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Nutrition and Hydration

  • Served With A Smile And Made With Love Video

    Click on the image to watch the video

    After a very successful seminar at the Dementia Care & Nursing Home Expo in Birmingham this week, we wanted to share with you the beautiful video created together with Jo Bonser and Big Ian Donaghy who managed to capture the essence of why the Hcsuk team are so passionate about improving the lives of loved ones living with dementia.

    Jo's presentation included her very personal story as a daughter, and how she transformed her Mum’s mealtimes so she could enjoy 4 more Christmas dinners together with her family.

    Jo's message:

    "This week, at the Dementia and Care Expo at the NEC I was so proud to launch our new, heartwarming short film, as part of my presentation to a packed Dementia Care Theatre, 'Served with a smile, made with love, why mealtimes are so much more than a plate full of food’.

    This beautiful video, ‘Made with Love’, has been produced for us by the amazing Big Ian Donaghy, who’s known for making one or two half-decent films! When I first came up with the idea, there was really only ever one man for the job.

    It’s a project which has been on the table, (pardon the pun), for over 2 years, and due to the pandemic has been shelved several times. There were moments when I wondered if we could ever make it happen.

    When I first saw it, I was in bits!

    It will make you laugh

    It will make you cry

    We hope it will make you think

    It has definitely been ‘Made with Love’ because we CARE about helping to make a difference to the quality of life of people living with dementia, and especially the part food, and mealtimes play in that.

    Dedicated to my Mum, Anne, who lived with vascular dementia, and whom I helped to support for over 6 years; together we overcame her many eating difficulties which allowed her to blow out 390 more birthday candles before finally leaving us on Mother’s Day in 2020.

    It’s not just about food

    It’s so much more.

    Have your tissues ready!

     

  • Our MD, Jo Bonser will be speaking live at the Care and Dementia Expo on September 15th, will you be joining us?

    Jo will be sharing her personal story of helping to care for her Mum, which has led her to help care homes improve their mealtime experience for people living with dementia.

    Jo told us:

    In November of 2016, my sister and I were told our Mum wouldn’t survive Christmas.

    These are the words no one ever wants to hear about their loved one, but my Mum’s GP warned us that Mum had given up on life and was ready to die.

    There was no denying that Mum was really poorly, living at home with vascular dementia aged 95, she had suffered 3 falls, several urinary and chest infections and had no appetite or interest in eating or drinking resulting in dramatic weight loss and dehydration. She would not pick up a knife or fork to eat and if you tried to assist her with a meal she would turn away from you.

    However, my Mum was an incredibly strong, and stubborn, lady and we weren’t prepared to just accept what the care professionals said, so we set to work to do whatever we could to help her recover.

    With my, then, 26 years experience from working in the care sector, and having some knowledge of nutrition and hydration for our elders, I decided to take charge of Mum’s mealtimes and began to observe her mealtime behaviours to see what I could do to improve her dining experience and ultimately her nutrition levels.

    I learned that getting people with dementia to eat can be challenging, and that complex interaction with the mealtime environment, plus many eating difficulties can prevent their nutritional intake.

    Following research, I found an online mealtime assessment tool and started to observe Mum’s mealtime behaviours, to identify, find solutions and create a care plan to help overcome her mealtime eating difficulties with the goal of bringing enjoyment for her at mealtimes, giving her back her mealtime independence, preventing malnutrition and improving her quality of life.

    The assessment tool provided me with a list of suggested interventions of which I chose several to trial with Mum including:

    • Decluttering the mealtime environment to reduce confusion levels.
    • Reducing noise levels resulting in a calmer setting which improved her nutrition
    • Introducing adapted crockery and cutlery to help her regain eating independence
    • Eating with her to make mealtimes more social occasions

    Mum’s transformation was miraculous! Within weeks, Mum was back to eating completely independently, enjoying her meals and gaining weight.

    The care professionals couldn’t believe her transformation and her end-of-life care nurse, Sally, stopped her visits saying ‘you don’t need my help anymore!’

    Having seen Mum’s transformation, I wanted to share my learnings with others, who were caring for people with dementia, to enable them to also experience more positive and dignified mealtimes and improved nutrition.

    And so Mum provided me with the inspiration to write my guide, as a free resource, with one aim – to help people with dementia achieve the most dignified, independent and delicious dining experience possible.

    I had walked a mile in the shoes of those who care for people with dementia. I had faced their challenges, and I had been able to overcome them and I wanted to share the strategies which had worked for us.

    I wanted to empower care managers and their teams and family members caring for people living with dementia to understand they CAN make a big difference in the way they support their people to lead to improved engagement, enjoyment at mealtimes

    I wanted them to really think about how their dining experience made their residents feel by putting themselves in their shoes.

    Would their dining experience pass the ‘Mum’ test - would it be good enough for their loved ones? And if not why should it be good enough for anyone else?

    My guide is designed for busy care managers, combining solutions to common mealtime challenges, packed with best practice guidance and tips to improve the dementia mealtime experience and ideas of product solutions that are available to be enabling for people with dementia. All from one trusted source, to save them valuable time.

    My guide launched in 2017 and was requested and distributed to many different care professionals and types of organisations, more than I could have imagined:

    OT’s, care home managers, local authorities, care trainers, CQC inspectors, SALT teams, dietitians, care quality consultants, care catering specialists, end of life nurses, home care companies are just some of the people who have had copies and have fed back what a valuable resource it has been.

    Following feedback from a senior dietitian within the BDA, who highly rated it and helped me with areas to improve, I updated it in 2018 and very much see it as an evolving resource as I learn more and more research is done.

    In 2018, I delivered ‘The Dementia Mealtime Challenge’, an interactive workshop I created based on my guide, at the National Association of Care Catering annual training and development forum. Several people who were present, have since come back to say thank you we have implemented all the suggestions from your workshop!

    This is now available as a workshop for teams in care homes who are serious about looking at ways to improve their mealtime experience.

    2019 saw me start my first consultancy project after an outstanding care provider approached me to work with them on a project to further improve their already excellent mealtime experience. This led to me developing a range of services to offer care homes including:

    • Mealtime observational audits
    • Enabling independence at mealtimes assessments for individuals
    • Creating enabling dining environment audits for people living with dementia
    • Mealtime equipment audit
    • Partnership working with care teams on improvement plans and implementation.
    • Retained support to measure continuous improvement.

    I am passionate about helping people and sharing my knowledge, and with my own experience and care sector background would love to work with more care homes to help them too.

     

    I am thrilled to be speaking in the Dementia Theatre at the Care and Dementia show, and also to be providing a further sensory learning experience and a fun competition with great prizes we are offering if you come and see us on our stand at the show.

     

     

    Download your own copy of our Dignified Dining Solution Guide below or visit our website at www.hcsuk.co.uk.

    Many people have asked me, ‘how much is your guide?’ and they are delighted when I tell them it’s free and I call it my little gift to the universe.’

     

  • How To Prepare Great Looking Rice And Pasta Dishes For Dysphagia Diets

    We are very excited to be able to offer you 2 new additions to our already extensive range of silicone food moulds which are designed to help you to significantly improve the presentation of pureed meals for the people you support with dysphagia.

    You can now add rice to your curry and pasta to your bolognese to increase the range of dishes and meals you are able to prepare, but given the consistency of these food types, what are the top tips and secrets to making visually appealing rice and pasta dishes?

    This is a question we have been asked recently, and we always like to provide helpful and informative answers to customers questions.

    Rice and pasta moulds - The key to being able to get good results with these two shapes is selecting the right thickener and the type of product used.

    For example, with rice, there is a bit of food chemistry involved and knowing the ratio of two main starches, i.e. amylose and amylopectin.

    Here is a little food chemistry to put you to sleep……

    Amylose is a long, straight starch molecule that does not gelatinize during cooking. Grains with high amounts of amylose will be fully and separated once cooked. Long grain rice typically has high amounts of amylose (about 22%) and the least amount of amylopectin (ex. long-grain varieties, Basmati and Jasmine).

    Amylopectin is a highly branched starch molecule that is responsible for making rice gelatinous and sticky. Rice with a high amount of amylopectin will be very sticky once cooked. Short grain rice typically contains the lowest levels of amylose and the highest of amylopectin (ex., short-grain, Asian-style types of rice).

    So, with all that said, it is best to use long-grain rice such as basmati or jasmine.

    Click here to view our full range of silicone food moulds including the rice and pasta moulds

    The Next Thing To Consider Is Which Thickener Should I Use?

    Our manufacturers believe that using an Agar Agar based thickener or potentially gelatine is the way to go to get the best results.

    In case you are unaware of Agar Agar thickener, it usually requires you to heat to a certain temperature to activate its gelling properties.

    So, here is a basic method for you, of what the manufacturers have done to get the best results:

    1. Add equal portions of cooked rice (long grain) or pasta and liquid (stock) to the blender N.B. Be sure to rinse and drain uncooked rice well to remove excess starch before cooking.
    2. Blend until pureed
    3. Add Agar Agar thickener and blend again
    4. Transfer contents to saucepan
    5. Heat mixture to ~ 90C to 'activate' the thickener
    6. Transfer mixture to mould cavities and cover
    7. All to cool in the fridge or otherwise freeze
    8. Heat moulded meal as per normal routine

    NB. If you are supporting people with dysphagia, please always refer to a Speech and Language Therapist for professional advice on suitable meal choices and suitable consistencies to avoid the risk of choking.

    Watch the video on how to prepare pureed rice here.

     

     

     

     

    If you would like more ideas of how to achieve greater meal variety for the people you support with dysphagia, you might like this article we previously wrote.

     

    Helping you create more varied meals for people you support living with dysphagia

     

     

    You can also download your free copy of our dignified dining guide here for more hints and tips on improving meal presentation and managing dysphagia.

  • Our Best Tips And Information In Support of Nutrition And Hydration Week 2021

    This week is Nutrition and Hydration week 2021 – an annual event sharing good nutrition and hydration practices, and as one of my passions is helping to share my knowledge and help care managers improve their mealtime experience for the ladies and gents they support, we have rounded up some of our most well-read and subject relevant articles to share with you, I hope you find them valuable.

    My first choice article is a very personal account of caring for my Mum living at home with vascular dementia for 6 years, and the transformation I was able to achieve with her eating and drinking and then wanting to share this with others

    Read the article here: How to help encourage people with dementia to eat better

     

    The second article was written in response to many people asking me for resources around hydration, so I researched and published "Getting the measure of hydration" to share information, best practice, and the latest hydration hacks

    Read the article here: Getting the measure of hydration

    And my final choice explores complex interactions with the mealtime environment which people living with dementia experience, which added to other eating difficulties that can prevent nutritional intake, and highlights top suggestions to improve the dining experience

     

    Read more: Our top 10 recommendations to help you to improve the dining experience for people you support with a Dementia

    For everyone out there who cares for a person/people living with dementia, I want you to know, I see you and I hear you, I have walked a mile in your shoes and I understand your challenges.

    I have written a free resource guide to help you, to share my knowledge, to share what I learned and what works, you can download it here

    And in recognition of N&H Week, I am offering 10 half-hour discovery calls for anyone who would like to discuss their challenges supporting people living with dementia to eat well, and hopefully offer some advice and pointers.

    Book your discovery call today

  • Helping You Create More Varied Meals For The People You Support With Dysphagia

    I remember well, having a conversation with Sinead, a care catering chef customer of mine, that whilst in hospital being treated for throat cancer, her Dad was served only 3 things at mealtimes, rice pudding, custard and jelly for the entire time he was there.

    It was a clear demonstration that hospital catering staff were ill-equipped to cater for people with Dysphagia, and Sinead was both appalled and heartbroken at the lack of dignity, care and attention shown to her Dad concerning his nutrition because he had swallowing difficulties.

    Sinead went back to her care home, a lady on a mission, passionate to improve a) the presentation and b) the variety of pureed meals they served for their ladies and gents, and went on to write a book and to work with us helping to educate other care catering teams.

    We regularly get asked by care home managers how to achieve greater meal variety for dysphagia diets so we know this is a genuine challenge you face, and we always love helping you to solve your challenges!

    You may like one of our previous articles with recipe ideas we recently wrote:-Puree Food Molds – 5 Nutritious Puree Food Recipes

    As people with dysphagia have a higher risk of malnutrition, it is absolutely vital that they get a good variety of tasty, nutritious and visually appealing meals and, more importantly, also that they do not feel marginalised or treated differently at mealtimes.

    With a few notable exceptions, with the right tools at your fingertips most foods are easily pureed.

    So, it is more the case that we need to work on our pureed food mindsets, get creative and remember that:

     

    1. Pureed food is still food. It doesn’t have to be bland and tasteless. Some of the world’s great chefs use pureeing.
    2. People living with dysphagia have the same needs for balanced meals as everyone else does. And their taste buds are still active too!

    What is preventing you from serving the same meals to all of the people you support, regardless of their needs and creating a fantastic inclusive mealtime experience for all?

    Having the right tools to create dysphagia diets is key as the finished dishes must meet the international IDDSI standards that follow clinical recommendations to reduce risk.

    So having a good quality food processor or blender is essential to finely process foods to a completely smooth consistency.

    Food thickeners are used to thicken liquids and foods to various consistencies. They help to slow the transit of foods and fluids to allow more time to coordinate the swallowing process safely.to create the exact required safe consistency. This prevents foods and fluids from entering the lungs and causing serious complications.

     

    NB: Always refer to your Speech and Language Therapist for correct clinical advice for the people you support with dysphagia

    It’s also really important to remember that people often refuse to eat what they can’t recognise, and one of the key challenges with pureed food is how to recreate the original shapes of meals.

    Here, food moulds can be incorporated to create the original shapes of pureed food, ie a piece of chicken, a portion of peas, sausages and more. They are available in 12 varieties by food type, as listed below, however they are extremely versatile to help create many different meals as we explain.

    NB: Food thickener is added to the food prior to placing in the mould to help retain the food shape and create the appealing finish

    Handy tip

    When I talk to care home chefs who have mastered the use of food moulds they also tell me that they have helped to significantly reduce their food waste, as any leftover foods they have, they now just puree down, fill their moulds and freeze portions for another day. Quick, simple, done!

    Here are a few meal suggestions:

    Breakfast:

    • If the people you support love eggs, prepare pureed eggs either scrambled or poached on toast
    • Try a cooked breakfast with sausage, scrambled eggs and baked beans
    • Prepared with care, cooked pureed porridge is a hearty and satisfying option with options to add apple and cinnamon for a tasty twist.
    • Mashed bananas can be created using the sausage mould
    • If you’re feeling adventurous, what about a hot bacon sandwich or baked beans on toast?

     

    Lunch: Midday presents another opportunity for tasty, nutritious meals, here are just some examples of what you can produce:

    • Build a puree roast dinner featuring favourite sliced meat( in sliced meat mould), mashed potatoes( in rice mould) and one or two veggie portions (carrot, broccoli, green beans or cauilflower)
    • Steak and chips can be easily presented, (providing the meat is tenderised) using the chicken breast and green beans moulds, or substitute steak for fish (fish fillet mould) if you prefer
    • Many casserole dishes and stews can be processed and presented. Try a pork and apple casserole with mash and veg using the cubed meat mould, rice (for mash) and any veg.
    • Create vegetarian options including a Mediterranean vegetable pasta dish (using pasta mould) with vegetable portions, or a mac and cheese with the pasta mould

    Lighter meals and snacks:

    Again, think about what you’d like on a plate. Very often, a pureed version can be just moments away. Just because someone is on a pureed diet doesn’t mean they can’t also enjoy sandwiches, biscuits and cakes. Using a soaking solution process, your people can get to enjoy their favourite snacks and treats too!

     

     

    If you would like more helpful hints and tips on managing dysphagia, then please download our free Dignified Dining Guide here

    Testimonial

    "My daughter is 12yo. She has diagnoses 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 moulded' 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 mould. "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 moulds 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 moulds and stored them in another container in the freezer to use later. One can use the broccoli mould for cauliflower and sprouts. The pumpkin mould for turnip and sweet potato and as I mentioned earlier parsnip in the carrot mould. But what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the moulded food. From my experience, the silicon food moulds have been a success.

    Mrs D. Drewery

  • Our Top Tips To Help You To Fortify Texture Modified Meals For People You Support With Dysphagia To Prevent Malnutrition

    In our latest educational article we address the challenge of the links between people living with Dysphagia and the heightened risk of malnutrition and specifically answer the question recently posed to us how can we fortify meals to ensure that the people we support’s daily food intake meets daily dietary requirements.

    Jo Bonser MD told us:

    ‘We absolutely understand that supporting ladies and gents 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. These people are at high risk of being deficient due to consistently having to eat texture modified meals, which can offer less nutritional value, and finding it difficult to tolerate large volumes of fluids.

     

    I know from my own experience caring for my own Mum, of the challenges of supporting someone with malnutrition and learned a lot about how to fortify her meals without increasing her portion sizes, just to improve her daily calorie intake.

    The question of how can we fortify modified texture meals came up in a seminar I attended recently so it has prompted me to write a helpful, educational article which hopefully will help others too.’

     

    Dysphagia, (or swallowing difficulties) can affect a person’s ability to eat and drink leading to an inability to meet food and fluid needs and take medication, affecting their health and quality of life. This can result in a person becoming at risk of malnutrition, weight loss and dehydration.

    The key to maintaining nutrition and hydration in people with dysphagia is to promote safe swallowing and to ensure that the person has food and fluids which are of the appropriate texture and thickness.

    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.

    This is a way of increasing the nutrient and energy content of food and drink without increasing portion sizes, making it easier to eat more calories and protein every day.

    Our top pureed food fortification tips:

    Choose liquids to added to pureed/semi-solid foods with nutritional value rather than water such as

    • Whole (full fat) milk, fortified milk and cream
    • Broth
    • Fruit juice (avoid those labelled diet, sugar-free and no added sugar)
    • Cheese sauce, white sauce, parsley sauce, bread sauce
    • Gravy
    • Custard

    High calorie snacking between meals with foods such as sandwiches, biscuits and cakes, which can be texture modified using a soaking solution, can also help.

     

    We all eat with our eyes first so it is paramount to ensure, that in addition to providing the RDA, pureed food always looks appetising and is attractively presented. It is common for people with a Dementia to refuse to eat what they cannot recognise, and as Dysphagia is common as dementia progresses, improving meal presentation with colour and contrast on the plate for everyone, regardless of their condition, ensures that nobody feels isolated or treated differently.

    The use of food moulds is becoming increasingly popular to recreate the original shapes of pureed foods as family members and care caterers understand the key benefits:

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

    food molds and molded food

    Why not download our free Dignified Dining Solutions Guide here to learn more ways to help manage Dysphagia and improve the mealtime experience for the people you support.

    What challenges are you currently facing with helping the people you support living with dementia to eat better?’

    Lets get started

     

    We are offering 10 free half-hour‘ discovery’ calls with our MD Jo Bonser who supported her own Mum and transformed her mealtime experience and nutrition levels and understands the challenges you are facing.

    Get in touch

    Testimonial

    "My daughter is 12yo. 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 moulded' 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 mould. "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 moulds 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 moulds and stored them in another container in the freezer to use later. One can use the broccoli mould for cauliflower and sprouts. The pumpkin mould for turnip and sweet potato and as I mentioned earlier parsnip in the carrot mould. But what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the moulded food. From my experience, the silicone food moulds have been a success".

    Mrs D Drewery

     

     

  • Do I Need To Have My Patients Weighing Scales Calibrated?

    Do I need to have my patients weighing scales calibrated

    Patient weighing scales are vital pieces of equipment in care home settings. Being able to regularly record residents’ weights provides vital information for detecting fluid retention, calculating proper medication dosages, screening for malnutrition and assessing general wellbeing.

    Continue reading

  • Puree Food Molds – 5 Nutritious Puree Food Recipes

    Each year, individuals of all ages all around the world are diagnosed with feeding or swallowing difficulties (dysphagia). Put simply, dysphagia can be described as difficulty moving food, liquid, saliva or medication from the mouth to the stomach.

    Continue reading

  • How To Help And Encourage People With Dementia To Eat Better

    How To Help And Encourage People With Dementia To Eat Better (1)

    For ladies and gents living with Dementia, there are complex interactions with the mealtime environment plus many eating difficulties which can affect nutritional intake.

    Jo Bonser, MD of HCSUK, speaks from personal experience on this very prevalent challenge, as she helped to care for her own Mum who was living at home with Vascular Dementia.

    Continue reading

  • How we helped Lister house improve their mealtime experience for the people they support living with a Dementia

    I was both humbled and also delighted to learn recently from Brian Preston, Catering Manager at Lister House Care Home part of the Royal British Legion, about the redesign work he is doing in his dining area for the people he supports with a Dementia and as a result, that his ladies and gents are enjoying a completely different mealtime experience.

    Brian took part in my interactive Dementia Mealtime Challenge Workshop presentation back in October of 2018 at the annual Training and Development Forum for the National Association of Care Caterers, and I bumped into at him again this year’s event. He was very keen to tell me all about the changes that he had made, following on from what he had learnt in my workshop and in our Dignified Dining Guide.

    Continue reading

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