• How challenging is implementing the new IDDSI framework in your care home? (We’re sharing our industry expert’s advice to help you get it right.)

    As June is National Dysphagia Awareness month, all month we are focussing on the different ways we can help and support you to achieve improved nutrition and hydration and a more dignified dining experience for the ladies and gents you support with Dysphagia.
    This week we’re talking about all things IDDSI – the new International Dysphagia Diet Standardisation Initiative.
    What is IDDSI?

    The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard published internationally with terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and for all cultures..

    The framework consists of a continuum of eight levels (0-7) and includes descriptors, testing methods and evidence for both drink thickness and food texture levels. IDDSI aims to improve clinical safety and efficiency by offering healthcare providers standardised terminology to assist in the development of international collaborative clinical research and to standardise the terminology and consistency of different food providers in order to reduce risks.

    All care providers should now be aware of the new IDDSI system, which was implemented as from April 2019

    How do you find out more about IDDSI?

    The website www.iddsi.org offers comprehensive information about IDDSI. There will also be updates from the British Dietetic Association, The Royal College of Speech and Language Therapy and the companies producing commercial thickeners and texture modified meals will also be aware of any changes.

    And there are loads of other resources available which include:
    FAQ- these cover food and drink textures and the FAQ about bread is particularly interesting.
    Print and display posters – these can be displayed in care areas, kitchens and in individual care plans Consumer handouts to explain each texture and also things to avoid

    The Association of UK Dietitians have also published a really useful document:
    IDDSI Frequently Asked Questions which is available for you to download here:

    Our care industry colleague and expert social care consultant and trainer Tim Dallinger of Social Care Consultants told us: ‘It seems that almost every time I undertake consultancy work with care providers that I need to make them aware of IDDSI and then train managers and staff.’

    And Tim has shared his expert advice to care managers and providers below so that we can all work together to provide safer services.

    Care providers must take action to ensure that:-

    Care plans refer to IDDSI descriptors
    All staff understand the IDDSI descriptors and how to ensure that food and drink is provided in a safe manner
    All staff recognise the signs of dysphagia and know how to report and record this.
    Advice is sought from specialists (SALT) whenever there is a risk of dysphagia
    Care plans and risk assessments are consistent

    The CQC refer to this issue in their “Learning from safety incidents”- issue 6, this details a case study where a care plan was not updated to reflect the advice of dysphagia specialists leading to choking incidents.

    If you have any questions relating to IDDSI or are coming across challenges implementing the new system and would like further guidance or training then please don’t hesitate to get in touch with us as at [email protected] or telephone us on 01773 713713. We have a great network of experts who can help you.

    Here is another article we recently wrote around Dysphagia

    Also you can request your FREE copy of our Dignified Dining Solutions Guide – to help people with a Dementia to eat better, which includes best practice advice and tips to help support your ladies and gents with Dysphagia to enjoy more independent and dignified mealtimes or visit our website to view our range of fit for purpose product solutions to help enable people living with Dysphagia.

  • How to improve nutrition for your residents with Dysphagia and help them to enjoy more dignified mealtimes.

    I would like you to imagine that, following a stroke you are unable to chew or swallow food and drink normally or to safely pass liquid or solid foods from your mouth to your stomach.

    As a result of this, and in order to minimise the risk of you aspirating or choking, you are prescribed a texture modified diet, where your meals have to be pureed down to a smooth, moist and uniform consistency. You become increasingly dependent on carers at mealtimes to assist you, no longer are you able to enjoy dignified, independent eating, which can be both degrading and upsetting.

    You are served your pureed meals either all mixed up in one bowl, where all ingredients have been pureed down together and which look colourless and smell and taste disgusting, (I know as I have tasted this, and it made me cry) or a number of coloured blobs on a plate where the individual foods have been pureed separately, at least, but are unrecognisable and unidentified, therefore you don’t know what you are eating.

    Would you want to be served food that looked like this?


    Or one like this? Is it scoops of ice cream?!

    It may take you longer to physically consume your meals, meaning that your food can go cold and unappetising; no one likes to eat food which has gone cold right?

    How would you feel if you, or one of your loved ones, were presented with either of the above meals? Would you want to eat them?

    And if your answer is no, then why would it be considered acceptable to present these meals to people with Dysphagia?

    After all, we all eat with our eyes first.

    You could easily lose your appetite and not want to eat meals presented in this way, resulting in weight loss, depression and anxiety, or fear at mealtimes which can exacerbate malnutrition. Secondary complications could include constipation, poor wound healing, increased susceptibility to infection and impaired muscle function.

    So managing, the ladies and gents you support with Dysphagia and ensuring that they maximise on the correct levels of nutrition and hydration represents a huge challenge to care managers, and their teams, given that these residents are at high risk of being deficient due to consistently having to eat an altered consistency of meals, which can offer less nutritional value, and finding it difficult to tolerate large volumes of fluids.

    And Dysphagia is known to affect between 53%-74% of nursing home residents. It may occur in people who have a Dementia, stroke, motor neurone disease and other neurological conditions

    What are the warning signs and symptoms to look out for?

    • Coughing or choking
    • Watery eyes
    • Changes in eating habits – eating more slowly or avoiding certain foods
    • Frequent throat clearing
    • Difficulty holding food in the mouth and drooling
    • Feeling food is stuck in the throat
    • Unexplained weight loss
    • ‘Wet’ or gurgly voice
    • Recurring chest infections
    • Vomiting or regurgitation

    If you notice any of the above signs it is important to make a referral to SALT (Speech and Language Therapist) for an assessment.

    Our top tips to help you support people with Dysphagia achieve optimal nutrition and hydration

    1 - Oral Hygiene

    • Good oral hygiene is really important as any oral pain can make chewing difficult and uncomfortable.
    • Make sure that dentures are correctly fitted

    2 - Assisting a person at mealtimes

    • Ensure the person is alert and sitting upright before offering food and drink
    • Gently rubbing their cheek or neck may help to prompt them to swallow.
    • If, due to their condition they are slow eaters, consider the use of a ‘Keep Warm Plate’ or bowl to help keep their meals warmer and more palatable for linger.

    3 - Fortification of meals

    A texture-modified diet should ideally meet the recommended daily allowance of energy, protein and micronutrients for a meal. However, due to poor nutrient density, high dilution factor and limited palatability, modified consistency meals are known to result in significant weight loss. In view of difficulties in achieving an adequate nutritional intake from a modified consistency diet alone, food fortification may be necessary.

    • In preference to water, liquids added to pureed/semi-solid foods should have some nutritional value
    • Higher calorific additions such as full fat milk, cream, butter and sauces provide extra protein, energy and calcium

    4 - Meal Presentation

              For people on a pureed diet particularly, meal presentation is as fundamental as the dish itself. We all eat with our eyes and it is common for people with a Dementia to refuse to eat what they can’t recognise.

    It’s so important to ensure that food always look appetising and is attractively presented using colour and contrast on the plate for everyone, regardless of their condition so that no one is isolated or treated differently.

    The clever use of food molds is an increasingly popular tool to help recreates the original shapes of pureed foods as family members and care caterers understand their key benefits:

    • Improved meal presentation and nutrition
    • Increased dignity and enjoyment at mealtimes
    • Greater meal variety
    • Reduced preparation time and wastage

    But don't just take our word for it, read below what a difference it made for one 12 year old little girl and her enjoyment at mealtimes when her Mum started to shape her foods with our range of food molds.

    "My daughter is 12 years old. She has diagnosis' of Down's syndrome, oral dysphagia, autism, sensory processing disorder and food intolerances. I have only been able to give her pureed or mashed food which she was not particularly interested in. She is assisted while eating. The first time she saw her 'food molded' dinner she shouted, "carrots!". The second time she wanted to know what every bit of food was on her plate. This time I had used parsnips in the carrot mold. "What's that, what's that?", she said as she used a fork to scoop up individual pieces of dinner into her mouth with glee. I have neither the time, energy nor interest for 'faffing' about these days so the molds are extremely practical. Easy to clean, easy to fill with food, easy to freeze and the frozen food just pops out. I have made batches of vegetables, meat and fruit, popped them out of the molds and stored them in another container in the freezer to use later. One can use the broccoli mold for cauliflower and sprouts. The pumpkin mold for turnip and sweet potato and as I mentioned earlier parsnip in the carrot mold. But what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the molded food. From my experience, the silicon food molds have been a success." - Mrs Dewery, Private Customer

    5 - The use of food thickeners

    Food thickeners are used to thicken liquids and foods to various consistencies, helping to slow the transit of foods and fluids to allow more time to coordinate the swallowing process safely, thus preventing food and fluid entering the lungs and causing serious complications including chest infections and death due to choking or aspirational pneumonia.

    They are added to pureed foods prior to placing in the food molds to help retain the food shape and to create the appealing finish.

    Regular staff training should take place to ensure that the correct volume and amount of thickener is used for both foods and fluids, to ensuring safe and acceptable consumption for the resident.

    6 - Varying the menus.

    The more varied and interesting the menu choices are for residents on pureed diets the greater chance of increased acceptability of foods and nutritional intake.

    7 - Training - a whole team effort

    Where I have witnessed the best success stories for improving mealtime experience for residents with Dysphagia is where the whole team including management, care staff and catering teams have all embraced the concept of ‘why we want to achieve this’ to ensure continued and sustainable improvements.

    We have teamed up with experienced and passionate care industry chef/trainers to bring you a range of training packages to help educate and inspire care teams to deliver better outcomes for the people they support with Dysphagia.

    Please contact us if you would like to learn more details on the training packages available of if you would like to request your FREE copy of our unique and innovative Dignified Dining Solutions Guide designed to help people with a Dementia to eat better.

    At [email protected] or by telephone 01773 713713 today.

    For more information on Dysphagia and how to help those in your care with it you can visit our blog for more articles about this important topic. 

    #dysphagia #nutrition #nutritiontips #nutritioneducation #dignity #safety #carehome #caremanagement #carehomes #care #carelikefamily #passionatepeople

  • UPDATE!! The Health Care Extreme Makeover - Home Edition!

    We know you've all been keenly waiting to hear the news from Red Rose about their brilliant refurbishment project and here's the latest update. As you can see, there is a lot of work going into this project and we know it will help to make a huge difference in end of life care for many people and their loved ones.

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  • How can Hcsuk help you to reduce the number of falls in your care home?

    This week is Falls Prevention Week September 22nd-28th and we wanted to get you all thinking about what you could do to reduce the risks of falls in your homes, make you aware of some statistics around falls in care homes and also to tell you about our unique and best selling Falls Management Solutions.

    • According to L Z Rubenstein Falls in Older People study, falls account for 40% of all injury deaths which occur in care homes.

    • Falls are 5 times more likely to occur in care homes than in the community (WHO)

    • One in ten care home residents who fall sustain a fracture

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