Food first for care homes
Last edited: 16/12/2022
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In this information, we will cover:
Malnutrition and food first
Malnutrition is common in care homes. People at risk of malnutrition are those who are underweight or have a significant amount of unplanned weight loss. People at risk can be identified using the Malnutrition Universal Screening Tool (MUST). Please ask your dietitian for more information about this.
Malnutrition is usually caused by an increase in energy needs (due to certain illnesses) coupled with a reduction in food or energy intake (due to poor appetite, texture modified diets etc.). This leads to an energy deficit and weight loss.
To prevent malnutrition in those residents who are at risk – with a MUST score of one or more – we recommend offering high energy (kcal) food and drinks. This is described as food first nutrition support and aims to give the maximum amount of nutrition, in the minimum portion size to make every mouthful count. Food first nutrition support has been shown to reduce weight loss.
Improving intake
These are some basic ideas which can help improve the mealtime experience for residents.
Little and often
- Offer five to six small meals or snacks over the day.
- Try not to overload the plate as a large portion size can look daunting. You will also save money on food wastage.
- Be flexible with mealtimes to allow residents to eat or drink at the time that their appetite is best.
- Make sure meal and snack times are evenly spaced to maximise appetite.
Dining environment
- Does your resident like to eat alone or do they eat more around others in the dining room?
- Make sure the dining room is calm, clean and there are no distractions. Try some background music.
Appetite stimulants
- Try allowing residents to get some fresh air before a meal.
- A tipple of sherry may do the trick.
Dementia
- Maximise food intake when residents are more alert, by offering larger portions or extra snacks at these times.
- As sight is often compromised in dementia, using coloured crockery and cups can help.
- Taste changes are also common and food may taste bland, so try sweetening foods or adding extra flavouring.
Communication
- Using different coloured plates for those who need assistance and encouragement at mealtimes will mean all staff are aware of their needs.
- A list of likes, dislikes and food first recommendations for residents can help everyone offer the best care.
- Set out routine snack times with a few options on offer. Keep a list of three snacks each resident likes and at what times, for all staff to access.
Snacks
Why are they important?
For people who have a poor appetite, large portion sizes at mealtimes are difficult to manage and may even put them off their food. By offering smaller portions at mealtimes and snacks in between, you may find your resident can manage more food in a day.
When should they be eaten?
Snacks should be offered three times a day, mid-morning, mid-afternoon and before bed. Try offering with a nourishing drink to increase energy and fluid intakes.
What snacks are best?
It is important that a person has a snack they will enjoy, so have a few savoury and sweet options available each day.
Snack ideas
Here are some snack ideas, with different consistencies. Each star (*) in the tables below is equal to 50kcal per average portion.
Normal consistency snacks
Snack and energy (kcal) * rating
Fruit cake and cream ********
Scones with clotted cream and jam ********
Apple pie with cream *******
Apple turnover *******
Crackers with cheese and butter x two ******
Flapjack ******
Egg custard tart ****
Dried fruit and nuts (small handful) ***
Cheese and pickle sandwich ***
Crisps (one bag) ***
Biscuits (high kcal options such as shortbread, hobnobs etc.) x two ***
Cheese twists x three **
Toffee *
Soft consistency snacks
Snack and energy (kcal) * rating
A croissant with butter and jam *******
A slice of cheesecake *******
An individual rice pudding pot ****
Tiramisu ****
Trifle ****
Chocolate buttons ***
Fudge **
Jelly made with 50g of evaporated milk **
Scrambled egg with cheese ****
Puree consistency snacks
Snack and energy (kcal) * rating
Angel delight, made with full fat milk and double cream *********
Ice cream with evaporated milk or cream – choose dairy ice cream or make up with Complan and double cream *******
Cheese mash x three scoops *******
Pâté with puréed vegetables *******
Custard made with double cream ******
Fruit mousse *****
Weetabix with cream and milk *****
One pot of thick and creamy yogurt ***
Finger foods
Foods which can be eaten without using utensils, known as finger foods are particularly helpful for those with dementia, as they can be eaten independently or on the move.
Try having a buffet or picky plate option available at mealtimes.
Finger food ideas
- Sandwiches with fillings such as, grated cheese, peanut butter, cream cheese, egg mayonnaise or pâté.
- Chips, waffles or hash browns.
- Chicken in breadcrumbs.
- Fish fingers.
- Sausages or sausage rolls.
- Pork pie.
- Scotch egg.
- Samosas.
- Scotch pancake with chocolate spread.
- Ice cream cones.
Food fortification tips and recipes
What is food fortification?
Food fortification means adding high energy and protein foods into meals, snacks and desserts. This can help residents increase their energy intake without having to eat a larger portion.
Will high fat food harm health?
High fat foods can cause cholesterol levels to be raised but initially the main concern is further weight loss with the aim of preventing it. As food fortification is a temporary measure, the possibility of raised cholesterol harming health is unlikely. If you have specific concerns, please ask your dietitian for further advice.
What if someone has diabetes?
Food fortification techniques are still appropriate for those with diabetes, however, sugary drinks should still be avoided. As it is a temporary measure, if blood sugar levels rise, this can be controlled with medications at that time. An individualised plan can be made with your dietitian.
Ideas for food fortification
- Skimmed milk powder
- Full fat milk - Four tbsps to one pint of full fat milk – use on cereal and in tea or coffee
- Cream- Whip four tbsps to one pint of cream to put on desserts
- Double cream or condensed milk
- Ice cream - One tbsp on two scoops
- Cake - One tbsp on one slice
- Porridge - Two tbsp mixed in one bowl
- Custard - Four tbsps per pint
- Rice pudding - One tbsp per bowl
- Oil
- Sauces - One tsp per portion
- Mashed potato - One tsp per one tbsp of mash
- Milkshakes - One to two tsps per 200ml
- Pasta or rice - One to two tsps per portion
- Butter
- Vegetables - One tsp melted over one portion
- Mashed potato - One to two tsps in one tbsp of mash
- Purée meals - One to two tsps into one meal
- Toast or bread - Spread thickly
- Fish - Melt one to two tsps on top of a fillet
- Scrambled egg or omelette - Two tsps per one egg
- White or cheese sauce - Two tsps per portion
- Pasta or rice - Two tsps melted into one portion
- Cheese
- Soup - Grate 30g into one bowl
- Shepherd’s or fish pie - Grate 30g onto one portion
- Mashed potatoes - Grate 30g onto one portion
- Full fat yogurt
- Fruit - One medium pot
- Cereal - One medium pot
- Original Complan or Meritene powder
- Gravy, sauce, soup or custard - One sachet per 200ml of all liquids
- Cake-mix - Add to standard cake mix
- Porridge - One sachet per 200ml of milk
- Cereal
- Sugar
- Cereal - One to two tsps per portion or drink
- Hot drinks - One to two tsps per portion or drink
- Fortified milk
- Sauce - Use in place of normal milk
- Gravy - Use in place of normal milk
- Eggs
- Bread - Soak in one beaten egg and fry
How to adapt recipes
Recipes can be adapted to make them more nourishing. Below are some ideas on how this can be done and the difference it makes to the nutritional content.
| Milk | One pint | Add five heaped tbsp of milk powder to whole milk | 375 |
630 Extra 70 per cent |
| Custard | Large ladle (125mls) | Add one heaped tbsp of milk powder and two tbsp of cream to custard made with whole milk | 140 |
440 Extra 95 per cent |
| Soup | Large ladle (125mls) | Add one heaped tbsp of milk powder and two tbsp of cream to soup | 80 |
350 Extra 340 per cent |
| Porridge | Large ladle (125mls) | Add one heaped tbsp of milk powder and two tbsp cream to porridge made with whole milk | 170 |
440 Extra 160 per cent |
| Mashed potato | One scoop | Add an extra one tsp of margarine or butter and one tbsp of cream to mashed potato | 70 |
250 Extra 315 per cent |
| Vegetables | Two tbsp | Add one tsp of margarine or butter to vegetables and allow to melt | 15 |
90 Extra 500 per cent |
| Ice cream | One scoop | Pour two tbsp of cream over the ice cream | 115 |
335 Extra 190 per cent |
| Sponge pudding | Two tbsp | Place an extra two tsp of jam or syrup to the sponge when serving. Then serve with high calorie custard or ice cream | 425 |
525 Extra 25 per cent |
| Breakfast cereal | Small serving (25g) | Use the high calorie milk and add two tsp sugar Optional: Add an extra one tbsp cream (total 360, extra 120 per cent) | 155 |
200 Extra 60 per cent |
| Milk puddings (rice, semolina, or tapioca or sago) | Large ladle (125mls) |
Add one heaped tbsp of milk powder and two tbsp of cream to the milk pudding made with whole milk Optional: Add an extra two tsp of jam (total 565, extra 190 per cent) |
195 |
465 Extra 140 per cent |
Sample menu
Here is a sample menu illustrating how food can be fortified and the difference this can make to nutritional content.
Calorie content before food fortification was 2,400 kcal and after it is 3,300 kcal.
Breakfast
Porridge with full fat milk - Add one tbsp of double cream and one tbsp milk powder
Mid-morning snack
Two rich tea biscuits - Swap for shortbread
Lunch
Shepherd’s pie - Grate 30g cheese on top
Rice pudding - Add one tbsp double cream
Mid-afternoon snack
A slice of sponge cake - Swap for fruit cake and serve with cream
Evening meal
Soup and a sandwich - Grate 30g cheese on top of the soup, spread butter thickly in the sandwich and add full fat mayonnaise
Yoghurt - Use thick and creamy version
Bed time snack
Hot chocolate - Add two tsps double cream and two tsps milk powder
Two digestive biscuits
Nourishing drinks
What to have on the drinks trolley:
Fortified tea: In one cup of tea (200ml), add one to two tsps milk powder, full fat milk and sugar to taste.
Fortified coffee: Add instant coffee to a cup of warm full fat milk, add one tablespoon of double cream, one to two tsps of milk powder and sugar to taste.
Cold drinks: Avoid no added sugar squash and choose traditional syrup style mix (high juice, Robinsons, Ribena etc.) or fresh fruit juice, lemonade, Lucozade, ginger beer, bitter lemon or tonic water. Trial fresh fruit juice made up with lemonade and ginger beer for a refreshing non-alcoholic cocktail.
Ovaltine or Horlicks: Four teaspoons of Ovaltine or Horlicks powder to one cup of full fat milk (200ml), add one to two tsps of milk powder and one dessert spoon of double cream.
Hot chocolate: Four teaspoons of chocolate powder to one cup of full fat milk (200ml), add one to two tsps of milk powder and one dessert spoon of double cream.
Smoothies: Orange juice, banana, mango and creamy yogurt or try orange juice, strawberry, raspberry, banana, honey and vegetable oil.
Milkshakes: Full cream milk, banana or alternative fruit, ice cream, milk powder, cream, sugar and vegetable oil or try cocoa powder, chocolate sauce, three tablespoons of milk powder, full fat milk and sugar.
Complan and Meritene drinks
These products are oral nutritional supplements designed to provide extra energy and nutrients for people who are at risk of malnutrition. They come in a powder form and can be made into a drink, soup or used in recipes. They are both usually available for purchase in pharmacies and supermarkets. Other supplements are available via prescription.
The ideas below all serve one person unless otherwise stated. Leave desserts to stand for 15 minutes before serving to make sure the Complan or Meritene is fully dissolved.
Milkshake: Whisk together one sachet of Complan or Meritene, 150ml full fat milk, 50ml double cream and one tablespoon of milk powder.
Malted drink: Whisk together one sachet of original Complan or Meritene, four teaspoons of Ovaltine or Horlicks powder and 150ml full fat milk.
Fizzy drink: Mix one sachet of Complan or Meritene of desired flavour with 200ml of desired fizzy drink.
Fruit juice drink: Whisk together one sachet of Complan or Meritene such as, banana, vanilla or strawberry with 200ml of fruit juice, for example apple, grape or orange juice.
Soup: Mix 60g or one sachet of Complan or Meritene original with one tin of condensed soup, then whisk with 200ml full cream milk. Heat gently for three to five minutes (do not boil), then serve.
Cheese sauce: Whisk together two rounded dessert spoons of cheese sauce granules, three level tablespoons of Complan or Meritene original and 100ml hot water to a thick consistency and serve.
Yogurt: Whisk together one sachet of vanilla Complan or Meritene, 200ml apple juice and 100g Greek yogurt.
Mousse (serves four): Whisk together one sachet of Complan or Meritene, one packet of instant dessert, such as Angel Delight, 200ml full cream milk and 100ml double cream.
Ice cream (serves four): Whisk together one sachet of Complan or Meritene and 200ml double cream until thick and smooth. Place in the freezer overnight (or until frozen). Remove from the freezer at least 10 minutes before serving.
Further information
- Complan recipes: www.complanfoods.com/recipes.php
- Bapen MUST tool: www.bapen.org.uk/must_tool.html
Contact us
Please contact the service though our Central Appointments Team:
0300 123 0861
kcht.centralisedappointmentteam@nhs.net
Monday to Friday, 9am to 3pm
This information should only be followed on the advice of a healthcare professional.
Do you have feedback about our health services?
0800 030 4550
Text 07899 903499
Monday to Friday, 8.30am to 4.30pm
kentchft.PALS@nhs.net
kentcht.nhs.uk/PALS
Patient Advice and Liaison Service (PALS)
Kent Community Health NHS Foundation Trust
Trinity House, 110-120 Upper Pemberton
Ashford
Kent
TN25 4AZ
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