Size Matters! Differences in Nutritional Care between Small, Medium and Large Nursing Homes in Germany

Area of Science:

• Gerontology
• Public Health Nutrition
• Healthcare Management

Background:

• Nutritional care is a critical component of quality of life and health outcomes for residents in nursing homes (NHs).
• Understanding the current state of nutritional care and factors influencing its provision, such as facility size, is essential for targeted improvements.

Purpose of the Study:

• To comprehensively describe the status of nutritional care in German nursing homes.
• To investigate whether nutritional care practices differ based on the size of the nursing home (small, medium, large).

Main Methods:

• A nationwide cross-sectional postal survey was conducted among 541 nursing homes in Germany.
• Questionnaires collected data on structural characteristics and nutritional care aspects (food provision, menu planning, nursing care, management, quality assurance).
• Nursing homes were categorized by size: small (≤50 beds), medium (50-100 beds), and large (>100 beds). Data were analyzed using frequencies and Chi2-tests.

Main Results:

• Food provision and menu planning aspects were widely implemented (77-100%), as were nursing care aspects (≥68%).
• Management and quality assurance aspects, particularly staffing (interface manager, nutrition team, dietitian), were rarely implemented (14%, 12%, 42% respectively).
• Significant differences in nutritional care were observed by NH size. Small NHs more frequently considered texture-modified food needs and prepared hot meals at the ward level, while larger NHs more often implemented aspects of food provision, menu planning, management, and quality assurance.

Conclusions:

• While kitchen and nursing-related nutritional care is prevalent in German NHs, management and quality assurance standards are frequently unmet.
• The study supports the hypothesis that nursing home size significantly influences the implementation and delivery of nutritional care.