First-rate care, First-rate people, First-rate value

Vitamin D Service Leaflet - information for patients and carers

  1. Home
  2. What we do
  3. Community and Outpatient Services
  4. Dietetics
  5. Nutritional advice
  6. Vitamin D Service Leaflet - information for patients and carers

This page provides vitamin D information for care homes

Vitamin D

Why do we need vitamin D?

Vitamin D is essential for bone and muscle health and supports a healthy immune system. Low levels of vitamin can cause lethargy, aches, and pains, although not everyone will have symptoms of deficiency.

How can people increase their vitamin D levels?

Sun

The main source of vitamin D is from the action of sunlight on the skin. From late March to the end of September, most people should be able to make all the vitamin D they need from sunlight.

Between October and early March, it is not possible to make enough vitamin D from sunlight. Furthermore, some people will not make enough vitamin D from sunlight all year round because they have very little or no sunshine exposure.

Food sources

Although sunlight is the main source of vitamin D, eating vitamin D rich food is
also beneficial, as part of a healthy balanced diet, such as:
• Egg yolks
• Liver
• Red meat
• Oily fish – such as salmon, sardines, herring and mackerel
• Fortified foods – such as most fat spreads, and some breakfast cereals.

Do care and nursing home residents need to take vitamin D supplements?

Public Health England recommends that everyone should take a daily supplement of vitamin D, particularly during the autumn and winter months. Some adults, including those who live in a care home, are advised to take a daily
supplement containing at least 400 international units (IU) of vitamin D, equivalent to 10 micrograms (μg) throughout the year as they are not often outdoors.

Where can you get vitamin D supplements from?

Low-cost vitamin D supplements can be purchased from pharmacies, most supermarkets and health food shops. Care homes should agree a route to purchase vitamin D supplements for residents. Vitamin D is available in two forms, vitamin D3 (colecalciferol), and vitamin D2 (ergocalciferol). Vitamin D3 is usually from animal sources, and vitamin D2 is from plant sources and is usually suitable for vegans. It is a requirement under the Care Quality Commission (CQC) for care homes to meet Regulation 14 of the Health and Social Care Act 2008, which states that the nutritional and hydration needs of service users must be met. This includes the adequate provision of vitamin D through sun, food sources and supplements.

Can vitamin D be prescribed for care home residents?

GP practices in Surrey and Sussex no longer routinely prescribe vitamin D
supplements on the NHS. Vitamin D can only be prescribed for short periods in higher doses for people who have persistent symptoms of deficiency, and which has been confirmed by a blood test. Residents who have completed a course of prescribed vitamin D to correct a deficiency need to then continue to take the maintenance dose of 400 international units (IU) / 10 micrograms per day.

Are there any residents who shouldn’t receive a vitamin D supplement?

There are some residents who will not need the vitamin D supplements. Check with the resident’s GP first if
they fall into any of the following categories:
• Advanced metastatic cancer, or cancer of
the parathyroid hormone
• Hyperparathyroidism, sarcoidosis, or
kidney stones
• Stage 4 or 5 chronic kidney disease
• High blood vitamin D levels (this is only likely
if a resident is already taking a high dose of
vitamin D supplements).
• Already taking a medication containing vitamin D

Which medications and supplements already contain vitamin D?

Vitamin D is often contained in calcium supplements and ‘One a Day’ multivitamin and mineral supplements. If residents take any of these daily, they may already be getting enough vitamin D. If the daily dose is less than 400 international units (IU) / 10 micrograms, it is insufficient, and a supplement should still be offered.
Some nutritionally complete oral nutritional supplements (ONS) contain vitamin D. Typically two servings per day are needed to meet requirements, so if a resident’s ONS intake is variable, supplements should still be offered.
Most enteral feeds (tube feeds) contain adequate vitamin D, if used as a sole or main source of nutrition. If you are unsure, check with a dietitian or pharmacist.

What considerations need to be in place when giving vitamin D to residents?

Vitamin D supplements should be managed in the same way as other medicines that residents bring to the care home, such as other vitamins and herbal remedies purchased by family or next of kin.

You should have a policy to support residents to take vitamin D supplements.
Individual care plans should detail how staff will support residents to take vitamin D. Considerations should include: how religious beliefs impact on dietary preferences (e.g. vegetarian, vegan, Kosher or Halal compliance), known allergies, and swallowing difficulties.

Vitamin D supplements offered and taken by residents need to be recorded.

Examples of where you could record administration include:
• Medicines Administration Record (MAR)
• Daily notes
• Nutrition or dietary records

Consent must also be sought from all residents prior to giving a vitamin D supplement. If an individual is unable to consent, a decision in the resident’s best interests may be made in accordance with the Mental Capacity Act 2005.

Is it possible to take too much vitamin D?

Daily doses of over 4000 international units (IU) / 100 micrograms per day,
should only be taken for a short time under medical advice, to correct a
diagnosed deficiency. If you are concerned, please contact the managing
healthcare professional.

Further information

www.gov.uk/government/publications/vitamin-d-for-vulnerable-groups/ vitamin-d-and-care-homes-guidance
www.cqc.org.uk/guidance-providers/adult-social-care/vitamin-dsupplements- supporting-people-who-receive-adult.

Alternatively, you can visit www.cqc.org.uk and type ‘Vitamin D’ into the search bar.
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
British Dietetic Association (BDA) Food Factsheet: www.bda.uk.com/vitamin-d

First Community provides front-line NHS community healthcare services in east Surrey and parts of West Sussex.

We provide first-rate care, through our first-rate people, offering first-rate value. For more information visit: www.firstcommunityhealthcare.co.uk

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us:

First Community (Head Office)

Call: 01737 775450 Email: fchc.enquiries@nhs.net Text: 07814 639034

Address: First Community Health and Care, Orchard House, Unit 8a, Orchard Business Centre, Bonehurst Road, Redhill RH1 5EL

To print this page, please select accessibility tools and the print this page icon. 

For office use: Version 1 PFD_TS078 Publication date: May 2022