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Jason Clark, who conducts training with different communities to boost the eating experience and nutrition for residents. IDDSI CHANGES THE GAME Clark says the biggest improvements to the puree diet have been due to a stan- dardization called IDDSI (The Interna- tional Dysphagia Diet Standardization Initiative), which is used around the world. “IDDSI is used universally to un- derstand the diet the resident or pa- tient needs to be on,” Clark says. “In the past, [senior living chefs] would use ‘mechanical ground’ food, but when that resident went to the hospi- tal for a procedure, the hospital would use the IDDSI diet. When the resident went back to the retirement commu- nity, the staff did not understand the diet because it didn’t match up with their terminology.” The IDDSI set of standards isn’t mandated officially in senior dining, “but a lot of hospitals have already gone that way,” Clark says. “Retire- ment communities are struggling to go there; it’s a lot of work and the nurses and the dining team have to be on the same page, with a lot of behind-the- scenes work to be done. But I think eventually IDDSI will be everywhere.” The IDDSI diet is a framework pro- viding a common terminology for de- scribing food textures and drink thick- nesses to improve safety for individuals with swallowing difficulties, placing foods into categories from Regular to Easy to Chew to Soft and Bite-Sized to Minced and Moist to Pureed, then Liquidized, which has its own set of classifications, from Extremely Thick to Moderately Thick to Slightly Thick to Thin on the beverage side. To learn more about the framework, visit the IDDSI website. It seems counterintuitive, but thin beverages or broths aren’t necessarily the best thing for those with dysphagia, Clark says, describing the sensation we’ve all had when a drink “goes down the wrong pipe” and you’re left gasping for air. TRAINING ON PUREES Using the IDDSI standards, senior dining chefs can test the consistency
A pureed waffle.
of each food item using a fork, eval- uating how easy it is to push a food through the tines of a fork. “IDDSI is attached to specific names with visual testing, making training much easier,” Clark says. Through lots of experimentation, Cura’s Puree Creations program began using a thickening agent, Simply Thick, to create what Clark sees as a food en- gineering feat: Pureed bread that can stand up to a sandwich. “We used to make a slurry with bread (soaking bread in a liquid), and you could eat that. Now, with IDDSI, there are no more slurries,” Clark says. “Because of consistency issues, slurries have become almost an unsafe practice. The slurry had been the only methodol- ogy that was known for a long time. It worked. But when you dip a cookie in milk and you dip it not long enough, it’s too crunchy, and if you dip it too long, it just dissolves. Bread is the same. The standardization is more smooth, and safer to do.” Now, with the method Clark and the team have created for bread—mak- ing a bread batter and cooking it off in a mold—not only are pureed sand- wiches possible, but also pureed waf- fles, French toast and pancakes. Oth- er menu items from Puree Creations include spaghetti and meatballs, and beef burgundy with braised beef, egg noodles and carrots (all pureed). The noodles are an improvement over tra- ditional pureed noodles from a mix, Clark has found. Depending on which
pasta shape is desired, chefs can use ex- truders and special pastry tips. Puree menus can echo regular menus, with seasonal specials such as a caprese salad with pureed tomatoes, cheese and pesto. “Our key is, we look at [each senior dining location’s] cur- rent menu and whatever we can do to replicate that menu to the fullest ex- tent,” Clark says. “We have to analyze from a staffing perspective and what kind of resources they have; it’s not a one-size-fits-all for everywhere. When I set it up, I work with a speech therapist, a dietitian, the foodservice director, the chef …they’re all highly involved in the menu process.” One of the most important goals of a great pureed diet is to provide nu- trition for residents and patients. “If they don’t get their nutritional needs met, I’ve seen people’s health decline very quickly,” Clark says. “If the food resembles ‘real food,’ they are more likely to eat it. We need to make sure these residents are at least maintaining their weight.” For senior dining chefs looking to el- evate their puree program, Clark says, “Sometimes it’s baby steps; maybe you can’t do the whole menu right away. There are a lot of moving parts to get- ting the program rolled out.” He recommends breaking down purees into manageable steps, such as working with proteins first, then starch- es, then vegetables. “It’s not a program you want to rush or just throw at some- body, because it’s a safety concern.”
Q3 2024
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