By Howard Rosenberg, Director of Dining Services at Amsterdam Nursing Home
Howard Rosenberg is the Director of Dining Services at Amsterdam Nursing Home, a 409-bed long-term care residence in New York City.
It’s no secret that adults with dysphagia are at higher risk of malnutrition and dehydration than most healthy adults. Transitioning from “regular” meals to thickened and pureed food is hard and met with resistance. Yet, overcoming the challenge is essential to both the individual and his or her caregivers.
After experiencing so many mealtime issues, my staff conducted an eight-week study of 16 residents with dysphagia. We observed that residents tried to open packages rather than wait for assistance, drank thin beverages before they were thickened, or refused them altogether after watching them be thickened.
Change was necessary – but it didn’t have to be drastic to make a difference. Our staff knew we needed to:
- Increase fluid intake of residents with swallowing difficulties
- Restore resident dignity, quality of life and desire to enjoy mealtime
- Re-establish a personal level of independence during meal service
In order to do so, we made the following changes, which can easily be adopted in the home setting as well:
- Thickening residents’ beverages before serving them, using a stable pre-thickened water or juice– available at many pharmacies (ask your pharmacist) – as the base of each recipe, which eliminates the need to thicken liquids in front of the residents.
- Pouring all beverages below the top of the cup, e.g. 4 oz. of juice in a 7 oz. cup, to reduce spilling caused by shaky hands, thereby boosting residents’ confidence in serving themselves.
- Serving pre-thickened ready to eat soups and a variety of flavored broths prepared with a pre-thickened water.
We also offered a variety of pre-thickened beverage flavors throughout the day – served with snacks, at the bedside and when taking medications.
After these adjustments, we’ve found that fewer seniors have requested help during each meal, and that residents’ fluid intake has increased significantly.
The key to our successful hydration program at Amsterdam Nursing Home has been using a pre thickened crystal clear unflavored nectar or honey water (in our case we use Thick-It® AquaCare H2O®). This product is the primary base for all the flavorful drinks and soups we serve our residents. We are also able to fulfill specific beverage requests, hot or cold, including ice cubes with this product. Using pre-thickened waters means no mixing or measuring thickeners, which we believe has a direct impact on the appeal of the drink, the independence it gives the resident to serve themselves, and subsequent consumption.
The program, although requiring some additional staff time for mixing the beverages, has actually saved us money due to the reduced waste per resident.
Residents have given positive feedback on the program – through their comments and overall moods – and are more engaged during mealtime.
Whether you’re a long-term care employee, a speech-language pathologist or caring for someone with dysphagia at home, these small changes can make mealtime a safer and more enjoyable experience for your patients or loved ones.