By Sophie Murray, Head of Nutrition and Hydration, Sunrise Senior Living (www.sunrise-care.co.uk)
In the industry we know that the numbers are rising for those who have swallowing problems and the skills required to modify foods are greatly needed in some sites as catering staff need much more than an ability to use a blender to break food down. This is as a result of the safety framework which ,many of us know called IDDSI, standing for International Dysphagia Diet Standardisation Initiative which has been built upon research of swallowing to be able to give very precise levels which comprise of very specific food and drink test to deduce if it is safe for the Level. Most foods can be modified but not all and the modification process requires equipment, techniques and knowledge. As foods themselves vary in texture, it is not as simple as adapting a recipe – a banana or an avocado are 2 examples of foods which can vary greatly in their ability to be soft enough to push a fork through with little pressure, and other foods such as white fish do not blend smoothly to a puree so may need to be replaced with an oily fish for a person who requires a pureed diet
There are publicised cases of fatalities such as in 2017 when a care home was prosecuted and closed by the Care Quality Commission (CQC), after a resident choked on porridge twice in one day and died.
Protocols and processes between care and catering teams needs to be watertight so that only those trained correctly modify the foods and this includes all snacks too – careful management to ensure safety as
well as choice are prime considerations – in itself this has challenges as a persons may have recommendations for
Care homes seeking to buy in ready modified food need to ensure that this matches the menu properly and meets needs and choices so that there aren’t
There IS only one qualification that can formally train and accredit Chefs called the Level 2 Award for Chefs in Healthcare but there are few providers offering this due to poor uptake and awareness – https://www.cthawards.com/qualifications/culinary-programmes/cth-ioh-level-2-specialist-award-chefs-health-social-care/
There is also a framework for care teams called the Inter-professional Dysphagia Framework (IDF) which sets out the knowledge and skills care staff require to do safely care for a person with swallowing problems. The IDF should be implemented in every care home to ensure residents receive safe and effective care but in reality care homes don’t all know about it and it needs translating to a workable process with solid training although it is written with good clarity.
Speech and Language Therapists are a great source of knowledge and support for care teams as they are the identified professionals who can diagnose a swallowing condition and recommend appropriate IDDSI Levels. IDDSI has set up a UK reference group so that best practice can be shared across the UK and organisations such as the NACC can provide support to care homes needing traning and awareness
When risks are fatalities as a result of poor practice, there is much to do to ensure amazing food and choice is offered and residents are safe from harm as a result of choking or aspiration.
The high risk is choking and aspiration.