The 100,000 older Australians missing from our nutrition conversation
There are 340,000 Australians currently receiving Support at Home funding. Between 30 and 50 per cent of them — somewhere over 100,000 people — show signs of malnutrition or are at clinical risk of it.
That’s not a small number. It’s bigger than the population of Bendigo.
And yet it almost never comes up.
The conversation we’re not having
Most older Australians at home are eating less than they used to. Smaller portions. Skipped meals. The cup of tea at four o’clock that quietly replaces the cooked dinner.
It happens gradually. People don’t notice it in themselves, and they don’t think it’s a problem. If you ask them how they’re eating, the answer is almost always fine. They mean it.
Their care managers ask the same question and get the same answer. Their families notice slowly — usually after weight loss has become visible, or a fall, or a hospital admission that didn’t seem to have a clear cause.
By the time it’s obvious, it’s already affecting strength, recovery, and independence.
Why this gap exists
Three things make this hard to see.
It’s hidden by self-reporting. Older Australians who are eating less don’t experience it as eating less — they experience it as eating enough. Appetite changes feel like normal ageing. The reference point quietly shifts down.
There’s no forcing function. Care plans are organised around visible needs — falls, mobility, medication, social support. Nutrition risk doesn’t show up unless someone is specifically looking for it.
No-one is supplying the answer. Even where care teams are looking, the established response — separate dietitian referral, separately purchased shake products, no clear pathway between the two — is fragmented and rarely delivered at scale. Most providers don’t have a clinical nutrition pathway because the pathway didn’t really exist.
Why screening is the missing piece
The fix to all three of those problems starts in the same place: a structured nutrition screen.
Five minutes, validated, completable by the client, a family member, or with care-staff help. Screening is the only reliable way to accurately identify who’s malnourished or at clinical risk — and, just as importantly, who isn’t. Asking “how are you eating?” doesn’t surface it. Weight loss only becomes visible after the fact. A short risk-based screen catches it earlier and on purpose.
Without that step, support either doesn’t arrive or arrives in the wrong place. With it, the rest of the pathway is built on something accurate. The people who need help get it. The people who don’t aren’t given an intervention they don’t need.
Why this is the moment to fix it
Nutrition support funding has been part of home-care funding for some time — including under the previous Home Care scheme. What's distinctive about Support at Home is that as client co-contributions were introduced across other funding categories, nutrition support has been maintained at no co-contribution for eligible clients. That's a signal of how the system is treating nutrition risk.
The funding is there. The eligibility is there. The products are there.
The only thing missing is the bridge: a screening pathway that identifies who needs it, a clinical workflow that documents and prescribes it, and a delivery model that doesn’t add operational load to providers who already have plenty.
That’s the gap.
The category problem we’re working through
The most common reaction we hear from care staff is that they assume what we offer is “another meal provider.” It isn’t.
Meals matter. Meal providers do important work, and the food-first approach to nutrition is right — it’s the foundation we work from. Our dietitians always start with food: what someone is eating, what they’re not, what would help.
But food isn’t always enough. When someone is losing weight, recovering from illness, or simply can’t eat enough to maintain strength, a clinically formulated nutrition shake — prescribed and monitored by a dietitian — is the next step. It complements meals; it doesn’t replace them.
That’s the model in plain terms: screening to identify who genuinely needs support, dietitian advice grounded in food first, and shakes where food alone isn’t covering the gap. Distinguishing those layers is most of the work right now.
Where this is going
At Eat Well Health, the pathway we’ve built looks like this. A short online screening — completed by the client, a family member, or with care-staff help, in five minutes. A dietitian-signed recommendation. A funded order, no co-contribution, delivered to the door. Documentation that supports a provider’s compliance with Aged Care Quality Standards, particularly Standard 5 around clinical care.
It’s clinical, it’s claimable, and — importantly for the providers we work with — it doesn’t add to anyone’s workload.
Why this matters
The 100,000-plus older Australians at clinical nutrition risk aren’t a market opportunity. They’re people who are already entitled to a clinical pathway the system hasn’t yet figured out how to deliver.
Support at Home has reset the funding signal — keeping nutrition support at no co-contribution while client contributions were introduced elsewhere. Closing the gap on the delivery side is what the next two years should be about — and it's the conversation we're trying to have, in one shape or another, every day.
If you’re a provider, dietitian, family member or care manager working with older Australians at home, that conversation is open. We’d value yours.
— Andrew Martin, Director, Eat Well Health