The International Dysphagia Diet Standardisation Initiative has been preparing for its official launch on May 1 of this year.
Previously we created a series of articles to help Aged Care Chefs to understand what the new texture modification standards are, and how to test for each level.
We recently spoke to Julie Cichero, one of the co-chairs of the IDDSI board about the process of implementing the new standards and how chefs in the aged care sector have been using the new food tests into their every-day processes.
The response to the new standards and testing methodology has been very positive. Initial apprehension around limitations were quickly dispelled as Chefs began to innovate and adapt menus to meet the standards.
“At the beginning people were worried that if a menu item ‘failed’ the IDDSI testing, it meant they simply had to remove it from the menu. Naturally, they were worried about a resident’s choice. In fact, what we want people to do is to work out why the item failed and then see how to fix it to make sure a resident’s choice is preserved. If you take an example of mashed potato, which might have been too sticky, by Chef adding some butter or cream, he or she could make the mashed potato looking and tasting great without being sticky.”
Julie says one of the biggest wins for Chefs and Dieticians was the assured consistency the new standards bring.
Previously, a common issue was the subjective nature of texture modification. Chefs were finding a meal which was passed as appropriate for a resident one day, could easily be rejected the next, if a different dietician was reviewing the meals. With more reliable new standards being implemented, the consistency of testing is creating vital time and waste savings in the kitchen.
As Julie explains:
“The IDDSI framework is helping to make sure that communication is clear, that the food texture the speech pathologist recommends is the food texture the resident receives. Chefs and Dieticians who I have spoken with, like the IDDSI framework because the testing methods are more reliable than the descriptions they are currently working with. If you’re only using descriptions, and meals are checked by clinical staff, Chefs were finding that a dish that passed one week with one clinician, might not pass the next week with a different clinician. The IDDSI testing methods mean that you can check very quickly to make sure the food texture is correct.”
Chefs are embracing the new standards and working out how they can incorporate them into their own kitchen processes so they become an integral part of the work flow. Many commercial kitchens are busy and any efficiencies are welcomed.
A large Aged Care facility in America has coined the phrase “IDDSI testing in 10 seconds or less”. Using a combination of pictograms (because the human brain understands a picture in less that 100 milliseconds) and text, they have each level displayed in the kitchen prep area.
As an example, for Level 5 Minced and Moist there are 6 pictograms with the text 1. Dice 2. Add moisture 3. Mince 4. Season 5. Take temperature 6. Do IDDSI Spoon Tilt and Fork test. Their motto is ‘Cook it, test it, correct as needed’.
One of the surprising aspects of the new standards has been the Chef’s willingness to find solutions within their menus to make sure the standards are consistently met.
Examples of menu adaptations
Understanding which cut of meat produces a more tender result when cooked is important. ‘Working muscles’ such as chicken thighs, beef blade and lamb shanks can be texturised more easily. Slicing across the grain can help create a Level 5 Minced and Moist texture.
Moisture retention when cooking helps with the more pureed levels and can be as simple as leaving the lid on the pot while cooking so the food doesn’t dry out at all.
Legumes such as lentils and chickpeas can be soaked for 30 minutes in cold water then ground down to the desired size for the texture level you wish to achieve.
Adding cheese can help increase the flavour but it also tends to increase the level of stickiness in the food as well. Chefs have found Parmesan cheese to be less sticky, yet with all the flavour. For desserts, which can be very sticky, whipped cream can be added and blended in for more flavour and to reduce the stickiness. Chefs are also using foams to add flavour and visual appeal to dishes.
Remember, the official launch of IDDSI is May 1 2019.