Putting Favourite Foods Back on the Menu - Catering for Dysphagia

Hadrian Healthcare Group executive chef Oliver Smith leads the catering teams based at each of the group's care homes. Oliver is also head chef at the group's Wetherby Manor care home and meets residents every day. Here he talks about Hadrian Healthcare's approach to preparing nutritious, tasty and attractive food for residents with dysphagia, a condition of the swallowing system.

At Hadrian Healthcare we believe that all residents, no matter what their capacity or condition, should have the right to eat tasty and beautiful food. The old fashioned image of care catering as bowls of pureed dinners, thrown together and blended, has cursed our industry and given both the public and chefs the wrong idea about the skill, knowledge and creativity required to produce great food for all care home residents.

Dysphagia can be a physical problem or a neurological problem and can affect anyone at any age, but it is most commonly seen as a side effect of growing old. As an example, a person with dementia may lose the capacity to process the message from brain to tongue to swallow correctly, and then cough when drinking liquids. Chefs have a key role to play in helping to improve the quality of life for a person with dysphagia.

A resident with dysphagia will first be assessed by a speech and language therapist to analyse how severe their condition is. Together we then plan how best to cater for them. We can alter the consistencies of drinks and foods to slow down the drinking and eating processes to help that person realise there is a drink or food in their mouth and then to swallow.

The biggest issues for chefs with a diet of this type are how to make foods look presentable and taste their best. Once foods are pureed they have no structure and their surface area becomes very large.

To create a good looking dish when food is pureed we use setting agents, hydrocolloids such as 'Vegi Gel' and 'Ultra-Tex', which stabilise the water molecules in the food and help it hold its shape. They are natural products mostly derived from seaweeds. They have higher melting points than the more well known setting agent gelatine, which doesn’t work for people with dysphagia as it melts in the mouth and can't be controlled in the mouth. Hydrocolloids must be used in the correct dosage to achieve suitable textures for each individual resident, thus they should be considered as important as medication.

For taste we may need to increase the seasoning for it to be effective. For instance if you eat a seasoned steak you taste the pepper and salt on the surface, but once blended that flavour is dispersed through the steak particles and more is needed to create the same sensation.

We strive to provide all meals for residents with dysphagia in a texture safe context, including breakfast and snacks, and we are developing new concepts and dishes all the time.

Making time for research is important, there are ways and means to produce almost anything, it's just finding the right method and setting agent.

For example, it’s possible to create a full English breakfast for a resident with dysphagia plated to mimic the original shapes of the foods. Toast can be made from pureed bread and Vegi Gel, set on a sheet and cut out. Beans can be pureed and set with Ultra-Tex, being careful to pass the puree through a fine sieve to ensure there are no bean shells. Bacon can be made by slow cooking a gammon joint and adding butterbeans and fried onions, then pureeing and setting with Ultra-Tex. Sausage skins are removed and then the meat is pureed with a little vegetable stock, similarly the mushrooms and tomatoes, and set with Ultra-Tex. The only thing missing is an egg, which we're working on, but eggs are difficult by nature as they set into a mass even when pureed so they are not dysphagia safe.

For a tasty main course, pictured, we have prepared gammon, peas and sweetcorn with Vegi Gel set puréed bread acting as the gammon fat. This illustrates another approach to presentation which aims to encourage a resident to eat by creating pleasing shapes, suggesting the flavour of the original food. We create texture, shape and colour to make the dish interesting and have height, using Ultra-Tex to set the meat purée and the vegetables.

Putting favourite foods back on the menu offers more choice, nutrition and hydration to our residents with dysphagia. We can do the same with biscuits and other snacks too that previously have not been available to those living with this condition.   
We are passionate about providing each of our residents with the best food, whatever their dietary needs. It’s part of our total approach to individualised care aiming to enhance each resident's wellbeing and lifestyle.

Oliver Smith was the National Association of Care Catering (NACC) Care Chef of the Year in 2015 becoming the third Hadrian Healthcare chef to win the national award in three consecutive years. Hadrian Healthcare Group is also a member of the NACC.

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