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Empowering Care homes to identify and treat malnutrition using real food approach.

The HCT Nutrition and Dietetics service in South and West Hertfordshire receives a vast number of referrals for care home residents who are identified as at risk of malnutrition. Visits to these patients take a great deal of clinical time. In 2018 the dietetic service introduced auditing of care home practices and provided tailored training around identifying and treating malnutrition. From this came a decision to further support care homes holistically regarding their malnutrition processes and catering from a dietetic perspective, rather than treating individual patients. The aim was to empower care homes to be able to assess for and treat uncomplicated cases of malnutrition without the need for a dietitian, evidenced through audit and accreditation.

What did we do?

  • Previous audits of care homes practices were analysed to determine what further training and support would be needed.
  • Current caseloads were reviewed to determine which patients could be treated by the whole home approach and what groups of patients were high risk requiring one to one input.
  • From this a pathway was designed and services, care homes and GPs were advised of the new process and referral criteria.
  • Care homes were trained on the real food approach.  The real food approach is based around fortifying foods with nutrient dense and calorific ingredients in order to increase at risk resident’s nutritional intake.

Care homes receive visits every three months by either the dietitian or a contracted social enterprise (Hertfordshire Independent Living Support) to audit and educate homes on this approach. A weekly telephone drop-in clinic was set up for care homes to call to discuss any difficulties that they are having with the real food approach and dedicated care home email address was set up to support this. Homes meeting the required standard are accredited in one of three tiers – Gold, Silver and Bronze and the homes are re-assessed yearly.


Within seven months care homes showed improvements in their malnutrition screening practices and treatment plans using the real food approach. Use of prescribed supplements has reduced to a minimum with any issues being flagged via audit. Waiting times for non-care home patients have improved significantly. Audit and monitoring shows that care homes are now using the real food approach rather than relying on referrals to the dietitian.

A summary of this work has also been written to reflect innovations and best practice and this is due to be published in the Journal of Human Nutrition and Dietetics.

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