Nutrition & Hydration Policy

When does a nutrition and hydration policy apply?

A nutrition and hydration policy explains how a care service meets the eating and drinking needs of the people it supports, under regulation 14. That regulation applies where care includes accommodation or an overnight stay, and where meeting these needs is part of the agreed care. A care home always needs one. Home care and supported living services need it where help with food, drink or meals is in the agreed care, and supported living tenants still choose and buy their own food.

Under regulation 14, these needs cover suitable, nutritious food and drink, prescribed supplements, needs that come from preference, religion or culture, and help to eat or drink.

Screening for malnutrition

The template follows NICE guideline CG32 on nutrition support for adults. NICE guidance is not mandatory, though staff should take it fully into account. NICE describes a person as malnourished if they have:

• a BMI under 18.5

• unintentional weight loss of more than 10% in the last 3 to 6 months

• a BMI under 20 together with unintentional weight loss of more than 5% in the last 3 to 6 months

Care homes screen on admission and when there is clinical concern, such as loose-fitting clothes, fragile skin, poor appetite or a long illness. In home care and supported living, NICE recommends that GP practices do the screening, so staff report any concern to the GP.

Swallowing, drinks and refusal

Anyone showing signs of dysphagia (difficulty swallowing) is referred to a swallowing specialist, usually a speech and language therapist. Signs include coughing or choking around swallowing, a wet or hoarse voice and repeated chest infections. Staff follow the therapist's advice on textures exactly.

Drinks are offered day and night and kept within reach. A person with capacity may make choices others think unwise, so staff explain the risks and record the talk. Repeated refusal goes to the Registered Manager and the GP. The template also reminds staff that failing to meet a person's need for food and drink may be neglect.

What to add before use

Add your screening tool and how often you weigh people, along with your local dietitian and speech and language therapy contacts. Delete the service-type lines that do not apply.

Prescribed supplements go on the medication record, such as the Medication Administration Record (MAR Chart). Eating and drinking in the last days of life follow the End of Life Care Policy & Procedure, and concerns about neglect go through the Safeguarding Policy & Procedure.