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What’s In A Name: Are We Talking Modified Food Or Food?

9 Mar 2019

The first experience I had with modified food for dysphagia happened before I had even started cooking in the care home where I had taken the position of head chef.

‘Does it have to be brown!”

The senior care manager stopped me in the corridor on the way to the kitchen on my first shift and asked, with real emotion in her eyes, “Why does the modified food for the residents with difficulty swallowing have to be brown?! – It’s always brown!”

I remember how I felt at that moment extremely well. How the tone of her voice and the look she gave me made me feel. Something was very wrong and must have been for a long time.

I also remember it because it was the easiest win I could have. Of course it would be easy to make the food colourful and vibrant. Food is colourful and vibrant .

Since then I have I have cooked for lots of people in need of many different food textures to reduce the risk of choking or aspiration. Oak House Kitchen courses teach the techniques needed to bring delicious and safe meals for people with dysphagia. It really is quite straightforward but you do need direction, training and experience.

The difficult part for me is to try and analyse why all the modified food was brown. That’s not a lack of skill or experience. Why did anyone think THAT was acceptable?

It’s a question that I reflect on very regularly in the work we do at Oak House Kitchen. When we train people involved in helping people with dysphagia eat a safer and more delicious diet we put them on the spot.

“Would you eat modified food?”

You see I think in this question lies the difficulty. We talk about ‘modified’ food – food that is modified.

“But it’s Modified”

In dysphagia diets the ‘modified’ part of the phase relates to making food safer. Safety is key. Safety is the first part of the puzzle and IDDSI have done the most amazing work in making food for dysphagia diets far safer than they ever have been. But it is too frequent that poor quality food is served ‘because’ it had to be changed, modified, for safety reasons. This is not always true.

The kitchen team that I worked with in the early days had very little knowledge of dysphagia. This doesn’t excuse the horrific results of their modifications because they should have seen that what was being served really was not fit for human consumption. However, in their minds they were making the food for the residents in their care first – and then modifying: blending, sieving, thickening what they had made as requested by the care team.

In this case I saw a disconnection between food and modified food – their attitude really was that their culinary efforts, however poor, were being destroyed by the modification process. “Roast chicken, in a blender!”

I appreciate that this point is an oversimplification – I had wanted the inclusion of a module on appetite in the new NVQ for health and social care chefs. The complexities around appetite need to be understood clearly in order to maximise the desire of individual people, with all their nuances, to eat well in care settings.

However, I do feel it’s important to start a conversation to unpick the psychology behind always serving brown slop to the most vulnerable of people.

Food is Food

We need to stop thinking of food that is suitable for dysphagia diets as modified food. It is food – period. Let’s go a stage further and look at the risks associated with dysphagia. We can see it needs to be desirable food, in every aspect.

You may well be thinking – “But it IS modified food! You can’t wish this fact away.”

How modified is modified?

When I cook a carrot I modify it. When I beat an egg I modify it. When sear a steak I modify it. When I bake a batter, to make a cake, I modify it. When I make a chocolate mousse I modify the ingredients. When I poach a salmon I modify it. When I cure a gammon I modify it. And on, and on, and on…

Even when I dress a salad – I modify it.

“It’s Only Cooking”

So cooking is modifying, and on this basis the food needed for dysphagia diets is no more or less modified than any food. It just must have certain textural qualities that improve the safety of people with the affliction.

In recent decades the prevalence of allergies and intolerance has increased drastically and quite rightly foods have become widely available that are ‘free from’.  It is different, and it is improving all the time. In fact, in many cases the ‘free from’ version is taking centre stage. However it is being treated as food first. Not as modified for certain needs. This may be why it has become big business, driving up the quality of ‘free from’ food.

In the world of dysphagia diets we need to take a similar approach. It is complex and we are really just setting out. The attitudes of the caterers I first started working with are not far away. But there is some very good work going on and we should be hopeful that standards will continue to rise.

It’s just a thought. Maybe losing the ‘modified’ idea will stop the excuses for why something horrific might be served to a very vulnerable human being in need of our help and best efforts.

For more information about how you can improve your knowledge of dysphagia click HERE

JB