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The study aims to highlight barriers and feasible opportunities to enhance nutrition support of elderly, long-stay patients in Australian hospitals.A total of 218 dietitians, nurse unit managers and food service managers from medical and rehabilitation wards of 184 hospitals completed a web-based survey about current practices, perceived barriers and priority opportunities to enhance nutrition support in their context.Cook-fresh food was the most commonly reported food-service system (50%). Eighty-eight percent still used paper menus and one- or two-week cycles were the most common menu cycle lengths. Lack of choice due to special diet, boredom arising from the length of stay, a lack of feeding assistance, limited variety and inadequate flexibility of food service were the key barriers identified. Food fortification, assistance with packaging, additional feeding assistance by nurses, non-nursing feeding assistance and further nutrition assessment were key priorities for improvement.A ‘toolbox’ of strategies is needed as no one intervention will improve nutrition support of all patients. Further practice-based outcomes and cost-benefit studies are needed to enhance support and advocacy for feasible food service interventions in the future.