Help with eating/foods for my 80-year-old Mom?

Sorry that you are going through this. If on hospice honestly I wouldn't push food , especially for nutritional reasons. But I understand wanting mom to have something in her belly. When my father began having choking episodes we tried anything in puree form. Applesauce pudding ice cream mashed potatoes sometimes we'd try scrambled eggs. He would shuffle his food around his plate , but when we fed him he would eat something. Before he lost all swallowing ability we would give him the same thing every day just to know he was having a little something. Hunger and thirst fades. I used to feel guilty thinking he was starving or thirsty but understood its the horrible disease. If mom wants ice cream all day ?? Let her have it. You're doing all you can. God bless

I cannot help much with ready to consume food availability for cases like your mother. But I can provide some advice regarding situations when swallowing gets compromised.

Below is an excerpt from my Book "Dementia Care Companion" available from Amazon.

When Swallowing Is Compromised
Swallowing involves complex neuromuscular coordination among a number of organs to allow food and fluids to pass from the mouth into the esophagus, safely bypassing the windpipe. A slight impairment anywhere in the process may result in food or fluids going the wrong way and into the windpipe, causing severe coughing.
·        Watch for signs of swallowing issues early in the course of dementia progression. If necessary, consult a speech therapist sooner, rather than later, to evaluate any swallowing issues.
·        Prepare yourself for a choking emergency by learning the Heimlich maneuver. Check for classes at your local hospital or community center.
The Danger of Food Aspiration
Swallowing problems tend to develop in the late stage of dementia progression, and sometimes as early as the middle stage. As the patient loses the ability to chew their food completely or swallow it safely, the possibility of food or fluids entering their windpipe grows more likely.
The entry of food and fluids into the windpipe is usually accompanied by severe coughing. Even if the patient is able to cough strongly enough to expel the errant food from their windpipe, some of the food may still end up in their lungs (food aspiration), which may result in lung infection (aspiration pneumonia).
Managing swallowing problems is a primary concern for caregivers because severe coughing is highly stressful, to the point that the patient may refuse to eat and drink altogether.

Puree Meals
Eventually, the patient will be unable to chew and swallow regular foods. At that point, there will be no choice but to puree their meals.
·        Thoroughly cook beans, peas, and other solids to make chewing and swallowing easy and to postpone having to switch completely to pureed meals.
·        Use a home blender or food processor to puree food to a consistency similar to yogurt. Pureed food does not require any chewing, is easier to swallow, and is less likely to end up in the patient’s windpipe or lungs.

Thicken Liquids
Swallowing problems impair the patient’s ability to drink fluids also. This time, the difficulty is due to the liquids being too thin, which makes it easy for the liquid to find its way into the patient’s windpipe and lungs.
·        Use food and beverage thickeners to thicken fluids, including drinking water. You can use commercial thickeners, or make your own using cornstarch.
·        When preparing liquids, add just enough thickener to get the liquid to the needed consistency (see below). Add a little mint or sugar to make it more palatable and reduce the taste of starch.
·        Initially, liquids need to be thickened just a little, similar to the consistency of syrup in canned fruits. But, over time, more thickening will become necessary. Eventually, the patient may need liquids at a consistency similar to that of honey or thick yogurt to be able to swallow safely. 

When the Patient Cannot Drink From a Cup
At some point, drinking from a cup may become impractical, as the patient will have difficulty controlling the amount of liquid they take in with each sip. To prevent aspiration, you may use a syringe to serve liquids to the patient one sip at a time, typically 5CCs per sip. Alternatively, you may spoon-feed liquids to the patient. 

It sounds as if your mum has an unsafe swallow. Please have her swallow assessed by a healthcare professional.

Does your mum want to eat? Is she hungry?

If yes, then proceed carefully with puréed foods or food replacement drinks. She may need her liquids thickened to reduce the chance of water easily slipping down her trachea instead of her oesophagus.

If no, then do not push your mum to eat and drink. That doesn't mean don't offer, but be aware of your mum only taking nourishment to please you. That isn't necessary.

Also, your mum should probably be on liquid medication now instead of tablets. Eventually, she will need intravenous medication.

There are two major problems for a person with an unsafe swallow. The first is that a small amount of food and drink going down the trachea to the lungs is likely to cause aspiration pneumonia. This is a very aggressive type of pneumonia.

However, some people feel that pneumonia is the sick and elderly's friend, since it can bring about death more quickly and save someone from lingering in discomfort.

The other more distressing complication is that a person's choking can cause them fear and distress. You do not want a loved one to die in this way; it is the very opposite of a peaceful death.

Mum had aspiration pneumonia a few months before her swallow was deemed completely unsafe, but it was clear that was the next stage. It was a sign that Mum was nearing the end.

Once Mum's swallow was no longer safe, at all, I stopped pushing her to eat and drink. It took longer for her husband to accept this situation, so I got the doctor to tell him that Mum was now "nil by mouth".

He took more notice of the male doctor than either me or the highly trained palliative care nurses (which was odd because he hadn't seemed at all sexist before). The doctor deferred to the nurses because he knew this was their area of expertise.

Mum was supplied with a syringe driver to deliver all her end of life medication. No more tablets or medicine.

The palliative care nurses came every morning to change the drugs and check on Mum and provide whatever assistance was necessary, including instructions for us and the daily carers. (This is in the UK and, even here, end of life care is a postcode lottery. Nevertheless, I hope that your hospice care, or the doctor, can provide the appropriate end of life medication when it's needed.)

Please treat yourself and your loved ones with grace. This isn't an easy time, but it can still be filled with precious moments and memories. Learning acceptance will help you.

I think it's easy to get hung up on trying to prolong a loved one's life, but there comes a time when all that matters is ensuring their comfort and giving them and yourselves peace of mind and heart.

My dad's last meal was a hamburger, fries and iced tea. I had to mash up the burger and fries to pudding consistency, but at least it tasted good. (The iced tea was thickened.) Get a food processor and you can get anything to the right consistency. You might have to add a little liquid, but that's about it. Season it to taste appealing. This way everyone eats the same things, even if hers looks different.

I just saw a food delivery service online the other day where you can order the meals pureed. Sorry I don't remember which company it was. A search should bring it up. You could try the company, Mom's Meals. They are senior oriented.

Hospice does not provide 24 hour care in the home. You can contact Hospice 24 hours a day if you need to but the primary caregiver(s) are the people that are in the home with the person on Hospice.
Hospice will do what they can to make sure that mom is comfortable.
Hospice should provide the product that you are using to thicken her food.
They should have instructed you to begin pureeing her food.

when my Husband was on pureed foods I would make all the food he would normally eat and put it in a blender. (actually I used the machine that most people make smoothies with as it is smaller than the blender I have)
So if you are having pizza for dinner, toss a piece in the blender. You might have to add a bit of water or broth.
Stew, soup, casseroles can all easily be blended.
Oatmeal, cream of wheat, I would often partially cook the cream of wheat then top it with an egg and finish cooking it. The egg cooked so it was not a "danger" and he got a bit more protein.

PLEASE talk to the Hospice nurse and ask her or him what you should be doing.

Discuss needs with the Hospice manager/MD
"Comfort care" include an ability to eat as comfortably as possible.
Push Hospice to provide this level of expertise if they do not readily help you (I believe they should). They may even have a dietitian you could speak to.

If not your local Hospice, see if there is an executive / administrative office.

You can always use a blender.
Include in a blendered drink / meal:
Bananas (I buy, cut up and freeze).
Frozen berries (I get from Costco)
Other fruit
Yogurt

If she is underweight, try ice cream although be aware that dairy causes mucus.
For myself, I include: small piece of garlic and small piece of ginger root.
Add: cinnamon, vanilla (to taste), perhaps honey.

Some people with digestion or swallowing issues do solely eat pureed foods.

Gena / Touch Matters

I had to do this for my husband.
I think many of us as adults are turned off by the consistency of pureed foods.
If she likes it, you can buy baby food and put servings on a plate for her. That would make it very easy for you! And inexpensive and readily available in any store!

If the consistency is not to her liking, try using a food processor to create more of a "minced" consistency. I would take things like a soft meat, such as salisbury steak or cooked hamburger, cut up in pieces and blend briefly in a food processor.
Other things I tried successfully were Arby's roast beef sandwich. Cut up, including some of the bread ( not all of the bread, because it's too much).
This works pretty well for any sandwich or hamburger.

I found that if you want to add a dressing or liquid - such as mayonnaise, or ketchup, or au jus or meat juices or gravy - it's best to add AFTER chopping up the dry food in the food processor. If you add liquid while it is blending, it just makes a paste.

Another little treat he enjoyed was ritz crackers, which you can easily crush in your hands, or in a plastic bag, then stir in a tablespoon or two of peanut butter. The final consistency should be crumbly.

Other soft food ideas; pudding, muffins (cut into small pieces) applesauce, yogurt, cottage cheese, tuna salad, scrambled eggs, and cut up bits of pancake.

You can buy minced or pureed meats and whole meals - Hormel has a great selection of prepared foods for dysphagia, which you can buy online - but it is expensive and you have to buy large quantities.

My rule-of-thumb on soft foods is, if you can press the back of a fork through it,
it is soft enough. I will sometimes cook carrots and sweet potatos and mash them gently with a fork, put a little butter on top - that is pretty good.

My husband has been on mechanical soft foods and thickened liquids now for 10 years. He has reached a point now where foods are not appealing to him.
He will ask me for something specific which he thinks he wants, and so I chop it up and prepare it for him, and after he takes one bite, I think it feels uncomfortable to him, so he doesn't want any more.
He prefers the protein smoothies I make for him every day.
I make a batch in the morning - 12 cups total, using a mix of Boost, milk, or plant-based milk, some water, and add a little flavored Jello or juice to create different flavors. Orange juice and strawberry-banana juice are the most successful. But, the acids in the juice will make milk curdle and makes it lumpy, so they have to be added slowly while the blender is running.
I always taste it to make sure it's ok before I give it to him. It's yummy! I would drink that all day! It's no wonder that is what he prefers now over food!

Oh - and my preferred thickeners for liquid are Hormel's Thick & Easy Clear, or Nestle Resource Thicken Up.

And one last tip ; I buy Take & Toss plastic cups for children, with a snap on lid and a straw. If she is at all unsteady or likely to drop or knock over her drinks, this will prevent a big mess. I also buy disposable paper cups thru Amazon, with a ripple exterior. It is easier to grasp and hold on to, and it makes my life easier by reducing the amount of time I spend washing out plastic cups. The paper cups come with a lid with a sip hole, and I can push a bendable straw through the sip hole, making it easy for him to use, and easy clean up for me. (my husband has a habit of throwing his cups on the floor when he's done)

First, gratitude for you and dad for working with the situation. Gratitude your mom is still sitting up to eat.
My parents are "allergic" to cow milk (causes flem in their throat and sneezing( so...no Ensure etc for them as they are all whey based. We found Orgain protein powder added to whatever - one in vanilla (my dad) and chocolate (my mom until she passed in January) that is pea based. My dad has it with oatmeal every morning. The consistency can change depending on water and length of time soaked etc.
I took Progresso's beef and barley soup and pureed it. It was good!
Applesauce to take meds - switch meds to liquid or crushable.

Touching her throat gently to get her to lift her head to swallow OR the opposite direction to get a swallow. Depends on where the "problem" seems to be. You should be able to ask Hospice for resources (people they know or can contact) to help figure out what will "comfort" the person while swallowing/ eating etc.
Our hospice people were WONDERFUL at answers specific questions about "how do I" whatever. If they didn't know, they would find out. We used them for six months when my mom fell and it looked bad, then she bounced back (mostly). Then just four days at "the end" and I am SO grateful to have been led through stuff. Gratitude for ALL help!
Gratitude for every moment you have with your mom.

Hi Doctor should really be prescribing meal replacement drinks- they have compact ones that haven’t too much liquid to ensure she gets nurishment
when my dad wasn’t eating I bought a tiny compact blender and put his dinner in it to help ease eating

elderly sometimes develop issues swallowing - might be worth medical checking out she hasn’t any problem
water was inportant
we had a dietician come round d and she watched my dad eating and noticed a weird chewing motion
when he lost some weight in Hospital his mouth shrunk and his dentures were loose so we’re moving as he ate causing him pain
solution- chemists sell denture cream which basically acts like glue keeping dentures in place
also found if we joined dad eating he ate and instead of feeding him we slowly encouraged him to hold a cup- hold his spoon to eat
helped where needed but got him involved
suddenly dad was eating on his isn
at his own pace
we put food on his lap and out tv in in front of him
put tv on one of those wheely stands so could adjust height and move it around the room
It all helped him get back to eating
i still avoid anything really chewy
now I no longer need to blend his food up-
water was a key factor in my dads recovery-
it affects so much mental and physical health/
Little and often
best wishes

Thank you all for your prompt responses to my questions. I’ve noticed that even moistened cooked rice is hard for her to swallow, and ground hamburger—whether with gravy, ketchup, or other additions—is also difficult. She doesn’t tolerate breads well either.

We make a lot of smoothies using fruit and protein drinks, which she loves. They’re also high in protein, which is a plus.

I worked in a long-term care facility for many years, but I wasn’t a dietitian, so I really appreciate all the guidance and suggestions. ☺️

Yes you should now be pureeing all of your moms foods. And you don't need any special recipes, you just puree what she normally would eat.
I would puree any meat and gravy and any vegetable for my late husband, and of course there are puddings, jellos, ice-cream, yogurt and the like that your mom can eat as well.
It sounds like your mom is aspirating her food, which means that her food and drinks are going into her lungs and not her stomach. that is very dangerous and in most cases deadly.
So puree all of her food and use the product Thick-It to thicken her drinks to help her not aspirate.

I think that pureed diets are often be better accepted if we centre the meal around familiar items, so I made a list of some common foods that are often served soft, smooth or pureed

SOFT and PUREE FOOD DIET IDEAS
Breakfast
scrambled eggs
oatmeal, cream of wheat, cornmeal mush, congee*
yogurt
pureed fruit

Lunch/Dinner
creamed soups
mashed potatoes, squash, rutabaga, sweet potato
finely chopped/ground meat in sauce or gravy*
pasta sauce over polenta or very tender pasta*
savoury custards/crustless quiche
refried beans
dahl
hummus
cottage cheese*
avocado and guacamole
fish pie
grits*

Snacks/Desserts
custard
milk pudding
yogurt
smoothies
applesauce and other variations
silken tofu puddings


(* these items may not be suitable for some levels of dysphagia)

When my 20 yr old brother had his jaw wired after a terrible car accident and could only drink his food, beside providing him with Ensure, my mother would cook him burgers for instance and then pulverize it in a blender down to a liquid state. Seems like anything blended enough can be liquified. In your mom's case straining would be an additional precaution. Otherwise baby food may be an option.

While my husband was in hospice puree, further along in that stage of transition, simply swabbing his mouth was all he could manage.

There are several websites that accommodate folks with dysphagia. I found them by Googling - Hospice pureed meals.