Improving Intake in Long Term Care: It’s More Than Just Supplements

Sophia Agreda, MS, RDN

When a resident’s intake starts to decline, the response is often immediate and familiar: add a supplement.

And while oral nutrition supplements absolutely have their place, they are often used as the first and sometimes only intervention. The problem is, this approach can overlook something incredibly important: how residents actually experience food.

Why Supplements Alone Are Not Always Enough

Supplements can be helpful, especially when needs are high and intake is low. But when the same supplement is offered every day, often in the same flavor, it can quickly become unappealing.

Over time, this can lead to:

Taste fatigue
Repeated exposure to the same flavor and texture can cause residents to lose interest. What may have been acceptable at first can quickly become something they begin to refuse altogether.

Decreased compliance
As interest declines, so does consistency. Residents may only take a few sips, refuse certain flavors, or stop consuming the supplement entirely, making it difficult to meet estimated needs.

Reduced overall intake
When supplements replace or overshadow more appealing food options, residents may consume less overall. Instead of supporting intake, the intervention can unintentionally contribute to further decline.

Simple, Actionable Ways to Improve Intake

Here are strategies that can be implemented immediately in most long-term care settings:

• Add Whole Food Snacks to Diet Orders

  Many facilities already have foods available that can support intake.

  Consider options like:

  • Yogurt with fruit or granola

  • Cheese and crackers

  • Cottage cheese with berries

  • Toast with a nut-free spread and banana

  • Smoothies or milkshakes

  These options provide protein and calories, but more importantly, they offer variety and familiarity.

• Rotate Snacks to Prevent Fatigue

  Just like supplements, even preferred foods can become repetitive.

  Try:

  • Rotating snack options daily or weekly

  • Alternating sweet and savory choices

  • Incorporating seasonal or rotating menu items

  Variety helps maintain interest and improves long-term intake.ion text goes here

• Use Preferences as a Clinical Tool

  Preference data is often collected, but not always used effectively.

  Take time to:

  • Review food preferences during visits

  • Ask residents what they are actually in the mood for

  • Adjust snacks and meals accordingly

  Small preference-based changes can have a significant impact.

• Collaborate with Dietary Staff

  Dietitians do not have to do this alone.

  Work with dietary teams to:

  • Identify available foods that can be repurposed as snacks

  • Create simple snack rotations

  • Ensure consistency in delivery

  This makes the approach more sustainable and realistic.

• Liberalize When Appropriate

  Whenever clinically feasible, liberalizing the diet can support better intake.

  Restrictive diets can reduce appeal and limit options. In many cases, allowing more flexibility leads to improved overall nutrition.

Finding the Balance

Supplements still have a role. They can be an important part of a nutrition care plan when used appropriately.

But they should not be the only strategy.

Improving intake requires a more flexible, resident-centered approach that prioritizes variety, autonomy, and real food.