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Inside IDDSI: What to know about the new dysphagia dining framework

Dining for seniors with dysphagia — swallowing difficulties — has always been a challenge for operators in the United States, for three key reasons. First, the natural challenges of determining which food residents can eat, and how thick that food can be. Second, procuring that food and adhering to those standards. And third, the lack of an overarching national framework dictating any of this.

That is changing. This month, the Academy of Nutrition and Dietetics (AND) is officially adopting the International Dysphagia Diet Standardization Initiative, or IDDSI, a texture-modified foods framework already in use in 34 nations. The framework provides clarity for operators on the physical form of food for residents with dysphagia.

IDDSI is now the only texture-modified food framework recognized in the Academy’s Nutrition Care Manual.

Culinary Services Group (CSG) already deploys the application of IDDSI framework in its dietary operations. The change can be easier than operators might assume.

“I hear all the time from operators, ‘Are you going to make us change to IDDSI?’” says Carolyn Wescott, Director of Innovation at CSG. “I say, ‘Yes, but you won’t even know it.’”

CSG uses IDDSI framework to provide consistency and clarity for expectations and training across its dietary operations, giving individual locations the ability to maintain the texture modification language they are accustomed to in diet orders. Although not traditional, this allows for an easier migration process while still reaping the benefits of standardized training, testing methods, and abbreviations on tray tickets.

Here are the three things every operator must understand about IDDSI.

IDDSI is now essential if you’re using the AND Nutrition Care Manual

According to the National Foundation of Swallowing Disorders, dysphagia affects up to 15 million adults in the United States, including 22% of those age 50 and older. Nutrition Care Manuals are an essential tool for non-nutrition professional staff members; a community’s NCM provides clear definitions and directions for fulfilling the therapeutic diets and textures offered in a community.

As of this month, communities using the AND Nutrition Care Manual should be aware that the IDDSI framework is the only texture-modified diet recognized.

This means that communities will need to either migrate to the IDDSI framework or write their own supplemental policies defining their texture modification levels and the foods within as determined by a speech language pathologist.

Texture modification is not a new concept and most providers and communities use, in some part, the National Dysphagia Diet (NDD) to manage texture needs from care providers to dietary teams. However, because NDD does not provide clear definitions and testing methods, a lot can be lost in translation.

It’s a problem that operators know too well.

“We’ve historically had a fairly loose framework around the texture modifications made for persons with dysphagia, which can lead to a lot of confusion when a new foodservice director, chef, cook or aide begins working, or when the resident returns home to the care of a family member or other provider,” Wescott says. “The IDDSI framework sets out comprehensive levels and clear definitions and testing methods for safe provisions for this population. This makes training new team members, and transitions to other communities or to the home, easier for someone requiring texture or fluid modification.”

IDDSI delivers consistency in food prep

The goal of this change to IDDSI is to offer consistent guidance about the size, texture and viscosity of food and drink for individuals with dysphagia or other oral motor disorders that affect chewing and swallowing abilities. Even operators whose NCM does not follow IDDSI still should start planning how they will move to using the IDDSI framework, Wescott says, because adoption of IDDSI is growing in popularity in acute settings, which will trickle-down to rehab and long term care centers.

For example, if an operator defines a particular meal as “mechanical soft,” the CSG team would know that, based on the senior living provider’s definition and expectations, the terminology applies to, say, an “Easy-to-Chew Level Seven base diet” with “Soft and Bite-Sized Level Six” meat. That framework allows operators to set expectations for staff members about the food they serve, letting them liberalize resident diets as much as possible.

“For Culinary Services Group, IDDSI is great because it sets out standards and specific terminology,” Wescott says. “Defining these things on your own may be fine for one community, but if you run multiple communities or if you are trying to train multiple people in a variety of places to prepare these foods safely, then everyone having their own rules creates opportunity for error and inconsistency. What IDDSI has provided us is a clear framework from which to build on.”

IDDSI offers food testing methods

To correctly prepare and deliver texture-modified food, cooks and diet aides must know how to measure food particle size, plasticity, cohesion and liquid thickness.

“To do that, you need sophisticated and complex scientific equipment, so people just eyeball it,” Wescott says. “Now, thanks to the work of the IDDSI committee, you can use very cheap, readily available tools to measure foods and fluids. For example, a simple, commonly available syringe can be used to test fluid thickness — you remove the stopper, use the timer on your phone and follow the instructions on the testing card and you can test the thickness of a liquid. This is a game-changer for homemade foods.”

Changes like this require a lot of effort and education for staff, and illustrate the importance of partnering with a great food service management company. Through IDDSI, Culinary Services Group is working to ensure that all operators can deliver great tasting, safe food to residents with dysphagia.

This article is sponsored by Culinary Services Group. To learn more about how Culinary Services Group can help your communities deliver dining to residents with dysphagia, visit

The post Inside IDDSI: What to know about the new dysphagia dining framework appeared first on Senior Housing News.

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