At CAREis we have noticed a number of forum discussions about the use of vitamin D in care homes. Some care home managers think it is nothing to do with them, while others are already providing this as a supplement.
Some of the confusion probably lies in the fact that the supplement was provided for free for four months during the pandemic.
Truth be told, the guidance is couched as guidance, not regulation, and the CQC seem to be remarkably quiet on the matter, with nothing obvious on their website about it.
Vitamin D is important in bone health and while it is found in a few foods, it is mostly made when people are exposed to sunlight. This means that during the darker winter months October to April, older people especially benefit from vitamin D given as a supplement.
That said, there is good evidence that during these same months younger people also benefit from vitamin D supplements.
There is an expectation that care home providers will offer Vitamin D supplements to all residents, taking a best interests’ approach where the resident does not have the capacity to make a choice for themselves.
While the Department for Health and Social Care posting identifies some individuals who should not be offered vitamin D off of prescription (see box), CAREis advises that all home clinical leads or managers discuss the provision with their visiting GP or other authorized prescriber.
Vitamin D only needs to be offered in the once daily dose of 10 micrograms – equivalent to 400 IU of vitamin D – and is available as a tablet and in liquid form, so people with swallowing difficulties will also benefit. This does not need to be prescribed and can be dealt with as a supplement or homely remedy instead.
Care homes may choose how they record dosing, including for people who are self-medicating, with the Department for Health and Social Care identifying options:
- MAR / eMAR.
- Daily notes.
- Nutrition records.
- Dietary records.
Of course, care home teams must update their residents care plans, including their digital ones (https://www.careis.net/) to identify that they have consented to taking the vitamin D supplement and how they will be supported in taking it.
Any person-centred planning approach will identify the most convenient time of day for the dosing with the person concerned – there being no prescribing advice about this.
At about £10 for a three-month supply for individual residents, vitamin D supplementation is not going to break the bank, but it may play an important role in keeping residents healthy, so is well worth the effort.
Of course, in most cases this is a reasonable cost to pass back to residents or fee-paying families, although it is not likely that local authorities, unless they are insisting on its use, will pay extra to care homes which provide it.
Many managers will be rightly cautious about using vitamin supplements provided by families and will need to develop local policies to address their approach to this.
Managers, clinical leads and medicating staff are advised to visit the guidance on vitamin D use in care homes which is situated on the Department for Health and Social Care website:
Other information about vitamin D use can be found on the National Institute for Health and Care Excellence website:
https://www.nice.org.uk/guidance/ph56/chapter/1-Recommendations