The Care Manager’s nutrition conversation: what to ask, when, and what to do next
For Support at Home care managers: the nutrition conversation is shorter than you think.
If you’ve been asked to start identifying clients at nutrition risk and you’re not sure where to begin, this is the version of the conversation we’ve seen work in practice. It’s three questions, three possible responses, one pathway.
The three questions
These get asked during a routine touchpoint — not as a clinical interview, just as a check-in.
1. “When you sit down to a meal, are you eating most of what’s on your plate, or are you finding you stop earlier than you used to?”
2. “Have your clothes been feeling looser lately — or have you noticed any change in how they fit?”
3. “In the last few weeks, how often have you had a proper meal — meat or protein, vegetables, the works — versus a sandwich or a cup of tea instead?”
These aren’t clinical questions. They’re recognition prompts. They’re built to surface the things older Australians don’t volunteer when asked “how are you eating?”
Three possible responses, three pathways
The way the answers come back tells you which of three pathways to take.
If the answers are “eating most of it, no clothes change, proper meals most days” — the client is most likely tracking fine. Note in the care plan; revisit in three months. That’s a documented Standard 5 outcome, not a non-event.
If the answers are mixed — some signs of intake change, some not — run the formal five-minute screen. It scores risk and gives a clear next step. Most clients in this group don’t need clinical escalation; they need a top-up product as a back-up for the days meals aren’t quite enough, and a recheck in a few months.
If the answers point clearly to intake change — smaller portions, looser clothes, infrequent proper meals — escalate to dietitian review. EWH dietitians take the referral, complete the assessment, and send back a recommendation. For eligible Support at Home clients, the resulting product is fully funded with no co-contribution.
What this looks like in practice
Total time: about five minutes during a regular visit. No new system to learn. No separate paperwork to lodge. The screening tool generates a documented outcome that supports compliance with Standard 5.
The hardest part isn’t the questions. It’s the moment of asking. Once you’ve had the conversation a few times, it becomes a normal part of a normal visit. Care managers we work with describe the change as “it stops feeling like a special interview” somewhere in the third or fourth client.
The discharge moment is where this script earns its keep
There’s one more place where the same three questions matter most, and we’ve seen it again and again: the moments after a hospital admission.
In a recent Australian tertiary hospital cohort, only 1 in 10 malnourished older adults had nutrition care recommendations carried into their electronic discharge summary (Gomes et al., 2024, Nutrients). Recognition was at its highest — a clinical team had just named nutrition as relevant — and the documentation chain broke before the patient got home.
The same three-question script, asked once during the first home visit after a hospital event, is one of the highest-leverage uses of five minutes in a care manager’s day. The patient’s body has been reset by the admission. Their appetite, strength, and weight may all have shifted. Recognition is high. The window is short.
What to do next
If you’re a care manager who’d like the question script, the screening tool, or a twenty-minute walkthrough of how it fits into your existing workflow — get in touch. We’ll send the practical version.