Personal Preferences
The person's preferences about eating and drinking should be understood, supported and respected.
- The person stops eating or enjoying food because:
- their preferences aren’t asked about or supported
- choices aren’t available
- they aren’t given the help they need to eat.
- The person lacks good information about their options and the risks of their choices.
- Social enjoyment of meals, including with family and friends, isn’t supported.
- Staff do not respect the person’s decision to eat and drink with acknowledged risk (EDAR).
- Take an individualised approach to understand and support what, when, how, and with whom the person wants to eat and drink. Recognise their needs and preferences may change over time.
- Regularly offer opportunities for the person to express their preferences and ensure they have a variety of food and drink options.
- Check if the person has an Advance Care Directive or other planning documents outlining their preferences for food, drink, or artificial nutrition and hydration. Ensure these documents are accessible to all care staff.
- Make sure the person and/or their decision-maker can make an informed decision about nutrition and hydration preferences and document the acknowledged risks if the person chooses to eat or drink items that aren’t recommended. Staff should stay up to date on other ways to reduce risks and support the person’s choices.
- If the person isn’t eating or drinking as expected, explore why. For example:
- Was the food undesirable or served at the wrong temperature?
- Were they not supported to eat?
- Are they struggling to feed themselves?
- Has eating or drinking become uncomfortable for them?
- Would the person like to review or change any of their previously acknowledged food and drink choices that carry a risk? For example, after experiencing a non-fatal choking incident.
- Adjust care based on changes in the person’s needs and preferences.
The Person Comes First in Nutrition and Hydration Decisions
The person who is dying should be at the centre of all decisions about their food and drink. They have the right to choose if and how they want to continue eating and drinking, including whether to have modified food or artificial nutrition and hydration. These choices may be influenced by their culture, faith, personal beliefs, or values.
It is important to understand and respect their preferences about:
- what they want to eat and drink
- when and how they want to eat
- who they want to share meals with
- any cultural or spiritual needs related to food and drink.
Supporting their choices helps ensure they feel comfortable, valued, and respected in their final stage of life.
The Person Has the Right to Refuse Food and Drink
People have the right to make their own choices about their care, even if those choices involve risks.
A person may choose not to eat or drink or to refuse artificial feeding or hydration. This is their right, and it should be respected.
They may also choose to keep eating and drinking in a way that carries risks. This should be supported after clear discussions with them about the possible risks to their health. This is referred to as eating and drinking with acknowledged risk.
Respecting their choices helps them maintain control, dignity, and quality of life in their final stage of life.
Relevant information is needed to inform decisions about nutrition and hydration
When talking with the older person and/or substitute decision-maker and family about what they want to eat and drink towards the end of life, it is important to share clear and helpful information. This includes:
- the different options available, including soft or modified foods and artificial feeding or fluids
- the possible effects and risks of eating and drinking certain foods, or not eating and drinking at all.
Preferences for food and drink in advance care planning
The Strengthened Quality Standards require aged care providers to regularly assess and plan for each person’s needs, goals, and preferences. This includes advance care planning and end-of-life planning if the person wishes.
If a person has shared their preferences about food and drink (especially about modified diets, artificial nutrition, or hydration) in an Advance Care Directive or other care planning documents, these should be known and respected.
However, not all preferences about food and drink may be included in an Advance Care Directive. While a person may have stated their wishes about artificial nutrition and hydration, they may not have detailed what foods and drinks they enjoy or how they like to eat. Because preferences can change, it is important to regularly check in with the person and update their care plan as needed. If they choose to eat and drink with acknowledged risk, this should be documented.
Involving others in decision-making
A person may choose to involve family, friends, or health professionals in discussions about their food and drink choices. Families and friends should also be kept informed about any changes to eating and drinking needs, as long as the person has given consent.