Support with nutrition for care homes
Community Clinical Dietitians
Hengrave House
Torbay Hospital
Torquay
TQ2 7AA
Tel: 01803 654396 (Monday to Friday, excluding bank holidays)
Email: Community Clinical Dietitians
The Community Clinical Dietitians support care homes in Torbay and South Devon with the nutritional care of residents.
Identifying residents at risk of malnutrition
You can use the Malnutrition Universal Screening Tool (MUST) to identify residents at risk.
Alternatives to MUST
If MUST is not suitable, the Patients Association Nutrition Checklist may be easier to use. These checklists are not specifically designed for care homes but can help you assess residents and develop care plans.
- Section A – this contains four key questions to assess someone’s potential risk,
- Section B – this provides guidance and information on what to do for anyone who was identified as needing support from Section A.
What to do next
If you are concerned about a resident’s nutritional intake, weight loss, or risk of malnutrition:
- Use the Guide to Managing Adult Malnutrition in the Community to support personalised care plans
- Refer to first-line information leaflets for people at risk of malnutrition
- Use the leaflet on homemade fortified drinks
- Watch the video on how to make fortified milk
- Use the booklet on creating a fortified diet recipe book
Advice and training
Somerset NHS Dietitians have developed free webinars for malnutrition.
Managing malnutrition
Listen to Specialist NHS Dietitians, Lesley Harper and Leah Seamark, giving valuable advice on how to identify if you may be at risk of malnutrition and tips of making simple dietary changes to improve your nutrition and health.
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Screening and supporting for malnutrition in care homes
Listen to Specialist NHS Dietitians, Lesley Harper and Marianne Williams, giving valuable advice on screening and supporting for those at risk of malnutrition, development of person-centred care plans, support to catering teams, monitoring and End of Life Nutrition.
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Hydration
Access the Good Hydration toolkit, training materials, and e-learning resources available on HIVE.
Clinical Community Dietitians
Dietitians can assess, diagnose, and treat malnutrition. They also provide advice on diet and hydration, work with carers and other services, and arrange nutritional supplements through a GP if needed.
Community patient referrals at risk of malnutrition (home assessments)
Prioritisation
All referrals will be prioritised according to clinical need. Dietetic assessment by a Community Clinical Dietitian will be offered to patients who meet the following criteria and who cannot attend an outpatient appointment.
Priority 1
- Grade 3+ pressure ulcer with evidence of nutritional problems, for example high MUST score, limited diet, poor fluid intake, poor diabetic control.
- MUST score of ≥3.
- BMI < 15.
- Very rapid unintentional weight loss >10% of body weight in response to clinical judgment.
- Patients with severe dysphagia/swallowing problems unable to manage solids.
- Patients where rapid clinical deterioration is anticipated and nutritional intervention may be beneficial (e.g. neurological conditions such as MND).
- Patients requiring PEG Assessment/consideration or tube feeding.
- Nutritional supplements are the sole source of nutrition.
- Concerns about safeguarding or self-neglect around eating and nutrition.
- Patients in severe crisis at home/at very high risk of hospital admissions with evidence of nutritional problems.
Levels of existing support may also be taken into consideration.
Patients with complex nutritional needs e.g. renal disease, liver disease, swallowing problems, poorly controlled diabetes and gastrointestinal disorders may need specialist dietetic advice/nutritional supplements.
The following referrals will be accepted if capacity allows:
Priority 2
Patients with malnutrition/at risk of malnutrition, evidenced by MUST score 2 and where first line support has been implemented by other health and social care professionals.
For example, no improvement observed after implementing care plan/first line support for someone with a MUST of 2. Patients can be seen earlier depending on clinical judgment, for example with more clinically or ethically complex patients.
- Advice required about special diets or nutritional assessment required following diagnosis e.g. renal disease, coeliac disease.
Resources
- Managing Adult Malnutrition in the Community
- British Dietetic Association Leaflet on preventing and management of pressure injuries
- Local South Devon and Torbay Formulary on management of adult malnutrition, including oral nutritional supplements
If you are unsure about a resident, please call 01803 654396 or email Community Clinical Dietitians.
Research trials
The REFRESH trial is a research study by Plymouth University looking at the best ways to treat malnutrition in older adults aged 65 and over living in care homes. For more information or to get involved, visit the University of Plymouth’s The REFRESH trial page.
Other resources
Food Fact Sheets covering a range of topics are available from the British Dietetic Association.
The Care Home Digest is a free resource about menu planning and food service for care homes. It has been developed by the British Dietetic Association and the National Association of Care Catering to support residential and nursing homes in providing high-quality food and drink for older adults.