With the introduction of IDDSI, soft diets should be teased apart into 6 – Soft & Bite-Sized for those assessed with dysphagia or 7 – Regular/Easy to Chew for those who do not have dysphagia but still require a soft diet. Implementation of IDDSI may require reassessment of residents by the Speech Pathologist to determine what level of diet is most suitable to maintain safety, dignity and quality of life.
Level 6 – Soft & Bite Sized – to reduce risk associated with asphyxiation from choking, food must pass both size and softness tests. Chewing is required for this level, but biting is not required.
Size – a maximum food size of 1.5cm x 1.5cm is recommended for hard and soft foods – about the size of your thumbnail or width of a standard fork. This size mimics a bite of food.
Softness – fork/spoon pressure test, consistent with tongue force used during swallowing. Apply just enough pressure to the food sample for the thumbnail to blanch noticeably to white. Press the flat of the fork prongs into the food with the thumb sitting on the bowl of the fork, just below the prongs until the nail blanches white. Food is to be soft enough so it can be separated into smaller pieces using pressure from a dinner fork or teaspoon held on its side.
Level 7 – Regular/Easy to Chew – suitable if strong enough chewing ability to break down soft/tender foods into pieces without help, there is no increased risk of choking, no swallowing problems and safe mealtime behaviours. Foods should be able to be cut or broken apart with the side of a fork or spoon.
Size of food is not restricted, but food should be soft and tender enough for residents to chew and swallow. Do not use foods that are hard, tough, chewy, fibrous, have stringy textures, pips/seeds, bones or gristle. A meal with mixed consistencies is acceptable in Level 7 and seek expert advice if in doubt.
Sandwiches – Suitable for Level 7 with soft fillings and crusts off. Not suitable for Level 6 (bigger than 1.5cm x 1.5cm). Suggestion: blitz fresh bread to large crumb size, and layer with soft moist filling.
Spaghetti bolognaise – Suitable for Level 7. Suitable for Level 6 when spaghetti, meat and vegetables are 1.5cm or less.
Roast meat – Suitable for Level 6 & 7 if soft and able to be cut with the side of a fork or spoon AND for Level 6, pieces are 1.5cm x 1.5cm or less.
Do not guess what level is best for your residents. Utilise the guidance, expertise and resources of your Speech Pathologist.
When will you implement the IDDSI framework? While IDDSI comes into effect from 1 May, you are not required to have moved to this international framework by this date. The first step may be to wait for care software to be updated with the IDDSI framework levels so that dietary profiles can be correctly completed and staff can ensure a quality outcome for each resident. Sensible advice from @BernadetteDutton from #Loqui suggests implement IDDSI at the speed of your organisation and software.
If a resident is on a texture modified diet, this is not a set and forget process once assessed. Regular supervision and observation by staff may highlight the need for further assessment before an incident occurs that affects the safety of a resident. Additionally, reassessment should be considered to enable a resident to move towards a less modified diet if and when able.
Important note: the correct texture of food and drink is essential at the time the resident consumes it. What is tested in the kitchen or at production may no longer meet the correct Level by the time the resident receives it and could place their safety at risk. It is essential that everyone involved in the meal service is aware of the Level requirements, including Care staff, Catering staff, volunteers, family and residents themselves.