for a refrigerator- 50 litres per resident; and (B) for a freezer- 5 litres per resident for the storage of perishable goods; and

(vii) has a sink with a drainer

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) Where laundering is done on the premises for residents –

(i) a laundry is provided and is equipped with-

(A) one five (5) kg capacity, automatic washing machine to handle incidental loads; and in addition, one ten (10) kg capacity, automatic washing machine for each 20 residents or part thereof; and

(B) one domestic dryer to match the 5kg washer; and in addition, one ten (10) kg capacity dryer for each of the ten (10) kg capacity washers;

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

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MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) Common areas are provided with a floor area of at least 0.5m² per resident; and (b) External common areas are roofed or covered. | Bedrooms | | | P4 Bedrooms must provide adequate personal space facilities for each resident. | A4

(a) The minimum unencumbered floor area for each bedroom is-

(i) for one person — 7.5m²; or (ii) for two people — 11m²; or (iii) for three people — 16.5m²; or (iv) for more than three people- 16.5m² plus an additional 5.5m² per additional person; and

(b) where more than one person sleeps in a room there is a minimum of 900mm provided between beds; and

(c) each bedroom is separately accessible without passing through any other bedroom; and

(d) each bedroom is provided with -

(i) a general purpose outlet; and (ii) storage for each resident with minimum dimensions of 300mm wide and 450mm

Queensland Development Code Page 9 MP 5.7 Publication Date: 16 November 2007 Residential Services Building Standard

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) there are no impediments to safe movement about the premises; and (b) chemicals are stored in a safe manner. | A5

Storage facilities for cleaning equipment are provided in the kitchen, laundry or an external storage facility. | Dining Room | | | P6 Suitable dining room facilities must be provided appropriate to the number of residents dining at any one time and the number of meals expected to be prepared. | A6

(a) Where meals are prepared or provided for residents, dining room facilities include—

(i) tables and seating of at least 600mm of table per resident for 50% of the residents; and

(ii) a dining room located-

MP 5.7 Page 10 Queensland Development Code Residential Services Building Standard Publication Date: 16 November 2007

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(i) a bath or shower for each 10 residents or part thereof; and (ii) a closet pan and washbasin for each 10 residents or part thereof; except that —

(A) if one urinal is provided for each 25 males up to 50 and one additional urinal for each additional males or part thereof, then one closet pan for each 12 males may be provided; and (B) at least one closet pan is screened from adjacent compartments with a door and partitions extending from the floor to at least 1.8m above the floor; and

(b) Hot and cold water is provided to all sanitary facilities except only cold water is provided to laundry wash troughs, water closets and urinals; and

(c) If females are provided with a receptacle for the disposal sanitary napkins, the receptacle should-

(i) have rigid walls; and

Queensland Development Code Page 11 MP 5.7 Publication Date: 16 November 2007 Residential Services Building Standard

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) Every floor, wall, partition, ceiling, roof and every ancillary fitting thereto of every building or other structure on such place is constructed and maintained to prevent the undetected entry of vermin into such places; and

(b) Every hole or opening in every floor, wall, partition, ceiling or roof and in every ancillary fitting of every building or other structure is securely covered with vermin-proof material.

MP 5.7 Page 12 Queensland Development Code Residential Services Building Standard Publication Date: 16 November 2007

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) Each habitable room is naturally ventilated by permanent openings with an opening or openable size not less than 5% of the floor area of the room required to be ventilated.

(b) Permanent openings are-

(i) windows, or (ii) doors; or (iii) ventilated skylights.

(c) Permanent openings are open to-

(i) a suitably sized court yard, or (ii) the sky; or (iii) an open verandah, carport, or the like.

Queensland Development Code Page 13 MP 5.7 Publication Date: 16 November 2007 Residential Services Building Standard

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) the height of the building; and (b) the construction of the building; and (c) the mobility and other characteristics of the occupants; and (d) the power supply available to the building. | A10 In all residential services buildings with less than 6 people, smoke alarms -

(a) are installed on or near the ceiling in every bedroom; and

(b) are installed on or near the ceiling in every enclosed or internal corridor, hallway associated with a bedroom or common areas at a maximum of 5m centres, or

(c) if there is no enclosed or internal corridor or hallway, are installed on or near the ceiling in an area between the bedrooms and the remainder of the building; and

(d) are installed on or near the ceiling on each storey; and

(e) comply with AS 3786; and

(f) are powered by-

(i) a consumer mains power supply, where available; or (ii) a tamper-proof lithium battery where a consumer power supply is not available.

Note- Buildings which are intended to provide accommodation for 6 or more people are required to comply with the requirements of the Fire Safety in Budget Accommodation Buildings under the Building Act 1975.

MP 5.7 Page 14 Queensland Development Code Residential Services Building Standard Publication Date: 16 November 2007

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

(a) the function or use of the building; and

(b) the floor area of the building; and

(c) the travel distance to an exit; and

(d) the characteristics of the occupants. | A11 In residential services buildings with less than 6 people, a system of lighting is installed which consists of-

(a) a light incorporated within and activated by the smoke alarm required by A10 (b) and (c); or

(b) the existing lighting located within the areas nominated in A10 (b) and (c) activated by the smoke alarms in these areas.

Note- Buildings which are intended to provide accommodation for 6 or more people are required to comply with the requirements of the Fire Safety in Budget Accommodation Buildings under the Building Act 1975. | Emergency Telephone Access | | | P12 Suitable provision must be provided for residents to ring emergency services in the event of an emergency. | A12 A landline telephone is provided.

Queensland Development Code Page 15 MP 5.7 Publication Date: 16 November 2007 Residential Services Building Standard

MP 5.7 - RESIDENTIAL SERVICES BUILDING STANDARD

Informative Notes:

In accordance with Clause 1.6.2 of AS/NZ 3500.4.2 - 1997, all new hot water installations shall, at the outlet of all sanitary fixtures used primarily for personal hygiene purposes, deliver hot water not exceeding- (a) 45°C for nursing homes or similar facilities for young, aged, sick or disabled persons; and (b) 50°C in all other buildings.

Note: Compliance with these temperature limits is optional for kitchen sinks and laundry tubs.

MP 5.7 Page 16 Queensland Development Code Residential Services Building Standard Publication Date: 16 November 2007

rou fre _ =

*=)) Queensland | Metro South

“QP Government Health ~~

A toolkit for healthy eating in supported accommodation: A best practice guide

Published by Queensland Health

First edition October 2017

ISBN: 978-0-646-97965-6

Licence and attribution

To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/

© State of Queensland (Metro South Health) 2017

The Queensland Government supports and encourages the dissemination and exchange of information. However, copyright protects this material. The State of Queensland has no objection to this material being reproduced, made available online or electronically, provided it is for your personal, non-commercial use or use within your organisation, this material remains unaltered and the State of Queensland (Queensland Health) is recognised as the owner.

For more information contact:

Access and Capacity-building Team Metro South Health access&capacity@health.qld.gov.au

About this toolkit

This toolkit was developed by and for supported accommodation providers in Queensland, Australia, in partnership with Queensland Health community nutritionists, to promote healthy eating in supported accommodation services.

Supported accommodation providers play a crucial role in keeping residents healthy, both through providing access to personal care services, and also by providing food that is nutritionally adequate to meet residents’ needs.

The toolkit includes practical information about providing healthy food for all residents, adjusting meals for residents with special needs, and how the surroundings of your facility can help residents to make healthier choices.

Every supported accommodation setting is different, so not all the suggestions will be relevant to your service. Choose the ideas that work for your service, or modify them to fit better into your setting.

You can read the toolkit from beginning to end or just turn to the section that you need help with right now. It might be helpful to first read 1 – Introduction to healthy eating to give you an understanding of the basis for the recommendations in each section.

Each section of the toolkit has been kept purposely brief, to give you the key information without wasting your time. If you are interested in learning more about a particular area, some useful links are provided at the end of each section.

A note about change

For successful change to occur in any setting, it’s important to get the support and involvement of others.

As you read each section of the toolkit and consider how some of the suggestions might apply to your service, also consider who in your service should be involved in the consultation or decision-making about any changes. This may be kitchen staff, food suppliers, external services that visit your facility, or residents and their friends and family.

Sharing information that is accurate and easy to understand is also an important way to bring people along with any new ideas or changes that you want to implement. Some templates and ideas about communicating suggested changes in your service can be found in 5 – Helping residents to make healthy food choices.

We would be interested to hear about your experiences, either good or bad, in implementing ideas suggested in this toolkit. If you would like to share your story, please contact: access&capacity@health.qld.gov.au

iii

Acknowledgements

This toolkit was developed by Metro South Health in partnership with the Supported Accommodation Providers Association (SAPA) and the Department of Housing and Public Works.

The project team consisted of Donni Johnston, Senior community nutritionist, Metro South Addiction and Mental Health Services; and Simone Johnston, Senior Community nutritionist, Metro South Health Access and Capacity-building Team.

In particular, special thanks go to the following supported accommodation providers for their time, expertise and support. Without their input this resource would not exist.

• Damien Negus and Annette Hudson-Phillips, Herston Lodge
• Tanya and Tony Sherlock, Tarampa Lodge
• Anne Rentoul, Willow House
• Christopher Veal, Greenmeadow Court
• Dianne McKenzie, Montray Villa
• Elena Schlyder, Gilbert Lodge and Bergin Gardens
• Kathy Bryant, Wamuran Park Home
• Ross Urqhart, Victoria Gardens
• Cathy Patterson, Fairhaven
• Rachel and Matt Farnan, Thomas Henry House
• Kylie Jewell, Fernvale Aftercare Centre
• Annette Rose, Actscare Housing
• Teresa Faraone, Murray Lodge
• Robyn Mackay, Diamond Valley Lodge
• Yvonne Orley, Orley Supported Accommodation
• Ann Zemo, Greenslopes House and Clayfield House
• Justin McNelly, Clayfield House
• Lee Reynolds, Thornfield Cottages
• Rob Walter, Colville Lodge
• Grant Kelly, Christine Court
• Louisa Galagher, Suncare Village

The project team appreciates the feedback and contributions provided by Barbara Radcliffe, Advanced Community Nutritionist, Metro South Health; Dr Mary Hannan-Jones, Senior Lecturer Nutrition and Dietetics, Queensland University of Technology; Denise Cruickshank, Dietitian Consultant, Statewide Foodservices Network, Metro North Hospital and Health Service; and Amy Davis, Senior Dietitian, Metro South Addiction and Mental Health Services.

The project team would also like to acknowledge Queensland University of Technology students Angel Fong, Christina Schmid, Natasha Macgregor, Zoe Sugden, Alexis Ng and Cath Wilsen, and University of Sunshine Coast students Rebecca Williams and Angela Seelig for their hard work in assisting in the development of this resource.

iv

Contents

About this toolkit ……………………………………………………………………………………………………………………….. iii A note about change ………………………………………………………………………………………………………………….. iii Acknowledgements ………………………………………………………………………………………………………… iv

1 Introduction to healthy eating

Accreditation ………………………………………………………………………………………………. 1 Food and nutrition essentials …………………………………………………………………………… 2 Food safety ……………………………………………………………………………………………….. 7 Food and nutrition frequently asked questions ………………………………………………………. 8

2 Menu planning

Accreditation …………………………………………………………………………………………………… 11 Menu planning guidelines ……………………………………………………………………………. 11 Example menu ………………………………………………………………………………………………. 14 Menu self-assessment checklist …………………………………………………………………… 15 Making menu changes ……………………………………………………………………………. 15 Menu action plan ………………………………………………………………………………………….. 17 Cooking and serving guides ……………………………………………………………………….. 18 Food label reading ………………………………………………………………………………………. 21 Making the most of your food dollar ……………………………………………………………… 23 Real-life stories from supported accommodation ……………………………………………………. 25

3 Healthy meal ideas and tips

Accreditation …………………………………………………………………………………………….. 27 Modifying recipes ………………………………………………………………………………………. 27 Healthy snack ideas ……………………………………………………………………………………. 33 Suggested recipes and cookbooks ………………………………………………………………. 34 Real-life hints and tips from supported accommodation ………………………………………………. 35

4 Food for special needs

Accreditation …………………………………………………………………………………………….. 36 Diabetes ……………………………………………………………………………………………….. 36 Mental illness and diet ………………………………………………………………………………………. 42 Cultural and religious meal considerations ………………………………………………………… 45 Food allergies and intolerances ……………………………………………………………….. 48 Chewing and swallowing difficulties ………………………………………………………………. 52 Increasing energy and strength ………………………………………………………………. 54

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A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Food for residents who are overweight …………………………………………………………… 57 Vegetarian diets ………………………………………………………………………………………………… 61 Real-life stories from supported accommodation ………………………………………………….. 64

5 Helping residents to make healthy food choices

Accreditation …………………………………………………………………………………………….. 65 Vending machines ……………………………………………………………………………………. 65 Food kiosks ………………………………………………………………………………………………. 66 Dining rooms – providing a pleasant mealtime environment ………………………………. 67 Promoting healthy eating to residents ……………………………………………………………… 69 The healthy eating message for visitors …………………………………………………………… 70 Example letters for communicating healthy eating philosophy …………………………….. 71 Ideas for active and enjoyable outings ……………………………………………………………. 73 Developing a nutrition policy ……………………………………………………………………… 74 Nutrition policy example ………………………………………………………………………………… 76 Real-life stories from supported accommodation …………………………………………………… 77

6 Where to get more help

How to find a dietitian ……………………………………………………………………………………. 78 Other helpful contacts …………………………………………………………………………….. 78 Links ………………………………………………………………………………………………….. 79

7 Glossary

A–Z list of nutrition terms ………………………………………………………………………………….. 82

8 Templates

Menu template ……………………………………………………………………………………………. 86 Action plan template ……………………………………………………………………………………….. 87 Nutrition policy template ………………………………………………………………………………….. 88 Menu self-assessment checklist template …………………………………………………………. 89

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1 Introduction to healthy eating

Accreditation

All supported accommodation service providers are required by the Queensland Government to comply with the Residential Services (Accreditation) Act 2002.

The Act recognises and safeguards residents’ rights and ensures that all buildings and amenities are safe. For Level 2 and 3 supported accommodation providers, it also regulates the provision of a food service and access to personal care services, which may assist residents with bathing, laundry and taking medication.

This resource aims to help supported accommodation providers meet the requirements relating to food services (section 43c):

2.1 Food and nutrition

• Residents are provided with food that is adequate in quality, quantity, variety and nutritional value to meet each person’s daily food requirements.

2.2 Kitchens

• The kitchen facilities comply with Amendment No. 51 of the Food Standards Code.

2.3 Food delivery and storage

• Procedures are in place to ensure the safe delivery and storage of food.

2.4 Food preparation

• Persons preparing food observe adequate hygiene standards and ensure food does not spoil before and during preparation.

2.5 Food serving

• Persons serving food to residents observe adequate hygiene standards and take all steps to prevent the contamination of food and the spread of disease.

2.6 Dining rooms

• Dining room facilities are clean and comfortable, close to kitchen facilities and separate from lounge room facilities.

The following sections of the resource will explain more specifically which accreditation standard that part of the resource will help you achieve.

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A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Food and nutrition essentials

We know healthy eating plays an important role in keeping our bodies healthy and strong, as well as preventing illness. This is particularly important for people living with an intellectual disability, acquired brain injury or mental illness, because they are more likely than the general population to have health issues associated with poor nutrition. These issues are common in people who live in supported accommodation. The Australian Dietary Guidelines (2013) provide up-to-date advice about the amount and types of foods and drinks that we need to eat regularly for health and wellbeing. They are based on scientific evidence and research, including a review of over 55,000 scientific journal articles by nutrition and medical experts.

Many of the fad diets you hear about in the media are based more on fashion than on evidence. Fad diets can also be expensive to follow and may even mean you miss out on essential nutrients.

Australian Dietary Guidelines

• Guideline 1: To achieve and maintain a healthy weight, be physically active, and choose amounts of nutritious food and drinks to meet your energy needs.
• Guideline 2: Enjoy a wide variety of nutritious foods from the five food groups every day and drink plenty of water.
• Guideline 3: Limit intake of foods containing saturated fat, added salt, added sugars, and alcohol.
• Guideline 4: Encourage, support and promote breastfeeding.
• Guideline 5: Care for your food; prepare and store it safely.

The five food groups

Different foods contain different key nutrients important for our health. Foods are grouped into five food groups of:

• Vegetables and legumes/beans
• Fruit
• Milk, yoghurt or cheese (mostly reduced fat)
• Grain (cereal) foods (mostly wholegrain and high fibre varieties)
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans

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1 Introduction to healthy eating

The role of the food groups in our body

Foods are grouped into five food groups because they provide similar amounts of the key nutrients in that group. Here are just some of the important roles foods from each food group play in our body:

• Vegetable and legumes group and fruit group: These foods help to keep our bowels regular, and there is evidence to show they help to prevent weight gain. They are protective for heart disease and help to prevent many cancers. They also help our immune system to ward off colds and other sicknesses.
• Milk, yoghurt or cheese group: These foods keep our bones healthy and are used by our nerves to carry messages from our brain to the rest of our body. New evidence also shows a link between drinking milk and a reduction in heart disease and some cancers.
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans group: These foods are important for us to be able to build and repair our body. They are needed to produce healthy blood and for our immune system to function properly. In particular, eating fish has been shown to prevent stroke, dementia, and age-related damage to our eyes.
• Grain (cereal) foods group: Wholegrain cereals still contain all three parts of the grain (the bran, germ and endosperm) and have more goodness in them compared to more refined or ‘white’ cereals. Wholegrain cereals give the body energy, help prevent constipation and are protective against bowel cancer and diverticulitis.

A note about water: Water is needed for nearly every function in our body! It is used in our bloodstream, in our digestion, to regulate our body temperature, to get rid of waste products, to lubricate and cushion joints, and to keep our skin healthy.

A note about healthy fats and oils: Small amounts of fats are important for our eyes, brain, skin and nerve tissues, and for making hormones. Healthy fats (unsaturated fats) also help to reduce the risk of heart disease and lower cholesterol levels when they replace unhealthy fats in the diet. For more information about which fats are the healthiest, see FAQ: What types of fats are best?

Variety

Eating a wide variety of foods from each of these five food groups every day means we get all the nutrients we need for good health over time. It’s also important to eat a selection of the foods within each group (such as eating different-coloured vegetables within the vegetable group, because orange carrots contain more vitamin A than white potatoes).

For these reasons it is essential that residents are offered a variety of foods from each of the five food groups every day, as well as different foods within each group over the menu cycle.

3

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

How much of each food group do we need each day?

The Australian Guide to Healthy Eating shows us visually the amounts of each food group that should generally make up our diet each day to get all the nutrients our bodies need.

In other words, throughout the day we should base most of our meals on the vegetables and wholegrain food groups, and then eat equally from the fruit, lean meats or milk, yoghurt and cheese groups. Small amounts of healthy fats are also an important part of a balanced diet. [For more information about which fats are the healthiest, see FAQ: What types of fats are best?)

Australian Government National Health and Medical Research Council Department of Health and Ageing

www.eatforhealth.gov.au

Australia Guide to Healthy Eating Enjoy a wide variety of nutritious foods from these five food groups every day. Drink plenty of water.

• Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties
• Vegetables and legumes/beans
• Fruit
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans
• Milk, yoghurt, cheese and/or alternatives, mostly reduced fat

Use small amounts Only sometimes and in small amounts

1 Introduction to healthy eating

More specifically, people of different ages, life stages and gender need different amounts of each food group. The table below shows the minimum amount of each food group most supported accommodation residents need to eat every day to get the full amount of nutrients their bodies need. This information can be particularly useful when planning what foods to offer your residents, and the quantities of foods to purchase. This is explained more in the Menu planning section of the toolkit.

SERVE SIZES

A standard serve of vegetables is about 75g (100–350kJ) or:

• ½ cup cooked green or orange vegetables (for example, broccoli, spinach, carrots or pumpkin)
• ½ cup cooked, dried or canned beans, peas or lentils*
• 1 cup green leafy or raw salad vegetables
• ½ cup sweetcorn
• ½ medium potato or other starchy vegetables (sweet potato, taro or cassava)
• 1 medium tomato

*preferably with no added salt

SERVE SIZES

A standard serve of fruit is about 150g (350kJ) or:

• 1 medium apple, banana, orange or pear
• 2 small apricots, kiwi fruits or plums
• 1 cup diced or canned fruit (with no added sugar)

Or only occasionally:

• 125ml (½ cup) fruit juice (with no added sugar)
• 30g dried fruit (for example, 4 dried apricot halves, 1½ tablespoons of sultanas)

SERVE SIZES

A standard serve (500kJ) is:

• 1 slice (40g) bread
• ½ medium (40g) roll or flat bread
• ½ cup (75–120g) cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur or quinoa
• ½ cup (120g) cooked porridge
• ⅔ cup (30g) wheat cereal flakes
• ⅓ cup (30g) muesli
• 3 (15g) crispbreads
• 1 (60g) crumpet
• 1 small (35g) English muffin or scone

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A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

SERVE SIZES

A standard serve (500–600kJ) is:

• 65g cooked lean meats such as beef, lamb, veal, pork, goat or kangaroo (about 80–100g raw)*
• 80g cooked lean poultry such as chicken or turkey (100g raw)
• 100g cooked fish fillet (about 115g raw weight) or one small can of fish
• 2 large (120g) eggs
• 1 cup (150g) cooked or canned legumes/beans such as lentils, chick peas or split peas (preferably with no added salt)
• 170g tofu
• 30g nuts, seeds, peanut or almond butter or tahini or other nut or seed paste (no added salt)

*weekly limit of 455g

SERVE SIZES

A standard serve (500–600kJ) is:

• 1 cup (250ml) fresh, UHT long life, reconstituted powdered milk or buttermilk

• ½ cup (120ml) evaporated milk

• 2 slices (40g) or 4 x 3 x 2cm cube (40g) of hard cheese such as cheddar

• ½ cup (120g) ricotta cheese

• ¾ cup (200g) yoghurt

• 1 cup (250ml) soy, rice or other cereal drink with at least 100mg of added calcium per 100ml

• To meet additional energy needs, extra serves from the Five Food Groups or unsaturated spreads and oils, or discretionary choices may be needed only by those adults who are taller or more active, but not overweight.

• An allowance for unsaturated spreads and oils for cooking, or nuts and seeds can be included in the following quantities: 28–40g per day for men less than 70 years of age, and 14–20g per day for women and older men.

• For meal ideas and advice on how to apply the serve sizes go to: www.eatforhealth.gov.au

Based on material provided by the National Health and Medical Research Council.

What about unhealthy, processed foods?

Cakes, biscuits, soft drinks, ice cream, and even highly processed meats are all examples of foods that don’t provide many (if any) nutrients for our bodies other than extra fats, sugars and salt. This is why sometimes they are called discretionary foods.

Many of our health problems are a result of eating too many of these foods. Type 2 diabetes, overweight, tooth decay, heart disease and stroke are all linked to a diet high in discretionary foods. These foods also replace healthy foods that contribute to wellbeing and fight disease.

We all know these foods can be an enjoyable part of our diet, but they are best included occasionally and in small serves.

6

Some residents who are very tall, very active or have higher energy needs due to illness need extra serves of foods. It is best if these extra serves come from the five food groups, particularly wholegrain cereals, vegetables and legumes/beans and fruit. They can, however, also sometimes include serves of discretionary foods.

On a day-to-day basis, eating too many discretionary foods can make the illnesses we already have worse or harder to manage. This is particularly relevant for many of the residents in supported accommodation services.

For more information about healthy eating:

• Eat for Health: Australian Dietary Guidelines (2013) www.eatforhealth.gov.au
• Healthier Happier http://www.healthier.qld.gov.au/eat/
• Dietitians Association of Australia: Healthy Eating https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/

Food safety

Preparing and storing food safely forms part of the Australian Dietary Guidelines and is a vital step in maintaining residents’ health and reducing preventable illness. Under Accreditation Standard 2.2: Kitchens, all supported accommodation providers are expected to comply with local council food safety standards.

All foods, and particularly fresh foods, need to be transported, stored and prepared properly to avoid contamination. Contamination can occur when:

• foods aren’t kept at the right temperature
• raw foods (especially raw meat, poultry, seafood and raw vegetables) aren’t separated from cooked and ready-to-eat foods
• utensils aren’t cleaned properly
• people preparing foods are unwell and don’t follow good personal hygiene practices.

Food poisoning can occur when we eat contaminated foods or drinks.

Symptoms of food poisoning

Symptoms of food poisoning can include:

• stomach cramps
• diarrhoea
• nausea
• headache
• vomiting
• fever.

Depending on the cause, food poisoning may start within an hour, but it may also occur up to weeks after eating contaminated food.

These symptoms may also be caused by viruses and may be highly infectious. It is important to investigate the causes of any gastro outbreak and act according to medical instructions. Staff should not attend work until 48 hours after their last gastro symptoms.

Who’s most at risk of food poisoning?

Anyone can get food poisoning. Most healthy people recover quickly from most types of food poisoning, but some people can experience serious health issues and even hospitalisation. Those more at risk include people who are pregnant, elderly or very young, or someone whose immune system is weak through illness or drugs.

For more information on safe food, training and licensing for businesses, contact your local city council.

Food and nutrition frequently asked questions

Q: Are low fat dairy foods better than full fat foods?

A: The Australian Dietary Guidelines currently recommend reduced fat dairy products (milk, yoghurt or cheese) for everyone over the age of two years. This is because full fat dairy products would mean more total fat, unhealthy fat, and energy or kilojoules in our diet, which can lead to overweight.

Sometimes flavoured low fat yoghurts or flavoured low fat milks can have lots of added sugar. Low fat natural yoghurts and low fat unflavoured milks are the best choices.

Q: What types of fats are best?

A: The healthiest types of fats are monounsaturated and polyunsaturated fats. Monounsaturated fats are found in avocados, almonds, cashews and peanuts, and in cooking oils, e.g canola, olive, rice bran, sesame, soybean and sunflower oils.

Polyunsaturated fats are found in fish, tahini, flaxseed, chia seeds, pine nuts, walnuts and Brazil nuts, cooking oils (e.g. soybean, sunflower, safflower and canola oils), and in polyunsaturated margarines.

Eating healthier fats can help the balance of good and bad cholesterol in our blood and lower our risk of heart disease.

It is recommended that we avoid eating saturated fats, which are found mostly in animal products (meat, chicken and dairy), coconut and palm oils, processed foods like cakes and biscuits, and takeaway foods.

Trans fats are also unhealthy and are best avoided. These are unsaturated fats that have been highly processed and behave like saturated fats; they are found in many packaged and baked foods and may be listed as ‘hydrogenated oils’ or ‘partially hydrogenated vegetable oils’.

Large catering packs of prepared foods are more likely to contain unhealthy fats than supermarket products. Contact the supplier if you are unsure.

Remember, the fats in foods are just one part of our diet. Eating more vegetables, fruit and whole grains is also important to keep healthy.

Q: Are all sugars created equal?

A: It’s well known that too much added sugar contributes to overweight and tooth decay. Added sugars are hidden in most processed foods. The Australian Dietary Guidelines recommend cutting back

on eating foods containing added sugars, such as lollies, soft drinks, fruit drinks, cordials, vitamin waters, energy drinks, sports drinks, biscuits, pastries and cakes.

There’s a huge range of sugars and syrups available today, including white sugar, raw sugar, honey, maple syrup, agave, coconut sugar, rice malt syrup and molasses. Despite their different colours and flavours, the nutritional value of sugars and syrups is very similar. They all add extra energy or kilojoules and not many other nutrients, and most are bad for your teeth.

Some sugars and syrups may have a few more B vitamins (e.g. honey), or more minerals like potassium, magnesium and iron (blackstrap molasses), but remember: they have much less than the amount of nutrients found in vegetables, fruits and wholegrains! It’s best for us to eat the sugars found naturally in whole foods like fruit and dairy products, avoid adding lots of extra sugars or syrups to our foods, and to keep processed, sweet treats to small serves eaten only sometimes.

Q: Should we use artificial sweeteners or ‘diet foods’?

A: Artificial or intense sweeteners such as stevia, aspartame, saccharin or sucralose are often found in processed ‘diet foods and drinks’. They do not contain kilojoules or energy, but neither do they provide any nutrients. Essentially, these foods are not really part of a healthy diet.

In the past, safety concerns have been raised about some artificial sweeteners. These concerns resulted from studies conducted on animals, but the doses or amounts were many times more than a person could really eat or drink. Food Standards Australia and New Zealand (FSANZ) has deemed these products safe for use in our food.

Regular use of artificial sweeteners, however, may train our brain to crave sweet-tasting foods. Studies have also suggested that some sweeteners may increase our appetite or disrupt our healthy gut bacteria, leading to weight gain, but more high quality research is needed to confirm these findings. Diet soft drinks also contain acids that are bad for our teeth.

The best thing to do is have as little as possible of all sugars, syrups and sweeteners. Add sweetness and flavour to food with ‘warm’ spices like cardamom, cinnamon, ginger and nutmeg. Muffins and cakes can usually be made with at least 25 per cent less sugar, and the sugar in stewed fruit and pie fillings can be cut in half. The best way to reduce sugar and artificial sweeteners in hot drinks is to gradually reduce the amount over time.

Q: Frozen, tinned or fresh vegetables?

A: Vegetables are nutritious whether they are fresh, frozen, canned or dried. If you use canned vegetables, choose those with no added salt. When a food is frozen, the nutrients are locked in at the time of freezing, so frozen veggies can be both convenient and nutritious. Check the label to make sure there is no added salt, sugar or fat. Fresh vegetables that are in season are often cheaper and tastier than other fresh vegetables.

Fried vegetables such as hot potato chips are best eaten only sometimes and in small amounts.

Q: Why is processed meat unhealthy?

A: Processed meats (e.g. sausages) and deli meats (e.g. ham, bacon and salami) are high in salt and unhealthy (saturated) fats. These meats are bad for our heart and other blood vessels. Processed meats have also been linked to some cancers. These types of meats are considered part of the discretionary or ‘extras’ group and we should avoid eating them regularly. It is best to choose lean meats or poultry that is trimmed of all visible fat and skin.

Q: Isn’t a high protein or a Paleo-type diet what is recommended now?

A: High protein diets seem to be the latest thing in the media. In particular, the Paleo diet is promoted as being better suited to our bodies and is supposed to be how our ancestors ate. Many researchers say this is simply not true: firstly, the diets of our ancestors depended on where in the world they lived and what foods they could access easily, so there really wasn’t just one type of diet. Secondly, it is likely that both humans and foods have changed since our caveman days.

While it’s true that most Australians don’t eat enough vegetables and fruit, and eat far too many processed or discretionary foods, the Paleo diet focuses a bit too much on meats, poultry, fish and eggs for most people. High protein diets also generally cost more and are hard to follow long term. Healthy starches or carbohydrate foods also provide essential nutrients and fibre, and are an important fuel for the helpful bacteria that live in our gut. In high protein diets, these benefits are being missed out on.

Paleo diets have not been studied over the long term, nor in many people. It’s important to remember that the Australian Dietary Guidelines are based on evidence from thousands of studies. So the bottom line is definitely to eat a diet containing vegetables, fruit, lean meats, poultry, fish, eggs and nuts. Also include whole grains and some low fat dairy foods – but keep processed foods to a minimum!

Sources of information

• Balogh R, Brownell M, Ouellette-Kuntz H et al. Hospitalisation rates for ambulatory care sensitive conditions for persons with or without an intellectual disability – a population perspective. Journal of Intellectual Disability Research. 2010; Volume 54, Part 9.
• Tiihonen J, Lönnqvist J, Wahlbeck K et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 Study). Lancet. 2009; 374 (9690): 620–627.
• Kato MM, Currier MB, Gómez CM et al. Prevalence of metabolic syndrome in Hispanic and non-Hispanic patients with schizophrenia. Primary Care Companion. Journal of Clinical Psychiatry. 2004; (6): 74–77.
• National Health and Medical Research Council (2013) Australian Dietary Guidelines. Canberra: National Health and Medical Research Council.
• https://www.eatforhealth.gov.au/guidelines
• https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/
• http://foodwatch.com.au/

2 Menu planning

Accreditation

This section outlines how to go about menu planning. Sound menu planning is the way to ensure residents are provided with food that is adequate in quality, quantity, variety and nutritional value to meet their daily food requirements as specified in Accreditation Standard 2.1: Food and Nutrition.

Well-planned menus also allow for better coordination of food deliveries and stock rotation, and are an aid in achieving Accreditation Standard 2.3: Food delivery and storage.

Use the Menu planning guidelines and Menu planning self-assessment checklist to develop a healthy, rotating menu that is based around the five food groups.

Use the visual Meal preparation guide to ensure the right amounts of foods from each food group are cooked for each meal. The visual Meal serving guide will help with serving residents the recommended quantities of each food group for a balanced meal.

Menu planning guidelines

Why plan a menu?

A menu is a list of foods or a combination of foods and drinks that will be served at specific meal times. A cyclical menu is planned for a certain period of time, such as two weeks, and is then repeated at the end of that time.

Here are the main reasons why planning a written menu makes good business sense.

• Having a planned menu can help to save money and time. It makes shopping easier for staff when they know the items required, and food can then be purchased in bulk or in advance. In other words, it reduces the need for multiple, frequent food shopping expeditions or deliveries.
• It can make it easier to plan workloads for your kitchen staff.
• It makes it easier to ensure residents are offered a healthy and varied diet from all the five food groups.
• It reduces boredom with meals, so residents are more likely to consume the foods offered. This means they are more likely to meet their nutrition needs.
• It’s also the easiest way to make sure you meet the special needs of residents.
• On-site storage capacity for foods can be considered well in advance, to reduce overstocking and to allow for better rotation of stock.
• There tends to be less food wastage as a result of better ordering and increased consumption of food.

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3. Plan modifications for special diets

• As a general rule, try to plan healthy meals that are suitable for all residents (including those requiring special diets) to reduce workload. i. Use lean meats most often. ii. Limit processed meats, e.g. sausages, frankfurts, cheerios, bacon and ham, which are high in salt and fat. iii. Use cooking methods such as roasting, steaming, barbequing, stewing or microwaving that use little or no added fat. iv. Reduce the added sugars in recipes if possible.
• Plan alternative foods or textures in addition to the main menu, as required, to meet special needs of residents.

4. Review the entire menu before finalising

• Use the menu planning self-assessment checklist to see if your menu is balanced.
• If you can’t quite meet all the items on the checklist, start an action plan to help you work towards this.
• Ensure you have taken into account staff and equipment availability.
• Check for repetition of any items throughout the cycle. Over a four-week cycle menu, it is acceptable to repeat some very popular meals.
• Communicate the final menu to staff and display the daily menu for residents to see.
• After implementation, evaluate resident satisfaction. This could be done by recording wastage, talking to residents and using a suggestion box in your facility.
• It is best practice to change your menu seasonally.

Menu example: winter

Week One

Menu self-assessment checklist

This checklist can be used as a guide to help you modify your menu to meet the Australian Dietary Guidelines (2013). Find an easy to use version of this checklist in 8 – Templates.

Each day we offer:

• two pieces of fruit per resident
• at least two different coloured vegetables (other than white potato) at lunch AND dinner
• wholegrain cereal foods, such as brown rice, wholemeal pasta and wholemeal or wholegrain bread, for at least half of the grain products
• low fat dairy foods such as low fat yoghurt, reduced fat cheese or low fat milk
• snacks that include fruits, vegetables, wholegrains and low fat dairy foods
• lean cuts of meat when possible, or meats trimmed of their visible fat
• meals that are flavoured with herbs, spices, garlic, onion or lemon juice instead of salt

We rarely offer/we limit:

• processed meats such as sausages, ham, bacon and luncheon meats
• celebration foods such as cakes, biscuits, chips and ice cream
• sugar-sweetened soft drinks and cordials, sports and energy drinks

Making menu changes

Adapting to change in our lives can be challenging. Residents who have little control over many aspects of their lives may be quite resistant to changes to their menu or foods. Staff who have been working the same way for a long time may also be wary of change, fearing extra workload or seeing changes to a menu as a sign of being unhappy with their work.

To minimise disruption to both staff and residents, move towards a healthier menu by making small changes over time. Consider these ideas when introducing new items to your menu:

• Involve residents in menu planning. Get an interested group of residents together to discuss proposed changes, and explain what you are doing and why.
• Make sure kitchen staff also understand why changes are being made and how important their roles are in making this happen.
• Make one change at a time. Rather than overhauling your entire menu, just choose one new dish to introduce per week.
• Consider taste-testing a new item and seeking resident feedback.
• Get creative with the presentation of a new meal to make it especially appealing.
• Try new recipes as a side dish with more familiar foods. This will also mean less wastage if the dish is not as popular as other dishes.
• If modifying an existing meal, slowly make changes over a period of time. For example, include a small amount of beans or legumes in a meat dish and increase the amount of beans in the recipe over a series of servings.
• Have a ‘launch’ or ‘promotion’ of a new menu or new dishes with an event or theme.

• Record food wastage and review how the new menu or new meals are going. Meet with other kitchen staff and provide regular feedback on how the changes are going.
• Give residents time to ‘get used to’ a new meal, and remind them of the benefits of the changes.
• Provide a ‘suggestion box’ in your facility for residents to give written feedback if they don’t feel comfortable talking face to face about some of the menu changes.
• Always talk to staff and residents in a positive manner about the new meals or changes you are making to the menu.
• Support the changes in the menu with other activities and promotion of healthy eating outside the kitchen, as suggested in 5 – Helping residents to make healthy food choices.

Balancing residents’ rights with promoting healthy eating

As a supported accommodation provider you cannot force or restrict residents from eating the foods that they wish. A resident has the right to decide how much they eat and whether they eat a certain food. But you can choose what food you provide, when you provide it and where it’s available. Accreditation Standard 2.1: Food and Nutrition states that it is your responsibility to provide food that is adequate in nutritional value to meet each person’s daily food requirements. Essentially, we want to enable healthy choices or, in other words, make healthy choices the easy choice for residents.

What does this mean for supported accommodation?

As a service you are providing and promoting healthy options so that residents can achieve their maximum physical potential and maintain independence, which is in line with The General Principles of the Guardianship and Administration Act 2000. Residents may still choose to purchase from external food and drink suppliers if they wish. You could consider it in the same way as smoking or alcohol. Residents may still purchase cigarettes or alcohol from external suppliers, but you would not provide these items as a service.

What you can do:

Focus your efforts on the elements of a resident’s diet that you can influence.

• What: Ensure that the food you provide on site is healthy and appealing. Both your main meals and snacks should be based on the five food groups as much as possible. Consider what food you make available to residents outside the kitchen.
• When: Consider the times you are providing food and drinks. Make sure you’re offering food from the five food groups, spread throughout the day.
• Where: Provide a pleasant mealtime environment. Adapted from Division of Responsibility in Feeding by Ellyn Satter.

Menu action plan

• Achieving everything on the self-assessment checklist could mean some big changes to your menu. Try a staged approach, focusing on just a few areas at a time. Use this template to document how you are working towards achieving the self-assessment checklist. This can include the area or issue you’d like to focus on and things you’ve tried that worked well or not so well. You can also use this document as evidence for your accreditation. Find a blank Action plan template in 8 – Templates.

Action plan example

Date plan developed: 29th August, 2017

Focus area: Offer fewer cakes, biscuits and slices as snacks.

Strategies:

1. Start offering sliced fruit and yoghurt as a snack twice each week. Start date: 4th September, 2017          Review date: 2nd October, 2017 We tried this strategy: [x] Yes    [ ] No What went well: Everybody loved the yoghurt. What could’ve gone better: Sometimes the fruit went brown or soggy by the time it was served. What else we could try: Store fruit in an airtight container coated in lemon juice, or choose longer-lasting fruits like grapes, melons and pineapple. Put this into a new action plan? No

2. Start offering air-popped popcorn as a snack once each week. Start date: 18th September, 2017          Review date: 16th October, 2017 We tried this strategy: [x] Yes    [ ] No What went well: Everybody loved the smell of the popcorn, and it was quick and easy to make. What could’ve gone better: Some residents were requesting toppings like salt and butter. What else we could try: We could look into herbs and spices to make savoury popcorn, or serve popcorn with some chopped, mixed, dried fruit through it. Look for new recipes to trial for afternoon snacks. Put this into a new action plan? Yes, new action plan to trial other snacks, e.g. zucchini slice. Action plan developed by (contact person): Jane Smith

Cooking and serving guides

We have developed some visual guides to help you prepare and serve meals with the recommended amount of each food group for general healthy eating.

Meal preparation guide

This guide shows what amounts of foods make up a healthy meal for any recipe.

• Different coloured vegetables should fill 1/2 of the pot.
• Lean meats, poultry, fish, eggs, tofu or legumes/beans should fill 1/4 of the pot.
• Grain (cereal) foods such as brown rice, wholemeal pasta or whole wheat couscous fill 1/4 of the pot.

Meal serving guide (1)

This guide shows the amounts to serve of each food group to make up a healthy meal.

• Different coloured vegetables should fill 1/2 of the plate.
• Lean meats, poultry, fish, eggs, tofu or legumes/beans should fill 1/4 of the plate.
• Grain (cereal) foods such as brown rice, wholemeal pasta or wholemeal or grain bread should fill 1/4 of the plate.

If dessert is served, choose low fat yoghurt, plain savoury biscuits with reduced fat cheese, low fat custard, tinned or fresh fruit or fruit crumble.

Serve water at every meal.

Meal serving guide (2)

This guide shows the amounts to serve of each food group to make up a healthy meal.

• Lean meats and grain (cereal) foods can be combined equally to make a meal to fill 1/2 of the plate.
• Different coloured vegetables should fill 1/2 of the plate.

If dessert is served, choose low fat yoghurt, plain savoury biscuits with reduced fat cheese, low fat custard, tinned or fresh fruit or fruit crumble. Serve water at every meal.

Food label reading

It’s important to remember that food labels are only found on food items that have been processed in some way. Many of the whole foods in the five food groups don’t have a food label (such as fresh vegetables – and we already know they are healthy).

It’s best to focus first on using labelled foods from the five food groups as much as possible. These could be items like cheese or milk, or canned fruit and frozen vegetables, or breakfast cereals and breads. Many other labelled foods are unhealthy or discretionary foods (e.g. biscuits, cakes and desserts) and should be used sparingly.

Understanding how to read food labels is useful to help choose the best type of a processed food from the five food groups. For example, it might be a healthier bread or cheese.

Labels on packaged food must meet strict requirements that include information for people with food allergies, food additive listings and food storage instructions. This is documented in the Australia New Zealand Food Standards Code.

Food labels can be confusing and often we don’t have time to work out what they mean and how to use them. Here are the key things to look for on food labels to help you make the best choices for your residents’ health:

1. Ingredient list

All ingredients in a food product must be listed on the label. They must appear in order, from largest to smallest, by weight.

You can use this list to spot foods that might be high in unhealthy fats, added salt or added sugars, because these ingredients would be listed in the first three or so ingredients.

Also look out for these other words for salt, unhealthy fat and sugar that might be on the ingredients list:

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

2. Nutrition information panels

Nearly all packaged foods must have a nutrition information panel in Australia. They can be used to compare packaged foods of the same food type to decide which product is healthier per 100g (or 100ml if liquid).

Nutrition information panels show the average amount of energy (kilojoules), protein, fat, saturated fat, carbohydrate, sugars and sodium (a component of salt) in the food. They also show amounts of any other nutrient referred to on the front of the food label. For example, if a food label has a ‘good source of fibre’ claim, then the amount of fibre in the food must be shown in the nutrition information panel.

HOW TO UNDERSTAND FOOD LABELS

What to look for…

Don’t rely on health claims on labels as your guide. Instead learn a few simple label reading tips to choose healthy foods and drinks, for yourself. You can also use the label to help you lose weight by limiting foods that are high in energy per serve.

Ingredients: Cereals (76%) (wheat, oatbran, barley), psyllium husk (11%), sugar, rice, malt extract, honey, salt, vitamins.

Ingredients ▲ Listed from greatest to smallest by weight. Use this to check the first three ingredients for items high in saturated fat, sodium (salt) or added sugar.

2 Menu planning

What about the Health Star Rating system?

The Health Star Rating system is a front-of-pack labelling scheme that was developed for use in Australia and New Zealand in 2014.

The Health Star Rating is designed to provide a quick and easy way to compare the nutrition of similar packaged food products. The nutrition rating is displayed as a number of stars. The more stars, the healthier the choice within that food category.

Health Star Ratings can also show the specific nutrient content of the product. Nutrient icons or badges provide information about the energy content, as well as the levels of saturated fat, sodium (salt) and sugars. In some cases, a badge may display a healthy nutrient (e.g. fibre). This positive nutrient icon is displayed to help you make healthier choices.

Health Star Ratings are voluntary and will be appearing on more food packages over the next few years.

What about health claims?

Sometimes manufacturers will use nutrition content claims like ‘low fat’, ‘reduced salt’ or ‘high fibre’ on the front of food packaging. These claims are only allowed to be used if the food meets certain criteria. For example, with a ‘good source of calcium’ claim, the food must contain more than a set amount of calcium specified by the Food Standards Code.

While nutrition content claims can generally guide you to healthier choices, it is important to check the claim by looking at the nutrition information panel. For example, products carrying ‘low fat’ claims may not be the healthiest option overall. Compare the nutrition information panels of similar products to see what the fat and also the energy (kilojoules) content is per 100g. For a more thorough assessment, you can also check if there are any healthy nutrients.

For more information on food claims, visit the Food Standards Australia New Zealand website.

Making the most of your food dollar: planning and shopping

Follow these hints and tips to get the most value for money from your food budget.

• Whenever possible, purchase food at a wholesale store. Buying basic food and supplies such as pasta, potatoes, rice, flour, oats, dried fruit, nuts, seeds and beans in bulk can save money. Keep in mind your storage capacity and stock rotation procedures for bulk purchases.

A note about catering foods:

• Some catering margarines might be vegetable based, but have a high amount of unhealthy, saturated fat in them. Check that the margarine you are purchasing is mostly polyunsaturated or monounsaturated, and fortified with vitamins A and D.
• Check that the breakfast cereals you are purchasing are fortified with B vitamins and iron.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

• Check the ‘best before’ or ‘expiry’ date on perishable foods. Only purchase items that can realistically be used before the specified date.
• Some grocery stores offer discounts for bulk purchasing or business purchasing. Check with your local grocery stores to find out what discounts you can negotiate.
• If you operate more than one site, purchase all food in the same trip, instead of making a separate trip for each site.
• Review the 20 items you purchase the most. Typically, this will represent about ½ of your total food budget. You should look for overcharges, possibly less-expensive alternatives, or bulk buying options.
• Consider partnering with another supported accommodation provider to increase your buying power when negotiating with food suppliers.
• Accessing FoodBank can be an option to save money when your food budget is especially tight – perhaps when resident occupancy is low. FoodBank regularly stocks healthy staple items like baked beans, wholegrain breads, and an ever-changing range of fruits and vegetables. It is best to purchase extras or discretionary food items from FoodBank only for special occasions such as Christmas or other cultural celebrations.

A note about purchasing fresh produce in bulk:

While bulk purchasing can save money, using and storing large amounts of excess fresh produce can be an added stress on kitchen staff.

You can incorporate some of your bulk, fresh produce in your current menu, and get creative by using that item in different ways, e.g. zucchini fritters, zucchini soup, or extra zucchini in a favourite casserole. Keep in mind, though, that residents need variety from both a nutrition point of view and so they don’t get bored.

You also need to consider the time kitchen staff will need to spend processing the fresh produce so it is able to be stored for a longer period – and whether you have the storage/freezer space.

This might include cooking tomatoes, zucchinis or eggplant in a pasta sauce, peeling and freezing bananas, halving passionfruit and scooping out and freezing pulp, pickling capsicums, or slicing and freezing beans, etc.

Making the most of your food dollar: preparing and serving food

• Consider your operational costs, i.e. the direct expenses you incur to ‘put meals on the table’, and see if you can increase efficiencies and reduce costs in these areas:
  • ✓ Processing, transporting, storing and handling food.
  • ✓ Salaries of cooks and other food service workers. Providing residents with the right training and skills to prepare and serve food can be a great help in the kitchen, as well as a great learning experience for the resident.
  • ✓ Kitchen equipment to suit your food preparation needs. Some facilities may benefit from items like combi ovens and programmable cooking equipment, which can increase efficiency and reduce operating costs.

2 Menu planning

• Preparing and cooking food can use a lot of electricity and/or gas. Shop around for the best utilities provider by using websites that are dedicated to finding you the best price (see http://www.energymadeeasy.gov.au/).
• Train staff to reduce all unnecessary waste; for example, scrape all residual ingredients from mixing bowls, especially when preparing large-volume recipes.
• Reducing waste is crucial to reducing food costs. Ensure you’re cooking the correct quantities and have a process for safely storing and making the most of leftovers. (Freezing and storing leftovers in single-serve containers for residents who may have missed meals is a much cheaper option than keeping frozen commercial meals in storage.)
• Extend meals by adding legumes and extra vegetables. By adding extra vegetables to meat dishes you will also reduce the energy (kilojoules) in the dish.
• Use all edible portions of vegetables, such as the stems of broccoli and cauliflower or the leaves of celery.
• Offer tap water instead of juice or sweetened drinks; it’s free and the healthiest choice. Try serving tap water with slices of cucumber and mint for added interest.

Sources of information

• Ellyn Satter Institute: Division of Responsibility in Feeding https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/

Real-life stories from supported accommodation:

Willow House

One of the biggest changes that we’ve made to our menu is replacing dessert at night with a cheese and fruit platter. Dessert was usually custard and fruit, carrot cake, fruit puddings served with cream or ice cream, or ice blocks and ice creams in the warmer months. We made the change because we noticed a lot of the residents were overweight and on medications for diabetes. We mentioned it first to our residents’ GP and they thought it would be a great idea.

Before we made the change we discussed it with the residents at our house meeting and explained the reason for the change and how these new foods are much better for their health. We also mentioned that the rest of the menu would be staying the same so that the change wasn’t too much all at once.

I let the staff know by discussing it at our staff meeting so that they were on board with the change and understood why we were doing it.

We found the platter took less time to prepare than our previous desserts did, and although it was slightly more expensive this was probably saved in staff preparation time.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

The residents liked the new dessert and we found they were quite proud to tell their GPs about this ‘healthy change’. Residents were even more pleased when they started to notice changes in their weight. One resident lost 13kg over 6–7 months with a bit of extra walking too.

They love their fresh fruit, and we noticed they ate a lot more when it was cut up for them and presented nicely on a platter. We’ve had lots of positive comments and there are rarely any leftovers, so we’ll definitely keep this on the menu.

This is a great example of how Willow House has swapped discretionary foods for snacks that are based around the five food groups. They also practised good communication with staff and residents to encourage support of the menu changes as outlined in the Menu planning guidelines.

If you think your menu might be offering too many discretionary items, head over to the Healthy snack ideas section for some alternatives to processed and unhealthy foods.

Fairhaven Care Centres

We had a four-week menu, but the residents got to know it by heart so we changed it to an eight-week menu so we could give them more variety and keep them guessing.

They didn’t like many of the new meals – they were too different. It was too big a change. So we are back to the four-week menu but try and change it with whatever is seasonal. So it’s the same meat but sometimes a different meal. The cooks enjoy the flexibility as well rather than sticking rigidly to the menu.

This is a good example of recognising the need to change menus to prevent resident boredom; however, big changes all at once can be challenging for residents to adapt to. It’s great how Fairhaven Care Centres were able to identify this and opt for smaller changes, sticking with foods that are familiar to residents whilst making the most of seasonal produce.

If you would like to base your cyclical menu around what’s in season, use the Menu self-assessment checklist to ensure you still have all your food groups covered to meet your residents’ needs. Use the Action plan template to help you make small changes over time to work towards bigger menu changes.

3 Healthy meal ideas and tips

Accreditation

This chapter provides you with some ideas to make your existing recipes healthier, and where to source new recipes.

Healthier recipes and snacks on your menu mean your residents have more opportunities to consume foods that are good for their health every day. It also shows them that you value their health as a priority.

A folder of standardised recipes is great evidence to present at accreditation to show how healthy your menu is. This all contributes to achieving Accreditation Standard 2.1: Food and Nutrition.

Modifying recipes

When preparing meals on site, you have the chance to create something that’s both satisfying and healthy. Well-known, favourite meals like spaghetti bolognaise, shepherd’s pie or barbeques don’t have to be abandoned if a few healthy changes are taken on board.

Follow this three-step guide to improve your recipes:

1. Swap less-healthy ingredients for healthier ones.
2. Use less of the ingredients that you can’t swap out.
3. Add extra goodness with vegetables and fruit.

Small modifications to regular recipes add up over time. These changes can really reduce the amount of unhealthy fats and sugars, or increase the amount of vegetables, that residents eat over a year.

1: Swap ingredients

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

3 Healthy meal ideas and tips

2: Use less

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

3: Add goodness

Add more veggies

3 Healthy meal ideas and tips

Add more fruit

Vegetable and fruit skins

When appropriate, leave the washed skins on vegetables and fruit – many nutrients are found in the skin.

Shop in season

Fruits and vegetables that are bought in season are both tastier and cheaper. Check out the Healthier. Happier. fruit and veg seasonality calendar to see what’s in season for Queensland at http://healthier.qld.gov.au/wp-content/uploads/2015/09/QH_O41832_T_Seasonal_Calendar_A4_2PP_23092015.pdf

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Shape up supported accommodation menu favourites in three simple steps!

We’ve selected some of the most common meals listed on supported accommodation providers’ menus and provided our top tips for recipe modification.

Roast dinner

1. Swap: Swap fatty roast meat for lean roast meat trimmed of all visible fat.
2. Use less: Use less salt; season your meat and veggies with mixed herbs, garlic and pepper. Use less fat in the gravy by draining away all visible fat from the meat juices in the pan first.
3. Add goodness: Add cauliflower, carrot and beetroot to your regular selection of roasting vegetables.

Fish and chips

1. Swap: Swap regular potato for sweet potato to make oven-baked chips.
2. Use less: Use less fat by baking in a combi-oven, grilling or steaming fish instead of deep or shallow frying.
3. Add goodness: Serve with a big, colourful side salad.

Beef stroganoff

1. Swap: Swap the cream or sour cream for reduced fat yoghurt.
2. Use less: Use less fat by choosing lean cuts of beef and removing all visible fat.
3. Add goodness: Add sliced mushrooms, capsicum, beans and peas to the dish.

Macaroni and cheese

1. Swap: Swap the cheddar cheese for a stronger-flavoured parmesan cheese and halve the quantity required.
2. Use less: Use less salt; season your macaroni with chopped herbs, e.g. parsley and basil, just prior to serving.
3. Add goodness: Sneak in finely diced or puréed veggies like cauliflower and pumpkin. Serve smaller quantities with a large side salad or different-coloured, cooked veggies.

Fruit crumble

1. Swap: For the crumble, swap butter for unsaturated (healthy fat) margarine, and swap your regular crumble mix for a healthier mixture of wholemeal flour, rolled oats and coconut.
2. Use less: Reduce the amount of sugar in the stewed fruit. Try warm spices like cardamom, cinnamon, ginger and nutmeg for extra flavour.
3. Add goodness: Add in as many fruits as you like; some great ones to try are apples, pears, blueberries, rhubarb and apricots.

Cake types and muffins

1. Swap: Swap white flour for a mixture of wholemeal and white flour. You may need to add a little extra liquid to keep the recipe moist.
2. Use less: Use less sugar; serve cakes and slices with a dollop of reduced fat yoghurt instead of sugary icing.
3. Add goodness: Choose fruit-based cakes, e.g. banana cake, apple teacake or berry muffins. The fruit adds goodness and brings natural flavour and sweetness without large amounts of sugar.

3 Healthy meal ideas and tips

Healthy snack ideas

Choose everyday healthy snacks that are based on the five food groups, such as the fruit, vegetable, or milk/yoghurt and cheese groups. The following ideas are alternatives to biscuits and cakes:

• Try sliced fresh fruit, fruit salad or tinned fruit. People are more likely to eat fruit that has been cut up than whole pieces of fruit.
• Make fruit muffins, pikelets or scones with wholemeal flour. Choose any fresh fruit in season, or tinned fruit to add to the batter. Bananas, berries, peaches, mangoes, apple and passionfruit (and even oranges and lemons!) all work well.
• Serve reduced fat yoghurt or reduced fat custard and fruit.
• Make savoury vegetable muffins, pikelets or scones with wholemeal flour. Choose any fresh veggies in season, frozen or tinned veggies to add to the batter. Try corn, carrot, zucchini and pumpkin.
• Serve raw vegetables cut into bite-sized pieces with healthy dips like salsa or hummus.
• Try zucchini slice or vegetable frittata portions.
• Use veggies to make dips: cucumber in tzatziki, eggplant in baba ghanoush, or chickpeas in a low fat hummus.
• Add a thin spread of ricotta cheese or nut pastes on top of fruit bread, wholegrain English muffins, toast or crumpets.
• Make low fat milk, yoghurt and fruit smoothies.
• Serve low fat cheese (e.g. cheddar, tasty, ricotta, cottage or cream cheese) and a few wholegrain crackers. Add sliced tomato for some extra colour and flavour.
• Make wholegrain or wholemeal finger sandwiches with colourful fillings, e.g. egg and lettuce, tuna and salad, cheese and tomato with chutney, or leftover roast meat and salad with mustard.
• Try single-serve containers of air-popped popcorn or a small handful of nuts.
• Remember to serve healthy drinks with your snacks. (Tap water is the cheapest and healthiest drink.) You could add cucumber and mint, slices of lime or lemon, or berries to water jugs for extra flavour.

Homemade cakes and biscuits

While homemade baked cakes, biscuits or muesli bars are often healthier than purchased ones, they still shouldn’t be everyday foods.

Serve your homemade snacks only sometimes and in small amounts.

How much? One serving of cake, muffin or doughnut is 40g. You can see from this photo that it’s a very small slice – about the size of a playing card and only the height of an apple.

It’s important to pay attention to portion size, as residents might actually be eating the equivalent of two or three discretionary food serves at one time.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

A note about muesli and nut bars

Nut, muesli and cereal-style bars can be a convenient snack choice, but did you know they are actually a discretionary food? This is because they are often high in added sugar and fats. They are also very bad for your teeth because they stick to teeth and cause decay.

If you are choosing a nut, muesli or cereal bar, always read the label to choose one with the lowest amount of sugar per 100g and that has mostly healthy sources of fats in the ingredient list. Or better yet, make your own healthy version (see recipe below).

Suggested recipes and cookbooks

A standardised recipe is one that has been trialled, tested and adapted for use in a specific food service. Using standardised recipes helps to make sure the quality and quantity of food is consistent each time the recipe is prepared. It can help to reduce waste, save time and money, and assist with staff training. Standardised recipes are also useful evidence for accreditation.

To standardise recipes for your service you may need to trial and readjust the recipe several times until you are happy with the final product. Note the serve sizes as well as the number of servings per batch.

Here are a few recipe resources available to purchase in hard copy or electronically.

Name: Really Cooking Good Food, ‘Kukumbat gudwan daga’

Author: Women’s centres of Manyallaluk, GulinGulin and Wugularr, with the assistance of The Fred Hollows Foundation

Cooking quantities: 30, 50 and 100 serves

Version: Hard copy

Link: http://www.healthinfonet.ecu.edu.au/uploads/docs/HeLP/Kukumbat%20gudwan%20daga%20really%20cooking%20good%20food.pdf

Name: Recipes from eMenu (online recipe bank)

Author: Queensland Association of School Tuckshops

Cooking quantities: 10–50 serves

Version: Electronic, available online (free of charge)

Link: http://www.qast.org.au/menus-and-recipes

Name: Meals on Wheels Recipes and Nutrition Folder 2013

Author: Angela Malburg

Cooking quantities: 10–100 serves

Version: Hard copy

Link: https://www.qmow.org/products/other-6

Sources of information:

• Diabetes Australia: Modifying recipes https://www.diabetesaustralia.com.au/modifying-recipes

3 Healthy meal ideas and tips

Real-life hints and tips from supported accommodation

Herston Lodge

Our residents love lasagne. So rather than the usual high-kilojoule, meat-and-cheese based dish, we’ve added a vegetable lasagne and a Greek lasagne to the menu too. The vegetable lasagne is a great way to use up leftover roast veggies. We usually layer it with roast pumpkin, sweet potato, eggplant, carrots or any vegetable that you can slice up. This way we know all our residents are getting lots of vegetables, and it suits the vegetarian residents too. Sometimes if we have a glut of tomatoes we cook and blend them up for the tomato sauce to layer in the dish.

The ‘Greek lasagne’ is actually just traditional moussaka! We serve it with a Greek salad on the side. We call it lasagne on the menu because the residents know what that is, so it doesn’t seem too new or foreign to them and it’s been a really successful menu item.

We try to think ‘outside the box’ with our menu planning. We believe that variety really is the spice of life and food should be an adventure… and we like to take our residents around the world with our menu!

Cathy Patterson, Fairhaven Care Centres

Vegie patties or fritters are always popular. We also hide grated carrot, zucchini or beetroot in mince dishes, which works well. Soup with lots of added vegetables is also a good way for residents to get their veggies.

We found most residents just do not like salad on a plate on its own, so we serve it as salad rolls.

Both of these examples show practical and appealing ways of getting more vegetables into meals for residents. They demonstrate a good understanding of their residents’ likes and dislikes, and Herston Lodge promotes their vegetable-filled meals cleverly by using a description the residents are familiar with. For more information on getting more vegetables into your recipes, see the three steps to modifying your favourite recipes.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

4 Food for special needs

Accreditation

Sometimes residents require a special diet that is different from the food on the standard menu.

This can be for many reasons, including medical needs (e.g. chewing or swallowing difficulties, allergies and intolerances), cultural and religious customs (e.g. halal), personal values (e.g. vegetarianism), or personal likes and dislikes.

Providing food relevant to individual needs should be prioritised, as it can impact directly on medical conditions and, in the case of severe food allergies, may be fatal.

Providing food considerate of individual needs is a component in achieving Accreditation Standard 2.1: Food and Nutrition.

This section will provide information on these areas, as well as some practical tips on planning, buying, preparing and serving foods for special needs.

Diabetes

Key points:

• No special menu is needed for the management of diabetes.
• A balanced, healthy diet is recommended.
• Choose slowly digested, starchy foods if possible.
• Only offer unhealthy, processed or discretionary foods occasionally.

Diabetes is the build-up of sugar (glucose) in the blood. If high blood sugar levels are not treated, people with diabetes can suffer serious health problems, including:

• heart disease (e.g. heart attack or stroke)
• eye damage
• kidney disease
• circulatory problems that might cause foot ulcers or infections.

People with severe mental illness are more likely to suffer these serious consequences from diabetes than the general population.

4 Food for special needs

There are two main types of diabetes:

Type 1 diabetes

• Usually develops in young people, but can occur at any age.
• Sugar is not removed from the blood because the body stops making the hormone insulin.
• Cannot be cured or prevented.
• Is managed by insulin injections and balancing a healthy diet and exercise.

Type 2 diabetes

• The most common type of diabetes.
• Sugar is not removed quickly enough from the blood because:
  • the body does not respond to insulin AND/OR
  • the body does not produce enough insulin.
• Managed by eating a healthy diet and doing regular exercise.
• Some people may need medication or insulin injections to help control blood sugar levels.

Healthy diet for diabetes

No special menu is needed for the management of diabetes. The recommended diet for residents living with diabetes is the same balanced, healthy diet from the five food groups, as recommended for everyone in the Australian Dietary Guidelines.

Some key things to remember about diabetes:

• Regular meals throughout the day are important for residents, especially those using insulin injections. This may include the need for between-meal snacks.
• Eating too much food at one time can make blood sugars get too high.
• Follow the Meal serving guide for people with diabetes to serve residents the recommended amounts of each type of food at each meal.
• Choose wholegrain and high fibre foods (e.g. wholemeal/wholegrain bread).

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

• Provide reduced sugar or sugar free condiments and desserts.
• Provide whole fruits instead of fruit juices.
• Keeping to a healthy body weight is important for people with diabetes. Carrying too much fat on the body makes it harder to control blood sugar levels.

Choosing the best starchy foods for a meal

Some types of starchy food are digested more slowly than others.

Choosing more slowly digested, starchy foods means:

• sugar is released into the blood more slowly
• it is easier for the body to control blood sugar
• we may feel fuller for longer, which could help weight control.

Choose these slowly digested starchy foods to fill ¼ of your plate.

• Grain and cereal foods (e.g. Basmati rice, wholegrain pasta, wholegrain breads or rolled oats)
• Slowly digested starchy vegetables and legumes/beans (e.g. sweet potato, sweetcorn, lentils, baked beans or kidney beans)

4 Food for special needs

Meal serving guide for people with diabetes

This guide shows the amounts to serve of each food group to make a healthy meal for people with diabetes.

• Different coloured vegetables should fill ½ of the plate.
• Lean meat, poultry, fish, eggs, cheese or beans should fill ¼ of the plate.
• Slowly digested starchy foods should fill ¼ of the plate:
  • starchy vegetables and legumes/beans (e.g. lentils, baked beans)
  • OR
  • grain (cereal) foods (e.g. brown/basmati rice, wholegrain pasta)

If dessert is served, choose low fat yoghurt, plain savoury biscuits with reduced fat cheese, low fat custard, tinned or fresh fruit or fruit crumble.

Serve water at every meal.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Tips for healthy meals for residents with diabetes

Planning and buying

• Plan a healthy menu from the five food groups that is suitable for all your residents, including those people living with diabetes.
  • ✓ Plan a variety of different coloured vegetables in the menu.
  • ✓ Plan slowly digested, starchy foods in the menu.
• When purchasing cooking oils, choose healthier fats such as rice bran oil, olive oil, sunflower oil or canola oil.

Preparing

• Add extra vegetables and legumes to casseroles, soups and stews.
• Try making sandwiches with one slice of wholegrain bread and one slice of white bread.
• Mix ½ wholemeal flour and ½ white flour when baking.
• Add fruits or vegetables to baked items (e.g. homemade blueberry muffins).
• Use wholegrain breadcrumbs in meat loaf.
• Make pizza using a wholemeal pizza base and top it with extra vegetables.
• Make changes gradually and trial the food with residents.
• Use low fat cooking options such as steaming, baking or grilling.
• Choose lean cuts of meat, trim any visible fat and remove the skin. Use processed meats (e.g. sausages, ham, bacon and luncheon meats) rarely or not at all.
• Offer unhealthy, processed or discretionary foods (e.g. cakes, biscuits, chips and ice cream) sparingly or only on special occasions.

Serving

• Serve whole fruits instead of fruit juices. Hot chocolate, flavoured milk and cordial should be offered only occasionally.
• Try serving a mix of brown rice and Basmati rice with casseroles.
• If you are trialling more slowly digested, starchy foods like Basmati rice or wholemeal pasta, continue to serve them regularly. Remember, it takes time for people to get used to the taste of a new food.
• Use small amounts of condiments. BBQ sauce, sweet chilli sauce and tomato sauce are high in sugar.
• Talk with residents about how a healthy diet will help them control their diabetes.

Diabetes frequently asked questions

Q: Can residents with diabetes have added sugar?

A: Small amounts of sugar are okay. Diabetes is not just about reducing added sugars – consider the serving size and the types of food eaten. For example, one teaspoon of sugar in coffee or tea at morning tea might have little effect, but if someone drinks ten cups of coffee a day, that amount is likely to affect the resident’s blood sugar levels. It is also likely to mean they will gain weight over time, which often makes diabetes harder to manage.

4 Food for special needs

Q: What about alternative or artificial sweeteners?

A: Artificial or intense sweeteners such as stevia, aspartame, saccharin or sucralose are often found in processed ‘diet foods and drinks’. They do not contain kilojoules or energy, but neither do they provide any nutrients. Essentially, these foods are not really part of a healthy diet.

In the past, safety concerns have been raised about some artificial sweeteners. These concerns resulted from studies conducted on animals, but the doses or amounts were many times more than a person could really eat or drink. Food Standards Australia and New Zealand (FSANZ) has deemed these products safe for use in our food.

Regular use of artificial sweeteners, however, may train our brain to crave sweet-tasting foods. Studies have also suggested that some sweeteners may increase our appetite or disrupt our healthy gut bacteria, leading to weight gain, but more high quality research is needed to confirm these findings. Diet soft drinks also contain acids that are bad for our teeth.

The best thing to do is have as little as possible of all sugars, syrups and sweeteners. Add sweetness and flavour to food with ‘warm’ spices like cardamom, cinnamon, ginger and nutmeg. Muffins and cakes can usually be made with at least 25 per cent less sugar, and the sugar in stewed fruit and pie fillings can be cut in half. The best way to reduce sugar and artificial sweeteners in hot drinks is to gradually reduce the amount over time.

For more information:

• How to choose more slowly digested starchy foods: https://www.baker.edu.au/-/media/Documents/fact-sheets/BakerIDI-factsheet-carbohydrates-and-glycaemic-index.ashx?la=en
• Diabetes Australia: https://www.diabetesaustralia.com.au/

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Mental illness and diet

Key points:

• Assist residents with a mental illness to maintain a healthy weight by offering a healthy, balanced menu.
• Excessive thirst (polydipsia) or excessive drinking needs to be managed on the advice of a health professional.
• Large amounts of caffeine can worsen or induce some mental health conditions.

A mental illness is a health problem that affects how a person feels, thinks, behaves, and interacts with other people.

There are many different types and degrees of severity of mental illness. Some of the major types are depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders and eating disorders.

People with a severe mental illness are more likely to have unhealthy eating habits and poor physical health. They are more likely to be overweight, have heart disease, diabetes and problems with their teeth.

Medications

Psychotropic medications play an important role in the treatment of severe mental illness. Residents on these medications may, however, experience side effects such as constipation, dry mouth and lethargy (tiredness). They are also more likely to have an increased appetite, and less likely to feel full when they eat. They might ask for larger meals and a second serving, which can lead to rapid weight gain.

Try these tips to help prevent residents from gaining unwanted weight:

• Suggest residents eat more slowly and chew foods well, rather than gulping food.
• Encourage residents to drink water before and with meals.
• Load meal plates up with low energy foods like vegetables.
• Don’t have unhealthy foods on show or easily available to residents.
• Offer residents healthy snack foods. Fruit, veggie sticks, wholegrain crackers, yoghurt and raw or unsalted nuts are all healthier snacks than chips, biscuits or cake.
• Consider whether other activities, such as walks or social outings, might help. They can serve as a distraction from hunger, as well as increase residents’ activity levels.

4 Food for special needs

Excessive thirst

Polydipsia (excessive thirst that can’t be quenched) occurs in around 20 per cent of people with a long-term mental illness, and can be life-threatening. When someone drinks very, very large amounts of water, they are at risk of seizures and cardiac arrest.

If you notice a resident drinking excessive amounts of water or other fluids, refer them to their GP. The main way to manage polydipsia is fluid restriction.

Eating disorders

Eating disorders are a group of mental health disorders where sufferers show unusual eating behaviours such as food restriction or refusal, bingeing or purging.

No special menu is needed for people living with an eating disorder, and they should be encouraged to eat a wide variety of foods within regular meal and snack times.

If you suspect a resident is suffering from any form of disordered eating, refer them to their GP.

A note about caffeine

Caffeine is a stimulant drug found in coffee, tea, cocoa, cola-flavoured soft drinks and energy drinks.

Consuming too much caffeine (more than 6–8 cups of coffee/day) can have side effects. Large amounts of caffeine can:

• worsen or induce some conditions such as anxiety, insomnia, panic attacks, psychosis, mania and delirium
• worsen emotional and behavioural symptoms, anxiety and sleeplessness
• interfere with the effectiveness of some medications
• provoke panic attacks in people with panic disorder and social phobia.

If excessive caffeine intake is a problem in your service, try:

• limiting access to coffee, or offering decaffeinated coffee
• offering herbal tea as a hot drink alternative
• limiting or removing access to cola and energy drinks in on-site vending machines.

Tips to include healthy meals for residents living with a mental illness

Planning and buying

• For residents who have gained unwanted weight due to medications, refer to the Food for residents who are overweight section.
• To help prevent constipation, a common side effect of psychotropic medications, include lots of high fibre foods such as veggies, legumes and fruit in your menu.

Preparing

• Choose healthy cooking methods, e.g. roasting, steaming, barbequing, stewing or microwaving, which use little or no added fat. This helps with weight control and is good for overall health.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Serving

• Decide whether your service offers larger portion sizes or second serves when requested. If residents request a second serve, offer extra non-starchy vegetables first.
• Poor memory and poor attention can be common in people with a mental illness. Prompt these residents to attend mealtimes.
• If food hoarding is a problem in your facility, try plated meals rather than a buffet-style service.
• Consider limiting coffee or caffeine-containing beverages to two or three times a day.
• Offer water regularly. This can help alleviate medication side effects such as dry mouth and constipation. Drinking plenty of water also helps prevent dehydration, which can affect mood, causing irritability and restlessness. You may need to monitor water intake for residents with polydipsia.
• Encourage residents to eat regularly throughout the day. Fuelling your body consistently with food can help to stabilise mood.

For more information:

• Beyond Blue: Healthy eating for people with depression, anxiety and related disorders https://www.bspg.com.au/dam/bsg/product?client=BEYONDBLUE&prodid=BL/0353&type=file

4 Food for special needs

Cultural and religious menu considerations

Key points:

• Food is a major aspect of culture.
• Ask residents about their ethnic background and eating patterns, and learn what, when and how they eat.

Cultural customs

Culture is closely linked to every part of our life. It is important for the wellbeing of all people.

Food is a major aspect of our culture. The role of food is not just about providing enough nutrition; food connects people with their identity, family and traditions.

Although your residents may have the same cultural background, it is important not to assume that their beliefs and views are the same when it comes to food.

The key aspect is to respect everyone’s food preferences.

Eating foods from a person’s own culture is important, but residents may also enjoy food from other cultures. People often choose a food intake that combines their traditional diet and meals from host countries. Culturally familiar food may provide comfort to people. Different cultural food also increases variety of menu choices for everyone in your accommodation.

Religious food practices

Food can also be a very important part of a person’s religion. A person may eat in a certain way, or not eat particular foods, because they are prohibited by their religion.

It is important not to assume what a person will eat just because they belong to a particular religion.

Practices can be diverse even within the same religion, and it is important to discuss with your residents what their religious food needs are.

In some religions, the way food is prepared and served is just as important as the food itself.

The following table provides a guide to common food restrictions for some of the religions you are likely to come across.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

4 Food for special needs

Tips to include healthy cultural or religious meals for your residents

Planning and buying

• Consider your residents’ ethnic backgrounds and eating patterns, and understand what, when and how they eat. You may be able to discuss some of these preferences with residents when they first come to live in your supported accommodation.
• Consider including traditional dishes from the ethnic backgrounds of residents to increase the variety of foods offered in your menu.
• Check with residents how strictly they follow the dietary rules of their religion, and refer to the attached table to assist you in planning suitable meals.
• Consider using a range of grain products in your meals to reflect different cultural grain foods. For example, use rice, pasta, noodles, couscous, quinoa bread and pita breads in your menu.
• Lots of cultures and religions follow a vegetarian diet, so you might consider:
  • using more meat alternatives, e.g. more legumes, tofu, soy products, nuts and seeds in your menu
  • purchasing dairy foods that don’t contain animal rennet or gelatine so they can be served to everyone.
• Consider cultural or religious festivals and celebrations in menu planning (see http://www.australia.gov.au/about-australia/special-dates-and-events).
• When purchasing halal or kosher meats or foods, look for the symbols to show the products are certified. Let your residents know that you have prepared certified halal or kosher food for them, or display it on the menu.

Preparing

• Consider different cooking methods to reflect different cultural cooking styles, e.g. baking, grilling, roasting, pan-frying, stir-frying, slow-cooking and steaming.
• Some religions require that food is handled in a certain way. For example, halal foods must be cooked separately from non-halal foods, and kosher dietary laws prohibit the mixing of meat and milk products (cooking and consumption). (See http://www.halalsquare.com.au/groceries/index.php/ and http://brisbanehebrewcongregation.com/about-us/kosher/.)
• Some religions also require that a person doesn’t consume alcohol. Use vanilla-flavoured essence that doesn’t contain alcohol, and avoid using alcohol in casseroles or pasta sauces.

Serving

• Some cultures prefer meals served in bowls instead of on plates, and some prefer to use chopsticks, or a spoon and fork, instead of a knife and fork.
• Provide traditional condiments on the table at mealtimes, e.g. soy sauce and fish sauce for Asian residents.
• Some residents might fast as part of their cultural or religious practice. Ask residents when and how they will fast and how you can support them.

For more information:

• For cultural/religious festivals and celebrations: http://www.australia.gov.au/about-australia/special-dates-and-events
• For further information about halal foods and where to source: http://www.halalsquare.com.au/groceries/index.php/
• For further information about kosher dietary laws and foods, and where to source: http://brisbanehebrewcongregation.com/about-us/kosher/

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Food allergies and intolerances

Key points:

• Food allergies are serious. Food allergies can be life threatening.
• A medical professional should diagnose an allergy.
• Food allergies and food intolerances are not the same.

Supported accommodation residents are more likely to have difficulty communicating their special food needs and managing their allergies.

It is important to take information communicated about a resident’s food allergies or food intolerance seriously and follow the recommended diet.

If you are concerned about a resident, encourage them to see a GP for an assessment.

What is anaphylaxis?

Anaphylaxis is a severe type of allergic reaction. Anaphylaxis can be life threatening and must be treated as an emergency. Look for these common signs:

• swelling of the lips, throat and face.
• a red, itchy skin rash.
• difficulty breathing.

These foods commonly cause anaphylaxis

• Peanuts
• Shellfish
• Eggs
• Tree nuts (e.g. almonds, cashews and macadamias)

If someone has anaphylaxis, they will probably carry a special medicine called an EpiPen or AnaPen. This gives an injection of adrenaline for emergency treatment. They will still need emergency medical attention after using this medicine.

4 Food for special needs

Coeliac disease

Coeliac disease is a condition where the bowel is damaged by a food protein called gluten. Avoiding gluten means the bowel will heal and symptoms will improve. Although coeliac disease cannot be cured, it can be controlled with a lifelong, gluten-free diet.

Gluten is found in barley, rye, oats and wheat. It can also be added as an ingredient to many processed foods.

Even a tiny amount of gluten in the diet of someone with coeliac disease can cause damage and symptoms.

Gluten-free foods

There are many gluten-free foods available that together can make up a healthy diet for those with coeliac disease. These foods are gluten free in their natural form. Natural form means without added sauces, spices or flavourings.

• Vegetables and legumes/beans
• Fruit
• Grain foods – rice, corn and quinoa
• Milk, cheese and yoghurt
• Lean meats, fish, eggs, tofu, nuts, seeds and legumes

If a resident has coeliac disease, it is recommended they see a dietitian. For more information on gluten-free foods and a sample meal plan, visit https://www.health.qld.gov.au/__data/assets/pdf_file/0026/149930/gastro_coeliac.pdf

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Lactose intolerance

Lactose is a natural sugar found in cow’s milk and also, in smaller amounts, in yoghurt and cheese. Lactose intolerance is a condition where the body has trouble digesting lactose.

The amount of lactose a person can tolerate varies, but it is usually not necessary to remove ALL dairy products from their diet.

Lactose-free foods

Most cheeses, and yoghurts with live bacteria, are very low in lactose and are usually well tolerated.

There are many lactose-free milks available, such as lactose-free cow’s milk, soy milk, almond milk and rice milk. When purchasing lactose-free milk products, choose those that are fortified with at least 100mg of added calcium per 100g.

Lactose is also found in many processed or packaged foods. Check the ingredients list for lactose, which may also be listed as milk solids, non-fat milk solids, whey or milk sugar. If you are unsure about the suitability of a particular product for someone with lactose intolerance, check with a dietitian.

For more information:

• Further information on allergies:
  • National Allergy Strategy: All about Allergens (free online training for people working in food service): www.foodallergytraining.org.au
  • Download or order free allergy and anaphylaxis posters here: https://allergyfacts.org.au/shop/posters
• Further information on coeliac disease:
  • Coeliac Australia: http://www.coeliac.org.au/
  • Dietitians Association of Australia (DAA): What is coeliac disease? (www.daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/what-is-coeliac-disease/)
  • Queensland Government Department of Health: Coeliac Disease (www.health.qld.gov.au/__data/assets/pdf_file/0026/149930/gastro_coeliac.pdf)
• Further information on lactose intolerance:
  • Dietitians Association of Australia (DAA): Understanding lactose intolerance (www.daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/understanding-lactose-intolerance/)

4 Food for special needs

Tips for healthy meals for food allergies or intolerance

Planning

• Know which residents have an allergy or intolerance that has been verified by a doctor. Keep a list in the kitchen.
• Know which foods to exclude. Use pictures on your kitchen wall to show all kitchen staff the foods they must exclude.
• Store products with allergy foods separately from other products. Cross-contamination of food products might be enough to trigger a severe allergic reaction.
• Label storage containers clearly.

Buying

Check the ingredients list to make sure packaged foods do not contain allergy foods.

Preparing

• Use a commercial dishwasher to clean boards, knives and other utensils to avoid cross-contamination.
• Label and use a separate toaster, sandwich maker and strainers to avoid cross-contamination.

Serving

• Use colour-coded plates to distinguish allergy-free meals from standard meals, for example red plates for a seafood-allergy-friendly meal.
• Clearly label allergy-free meals for residents, and have processes in place on how you will label and store any leftovers.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Chewing and swallowing difficulties

Key points:

• Residents with chewing or swallowing problems are at risk of choking or having food or liquid go into their lungs. This can cause pneumonia.
• Follow recommendations from a speech pathologist about the need to change the texture of a resident’s diet. Get diets reviewed as necessary.

Do you have residents

• with missing teeth or poorly fitting dentures;
• who have had a stroke or a recent operation; or
• who are living with a disability?

If you are concerned about a resident, encourage them see a health professional to check if they need changes to their diet for a chewing or swallowing difficulty.

Meals can be made softer or prepared using smaller pieces of food to make them easier to eat. This is called a texture-modified diet.

Residents requiring texture-modified meals

Residents may be prescribed a texture-modified diet by a health professional. It is important to follow this recommendation to keep your residents safe from choking. Review this recommendation with a health professional if you are unsure.

Textures of meals

Soft food:

• is moist, naturally soft or requires minimal cutting
• can become more moist by adding sauce or gravy
• is easily broken into small pieces (no larger than a small grape).

Minced/moist food:

• is soft, moist and easily formed into a ball
• doesn’t contain any hard or sharp lumps
• is easily broken or mashed into very small pieces (no larger than a sultana).

Smooth puréed food:

• is very smooth and lump free
• is moist and can hold its shape on a spoon
• should be puréed using a blender, vitamiser or food processor.

4 Food for special needs

Tips for texture-modified meals

Planning

• Provide a variety of healthy foods from all the five food groups to residents requiring a texture-modified diet.
• Include different-coloured foods to make meals more appealing.
• Have appropriate equipment, e.g. a food processor and moulds (there are a variety of food moulds available online).
• Plan the same amount of food and similar types of meal as other residents’ meals.

Preparing

• Remove the skins and seeds from fruit and vegetables before puréeing.
• Prepare foods in defined shapes; for example, bake minced or blended foods in loaf tins and serve as slices. Shape puréed foods into patties.
• Cook foods until very soft.
• Add spices (not salt) to enhance flavour.
• Chop larger foods, such as meat, into smaller pieces before blending.
• Use soups, gravies, sauces, melted margarine, juice or milk to moisten pureed foods instead of water. Make sure the temperatures of these liquids match the food being puréed (hot liquid with hot food).
• If the purée is too thin, thicken with mashed potato or more solid food until it can hold its shape.

Serving

• Use food moulds to shape purées into recognisable foods or shapes.
• Use icing bags with shaped heads (e.g. star or noodle shaped) to create shapes with firm, blended food.
• Serve each food item separately on the same plate; for example, serve puréed chicken, beans, carrots and potatoes separately, not mixed together.
• Serve hot foods hot and cold foods cold.
• Taste the food before serving to make sure that it is acceptable.
• Tell residents what the meal is (particularly minced and puréed food).

For more information:

• Queensland Government, Nutrition Education Materials Online: Texture-modified diet and sample meal plans (https://www.health.qld.gov.au/nutrition/nemo_textmod)
• Australian Standards for Texture Modified Food and Fluids (free printable poster): https://daa.asn.au/wp-content/uploads/2015/04/A3_Aus-Standards-Food-and-Fluids-Poster-Check-2.pdf

These Texture Modified Food Images were originally developed by NAQ Nutrition for their ebook publication: Improving the Dining Experience in Residential Aged Care and have been reproduced here with permission. Visit www.naqld.org for more information.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Increasing energy and strength

Key points:

• Residents who are underweight, losing weight, not eating or have an illness or injury may need extra dietary care (or nutrition).
• Provide foods high in protein and energy, e.g. meat, legumes, eggs, dairy, grains, and healthy fats and oils.
• Offer these foods at every meal and snack. This can include supplements or modified recipes.

Have you noticed a resident who has:

• lost weight without trying;
• been regularly avoiding meals or leaving lots of food on their plate;
• had trouble eating because of sore teeth or poorly fitting dentures;
• been sick for a long time; or
• broken a bone?

If you are concerned about a resident, encourage them to see their GP.

Which foods will help my resident?

Foods high in protein and energy (kilojoules) are recommended because they can help to maintain or improve a resident’s weight, strength and independence.

High protein foods:

• Lean meats, poultry, fish, tofu and egg food group.
• Milk, yoghurt or cheese food group.

High energy foods:

• Healthy fats and oils.
• Grain (cereals) food group.
• Supplement drinks.

Enriched milk recipe

This is a low-cost alternative to supplement drinks. Use enriched milk any time that you would use regular milk.

Ingredients:

• 1 litre full cream milk
• 4 tablespoons milk powder

Directions: Pour milk into a jug. Stir milk powder in with a whisk until blended.

Keep this enriched milk in the fridge.

Up to 1 cup of milk powder can be added to 1 litre of milk, depending on needs and taste preference.

4 Food for special needs

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Tips for increasing energy and strength in residents who need it

Planning and buying:

• Plan to have these residents weighed and reviewed by their GP or dietitian regularly.
• Plan protein foods, e.g. eggs, meats or dairy foods, for every meal or snack. This means each meal is more nutritious and residents don’t need to eat larger serves.
• Purchase full-cream dairy foods whenever possible (milk, cheese and yoghurt).
• Save dinner leftovers in takeaway containers for an easy lunch option.

Preparing:

• Add extra healthy oils and fats when preparing sauces or cooking meat.
• Use a thicker spread of butter/margarine on toast or sandwiches.
• Add milk powder into creamy soups, porridge and mashed potatoes.

Serving:

• Six smaller meals may suit your resident better than three larger, more filling meals.
• Provide energy-rich drinks such as milk or 100% juice instead of tea, coffee or plain water.
• Add extra dressings to salads, and healthy oils to pasta at the time of serving.
• As a resident’s appetite returns to normal when they are feeling better, you may need to increase serving size to match their increasing appetite.

Increasing energy and strength frequently asked questions:

Q: Can the resident just have soft drink and chocolates for extra energy?

A: These foods are not a good source of protein, vitamins or minerals. Better choices to help residents recover from an illness are high energy, high protein foods from the five food groups.

Q: What if my resident can’t eat dairy foods?

A: In this case, provide alternatives to dairy, such as calcium-enriched soy milk, nut milks or rice milk, and soy yoghurt and soy cheese.

Q: What if other residents want the same meals?

A: Eating an extra high protein and high energy diet is not suited to everyone and may make the management of some illnesses, such as diabetes, worse.

Q: Is this diet only for residents who are underweight?

A: Any resident, regardless of their size, may be prescribed this diet by their GP or dietitian, especially if they are losing weight without trying.

For more information:

• Queensland Health, Nutrition Education Materials Online (NEMO): High protein, high energy resources (https://www.health.qld.gov.au/nutrition/nemo_nutrsup)
• Dietitians Association of Australia: Find an accredited practising dietitian (https://daa.asn.au/find-an-apd/)

4 Food for special needs

Food for residents who are overweight

Key points:

• Excess weight occurs when a person consumes more energy (kilojoules) than their body uses in activities and at rest.
• A balanced, healthy diet with limited discretionary foods is recommended.
• Make small, gradual changes towards healthy eating rather than restrictive dieting.

Overweight and obesity is when a person has excess body weight in the form of fat. Excess weight occurs when the energy (kilojoules) we eat from food and drink is more than the energy used by our bodies in activities and at rest.

This can happen from either eating too much food or making unhealthy food choices. Small imbalances over a long time can lead to a person becoming overweight.

When you have too much energy going into the body through food and drink, weight gain can occur.

Why do some people become overweight?

People make unhealthy food choices for a number of reasons – something that’s important to remember when considering how to help a resident manage their weight problem. Some factors known to increase the risk of being overweight include:

• the modern environment – easy access to unhealthy food, food marketing and less opportunities to be active
• being overweight as a child or teenager
• low levels of education and income – this can mean having less money to purchase healthy foods, and less opportunity to learn about healthy foods and how to prepare them
• homelessness or uncertain access to food. People who are unsure of where their next meal will come from may be more likely to overeat or hoard food.

What causes overeating?

• Stress and/or anxiety
• Boredom
• Habitual overeating
• Not listening to body cues when full
• Eating for comfort
• Quitting smoking
• Medication side effects

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Why is being overweight harmful?

Excess body weight is a risk factor for a number of illnesses. It also reduces the mobility of residents and their ability to maintain independence.

For supported accommodation providers this can impact on providing access to personal care services.

What’s the best weight management approach?

‘Dieting’ and skipping meals are not effective ways of managing weight. Effective weight management requires a commitment to making small, gradual changes towards healthier eating and being physically active over time.

Healthy eating includes both having good meal habits and enjoying a wide variety of foods. If you have residents who are overweight or obese and would like to manage their weight, consider:

• limiting discretionary foods available on site
• reducing food and drink portion sizes
• encouraging residents to be more active in their everyday lives.

Goals for weight loss

Gradual weight loss is best. For some residents an initial goal of maintaining current weight and preventing further weight gain is the priority.

Progress can be measured by changes to waist circumference, how clothes fit, and how your resident feels.

The importance of sleep

Getting less than 7 hours sleep per night has been linked to weight gain. Just one or two nights of reduced sleep can make you have trouble concentrating and be irritable, moody and depressed.

Regularly sleeping less than 7 hours causes:

• an increase in hunger and appetite
• an increase in cravings for high energy comfort foods
• tiredness and lack of energy to participate in physical activity
• more fat to be stored in the body.

4 Food for special needs

Practical tips for weight management

Planning and buying

• Plan meals and snacks around the five food groups. Avoid offering unhealthy foods (e.g. cakes, biscuits, ice cream and processed meats) as regular items on the menu, which can lead to weight gain in residents over time.
• Choose reduced fat spreads and cooking sprays to reduce the amount of fat being used. (When you do buy oils, remember to choose healthier fats such as rice bran oil, olive oil, sunflower oil or canola oil.)
• Purchase reduced fat milk, cheese and yoghurt.

Preparing

• Choose healthy cooking methods such as roasting, steaming, barbequing, stewing or microwaving that use little or no added fat.
• Consider modifying recipes to add more filling foods, e.g. extra vegetables, beans and legumes. This will help residents to feel fuller for longer.
• Choose lean cuts of meat, trim any visible fat and remove the skin. Only use processed meats like sausages, ham, bacon and luncheon meats rarely or not at all.

Serving

• Use the Meal serving guide to ensure residents have half of their plate filled with vegetables and salads.
• Limit or avoid offering sugary drinks, e.g. juice, flavoured milk, hot chocolate and cordial. Choose water – it’s the healthiest option and it’s free.
• If residents request second serves at mealtime, offer non-starchy vegetables or fruit rather than an additional serve of every food group.
• Use small amounts of condiments; BBQ sauce, sweet chilli sauce and tomato sauce are high in sugar.

Weight management frequently asked questions:

Q: Is a low carbohydrate diet the key to weight management?

A: Low carbohydrate diets have gained popularity recently for weight management. One example is the Atkin’s diet. The basic concept is to eat fewer carbohydrates or starchy foods in the hope of losing weight.

The most common source of carbohydrates, or starchy foods, is grain foods such as bread, rice, pasta, oats, couscous and quinoa. Some vegetables and fruit are also a source of carbohydrates, as are processed, unhealthy cakes and biscuits.

Healthy starches or carbohydrate foods provide essential nutrients, including B vitamins and fibre, and are an important fuel for the helpful bacteria that live in our gut. In low carbohydrate diets, these benefits are being missed out on.

Of course, unhealthy carbohydrate foods such as cakes, biscuits, lollies and takeaway foods with lots of pastry are high in energy (kilojoules) because they contain lots of added sugars and fats. For this reason they are best avoided for weight loss.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

It’s important to remember that the Australian Dietary Guidelines are based on evidence from thousands of studies. The best way to maintain a healthy weight is to combine a balanced diet that includes vegetables and fruits, whole grains, lean meats and alternatives, legumes, and low fat dairy products like milk, yoghurt and cheese with daily exercise.

Q: Can you gain weight from eating healthy foods?

A: Eating too much of any food, whether it’s healthy or unhealthy, can lead to weight gain. The important thing to remember is to listen to your body, only eat when you’re hungry and stop when you feel full. Be mindful of eating for other reasons, such as boredom or to avoid uncomfortable emotions like anxiety.

Coloured vegetables and salads are lower in energy (kilojoules) and packed full of nutrients and fibre to help you feel full, so these are a good choice for weight management.

Q: Is quitting sugar the answer to losing weight?

A: Sugar is found in a lot of everyday food and drinks. It can be naturally occurring, as in fruit and dairy products. It can also be added during processing, as in cakes, biscuits, pastries and sauces.

Too much added sugar in your diet can lead to tooth decay and weight gain, so it’s definitely important to avoid foods with large amounts of added sugar (e.g. soft drinks and lollies) and also foods where sugar is accompanied by lots of fats (e.g. cakes and chocolates).

Limit your intake of these discretionary foods to small amounts on special occasions to reduce your intake of added sugars, and enjoy a wide variety of foods from the five food groups in sensible portions. This will assist with weight loss and also reduce your risk of tooth decay.

For more information:

• Eat for Health: Tips for losing weight healthily https://www.eatforhealth.gov.au/eating-well/tips-eating-well/tips-losing-weight-healthily/
• Dietitians Association of Australia: Weight management https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/weight-management/

4 Food for special needs

Vegetarian diets

Key points:

• Vegetarian diets are plant based and avoid meat products.
• People may follow a vegetarian diet for a range of health, environmental, ethical, religious or economic reasons.
• Vegetarian diets can be healthy, but they do need to be planned to make sure they aren’t low in important nutrients.

A vegetarian diet is generally based around plant foods, e.g. vegetables, legumes, fruit and grain (cereal) foods, and avoids the flesh of all animals, including fish and poultry. Vegetarian diets are usually followed in one of the following ways:

• Lacto-vegetarian diet: Dairy foods are also eaten.
• Lacto-ovo vegetarian diet: Dairy foods and eggs are also eaten.
• Vegan diet: Only plant foods are eaten.

People may follow a vegetarian diet for a range of health, environmental, ethical, religious or economic reasons. Vegetarian diets can be really healthy, but they need to be well planned to make sure all the nutrients needed by our bodies are included.

Iron deficiency

Vegetarians and vegans are at an increased risk of being iron deficient. Use the following tips to increase the absorption of iron from plant foods:

• Avoid drinking tea and coffee at mealtimes. This can block the iron in food from being absorbed into the body.
• Eat foods that contain vitamin C (e.g. tomatoes, broccoli, citrus fruits, berries, kiwi fruit, brussels sprouts and capsicum) at mealtimes. These foods will help the body to absorb more iron from foods.
• Cook vegetables to increase the amount of iron available from them.

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

A balanced vegetarian diet

Eating a wide variety of foods is particularly important for vegetarians. Here’s a guide to vegetarian-friendly options from each of the food groups.

Vegetables and legumes/beans, and Fruit food groups Vegetarian diets include all items in these food groups, so choose a wide variety of coloured veggies, legumes and fruit.

Grain (cereal) foods Vegetarian diets include all items in this food group, so choose a wide variety of wholemeal and wholegrain options.

Milk, yoghurt or cheese food group Include these items as usual for lacto and lacto-ovo vegetarian diets. For vegan diets choose from a wide range of dairy alternatives, e.g. rice, soy or nut milks.

Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans food group Legumes/beans (lentils, chick peas or split peas), tofu, nuts, seeds, tahini or other nut/seed pastes are all good meat alternatives. Include eggs for lacto-ovo vegetarian diets.

A note about tofu

Tofu is a good meat-free source of protein and is low in unhealthy fat. When cooking with tofu, use healthy cooking techniques such as grilling, baking and stir frying. To get a crispy-style tofu without the deep frying, drain a cube of extra-firm tofu, slice, press down with paper towel to remove any extra water, season as desired, and bake in the oven until crispy.

Special-needs residents: Vegetarian residents who require a high energy, high protein diet can be at higher risk of nutrient deficiencies. Talk to your GP or dietitian to ensure all their nutrient needs are met.

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Practical tips for vegetarian diets

Planning and buying

• Consider planning a meat-free night once a week for all residents (e.g. meat-free Mondays). Vegetarian meals can be healthier, cheaper, and better for the environment.
• Plan meals to include a wide variety of meat alternatives such as eggs, legumes/beans (e.g. chickpeas, lentils or baked beans) and tofu.
• When choosing canned legumes or beans, choose the ‘reduced salt’ or ‘no added salt’ options. Make meals visually appealing by planning to include a rainbow of coloured vegetables.
• Be aware that gelatine, commonly used in dessert dishes, is an animal product and is not suitable for vegetarian diets.
• Consider purchasing vegetarian-friendly beef- and chicken-flavoured stock. These stocks are not made from animal products and can be used across both vegetarian and regular dishes.

Preparing

• Make vegetarian meals interesting by combining flavours and textures. Top a smooth curry with a sprinkle of crunchy nuts, make a wholegrain egg sandwich with crisp lettuce, and spruce up tomato-based pasta with some crispy, grilled tofu.
• Try slow-roasting vegetables. When you slow-roast food it removes water and intensifies the flavour; for example, roasting tomatoes for a pasta sauce gives the sauce a greater depth of flavour, and slow-roasting carrots increases their sweetness.
• When making a vegetarian dish, prepare a few serves extra that you can label with the date and freeze for later use.
• Be aware that people following a vegetarian diet may prefer their food to be cooked and served with separate utensils and equipment that haven’t touched meat-based dishes.

Serving

• Label vegetarian meals, especially in a bain-marie setting, so that serving staff and residents know the correct meal is being received.
• A lot of sauces and gravies are made using meat juices from a roasting pan, or from meat-based stock. Keep these gravies separate from vegetarian dishes, and labelled so they aren’t mistakenly added.

For more information:

• Dietitians Association of Australia: Vegetarian diets https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/vegetarian-diets-the-basics/
• Nutrition Australia: Vegetarian diets FAQs http://www.nutritionaustralia.org/national/frequently-asked-questions/vegetarian-diets

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Real-life stories from supported accommodation

Herston Lodge

If a resident wants to lose weight they usually come and talk to me (the cook) and I give them a few ideas. Soft drink is consumed a lot around here, so that’s the first thing I suggest to cut back or stop buying. Then we talk about portion sizes with the residents. We find controlling portion size really works to help prevent residents from overeating. If they’re really hungry they can always come back and ask for seconds (which is a good opportunity to remind them about their weight loss goals!). It also reduces the amount of food left over on plates, which would otherwise be wasted.

Another thing that we discovered was that the weekend managers were providing larger portions than we did during the week. I gave them some information on what standard portion sizes should be and this has really helped.

We also make sure that we provide loads of fibrous veggies and salads at each meal so that the residents feel full without all the extra kilojoules.

After making sure that most of the menu is based on healthy foods from the five food groups, focusing on portion sizes is a sensible and balanced way to address a resident’s weight management needs. Herston Lodge are encouraging and supporting residents to take an active role in decision-making about their own health by talking to them about what they can do themselves and reminding them of their weight management goals when it comes to second servings. As with all changes, good communication with all staff is also a key to the success of this story. For more information on portion sizes have a look at the Meal serving guides.

Willow House

We have many residents with diabetes and we are always conscious about offering suitable meals for them. Breakfast used to be a nightmare because a lot of our newer residents were used to high sugar breakfast cereals and sugary juices. Then they would sprinkle even more sugar over their cereal!

Firstly, we put the sugar away at breakfast time. Then we introduced our residents to high fibre options like porridge with low fat milk. We also replaced our white bread with wholemeal bread for toast. The porridge is a real favourite in winter and in summer we offer low fat yoghurt with a sprinkle of nuts.

Willow House has made some simple swaps to cater to the needs of residents living with diabetes. Providing high fibre, wholegrain cereals and breads are a great way to maintain steady blood sugar levels and also help residents feel fuller for longer. Swaps like this are a healthier option for all residents, not just those with diabetes.

For more information on how to swap less-healthy ingredients or add goodness to your favourite meals, have a look at 3 – Healthy meal ideas and tips. If you’re looking for healthy breakfast cereal options why not try natural muesli, wheat biscuits or porridge with added seasonal fruit for flavour.

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Accreditation

To improve the eating habits of residents, we need to look beyond the dining room to all the ways that food is a part of their lives. Food may be available to residents through on-site vending machines and kiosks, or through visitors and support services that may facilitate access to food.

Ensuring that the whole facility promotes healthy eating contributes to Standard 3.4: Health Care, where the service encourages and helps residents to maintain their physical, dental and mental health, and ensures residents have access on site to information on healthy lifestyles.

In this section there is a step-by-step guide to developing your own nutrition policy to outline how you, as a supported accommodation provider, promote healthy eating to contribute towards achieving all elements of Standard 2.1: Food and Nutrition.

Vending machines

Having a vending machine on site stocked with unhealthy, highly processed foods can send mixed messages to your residents about healthy eating and the importance of their health. Vending machines expose residents to junk food advertising and can encourage mindless purchasing.

It is possible to have a vending machine for predominantly healthy snacks, which residents can access for food outside meal times, if required. Talk to your vending machine stockist and use the lists below to swap some of the unhealthy options for healthier ones.

You don’t have to remove all of the unhealthy items; rather, aim for around 80 per cent of the machine’s contents to be healthy choices and place these items at eye level so they are more prominent to residents.

Some facilities may find non-food items such as toothpaste, toothbrushes, shower caps, soaps or shampoo a useful addition to vending machines.

Food

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A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Drinks

Food kiosks

For small food kiosks, use the same advice as for stocking vending machines. Food kiosks mean more contact with the resident at the point of purchase, so why not try talking to them to see which healthy food items they would most prefer?

If you find the healthier food items aren’t selling as expected, consider some promotion of these foods:

• Offer taste-testing to trial new products. Ask residents for feedback on taste, suitability and suggested price.
• Promote new food choices in newsletters or posters.
• Use your existing pricing boards to advertise and highlight the new products. Consider creating your own ‘meal deals’ or ‘happy hour specials’.
• Stock healthy items at eye level on shelves, benches or cabinets.
• Stock discretionary food items on lower shelves or out of sight, as in the diagram below.

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Dining rooms — providing a pleasant mealtime environment

A dining room is more than just a space to provide food and drink. The dining room is the heart of your supported accommodation facility. It offers a source of socialisation, an opportunity for staff to connect with residents, and to monitor residents’ food intake and wellbeing.

Aiming for a pleasant, relaxed dining room atmosphere can add to residents’ overall improved health and wellbeing, and also help you achieve Accreditation Standard 2.6: Dining Rooms.

What does a pleasant dining room look like?

Colour scheme and natural lighting brighten the room.

Small seating arrangements encourage socialisation.

Outer tables are accessible for those with mobility aids.

Tables are kept clear and tidy with no clutter.

Natural lighting brightens the room.

Bright tablecloths are neat and appealing.

Stable and supportive chairs.

Outer chairs are accessible for those with mobility aids, and space is provided for wheelie walker parking.

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A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Display a menu board so that residents and visiting family members and friends know what will be served daily.

Open up the delicious smells of the kitchen with a servery window.

Consider whether an outdoor dining option suits your facility. This could be useful for celebration events, and for residents who like more space or just to enjoy the beautiful weather.

Changes you can make now

Below are some examples of how you can make your dining room a pleasant environment at varying cost investments. It’s important to discuss potential changes with residents and seek feedback on their preferences.

Low cost

• Arrange furniture for small groups of residents, e.g. two- to four-person tables to encourage socialisation.
• Provide a more inviting, home-like space by using clean and colourful tablecloths and well-placed table settings, e.g. cutlery and placemats.
• Provide residents with ample time to enjoy their meals without feeling ‘moved along’.
• Play background music during dining periods.
• Ensure there is enough space for residents to move around the dining room with ease. Consider whether rearranging furniture could improve this.

Moderate cost

• Ensure residents are comfortable during mealtimes by providing stable, supportive chairs.
• Re-paint the dining area in cheery colours to brighten the space.
• Review your lighting and window coverings; make the space bright and inviting.
• Make your dining room a cosy environment by ensuring the temperature is warm and draft free. Be aware that some older residents may feel the cold more than others.
• Consider how residents access the dining room. Ensure that the entrance is unobstructed and looks welcoming upon arrival.

High cost

• Use ceiling and floor surfaces that reduce noise at mealtimes.
• Re-design the working kitchen to open it up to residents. Allow them to better see how their food is made and enjoy those delicious cooking smells.
• Have an area for residents to entertain others, including family members and friends.

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Promoting healthy eating to residents

Promoting healthy eating to residents can help build interest and demand for the healthy food that you’re providing on the menu, as well as influence the food and drink choices that they make outside of your facility, e.g. purchases from the local shops.

Below are just some of the ways you could promote the healthy eating message to your residents. Choose the options that suit your service best.

• Posters: Posters are an easy way to remind residents about key healthy eating messages. Choose good-quality posters with a simple message and lots of pictures. Place them in high-traffic areas such as the dining room, on resident fridges, or beside kiosks and vending machines. For free healthy eating posters to download or order, go to www.eatforhealth.gov.au/guidelines
• On your menu: Display a menu board to let residents know what their meals will be for the day. Use tantalising descriptions to build enthusiasm for your healthy meals. If you offer a bain-marie style self-service, make sure you label the foods there too.
• Talk about it: Encourage staff and support services to talk to residents in a positive way about healthy eating. This can be done during mealtimes or at other points of contact during the day.
• On admission: If your service provides admission packs, consider including healthy eating information in them. When residents arrive at your facility, let them know that you provide healthy food because you value their health. Remember to ask about cultural considerations regarding food, and any food allergies.
• Fight the boredom: Boredom is a common factor in overeating. Try offering, or linking with support services, to provide activities for residents, e.g. art and craft, cooking groups, dancing, day trips, music, or anything that the residents enjoy. When residents find joy in other activities, they are less likely to rely as heavily on food to add interest and pleasure to their lives. See our list of ideas for active and enjoyable outings.
• Getting active: Increasing activity is a sure-fire way to improve sleep, mental and physical health. Try offering activities, or link with support services to provide sporting activities or walking groups to residents.
• Grow your own: No-dig gardens, vertical gardens, pots and hanging plants are all great ways you could grow your own veggies, herbs and fruit on site. Gardens have been shown to improve mental health, increase activity, and encourage a reconnection with food and where it comes from. Gardens have the added benefit of improving the look of an area at relatively low cost. Follow this link to get you started growing edibles, with information on growing methods, soil health and plant health: http://www.abe.net.au/gardening/features/ediblegarden.htm
• Your philosophy: Let residents and visitors know that providing a healthy eating environment is part of your organisational policy and an important part of how you care for residents. See our step-by-step guide on how to write your own nutrition policy.

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The healthy eating message for visitors

Providing healthy food within your supported accommodation is a great way that you can help improve the health of residents. It’s important to remember that while residents can choose to eat as they wish, they also have the right to nutritious food that maximises their health, just like everyone else. Your role is to make healthy choices easy for residents. This is in line with The General Principles of the Guardianship and Administration Act 2000 which promotes encouraging and supporting people to achieve their maximum physical potential and maintain independence.

Sometimes visiting families, friends and services might bring unhealthy, processed food on site or take residents out to purchase these items. This is usually done with the best of intentions, as they might not have considered the long-term impact it can have on residents.

Remember that for successful change to occur, it’s important to get the support and involvement of others. Sharing easy-to-understand information is a good way to bring people along with new ideas or any changes to your service.

For families and friends:

• Let visiting family and friends know that your service values the health of its residents and aims to provide healthy food on site. You can do this by providing a letter advising them of your healthy eating philosophy. There is a letter example below that you can adapt to meet your service’s needs.
• Let them know how they can support their family member to have healthy eating habits. Encourage them to consider non-food related gifts or bring in more wholesome options rather than providing residents with unhealthy, processed food items. Advise them of any new hobbies or interests the resident might have and what gifts or activities might be appropriate to support them.
• Display your nutrition policy at the entrance to your facility where it’s visible to all visitors.

For external services:

• Provide all health and support services with a letter notifying them of your healthy eating philosophy (either in person or via email). There is a letter example below that you can adapt to meet your service’s needs.
• Encourage external services to plan active and healthy outings for residents. A list of cheap, fun ideas is provided here.
• Share a copy of your nutrition policy with all health and support services that provide care to your residents. Share the policy with your vending machine stockist or other catering services that provide food on site.
• Display your nutrition policy at the entrance to your facility where it’s visible to all visiting services.

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Example letter to communicate your service’s healthy eating philosophy to family members and friends

Happy Hollows Lodge

Date

Dear family members and friends,

We support our residents to access nutritious food that maximises their health. Healthy food plays an important role in good mental health, and in preventing and managing lifestyle diseases such as diabetes, high blood pressure and high cholesterol.

As a Level 3 supported accommodation provider, it is our responsibility to ensure residents’ daily nutrition needs are met. We do this by providing regular, healthy meals and ensuring mostly healthy food is available on site.

You can also support the health of residents in a number of ways:

• Plan active and enjoyable outings that aren’t focused around unhealthy foods. Some ideas could include a visit to a park for a walk, thrift shopping or a healthy picnic. We’ve enclosed an information sheet with some with ideas for you. We’d love to hear more ideas you might already have.
• Consider bringing non-food related gifts (e.g. flowers, colouring books, magazines or a craft activity) when you visit. Is there a suitable gift that is linked to a hobby or interests that your family member/friend has?
• Limit or avoid bringing unhealthy, processed food [e.g. cakes, biscuits, soft drinks and ice cream) or takeaway foods {e.g. commercial pizzas, burgers and hot chips). These foods are best saved for celebrations or special events, as they do not provide any vitamins or minerals and often make a resident’s health issues worse.

We hope you will join us in keeping the best health interests of the residents in mind. For more information on healthy eating, visit www.eatforhealth.gov.au or talk to our office staff about the changes we’ve made to promote healthy eating.

If you have any feedback on the food that’s available to residents, please let us know!

Yours sincerely,

A TOOLKIT FOR HEALTHY EATING IN SUPPORTED ACCOMMODATION

Example letter to communicate your service’s healthy eating philosophy to external services

Happy Hollows Lodge

Date

Dear ,

We support our residents to access nutritious food that maximises their health. Healthy food plays an important role in good mental health, and in preventing and managing lifestyle diseases such as diabetes, high blood pressure and high cholesterol.

As a Level 3 supported accommodation provider, it is our responsibility to ensure residents’ daily nutrition needs are met. We do this by providing regular, healthy meals and ensuring mostly healthy food is available on site.

You can also support the health of our residents in a number of ways:

• Limit or avoid bringing on site unhealthy, processed food (e.g. cakes, biscuits, soft drinks and ice cream) or takeaway foods (e.g. commercial pizzas, burgers and hot chips]. These foods are best saved for celebrations or special events, as they do not provide any vitamins or minerals and often make a resident’s health issues worse.
• Plan active and enjoyable outings for residents that aren’t focused around unhealthy foods. Some ideas could include a visit to a park for a walk, thrift shopping or a healthy picnic. We’ve enclosed an information sheet with some with ideas for you. We’d love to hear more ideas you might already have.

We hope you will join us in keeping the best health interests of the residents in mind. For more information on healthy eating, visit www.eatforhealth.gov.au or talk to our office staff about the changes we’ve made to promote healthy eating.

Yours sincerely,

5 Helping residents to make healthy food choices

Ideas for active and enjoyable outings

Ditch the fish and chips and try one of these cheap, fun activities that are truly good for your health.

• Go thrift shopping and find some hidden, low-cost treasures.
• Head to your local library to stock up on reading or audio books. Local libraries often host a range of workshops, seminars, and even poetry readings.
• Head out to your nearest bay or waterway for a walk along the water.
• Visit your local swimming pool when the weather is warm.
• Check out the local art gallery or museum.
• Explore local markets.
• Take a healthy picnic along to your local park.
• Check out your local city council website for cheap activity groups such as walking, dancing or yoga.
• Try out a lawn bowls or ten-pin bowling club.
• Head along to watch your local sporting teams play.
• Join a community garden group. Your local city council should have information on what’s available in your area.
• Hire a bike and cycle around your local area. Some local councils have this service for a small fee.

Try something new today! Let us know what other great ideas you come up with.

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Developing a nutrition policy

Policies are a great way to ensure that the things you value as a service, or positive changes you make, are embedded in how the organisation operates well into the future, especially when staff or management change. A written policy is also useful for accreditation.

While some policies are mandated by authorities, e.g. through accreditation standards, many organisations and services also develop their own policies, which guide decisions and actions or are statements of intended action.

Why is a nutrition policy important to supported accommodation?

Policies can shape the way supported accommodation services are run, what food is provided, how external services, staff and residents interact, and much more. Rather than strict rules or regulations for supported accommodation, a policy can help maintain a level of agreed quality, help guide decision-making, communicate the things your service values, and set expectations for staff, residents and visitors.

How to develop a nutrition policy

This section will provide a step-by-step guide on how you can create a nutrition policy for your service.

Getting ready

• Make the decision: Decide to develop or revise a nutrition policy and set a date for implementation.
• Gain co-operation: Think about who may be affected by the policy and who should be involved in developing the policy. You might like to organise a small working group that includes resident representatives to work on the policy development together.
• Get informed: Pull together all the information you need to create the policy. This can include reviewing accreditation requirements, talking to other supported accommodation providers who have developed a nutrition policy, and talking with nutrition experts, staff and residents.

Preparing the policy

• Draft the policy: Use the template and example policy to get an idea of the components you might want to include.
• Seek feedback from key people affected by the policy: You can do this in person by making copies of the policy available, presenting it at meetings, or emailing it to different groups. Ask specific questions like:
  • Is the wording in the policy easy to understand?
  • Is the content of the policy appropriate/timely/necessary?

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Finalise the policy

• Improve the policy: Take into account all of the feedback provided on the draft policy and make a final version.
• Get it endorsed: Have the final policy endorsed by the supported accommodation’s management structure.

Implementing the policy

• Raise awareness: Let everyone know that you now have a nutrition policy and why. Share the policy with all residents, staff and visitors [including families, friends and services).
• Focus on staff: It may be necessary to hold a special meeting with staff to let them know what actions they can take to support the implementation of the new policy. Staff might require some extra training or equipment.
• Embed it: Make sure the policy is included in all new resident welcome packs and as a part of your orientation for new staff. Document what you have done and when. You can use this for evidence for accreditation.

Ensure the policy is working

• Monitor the way the policy is being implemented. Talk to residents, staff and visitors to see if the policy is achieving what you had hoped. Make and document any changes required.
• Review the policy on a regular basis. It’s important to make sure the policy remains up to date with your service’s current values, beliefs and practices, and with any accreditation requirements or food service legislation.

Adapted from Health Promoting Schools: a toolbox for creating healthy places to learn, work and play (2001).

Checklist for a good policy

• Consistent with current accreditation requirements.
• Based on information from recognised nutrition authorities.
• Developed in consultation with others, e.g. staff and residents.
• Specific and relevant to your service.
• Reviewed regularly.
• Promoted to others.

See the blank Nutrition Policy template here.

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Nutrition policy example

Name of supported accommodation provider: Happy Hollows Lodge

Date of policy development: 5th June, 2017

People involved in developing the policy: Jane Smith [Owner], Steve Williams (Cook) and three long-term residents

Review date: 5th June, 2018

Policy will be reviewed by: Staff and resident working group (5 people}

The policy will be located: /n the office policy folder and in the foyer, on the wall.

How the policy information will be shared with staff, residents and visitors: The policy will be on display in the reception area, a copy will be shared with all external service providers, and it will be discussed at the staff meeting and also at the resident meeting.

Healthy food

Our supported accommodation service:

• has a four-week cyclical menu, based on the five food groups
• provides everyday snacks that are based on a food group, such as the Fruit, Vegetable, or Milk, yoghurt and cheese groups
• offers water as the main drink at all times. We do not provide sugary drinks like cordial, soft drinks or fruit drinks.

Resident needs

Our supported accommodation service:

• provides residents with the opportunity to participate in the menu planning process
• asks residents about, and caters for, specific cultural/religious requirements (e.g. kosher or halal foods), medical needs, allergies/intolerances or personal likes/dislikes (e.g. vegetarian foods).

Healthy environment

Our supported accommodation service:

• provides an inviting place for residents to eat
• makes sure that the vending machine stocks 80% healthy food and drink choices
• encourages external service providers to respect and support healthy eating and healthy lifestyles for our residents.

Signed: ………………………………………………….. Signed: ………………………………………………….. (Owner) (Cook)

Date: / / Date: / /

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Sources of information

• Queensland Government, A Better Choice Tool Kit: Healthy vending machines https://www.health.qld.gov.au/public-health/topics/nutrition/choice
• Victorian Government, Dementia-friendly environments: Dining areas, kitchens and eating https://www2.health.vic.gov.au/ageing-and-aged-care/dementia-friendly-environments/dining-areas-kitchens
• Queensland Government, Health Promoting Schools: a toolbox for creating healthy places to learn, work and play (2001).
• Queensland Health, PANOSH: Physical Activity and Nutrition Outside School Hours (2004).

Real-life stories from supported accommodation

Tarampa Lodge

Since NDIS has come in our area we’ve had a support worker helping one of the residents to create an herb garden. The support worker has walked through each step with the participant, from garden design to shopping for the plants and equipment, to planting up the garden. The resident has now gained more confidence in gardening and is more active doing the things that he enjoys. For us, our cook can access fresh herbs every day. Now we’re going to start up a veggie garden too!

We’re also starting to find more ways that we can provide residents with the equipment and space to be more active every day. We already have a pool, basketball/tennis court and pool table and are now looking at marking out a walking track around the property so that residents can walk in a safe place. We might also try and get some exercise equipment too. That way when support services come on site it’s much easier for them to engage residents in healthy activities because we have it all here.

Fairhaven Care Centres

The residents have grown vegies on site on a few different occasions. The garden is led by the residents, so the popularity varies and we’ve seen the garden revamped quite a few times now.

The residents decide what they’d like to plant and we’ve noticed that they prefer to grow veggies that they can touch, hold and eat rather than herbs. Tomatoes, corn and pumpkins are very easy to grow and have been successful here in the past. They have been really proud to have the cooks prepare and serve ‘their’ vegies, especially when the corn gets cooked on the barbeque!

Making gardening activities and exercise equipment available are great practical ways to encourage residents to be healthier outside of the dining room and have a greater participation in community life, as outlined in The General Principles of the Guardianship and Administration Act 2000. Gardening has been shown to improve mental health, increase activity and encourage a reconnection with food and where it comes from. Have a look here for other ways to promote healthy eating to residents.

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6 Where to get more help

How to find a dietitian

Individual residents may be able to access a dietitian under Medicare via the Chronic Disease Management scheme, using a GP referral. Encourage residents to talk to their GP for more details.

For a comprehensive menu review, contact your local Accredited Practising Dietitian (APD).

Accredited Practising Dietitians are university-qualified nutrition professionals. They undertake ongoing training to ensure that they are your most up-to-date and credible source of nutrition information. They are able to translate the latest scientific information into practical and safe nutrition advice.

Look for an APD who has experience with food services and menu review. To find one near you, head to the Dietitians Association of Australia website: https://daa.asn.au/find-an-apd/

Getting the most out of your dietitian

When enlisting the help of a dietitian:

• check what their experience is in assessing menus for accommodation services or other food services
• ask them to provide advice on seasonal menus
• ask them for suggestions or general guidelines on how to substitute menu items
• check they are available to contact for advice in the future
• consider partnering with other supported accommodation providers to see if you can receive a group discounted rate.

Other helpful contacts

Emergency
Police, fire and ambulance
000

13 HEALTH
Qualified staff will give you confidential, non-urgent health advice and assistance 24 hours a day, 7 days a week.
13 HEALTH (13 43 25 84)

MH CALL
Access local mental health services for information and assistance in times of mental health crisis 24 hours a day via a centralised phone number.
1300 MH CALL (1300 64 22 55)

DVConnect
Domestic violence hotline
1800 811 811

Sexual assault, domestic and family violence support
1800 737 732

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6 Where to get more help

Gambling helpline
1800 858 858

Alcohol and Drug Information Service
1800 177 833

Disability Services
The Queensland Government provides a range of disability support services for people with disability. Contact them for information about disability support services, how to apply, and the National Disability Insurance Scheme.
13QGOV (13 74 68)

Disabilities Information and Awareness Line – DIAL
Information on services for people with disabilities
Free call Monday to Friday, 9:00am–5:00pm
1800 177 120

Queensland Aged & Disability Advocacy Inc.
QADA provides advocacy, information and support for aged and disabled.
1800 818 338 or 3637 6000

Links

This Healthy eating in supported accommodation resource takes a ‘toolkit’ approach in that it summarise key points and refers to a range of other available resources and links for more information. The many resources and links that have been referred to throughout the document are listed here.

Links for 1 – Introduction to healthy eating

Residential Services Accreditation Act (2002) www.hpw.qld.gov.au/Housing/IndustryRegulation/ResidentialServices/Pages/default.aspx

Eat for Health: Australian Dietary Guidelines (2013) www.eatforhealth.gov.au

Healthier Happier http://www.healthier.qld.gov.au/eat/

Dietitians Association of Australia: Healthy eating https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/

Local city councils have information on safe food, training and licensing for businesses. Contact your local city council.

Links for 2 – Menu planning

Eat for Health: Food label reading https://www.eatforhealth.gov.au/eating-well/how-understand-food-labels

Food Standards Australia and New Zealand (FSANZ) www.foodstandards.gov.au

Food Act and Food Standards Code www.health.qld.gov.au/public-health/industry-environment/food-safety/regulation/act-standards

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Health Star Rating System www.healthstarrating.gov.au

Australian Government: Energy made easy http://www.energymadeeasy.gov.au/.

Links for 3 – Healthy meal ideas and tips

Grains and Legumes Nutrition Council: Legume cooking advice http://www.glnc.org.au/legumes-2/legume-cooking-tips/

Diabetes Australia: Modifying recipes www.diabetesaustralia.com.au/modifying-recipes

Healthier. Happier. fruit and veg seasonality calendar http://healthier.qld.gov.au/wp-content/uploads/2015/09/QH_O41832_T_Seasonal_Calendar_A4_2PP_23092015.pdf

Links for 4 – Food for special needs

Diabetes

Diabetes Australia www.diabetesaustralia.com.au/

Baker IDI Heart and Diabetes Institute: Carbohydrates and Glycaemic Index (GI) fact sheet www.baker.edu.au/-/media/Documents/fact-sheets/BakerIDI-factsheet-carbohydrates-and-glycaemic-index.ashx?la=en

Mental illness and diet

Beyond Blue: Healthy eating for people with depression, anxiety and related disorders www.bspg.com.au/dam/bsg/product?client=BEYONDBLUE&prodid=BL/0353&type=file

Cultural and religious menu considerations

Cultural and religious festivals and celebrations www.australia.gov.au/about-australia/special-dates-and-events

Brisbane Hebrew Congregation: Kosher dietary laws and foods, and where to source www.brisbanehebrewcongregation.com/about-us/kosher/

Halal Square: Halal foods and where to source www.halalsquare.com.au/groceries/index.php/

Food allergy and intolerance

National Allergy Strategy: All about Allergens (free online training for people working in food service) www.foodallergytraining.org.au

Download or order free allergy and anaphylaxis posters here: https://allergyfacts.org.au/shop/posters

Coeliac Australia http://www.coeliac.org.au/

Dietitians Association of Australia (DAA): Coeliac Disease www.daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/what-is-coeliac-disease/

Queensland Government Department of Health: Coeliac Disease www.health.qld.gov.au/__data/assets/pdf_file/0026/149930/gastro_coeliac.pdf

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Dietitians Association of Australia (DAA): Understanding lactose intolerance www.daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/understanding-lactose-intolerance/

Chewing and swallowing difficulties

Queensland Government, Nutrition Education Materials Online: Texture-modified diet and sample meal plans https://www.health.qld.gov.au/nutrition/nemo_textmod

Australian Standards for Texture Modified Food and Fluids (free printable poster) https://daa.asn.au/wp-content/uploads/2015/04/A3_Aus-Standards-Food-and-Fluids-Poster-Check-2.pdf

Increasing energy or strength

Queensland Government: Nutrition Education Materials Online: High protein, high energy resources https://www.health.qld.gov.au/nutrition/nemo_nutrsup

Dietitians Association of Australia: Find an accredited practising dietitian https://daa.asn.au/find-an-apd/

Food for residents who are overweight

Eat for Health: Tips for losing weight healthily https://www.eatforhealth.gov.au/eating-well/tips-eating-well/tips-losing-weight-healthily

Dietitians Association of Australia: Weight management https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/weight-management/

Vegetarian diets

Dietitians Association of Australia: Vegetarian diets https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/vegetarian-diets-the-basics/

Nutrition Australia: Vegetarian diets FAQs www.nutritionaustralia.org/national/frequently-asked-questions/vegetarian-diets

Links for 5 – Helping residents to make healthy food choices

Eat for Health: Ordering healthy eating resources www.eatforhealth.gov.au

ABC: The Edible Garden http://www.abc.net.au/gardening/features/ediblegarden.htm

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7 Glossary

Artificial or intense sweeteners: These are substances that can replace sugar in foods or in cooking. They provide a sweet taste like sugar while having much less food energy (kilojoules). Some sweeteners are produced by nature, such as stevia. Others are produced synthetically, such as aspartame, saccharin or sucralose. Sweeteners are often found in processed ‘diet’ foods and drinks.

Diabetes: The build-up of sugar (glucose) in the blood. If high blood sugar levels are not treated, people with diabetes can suffer serious short-term and long-term health problems. There are two types of diabetes:

• Type 1 diabetes usually develops in young people, but can occur at any age. Sugar is not removed from the blood because the body stops making the hormone insulin. This type of diabetes cannot be cured or prevented and is managed by insulin injections together with a healthy diet and being physically active.
• Type 2 diabetes is the most common type of diabetes. Sugar is not removed from the blood quickly enough because the body does not respond to insulin and/or the body does not produce enough insulin. It can be managed with a healthy diet and regular exercise, but some people may need medication and/or insulin injections.

Discretionary foods: Cakes, biscuits, soft drinks, ice cream and highly processed meats are all examples of discretionary foods. They can also be called ‘junk foods’, ‘energy-dense, nutrient-poor foods’, ‘sometimes foods’ or ‘extra foods’. They are foods that don’t provide many (if any) nutrients to our bodies, other than extra fats, sugars and salt.

Fibre: The indigestible part of plant foods, such as vegetables, fruits, grains, beans and legumes. It is a type of carbohydrate or starch that helps keep our bowel healthy. Eating high fibre foods can help prevent constipation and help people feel fuller for longer, which can aid in weight management.

Five food groups: Foods are grouped into five food groups because they provide similar amounts of key nutrients in that group. The five food groups are:

• Vegetables and legumes/beans
• Fruit
• Milk, yoghurt or cheese (mostly reduced fat)
• Lean meat and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
• Grain (cereal) foods (mostly wholegrain and high fibre varieties)

Iron: An important mineral which carries oxygen around the body. This is essential for providing energy for daily life. While the body can store iron, it cannot make it. You need to get iron from food. Good sources of iron include red meat, offal, whole grains (especially iron-fortified breakfast cereals), dried beans and lentils, and leafy green vegetables.

Kilojoules (kJ): The measure of how much energy people get from consuming a food or drink. It is normally the first item listed in the nutrition information panel on a food label. The common term for this used to be ‘calorie’, but kilojoule is the measure now accepted in Australia.

To find out more about how many kilojoules adults should consume each day, visit the Eat for Health website: https://www.eatforhealth.gov.au/eat-health-calculators

Magnesium: A mineral that is used in almost all tissues of the body, especially nerves. Most people get all the magnesium they need from food. Good sources of magnesium are leafy green vegetables, legumes (lentils, soybeans and chickpeas), nuts, seeds and whole grains, spinach and potatoes.

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Potassium: A mineral needed for your heart, nerves and muscles to work properly. Most people get all the potassium they need from their food and drink, but having low or high potassium levels can cause serious problems. Sources of potassium are all vegetables and fruits, yoghurt, milk, nuts and seeds.

Protein: An essential nutrient for the human body. Proteins are one of the building blocks of body tissue. Our muscles, organs, and the immune system are made up mostly of protein. Protein in food can also serve as an energy source for the body. Protein can come from animal or plant foods such as those in the Lean meat and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans food group and the Milk, yoghurt or cheese food group.

Saturated fats (also known as unhealthy fats): Fats found mostly in animal products (meat, chicken and dairy), coconut and palm oils, processed foods such as cakes and biscuits, and takeaway foods. Eating a lot of saturated fat increases your risk of developing heart disease and other blood circulation problems.

Sugar:

• Added sugars: Sugars and syrups put in foods during preparation or processing, or added at the table.
• Naturally occurring sugars: Sugars found naturally in foods such as fruit (fructose) and milk (lactose).

Trans fat: An unhealthy fat found mostly in foods that use partially hydrogenated vegetable fats, e.g. deep-fried foods and baked foods such as biscuits, cakes, pastries and buns. Some meat and dairy products also contain small amounts of naturally occurring trans fat. Eating trans fat increases your risk of developing heart disease.

Starchy foods (also known as carbohydrate foods): Foods found in the Vegetables and legumes/beans and Grain (cereal) food groups. They include peas, corn, potatoes, beans, pasta, rice, bread and grains. In a healthy, balanced diet, starchy foods are the main source of energy for the body.

Unsaturated fats (also known as healthy fats): Fats found mostly in plant foods and fish. Choosing unsaturated fats instead of saturated fats will reduce your risk of developing heart disease. There are two main types of unsaturated fats: monounsaturated and polyunsaturated fats.

Monounsaturated fats: Healthy, unsaturated fats found in avocados, almonds, cashews and peanuts, and in cooking oils such as canola, olive, rice bran, sesame, soybean and sunflower oils.

Polyunsaturated fats: Healthy, unsaturated fats of two main types:

• Omega-3 fats, which are found in fish (especially oily fish such as tuna, salmon, sardines and blue mackerel), walnuts, linseed (flaxseed), chia seeds and oils, and spreads made from canola or soybean.
• Omega-6 fats, which are found in some oils such as safflower and soybean oil, and in some nuts, including brazil nuts.

Vitamin A: An important vitamin for the eyes, especially for being able to see at night. It is also important for the immune system and the skin. Good sources of vitamin A include liver, kidney, eggs, milk, cheese and orange, or yellow-coloured fruit and vegetables (e.g. pumpkin, orange sweet potato and carrot).

Vitamin B: The B-group vitamins (B1, B2, B3, B5, B6, B7, B9 and B12) are a group of eight vitamins that our body needs to live. B vitamins help the body to use the fuel that we get from eating foods. Most of these vitamins can’t be stored by the body and have to be consumed regularly in the diet. B vitamins are found in a variety of foods such as:

• animal-based foods, including fish, meat, eggs and dairy products
• leafy green vegetables, beans and peas
• wholegrain cereals and breads that have B vitamins added to them.

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Vitamin D: A vitamin that is important for strong bones, muscles and overall health. It is hard to get enough vitamin D from diet alone; exposure to the sun is needed for the production of vitamin D in the skin. The sun provides the best natural source of vitamin D.

Vitamin C: A vitamin that is important for keeping skin, bones and body tissue healthy. It also helps with wound healing and preventing infections. Vitamin C is found in many different fruits and vegetables, including citrus fruit, berries, kiwi fruit, guava, rockmelon, raw capsicum, cooked broccoli and brussels sprouts.

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8 Templates

Menu template Action plan template Nutrition policy template Menu self-assessment checklist template

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Season: ……………………………………. Week: ……………………………………. Serves …………………………………….

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8 Templates

Action plan

Date plan developed: _______________________________________________________________

Focus area: List the area that you’d like to work towards improving.

Strategies: List the actions or changes that you will take to address the focus area.

Start date: Review date:

We tried this strategy: Yes No

What went well: _ ________________________________________________—————

What could’ve gone better:________________________________________________________

What else we could try:________________________________________________———–

Put this into a new action plan?_ ________________________________________________—

Start date: Review date:

We tried this strategy: Yes No

What went well: _ ________________________________________________—————

What could’ve gone better:________________________________________________––––

What else we could try:________________________________________________———–

Put this into a new action plan?_ ________________________________________________—

Action plan developed by (contact person): _ _________________________________________

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Nutrition policy

Name of supported accommodation provider: ____________________________________________

Date of policy development: _ _________________________________________________________

People involved in developing the policy: ________________________________________________

Review date: _ _____________________________________________________________________

Policy will be reviewed by: _ ________________________________________________–––––

The policy will be displayed: ________________________________________________–––––

How the policy information will be shared with staff, residents and visitors: ___________________

Healthy food

Our supported accommodation service:

Resident needs

Our supported accommodation service:

Healthy environment

Our supported accommodation service:

Signed: ………………………..…………….. Signed: ………………………..…………—– (Owner) (Cook)

Date: / / Date: / /

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Menu self-assessment checklist

This checklist can be used as a guide to help you modify your menu to meet the Australian Dietary Guidelines (2013).

Each day we offer:

• two pieces of fruit per resident
• at least two different coloured vegetables (other than white potato) at lunch AND dinner
• wholegrain cereal foods, such as brown rice, wholemeal pasta and wholemeal or wholegrain bread, for at least half of the grain products
• low fat dairy foods such as low fat yoghurt, reduced fat cheese or low fat milk
• snacks that include fruits, vegetables, wholegrains and low fat dairy foods
• lean cuts of meat when possible, or meats trimmed of their visible fat
• meals that are flavoured with herbs, spices, garlic, onion or lemon juice instead of salt

We rarely offer/we limit:

• processed meats such as sausages, ham, bacon and luncheon meats
• celebration foods such as cakes, biscuits, chips and ice cream
• sugar-sweetened soft drinks and cordials, sports and energy drinks

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Guideline for Medication Assistance

RESIDENTIAL SERVICE PROVIDERS (LEVEL 3 SERVICES)

Contents

Purpose | 1 Medication Assistance Compliance Checklist | 2-3

1. Principles of quality use of medicines in level 3 residential services | 4 Why is quality use of medicines important? | 4 Achieving quality use of medicines in level 3 residential services | 4 General principles for medication assistance | 4 1.1 Medical decisions | 4 1.2 Duty of care | 4 1.3 Written consent | 4-5 1.4 Privacy and confidentiality | 5 1.5 Record keeping and prescribed records | 5-6 1.6 Staff training | 6-7 1.7 Seven ‘rights’ for safe medication administration | 7 1.8 Storage of medication and discrepancy reporting | 7-8 1.9 Secure storage of medication by a resident | 8 1.10 Safe disposal of a resident’s medication | 8 1.11 Refusal to take medication by a resident | 8-9 1.12 Dealing with and recording a medication incident | 9
2. Assistance with medication in level 3 residential services | 10 2.1 Packaging of medication and directions | 10 2.2 Handling medication | 10-11 2.3 Routes of administration for which assistance may be provided | 11 2.4 Routes of administration for which assistance should NOT be provided | 11 2.5 Residents who self-medicate | 11 2.6 ‘When required’ medication (pro re nata, PRN medication) | 11-12 2.7 Non-prescription (over the counter, OTC) medication | 12 2.8 Complementary and alternative therapies | 13 2.9 Adverse reactions to medication | 13 2.10 When a resident is temporarily off-site | 13
3. Quality use of medicines activities | 14 3.1 Service agreement for supply of medication and associated professional services | 14 3.2 Medication review | 14 3.3 Self-assessment | 14 3.4 Medication audits | 15
4. Resources | 15

APPENDICES………………………………………………………………………………………………………………………………………….16 Appendix 1: Written request/consent for assistance with medication | 17 Appendix 2: Medication Record | 18 Appendix 3: Medication Distribution Record | 19-20 Appendix 4: Staff Training Record | 21 Appendix 5: Medication Incident Report Form and Flowchart for responding to a medication error | 22-23 Appendix 6: Routes of administration for which assistance can be given | 24-25 Appendix 7: Medication Record (Temporarily Off-site) | 26

Glossary………………………………………………………………………………………………………………………………………………..27

Current at October 2021

Purpose

The Department of Communities, Housing and Digital Economy has developed this guideline in consultation with Queensland Health and Crown Law, to ensure the health and safety and basic freedoms of people living in residential services across Queensland who request assistance with their medication. The purpose of the guideline is also to support service providers to develop policies and procedures, implement safe practices and to minimise the risk of harm from inappropriate use of medication.

Regulatory Services regulates privately-owned and operated boarding houses, aged rentals and supported accommodation, which are captured by the provisions of the Residential Services (Accreditation) Act 2002 (the Act). Residential services typically accommodate some of the most vulnerable Queenslanders, including people with an intellectual and/or psychiatric disability, drug and alcohol problems, brain injury, problems associated with ageing, social and economic disadvantage, and social isolation.

The main objects of the Act are to provide consumer protections to residents, to encourage continual improvement by service providers and support fair trading in the residential service industry. The regulatory system establishes minimum standards for the provision of residential services, compulsory registration of service providers and three levels of accreditation.

A residential service provider must be accredited at level 3 to provide a personal care service in the course of operating a residential service. The Act provides a definition of a ‘personal care service’, which includes regularly providing a resident with assistance in taking medication as noted in schedule 2 of the Act.

Assistance with medication falls under the accreditation matter ‘Assistance with Medication’ as outlined in section 7 of the Residential Services (Accreditation) Regulation 2018 (the Regulation), which states: “If residents ask for help in taking their medication in accordance with medical directions, help is given in accordance with the guideline for medication assistance in residential services with level 3 accreditation published by the department on the department’s website.”

The department received coroners’ reports outlining recommendations in relation to two cases of death in care, where a person was residing in a level 3 accredited residential service. The coroners’ recommendations concern a number of matters including the management of medication by level 3 accredited services. These include appropriate storage of medication, distribution of medication and recording of this process, advising doctors when medication is not taken, documenting procedures, and audits to ensure medication is being received regularly by residents.

This guideline outlines the criteria that the delegate of the Chief Executive considers appropriate to make a decision in relation to the level 3 accreditation standard for Assistance with Medication. During an accreditation assessment for level 3 services, the delegate of the Chief Executive takes into consideration the criteria set out in section 44 of the Act.

These criteria include:

1. the extent to which the service provider provides the personal care service in a way that meets the individual needs of the residents to whom the service is provided, protects their interests and maintains and enhances their quality of life generally, and
2. the suitability of the staff members providing the personal care service.

Compliance with this guideline will be a condition of accreditation as a level 3 residential services provider.

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Medication Assistance Compliance Checklist

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1. Principles of quality use of medicines in level 3 residential services

Quality use of medicines is one of the objectives of Australia’s National Medicines Policy. While medications make a significant contribution to preventing and treating disease, increasing life expectancy and improving quality of life, they also have the potential to cause harm.

Quality use of medicines aims to maximise the benefits and minimise the risks of harm from the use of medications. In the residential service sector this means assisting residents to use medications safely and effectively to get the best possible results.

The management of health conditions using medication is an increasingly complex issue. In the residential service sector, residents may progress from low to high needs during their residency, have a greater number of illnesses and take multiple medications. Residents of residential services often require more medications than those living in the community, and may need more than one medication to manage each condition. This can present an increased potential for medication interactions, adverse effects and other medication-related problems.

Achieving quality use of medicines in level 3 residential services

The goal of managing illness with medication is centred on achieving the optimum health outcomes for the resident and must focus on the safe and effective use of medications.

The provision of assistance to a resident with taking medication in level 3 residential services (‘Assistance with Medication’) is done:

• in response to a request from the resident (or authorised substitute decision-maker); and
• in accordance with medical directions as prescribed, the directions on the dispensed medication label and any additional advice provided by authorised health professionals directly involved with the resident’s care (doctor, pharmacist, nurse); and
• in accordance with local policy and procedure manuals developed by service providers to reflect the operational implementation of this guideline.

General principles for medication assistance

1.1 Medical decisions

Service providers and staff of residential services provide assistance with medication to residents in a non-clinical setting, and should not make medical or clinical decisions, or be placed in a position where they make discretionary judgments concerning a resident’s health status or medication. For these reasons, there will be times when a service provider and/or staff member needs the assistance of expert health personnel, such as a medical practitioner, pharmacist, community nurse or other health professional.

1.2 Duty of care

Service providers are encouraged to seek their own independent legal advice on their duty of care obligations.

1.3 Written consent

Section 77 of the Act stipulates the service provider for a registered service must make, and keep for at least the time prescribed under a regulation, the records prescribed under a regulation. Failure to do so may result in a penalty.

Under section 11(4) of the Regulation, it is a requirement for the service provider of a residential service providing a personal care service, to make and keep a record of the following:

(a) the daily living and medical or health supports required by each resident;

(b) the name and contact details of each resident’s doctor;

(c) the name and contact details of each entity that referred a resident to the service, if known;

(d) the details of any instruction given by the resident to the service provider, an associate of the service provider or staff of the residential service about the personal care service.

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Under section 11(5) a service provider for a residential service must keep a register of the records required to be kept under this section at the registered premises for the service.

Further, under section 11(6) of the Regulation, the records mentioned in this section must be kept for at least three years after:

(a) the day a resident to whom the record relates leaves the residential service; or (b) if the resident dies, while residing at the residential service, the day the resident dies.

Service providers must ensure they obtain an initial request (in writing) from the person requiring assistance with their medication. Alternatively, if a person requiring assistance has impaired decision making capacity, a substitute decision maker as defined under the Powers of Attorney Act 1998 and Guardianship and Administration Act 2000 may request assistance in writing on behalf of the resident. Assistance should only be given where a formal, written request has been made.

A ‘substitute decision-maker’ is a person permitted under the law to make important decisions on behalf of someone who does not have capacity. A person can have more than one substitute decision-maker. The decisions made on behalf of a person by their substitute decision-maker(s) can be about personal matters, which includes health matters, or financial matters.

A substitute decision-maker can be appointed formally through:

• an order of the Queensland Civil and Administrative Tribunal (as a guardian), or
• an Enduring Power of Attorney (as a health attorney and/or financial attorney), or
• an Advance Health Directive (as a health attorney).

A form for documenting written consent is attached (Appendix 1).

1.4 Privacy and confidentiality

Service providers must comply with the privacy and confidentiality requirements of section 6(2) of the Regulation. Privacy and confidentiality of information about each resident’s medication must be maintained when assisting each resident, when storing medication and medication records, and when discussing the resident’s medication and medical condition(s).

1.5 Record keeping and prescribed records

Service providers are required to keep prescribed records under section 77 of the Act. Section 11 of the Regulation specifies that services must keep a record of the daily living, medical or health supports required by each resident. Regulatory Services interprets this as including the keeping of records of assistance provided to residents in managing their medication. Regulatory Services requires these records to accurately reflect the medication assistance provided to residents.

Accurate and legible records of assistance given with medication should be maintained to avoid any gaps or errors in the medication regimen.

Records must be retained for the period of time specified in Section 11(5) of the Regulation.

It is strongly recommended that service providers establish and maintain medication-related documentation in a confidential file for each resident. Documentation includes:

• the resident’s written, informed request and consent for assistance with medication or, where the resident has impaired decision making capacity, written consent from the resident’s substitute decision-maker for health matters
• the resident’s substitute decision-maker’s contact details (if applicable)
• contact details of the resident’s treating medical practitioner(s)
• a recent photo of the resident (with written consent). The service provider is responsible for arranging a recent photograph of the resident.
• the resident’s medication information:
  • records of daily medication doses taken (a Medication Distribution Record)

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• records of the resident’s refusal to take medication (see section 1.11)
• documentation of any medication incidents/errors (see section 1.12)
• information about the resident’s allergies and details of any previous adverse reactions (see section 2.9)
• comments regarding any medication changes and medication-related issues
• a current medication list provided by the resident’s pharmacist or medical practitioner, which is a detailed list of all the medications used by a resident with information on dose, frequency, indication, specific instructions and monitoring requirements. For example, warfarin requires testing of blood clotting (INR) at regular intervals to determine the most appropriate dose, clozapine requires blood tests at prescribed intervals to monitor for side effects.
• A Medication Record, which should be supplemented by any case specific information (Appendix 2).

Medication lists are increasingly being used as a source of information by health care providers and consumers to reduce the opportunity for medication errors, and to ensure that accurate information is available when needed. A medication list may be provided for residents following discharge from hospital, or by the dispensing pharmacist. The list should be kept as part of the resident records and can be checked against dispensed medications to ensure that they match the summaries provided by the pharmacy. Any discrepancy should be reported to the pharmacy. This will also assist in managing the risk that a resident is unintentionally given the wrong medication. Where a doctor has changed or ceased medication, a new medication list must be requested from the pharmacist.

If a resident leaves a residential service, a copy of their medical records should be provided to them, or their substitute decision maker. If the resident moves to another residential service, the new service provider should contact the resident’s medical practitioner to advise them that the resident has moved.

A Medication Distribution Record (Appendix 3) should be used for accurate and timely recording of each occasion where medication assistance is provided, and the record should include the following elements:

• the full name of resident (and photo identification if available)
• differentiation between residents of identical or similar surname
• the date and time of day for regular medication doses (e.g. breakfast, lunch, dinner, bedtime)
• the date and time of day when PRN and ‘immediate’ (STAT) medication is taken
• space for the staff member to initial each time that medication has been given and taken
• a legend for description of specific situations, for example:
  • R medication refused – notify prescriber
  • A resident absent (e.g. on leave, at medical appointment)
  • S resident given medication for self-administration
  • H resident in hospital
  • U resident unable to take dose (e.g. due to vomiting)
  • N medication not available – obtain supply and/or notify medical practitioner (e.g. waiting on delivery from pharmacy)
• a section for staff to document any relevant comments and reasons for refusal of medication.

At the beginning and end of each shift, the service provider or staff member should check all dispensed medication and appropriate records to ensure that medication documentation has been completed, that no medication has been missed, and that accurate records have been kept.

1.6 Staff training

The service provider must ensure that staff are given training in the policies and procedures for assisting with medication, obtaining and storing medication, familiarisation with packaging and labelling, and the completion of medication records.

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This training should be provided prior to staff undertaking assistance with medication management at the residential service to ensure that staff have the necessary level of skills, knowledge and competency.

Training should be provided by a Registered Training Organisation using a competency unit aligned to HLTHPS006 – Assisting clients with medication (or equivalent). (www.training.gov.au/Training/Details/HLTHPS006).

Staff who have responsibility for assisting residents with medication are also to maintain a current certificate in first aid and CPR from an accredited training provider.

Refresher training at 12 month intervals should be undertaken by staff. If it is identified through incident reporting that staff require further training, this should be given as a matter of urgency.

Training records must be maintained for all staff. A form for documenting staff training is attached (Appendix 4).

1.7 Seven ‘rights’ for safe medication administration

To reduce the risk of a resident experiencing a medication error, it is recommended that staff assisting with medication follow the principles of the seven ‘rights’ for safe medication administration that have been developed within the healthcare sector and are widely used:

Right person – check the resident’s photo identification to ensure the medication is for the right person. Check that the name on the medication container label matches the resident’s name. When the resident is commenced on a new medication, check that they have no previous allergy to the medication.

Right medication – cross check the medication name in the Medication Record with the medication label. Check the medication has been stored correctly, and where an expiry date is visible check the medication has not expired.

Right dosage – for dose administration aids, check the right number of capsules or tablets are contained in the section that is to be used. For other medication packaging, ensure the dose is clearly documented on the pharmacist’s label on the medication container.

Right time – ensure medication is taken as close as possible to the prescribed time. Some medications have further instructions that should be adhered to, e.g. ‘with food’, ‘half hour before food’ or ‘after other medications’ (this additional information is provided by the dispensing pharmacist). Confirm the time since the last dose is appropriate, particularly for ‘when required’ (PRN) medications (prescribed medication that is taken only if needed and is not intended/scheduled for regular continuous use).

Right route – ensure medication is taken or applied via the prescribed route, e.g. oral, topical, inhalation. Instructions for the specific route should be provided in writing by the resident’s medical practitioner, which staff are to follow.

Right to refuse – the resident has the right to refuse to take a medication. If a resident refuses to take their medication, this must be recorded on the Medication Distribution Record, and contact should be made with the resident’s medical practitioner or pharmacist and their instructions followed (refer to section 1.11).

Right documentation – ensure that the medication is signed for by the staff member on the relevant form and that the correct code for specific circumstances is used when applicable (refer to section 1.5).

When assisting with medications, avoiding interruptions will also help to reduce the risk of error.

1.8 Storage of medication and discrepancy reporting

All medications must be stored out of reach of children, in a cool, dry location or refrigerated if required.

Medication must be stored in original packaging, such as a Dose Administration Aid (DAA) or other dispensed container to minimise the risk of errors. For example, a package marked with days of the week on which individual doses of the medication is to be taken (see Glossary).

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All medications must be kept in secure lockable storage that is not able to be accessed by other residents or unauthorised staff. Keys to the storage must be in the personal possession of staff at all times. Storage must also conform to the pharmaceutical or storage instructions given for the particular medication as indicated on the label, to ensure that the medication maintains its stability and potency.

If medication needs to be refrigerated, the refrigeration unit should be lockable, or a lockable container e.g. a lockable first aid container should be used and stored in a refrigerator separately from any food items.

Medications that may be required urgently by the resident need to be readily accessible and able to be used promptly when required (for example an asthma inhaler for relief of acute shortness of breath).

Discrepancy reporting

Any unexplained discrepancy involving medications requires action and investigation by an appropriate authority as described in the next paragraph. If a discrepancy in medication is noted that may indicate theft or misappropriation has occurred, address the matter and any security issues promptly.

This may involve reporting the matter to the police, or seeking advice from the pharmacist or contacting the nearest Queensland Health Public Health Unit (www.health.qld.gov.au/system-governance/contact-us/contact/public-health-units).

Keeping only sufficient stock of medication to meet short-term needs, and avoiding stockpiling, will also assist in reducing the risk of diversion of medication.

1.9 Secure storage of medication by a resident

Where residents retain responsibility for the management and storage of their medication, the service provider (or resident) should make a lockable cabinet available within the resident’s room and assist residents to ensure their rooms are locked when unattended. This will minimise the risk of harm to both the resident and other residents at the service through limiting possible intentional or unintentional misuse of the medication.

1.10 Safe disposal of a resident’s medication

All medication that is no longer required, or is unwanted, ceased or has expired should be stored in a secure container separate to other medications, and be returned promptly to a pharmacist for safe disposal. Under no circumstances should medication intended for disposal be kept for use by any other resident. It is not legal to provide a resident’s medication to another person.

1.11 Refusal to take medication by a resident

At the time of occupancy, written consent should be obtained from the resident stating that if they refuse to take their medication, the service provider or staff will contact their medical practitioner or pharmacist.

If a resident refuses medication, or has missed taking their dose for other reasons:

• observe the resident for any changes to their condition and/or behaviour
• if it is believed that a resident may suffer acute symptoms unless prompt treatment is given, or their safety may be at risk, call an ambulance
• contact the resident’s medical practitioner or pharmacist as soon as possible and follow their instructions
• if the medical practitioner or pharmacist are not available, call the Medicines Line on 1300 633 424 or 13HEALTH
• if changes in the resident’s condition or behaviour are observed, or it is suspected that a resident is displaying withdrawal effects, contact the resident’s medical practitioner for instruction.

The service provider and staff must be aware of the risk of withdrawal effects in instances where a resident has refused to take their medication.

The Consumer Medicines Information (CMI) leaflet that is available for prescription medications and some non-prescription medications may also contain information on what should be done if a dose is missed. (CMI may be found in the medication container or online at www.nps.org.au/consumers/consumer-medicine-information-cmi, or can be requested from the pharmacist or doctor).

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Additional information specific to medications associated with the treatment of mental health problems can be found online at www.choiceandmedication.org/queenslandhealth.

The resident’s refusal and reason for refusal must be documented on the resident’s Medication Distribution Record. The resident has the ‘right to refuse’ (see section 1.7) and there could be good reason for doing so, e.g. if feeling unwell, or if the resident has identified a potential error in their medication pack.

1.12 Dealing with and recording a medication incident

A medication incident is any preventable event that may lead to inappropriate medication use or result in harm from medications, and may include a mistake with medication, or a problem that could cause a mistake with medication. Examples of medication incidents include:

• medication errors:
  • medication given to the wrong person
  • incorrect medication is given
  • incorrect dose is given
  • given at an incorrect time or by an incorrect route
  • incorrect medication has been supplied
• adverse reactions to medication
• missing medication
• out-of-date medication
• resident refuses or requests not to be given medication
• lack of documentation such as consent, clear instructions, Medication Administration Record
• incorrect storage of medications.

In the event of becoming aware of a medication error (which is a type of medication incident), follow the procedure outlined in Appendix 5.

Record all medication incidents on a Medication Incident Report Form (Appendix 5) as soon as possible after the incident, but no later than by the end of the shift. The report should include the following information:

• date that the incident occurred (and date that the incident was identified)
• date that the incident was reported to management/service provider
• name of resident
• description of the incident
• what action was taken at the time of the incident and the outcome
• if any corrective action was taken subsequent to the incident to prevent a recurrence and any follow up action(s) required.

Service providers are responsible for monitoring patterns of medication incidents and errors. This responsibility includes reporting errors to the relevant medical practitioner, ensuring the advice of the medical practitioner is followed in addressing an error, documenting any errors on the resident’s medication records and ensuring processes are in place to minimise the risk of continued or future errors.

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2. Assistance with medication in level 3 residential services

The service provider/staff should only assist with medication:

(a) where a pharmacist has dispensed medication into a Dose Administration Aid (DAA) pack;

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(b) from the original container dispensed by a pharmacist and labelled for the individual resident (prescription and non-prescription medications);

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(c) in accordance with any directions on the label attached to the medication container and in the Consumer Medicines Information (CMI) relevant to the specific medication. Where applicable, any warning statements, and safety and first aid directions provided by the manufacturer or supplier of the medication should be adhered to.

The directions on the DAA packaging must indicate dosage, time and days. If this information is not provided, contact either the medical practitioner or pharmacy to verify and request the directions in writing, and request the pharmacist to provide appropriate labelling for the medication.

All changes to, or cessation of, medication should be followed up in accordance with instructions from the medical practitioner. If a medication is to be changed or ceased, the DAA pack or other dispensed medication container must be returned to the pharmacy for the changes to be made by the pharmacist.

If the change is to take place immediately, the medical practitioner can either communicate the required changes directly to the pharmacist or can provide a new prescription to be taken to the pharmacy. Medication changes should be reported to the service provider and documented in the resident’s Medication Record by the medical practitioner or pharmacist.

2.1 Handling medication

Service providers/staff members can open a resident’s dispensed medication container to take out the required dosage and assist the resident to take this medication in accordance with the label directions.

When assisting residents, ensure that the medication is handled according to the specific recommendations and/or precautions for the medication and that the policies and procedures of the residential service are followed.

If there is uncertainty about how to safely handle medication, contact the medical practitioner or pharmacist for clarification.

Hand washing should be done immediately prior to and at the completion of assisting each resident.

Medication from the dispensed container (or the perforated DAA blister compartment for the correct day and time) should be provided directly into the resident’s hand. A clean dry medication cup may be used for an individual resident if required due to the number of medications to be taken or if the resident has a problem with dexterity, or if a liquid medication is being used. The medication cup should be washed immediately after use.

Medication should generally be taken immediately, with the staff member observing that the resident has taken the medication. If the medication is provided to the resident to take or use at a later time, the service provider/staff member cannot verify it was taken and should not record it as taken by the resident.

It should be recorded as provided to the resident to self-administer at a later time. This should only occur as an exception, and with the approval of the resident’s medical practitioner.

If the resident refuses to take the medication, record this on the resident’s Medication Distribution Record and contact the resident’s medical practitioner (see section 1.11).

If a resident has identified they will not be at the residential service when their medication is normally provided by the service provider or their staff, this medication should be handed to them to take prior or later, as long as it is in line with prescribed requirements (e.g. if a resident is going to a movie at 5pm when medication is normally given to all residents, they could be given it at 4pm before leaving).

2.2 Routes of administration for which assistance may be provided

Assistance can be provided for medications that are:

• taken orally (capsule, tablet, wafer, liquid)
• inhaled
• used topically on the skin (medicated creams, ointments, lotions, transdermal patches)
• used topically for eye, ear or nasal conditions.

Appendix 6 provides additional information on the safe use of medication for each of these routes of administration.

Other resources for correct technique and use of specific types of products include:

• Consumer Medicines Information leaflets (available online: www.nps.org.au/consumers/consumer-medicine-information-cmi)
• ‘How to use’ leaflets available from pharmacies.
• Additional information specific to medications associated with the treatment of mental health problems can be found online at www.business.qld.gov.au/industries/service-industries-professionals/housing-accommodation/residential-service/providing-medication-assistance.

2.3 Routes of administration for which assistance should NOT be provided

• Suppositories/enemas/pessaries/creams for rectal or vaginal use: medication that is required to be used rectally or vaginally should be self-administered by the resident according to the specific directions for the product. Where self-administration is not possible, contact the resident’s medical practitioner for advice about whether an alternative medication and/or route of administration may be suitable, or whether assistance from community nursing services may be appropriate.
• Injections: The service provider/staff must not administer injections unless qualified to do so under the Health (Drugs and Poisons) Regulation 1996.

A resident may self-administer their own insulin and this must be recorded on the resident’s Medication Distribution Record. If the resident is unable to self-administer insulin, contact the resident’s medical practitioner to consider whether community nursing services may be engaged to undertake this task.

For residents who require insulin, blood sugar level readings should be recorded, and a hypoglycaemia (low blood glucose) treatment plan endorsed by their medical practitioner should be documented.

2.4 Residents who self-medicate

Residents should be encouraged to maintain their independence as long as possible including managing their own medications in a safe and effective manner. However, service providers and staff should regularly monitor residents who self-medicate to ascertain their capacity to continue to do so. Prompting the resident to ensure that they have taken their medication at the prescribed times can be of help in ensuring they do not miss any doses.

Service providers and staff who are concerned that a resident does not have or no longer has the capacity to self-medicate should raise their concern with the resident’s medical practitioners. A formal assessment by a suitably qualified healthcare practitioner may be undertaken if needed.

Residents who self-medicate should also be encouraged to keep records of their medication, including a current medication list.

2.5 ‘When required’ medication (pro re nata, PRN medication)

PRN medication is medication that is to be taken on an as required basis and is not intended for regular, continuous use. PRN medication can only be provided when the resident requests assistance, and is to be prescribed by a doctor to be given under specific circumstances. It is recommended the doctor provide written instructions about the particular circumstances under which the medication is to be given to a resident for relief of symptoms (temporary or intermittent), the interval between doses and the maximum total dose in 24 hours.

PRN medication can include pain relief for intermittent pain, sedatives for insomnia, or medication used for behaviour modification.

PRN medication must be given from a container that has been labelled for the specific resident. When assisting with PRN medication, check the Medication Record to ensure that the medication is given according to the prescribed time interval and that the maximum daily dose has not been exceeded. If advice about the use of PRN medication is needed, contact the resident’s medical practitioner or pharmacist.

It is recommended that staff also advise the service provider verbally before assisting with PRN medication or providing PRN medication to the resident for self-administration.

Doses of PRN medication taken by a resident must be recorded by the service provider and staff. It is also the responsibility of the service provider and staff to advise and familiarise the next shift of what PRN medication has been used or self-administered during the shift.

2.6 Non-prescription (over the counter, OTC) medication

‘Over the counter’ (OTC) medication is medication that is available from a pharmacy without a medical practitioner’s prescription for the symptomatic relief of common minor ailments such as coughs, colds, hay fever, tinea, headache (e.g. paracetamol, ibuprofen, antihistamines and decongestants).

OTC medications may be labelled as PHARMACY MEDICINE or PHARMACIST ONLY MEDICINE, for substances listed in Schedules 2 and 3 respectively of the Australian Government Poisons Standard (Therapeutic Goods Act 1989). Some OTC medications are not listed in the schedules.

If a resident requires OTC medication, it is recommended that the service provider/staff initially contact the resident’s medical practitioner to obtain information about any OTC medication that should not be taken (as there is potential for OTC medication to adversely interact with other medications or be inappropriate in some co-existing medical conditions).

For OTC medication that is not part of the resident’s regular medication regimen, the duration of use of the medication should be specified by the resident’s medical practitioner as OTC medication is generally required only for limited periods of time, often no longer than 24 hours.

The following procedures are recommended for the use of OTC medication:

• OTC medications should be prescribed by the resident’s medical practitioner and obtained from the pharmacy that usually dispenses the resident’s prescription medication
• OTC medication is to be recorded on the resident’s Medication Distribution Record as for prescription medication
• if OTC medication is purchased independently by the resident, the resident should be encouraged to inform staff so that their medication record can be updated. This requirement may be included in the written consent given by the resident
• where a resident is already taking medication(s) or involved in complementary and alternative therapies, the medical practitioner and/or pharmacist should be contacted to determine whether commencing a new OTC treatment will interact adversely with the existing medication(s). If the medical practitioner, pharmacist, or therapist is unavailable, contact the Medicines Line on 1300 633 424, or the Emergency Department of the local hospital. It is important in these circumstances that the service provider/staff are familiar with the resident’s usual medication schedule
• if symptoms are not relieved by the OTC medication, contact the resident’s medical practitioner for further instructions or assessment.

2.7 Complementary and alternative therapies

Where a resident requires assistance with the use of complementary or alternative treatments, written consent and instructions should be received from the resident’s medical practitioner and be documented in the resident’s Medication Record as for prescribed medications.

2.8 Adverse reactions to medication

Should service providers or staff identify or suspect that a resident is experiencing an adverse reaction to medication, or the resident reports this to the service provider, the resident’s medical practitioner must be contacted, and staff should act in accordance with the medical practitioner’s instructions.

• call an ambulance immediately if the resident is in distress or showing signs of requiring hospitalisation, for example difficulty breathing, chest pain, unexpected drowsiness, dizziness, change in consciousness, seizures, or extreme changes in behaviour
• administer first aid as required, if qualified to do so
• if an ambulance is not required, seek advice by phoning the prescribing medical practitioner and continue to observe the resident for changes in behaviour or well-being
• if a medical practitioner is unavailable, seek advice from either:
  • the resident’s pharmacist, or
  • the Adverse Medicines Events Line on 1300 134 237 (Monday to Friday, 9am to 5pm AEST), or
  • Health Direct Australia on 1800 022 222 (available 24 hours), or
  • the Queensland Poisons Information Centre on 13 11 26.

The Consumer Medicines Information (CMI) leaflet that is available for prescription and some non-prescription medications can also be referred to for information about common reactions to medications.

A Medication Incident Report should be completed as soon as possible after the incident, but no later than by the end of the shift (see section 1.12 and Appendix 5).

2.9 When a resident is temporarily off-site

When a resident is temporarily off-site (e.g. social outing, temporary home visit) and will require doses of medication, the resident’s originally dispensed medication or a separately dispensed supply sufficient for the period of the absence, and labelled and provided by a pharmacist, should be used.

The Health (Drugs and Poisons) Regulation 1996 does not permit the service provider or staff member to repack medication (e.g. placed in envelopes or other types of temporary containers).

A form should be used to document each occasion where medication is provided for the resident to use when off-site. The Medication Record (Temporarily Off-site) (Appendix 7) should include the following information:

• medication administered to residents during the time they are temporarily off-site
• all medication returned by the resident at the conclusion of their period off-site
• all refusals to self-administer medication while off-site (if known).

If an incorrect dose of medication has been taken by a resident, or their medication has not been taken at all, inform the prescribing medical practitioner of the error and follow the advice or instructions given. All errors or omissions in self-administering medications must be recorded as a medication incident.

If an ambulance is called and/or the resident goes to hospital, it is important that information about their medication (and/or a copy of their current medication list) is handed to the paramedic, ambulance officer or authorised person in the hospital unless alternate arrangements have been made with the hospital.

3. Quality use of medicines activities

To support safe and effective use of medications, and reduce the risk of medication incidents, additional activities can be undertaken. The following examples are given to assist service providers with achieving quality use of medicines.

3.1 Service agreement for supply of medication and associated professional services

To assist with continuity of care it is recommended that residential services providing medication assistance establish a service agreement with the pharmacy that supplies medication for the resident(s). Ensure that each resident has freedom of choice in relation to the selection of a pharmacy to provide their medications.

The service agreement would generally cover the following aspects of medication management:

• dispensing and supply of prescription and non-prescription medications, and relevant Consumer Medicines Information leaflets, where available, for individual medications
• agreed delivery arrangements
• arrangements for provision of dose administration aids where required
• procedures for dealing with changes to medication (e.g. changes to dose or frequency, or cessation of medication)
• maintenance and supply of accurate medication lists for individual residents
• a process to ensure continuity of medication supply and timely dispensing of repeat prescriptions
• procedures for after-hours services for supply of urgent medication and advice
• procedures for safe disposal of medication
• procedures for dealing with errors and discrepancies
• provision of education and advice about medication use, medication reviews and audits
• a requirement for regular meetings (at least quarterly) between the pharmacist and the service provider/staff to discuss medication-related issues
• provision of the above services in accordance with Pharmacy Board of Australia Codes, Guidelines and Policies, and other applicable professional practice standards.

3.2 Medication review

It is the responsibility of medical practitioners to ensure that residents on long-term medication have a formal review of their medication conducted at least annually. The review may include the resident/substitute decision-maker, resident’s medical practitioner and other stakeholders (e.g. psychologist or mental health worker, pharmacist) directly involved in the health care of the resident. An accredited pharmacist can also perform a medication management review (Home Medicines Review) on a referral from the resident’s general practitioner.

Factors that may prompt the need for a medication review include:

• a discharge from hospital (frequently a source of medication changes)
• an observed change in response to the effects of medication
• a suspected adverse drug reaction
• continued refusal or suspected non-compliance with medication.

3.3 Self-assessment

To assist service providers in implementing these guidelines and meeting the requirements of level 3 services in assisting residents with medication, a self-assessment checklist (page 6-7) can be used to identify areas needing attention or development.

3.4 Medication audits

Audits of medication stored at the residential service may be undertaken at regular intervals, to minimise risks associated with the usage, storage and disposal of medication. Medication Incident Reports may indicate to service providers that more frequent medication audits are required. The audits may be carried out by the pharmacist who is contracted to provide the dispensing service for the residential service, or by an independently contracted pharmacist or other authorised health professional.

Medication audits may take into consideration:

• any medications on hand at the commencement of the period being audited
• any medications received from pharmacists during the period being audited
• medications used during the audit period
• medication signed-in by a resident returning from off-site
• medication returned to a pharmacist, medical practitioner or hospital
• any medication returned to a pharmacy for disposal.

After considering the results of a medication audit, service providers should contact the relevant medical practitioner and/or pharmacist to obtain advice on managing any issues identified. For example, differences in the reconciliation of actual medication stock on hand with expected stock on hand. The service provider would be responsible for ensuring appropriate steps are implemented to rectify emerging or ongoing issues.

4. Resources

The following resources are available to assist service providers and staff, and can be contacted if appropriate/necessary:

• Adverse Medicines Events Line on 1300 134 237 for information about suspected adverse effects of medications. Available Monday to Friday, 9am to 5pm.
• Medicines Line on 1300 633 424 for general information on prescription, over-the-counter and complementary (herbal, ‘natural’, vitamin and mineral) medications. This service is not for emergencies, medical advice or a second opinion. Available Monday to Friday, 9am to 5pm.
• Health Direct Australia on 1800 022 222 for hour advice and information from a registered nurse.
• 13HEALTH on 13 43 25 84 (24-hour service) for general health and well-being information (www.health.qld.gov.au/13health).
• Queensland Poisons Information Centre on 13 11 26 for information and advice to assist in the management of poisonings and suspected poisonings (including concerns about medications arising from an overdose or suspected poisoning, but not for information about missed doses or refusal to take medication).

Online medication-related information can be found at www.nps.org.au.

APPENDICES

Appendix 1: Written request/consent for assistance with medication

Appendix 2: Medication Record

Appendix 3: Medication Distribution Record

Appendix 4: Staff Training Record

Appendix 5: Medication Incident Report Form and Flowchart for responding to a medication error

Appendix 6: Routes of administration for which assistance can be given

Appendix 7: Medication Record (Temporarily Off-site)

The forms are available online at

www.business.qld.gov.au/industries/service-industries-professionals/housing-accommodation/residential-service/providing-medication-assistance.

Appendix 1: Written request/consent for assistance with medication

Queensland Government

Written request for assistance/ consent for medication assistance

I, [insert resident’s name] hereby request management and/or staff of [insert name/or address of the service] to assist me with medication as prescribed by my medical practitioner.

• I understand that this means assisting me at the correct times to access my prescribed medication from its container which has been dispensed by a registered pharmacist.
• I understand that this means assisting me to access appropriate non-prescription medication in accordance with the directions provided by the manufacturer.
• I understand that this means assisting me with alternate medications recommended by my medical practitioner and/or pharmacist.
• I authorise the safe storage of such medication in a locked area within the facility.
• I authorise that my prescriptions are given to the pharmacist as required.
• I acknowledge that should I refuse to take the prescribed medication, I do so at my own risk, and that staff will notify my medical practitioner.

Print name of authorised person | —|— Relationship to resident |

Appendix 2: Medication Record

Medication Record

Name | —|— Date of birth | Written request for assistance with medication signed and on file (tick box if request on file) | [ ] Doctors name | Day time phone | After hours phone | Pharmacy name | Pharmacy phone | Current medication list provided by resident’s doctor or pharmacist (tick box if on file) | [ ] Does the resident have any known allergies or previous adverse reactions to medications? | Location where these are documented: |

[Photo here]

Notes/comments relevant to resident’s medication

Queensland Government

Medication Distribution Record

Name of resident:

Staff initial — medication given and taken R — medication refused — notify prescriber A — absent (on leave, at medical appointment) S — resident given medication for self-administration H — resident in hospital U — resident unable to take dose (e.g. due to vomiting) N — medication not available — obtain supply and or notify medical practitioner (e.g. waiting on delivery from pharmacy)

B — Breakfast L — Lunch D — Dinner BT — Bed Time

Week beginning ⬇

Record of PRN medication

Record of refusal of medication

Appendix 4: Staff Training Record

Queensland Government

Staff Training Record

Course | —|— Trainer/presenter | Accredited training | [ ] Yes [ ] No | Date/s:

Name and signature of trainer

Staff attended

Appendix 5: Medication Incident Report Form

Queensland Government

Medication Incident Report Form

Name of resident/s:

Date incident identified:

Date and time incident occurred:

Describe the incident and what happened:

Describe how the incident was managed:

Date reported to management/service provider:

Describe any corrective actions planned or taken to prevent a recurrence:

Appendix 5: Flowchart for responding to a medication error

• Staff member identifies that a medication error may have occurred
• Attempt to clarify the nature and cause of the error
• Acknowledge that an error has been made and advise the resident if they appear unaware
• Is the resident in distress or showing signs of being unwell?
  • YES: Call on another staff member to provide assistance
    • Is the situation deemed to be an emergency?
      • YES: CALL AN AMBULANCE
        • Administer first aid as required if qualified to do so
        • Promptly inform the prescribing medical practitioner of the problem and follow the advice or instructions given by the medical practitioner
        • Continue to observe the resident for changes in behaviour and/or wellbeing and stay with the resident until advised that it is safe to leave them
        • Has the situation been resolved?
          • YES: Notify the prescribing medical practitioner of the outcome as soon as possible after the incident and seek advice regarding future treatment
          • NO: Seek further advice as above
        • Complete a medication incident report and ensure that other staff are made aware of the incident
      • NO: Promptly inform the prescribing medical practitioner of the problem and follow the advice or instructions given by the medical practitioner
        • Continue to observe the resident for changes in behaviour and/or wellbeing and stay with the resident until advised that it is safe to leave them
        • Has the situation been resolved?
          • YES: Notify the prescribing medical practitioner of the outcome as soon as possible after the incident and seek advice regarding future treatment
          • NO: Seek further advice as above
        • Complete a medication incident report and ensure that other staff are made aware of the incident
  • NO: Promptly inform the prescribing medical practitioner of the problem and follow the advice or instructions given by the medical practitioner
    • Continue to observe the resident for changes in behaviour and/or wellbeing and stay with the resident until advised that it is safe to leave them
    • Has the situation been resolved?
      • YES: Notify the prescribing medical practitioner of the outcome as soon as possible after the incident and seek advice regarding future treatment
      • NO: Seek further advice as above
    • Complete a medication incident report and ensure that other staff are made aware of the incident

IF MEDICAL PRACTITIONER CANNOT BE CONTACTED:

Contact:

• a general practitioner and/or after-hours medical service
• or the Emergency Department of the local hospital
• or the resident’s pharmacist
• or the Queensland Poisons Information Centre on 13 11 26 if the situation involves suspected overdose of medication

Seek further advice as above

1 Where the medical practitioner’s advice or instruction involves a change to the original medication schedule, the advice or instruction is expected to be in writing. Where it cannot be provided in writing, it should be verbally confirmed by the medical practitioner with either the service provider or staff member. A second service provider or staff member should repeat the instruction back to the medical practitioner for confirmation of accuracy, and request confirmation from the medical practitioner in writing as soon as possible thereafter. A written record of the verbal advice from the medical practitioner should be made as soon as possible by staff members in the resident’s medication record and in staff communication notes used within the service. If a new prescription is required, the medical practitioner’s oral instruction must be to the pharmacist who will be dispensing the medication.

Appendix 6: Routes of administration for which assistance can be given