Who Decides A Resident’s Diet In A Care Home
If your loved one needs gluten-free meals, diabetic-friendly food or can’t eat solid food, you want to know if the home will get it right for them every day.

That matters because nutrition risk is common in care settings due to poor meal planning for those with special dietary needs. In fact, BAPEN’s 2023 Malnutrition and Nutritional Care Survey reported 42% of care home residents screened were at risk of malnutrition.

Keep reading to learn more about special diets in care, how instructions are recorded and shared with the kitchen and care team and what you can look for when viewing a home to feel confident that your loved one is safe and well fed.

Who Decides a Resident’s Diet in a Care Home?

A resident’s diet is agreed through their care plan before they move into the home. And the resident’s preferences always come first when it’s safe.

Medical requirements are set or confirmed by clinicians, such as a GP and a dietitian. If there are swallowing problems, a speech and language therapist specifies the food texture and drink thickness. Staff keep a close eye on the resident, recording and reviewing the plan when needed.

Care Home Special Diets Explained For Families

Most care homes are juggling several diets at once and work hard to ensure they are both safe and of high-quality. Some diets include:

Allergies and intolerances

Clear allergen control from kitchen to plate is critical. In the UK, care homes are expected to manage and communicate the 14 named allergens, including gluten, dairy and nuts.

Look for:

  • Allergy and intolerance details are recorded in the care plan and kitchen system
  • Ingredient checking that includes extras, like sauces, stocks and desserts
  • Suitable controls to reduce cross-contact, with clear labelling and storage

Diabetes-friendly diets

Diabetes care in older adults is more nuanced, especially in care homes where undernutrition can be an issue. Diabetes UK highlights that malnutrition risk is common in care settings and diabetes can add to that risk.

Watch out for:

  • Meals and snacks planned around the resident’s routines, appetite and clinical needs
  • Staff who know what to do if someone eats poorly, skips meals or becomes unwell
  • Reviews when weight changes, appetite drops or support needs increase

Texture-modified diets for swallowing difficulties

Many services use IDDSI levels so textures are consistent and understood across teams.

Good practice looks like:

  • The texture level is written clearly in the care plan and followed at every meal
  • Thickened drinks are prepared to the correct level and checked for consistency
  • Food that still has flavour, variety and enough calories, especially for pureed diets

Fortified diets for poor appetite or weight loss risk

BAPEN’s MUST tool is widely used to screen for malnutrition risk and guide nutrition care planning.

This includes:

  • Regular screening and monitoring with clear triggers for review
  • Extra nourishing snacks and fortified meals when intake is low
  • Contacting the GP or dietitian if concerns persist

Vegetarian, vegan, cultural and religious diets

Make sure that:

  • Preferences are recorded clearly and respected every day
  • Balanced meals with reliable protein options
  • Maintaining these standards during weekends, events and even staff changes

How Special Diet Plans Work in Real Life in a Care Home

Once a diet has been agreed, it becomes part of the resident’s daily care routine.

After moving in, a resident’s diet requirements are recorded alongside medical information, including allergies, intolerances, diagnosed conditions that affect diet, swallowing guidance where relevant and food preferences. Current weight and recent changes in appetite are also noted, so staff have a baseline of what to work with.

That information is immediately shared with both care staff and the kitchen. The diet is documented in the care plan and reflected in kitchen records so meals are prepared correctly.

If a diet change, for example, after an illness or a swallowing assessment, the update must be made in both places on the same day.

Meals are then planned and prepared using those instructions. This can include adjusted textures, specific portion sizes, planned snacks or fortified meals if intake of a certain mineral is low. Residents are always offered suitable alternatives if they don’t want what’s on the menu, to ensure they don’t skip meals and leave the table satiated.

Some residents eat independently, but for those who need reminders, help cutting food or supervision or support with positioning due to swallowing risk, staff will be there to help. Drinks are provided in accordance with the agreed guidance, including thickened fluids when prescribed.

Diet plans are reviewed when there are changes.

Weight loss, reduced appetite, repeated missed meals, illness or changes in medication should quickly prompt a review and, where needed, referral back to the GP or dietitian.

Importantly, the same diet instructions should apply at weekends, during staff changes, at celebrations and when families bring in food.

Choosing a Care Home With Diet Support You Can Trust

In many care homes, support for special requirements works best when it’s clear, documented and reviewed as needs change. Families should be able to ask important questions about their loved one’s nutrition and get specific answers back about who sets the menu, how it’s shared with staff and what happens when something changes.

Premium care homes that manage special diets well are usually confident explaining the details, because they hold a high standard as part of their everyday care.

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