Frequently Asked Questions

Do we now refer all our residents ‘at risk’ of malnutrition, e.g. with a MUST of 1 or more to the dietitian?

Generally no. We would suggest placing these residents on a food first action plan (as per our booklet and pathway) and monitoring them. You may have some residents who will be a MUST score of 1 and they might stay a MUST score of 1 – you would then need to tailor their nutritional care plan to suit their needs. For example, if a resident has always been petite, you might find extra nourishing drinks are filling them up and having an adverse effect on their appetite. So if found not to be of benefit, you could discontinue the drinks, whilst continuing to include other food first actions and weight monitoring to help keep their weight stable. For those who have a MUST score of 2 or more we suggest following the food first action plan as per our MUST pathway and if they continue to lose weight after following this structured guidance for at least 4-8 weeks, you could then refer your resident to us for further support.

My resident is already on a fortified diet but is losing weight, should I refer?

Often it is assumed if the kitchen add extra butter and cream to meals that this should be enough for a resident at risk of malnutrition. We recommend the Nutrition Support Care Plan booklet is used to support residents at risk of malnutrition and ensure the home are offering a structured food first approach. This means ensuring set amounts of food toppers are added to meals, ensuring nourishing drinks are of high nutritional value (or using the recipes we provide) and ensuring high energy snacks are offered. The weekly food first prescription charts help to support a structured and consistent food first approach to meet your residents needs. We suggest if there is no improvement after 4-8 weeks and your resident continues to have a MUST score of 2 or more, consider referring using the referral form provided.

Our resident is prescribed oral nutritional supplements, should we refer them to you?

Firstly you could have a discussion with your residents’ GP about whether it would be okay to swap them to homemade nourishing drinks, puddings or shots (as per the recipes in our booklet). Oral nutritional supplements generally should not be prescribed long term (longer than 3 months). Supplements do not offer anything which cannot be found in ordinary food and a homemade nourishing drink can be as nutritious. If the GP is in agreement you could swap to a structured food first approach following the actions in the Nutrition Support Care Plan booklet. If your resident’s weight remains stable, their weight loss slows or they gain weight, your team should continue with a food first approach. If they continue to lose weight (not just fluctuating up or down by 5%) and their MUST score is 2 or more and you have followed the plan for 4-8 weeks you could then refer to us for further support.

Our care home already fortifies all the residents meals, do we need to use the booklet?

Yes, the booklet is recommended as it gives structured food first advice with specific portions sizes. The booklet is designed to to optimise nutritional intake and facilitate weight gain and/or minimise weight loss. We do not recommend a blanket food first approach for everyone. Meals should be nourishing but generally extra food first measures should only apply to those who are identified as at risk of malnutrition and/or MUST score of 1 or more. Nutrition support measures should not just include food fortification, they should also include extra snacks and homemade nourishing recipes drinks, desserts or shots) between meals – unless this is proved not to be of benefit. Refer to the ‘MUST care pathway for care homes’ and the ‘Screening and Support for Malnutrition in Care Homes’ webinar for further information on offering a tailored nutritional care plan.