A ‘food-first’ approach is a cornerstone of person-centred care.
Care homes are caring for residents with increasingly complex needs. Many are living with frailty, dementia or swallowing difficulties. At the same time, care teams are working under significant operational pressure. In this context, the wider role catering can play in residents’ lives can be overlooked.
However, few aspects of care touch a resident’s life as often as food and drink. Mealtimes provide opportunities to support health, encourage independence and enable social connection, while providing structure, pleasure and dignity.
Why ‘food-first’ matters
Maintaining a good nutritional intake can become increasingly difficult with age. Changes in appetite, illness, medication side effects, cognitive decline, poor dentition and swallowing difficulties can all affect how much a resident eats and drinks. People living in care homes or requiring care are recognised as being at increased risk of poor nutritional status and malnutrition.1
The scale of the challenge is significant. BAPEN’s 2023 ‘Malnutrition and nutritional care survey’ reported that 42 per cent of adults screened in participating care homes were at risk of malnutrition using the Malnutrition Universal Screening Tool (MUST).2
A ‘food-first’ approach asks care homes to think earlier, more consistently and more holistically about the role food and drink play in everyday wellbeing. Food should not be viewed only as a response to nutritional risk. High-quality food provision should be recognised as an essential part of high-quality care for every resident, every day.
Nutrition science and meeting nutritional requirements are both essential. Older adults need adequate, and in some cases increased, energy, protein, fluid, fibre, vitamins and minerals to help support health and wellbeing.3 For residents with reduced appetite or increased needs, food may need to be more nourishing, more frequent and more carefully planned.
However, a nutritionally balanced meal cannot provide benefit if it is left uneaten. This is why the dining experience also matters.
‘Food-first’ therefore brings together two essential ideas: nutritional adequacy and resident experience.
What does ‘food-first’ mean in practice?
A ‘food-first’ approach is not a single intervention but a whole-home culture, embedding food and drink into care planning, rather than it sitting separately as a catering task.
In practice, a ‘food-first’ approach means making nutrition visible in everyday routines: noticing when a resident eats less than usual, offering timely alternatives, sharing information between care and catering teams, and recording concerns so that support can be reviewed.
While food is not a replacement for medical treatment, dietetic advice or clinical care when needed, it is a powerful part of the wider care environment. ESPEN guidance on nutrition and hydration in older people emphasises the importance of routinely screening for malnutrition, supporting oral nutrition through food fortification and nutritional counselling, and taking an individualised, multidisciplinary approach.3
This reinforces a key message: nutrition is everyone’s responsibility. Catering teams, carers, nurses, managers, dietitians, families and residents all have a role to play.
Food at the heart of outstanding care
A ‘food-first’ approach is a cornerstone of person-centred care.
When food is done well, it supports far more than nutritional intake. It can help residents maintain independence, preserve dignity, participate socially, feel recognised as individuals and enjoy daily life. It can also give families confidence that their loved one is being cared for in a way that feels personal and thoughtful.
The future of care is about more than delivering increasing clinical interventions. It is about creating environments where people can live as well as possible. Food is one of the clearest expressions of that commitment.
When nutrition, enjoyment, choice and care come together, mealtimes become far more than a service. They become one of the most important ways a provider demonstrates what good care truly means.
To read the full Food-First Care Guide from apetito, including further insights and practical advice, visit:apetito.link/foodfirstguide
Rachel Sipaul
Rachel joined apetito as senior dietitian in 2025, bringing many years of experience in nutrition, healthcare and the food industry. Her expertise spans NHS healthcare, care homes and education settings, where she has helped shape nutritional support for diverse populations. Rachel is passionate about ensuring that good nutrition improves real-life outcomes for people at every stage of life. She is particularly committed to supporting older adults, advocating for food and nutrition that helps maintain independence, wellbeing and quality of life.
References
1. Norfolk and Waveney ICB Medicines Optimisation Dietetic Team. Nutrition in care homes guidance. Version 2.2. Norwich: Norfolk and Waveney Integrated Care Board; 2024.
2. Stratton RJ, Cawood AL, editors. Malnutrition and nutritional care survey in adults: UK Malnutrition Awareness Week, October 2023. Redditch: British Association for Parenteral and Enteral Nutrition; 2024.
3. British Dietetic Association. Care home digest: menu planning and food service guidelines for older adults living in care homes. 1st ed. Birmingham: British Dietetic Association; 2024.
4. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft AJ, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47.
