Key finding: Adding a range of off-menu alternatives is not enough to enable agency amongst aged care residents.

Context: Most aged care residents are vulnerable (i.e. unable to gain value from a service interaction) due to their inherent characteristics and their enforced dependence in a highly structured and regulated service environment. In this environment most residents lack agency i.e. the presence (or absence) of choice due to the level of control that a person can exercise.

Our focus: On the experience of agency and how service design/operations are impeding (or could enable) agency.

Method: In a study focusing on Food and Meal Experience (F&Mxp), we interviewed 67 residents, 41 family members, and 13 F&M staff across 5 facilities that had recently implemented changes intended to increase choice of food.

Findings: Before and after measures showed a slight improvement in “I get to choose” but not an increase reflective of the investment in service change. Most residents could not recall ‘having alternatives’, didn’t know how ‘to action them’, and ‘wouldn’t want to impose’. NoK perceived that their loved ones ‘lack the ability to choose’. Staff perceived enabling choice was ‘something to get through as quickly as possible’.

Significance: The service process and staff as key enablers of agency amongst the residents will be discussed. This is relevant to current attempts (e.g. Food and Nutrition Standard 2023) to balance increased demands for clinical care while meeting the emerging autonomy, independence and choice needs of ‘todays’ consumer – within scarcely resourced service models.