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My Mother is in a nursing home and has Dementia and just diagnosed with Dysphagia. She is on "Honey" thickness. The night before she was diagnosed she was fine with eating regular food and was even eating cookies and fig bars, and now all of a sudden is on "Honey" thickness foods. I always thought you would gradually go on the different types of chopped foods before going straight to "Honey " thick.


Its been a nightmare because now she is at the point that I have to feed her because she doesn't like the pureed food and will not even pick up the spoon to feed herself because lets face it, who wants to look at that consistency and pickup a spoon and put it in your mouth. LOL. I am looking for tips on how to go about this. And also I feed her lunch everyday but I am not sure if the aides at the nursing home are going to try when she tells them NO and she is very thin and needs to gain weight. It's an endless cycle.

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I don’t know if this would work for everyone, but I was caring for a woman on puréed food as well. She hated it. So I spent some time figuring out how to purée foods that she loved. I added marinara and blended pasta and lasagne, milk or cream and blended oatmeal, grits, and soups, sharp cheddar and enchilada sauce to Mexican dishes. I made sure to add spices. Then I tasted all of them to make sure that the flavor was delicious. I always told her exactly what she was eating, and that I had tried it. After the first two weeks of refusing food, she ate normally again. I don’t know what the deal is with commercial puréed foods. They taste bland, and have a strange texture. You can’t make all of her food, but maybe one meal a day. Milkshakes help on days that she won’t eat. Good luck. It is really touching how much you care.
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NeedHelpWithMom Apr 16, 2019
And touching that you cared as well. You are a good caregiver.
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Have you tried the putrified food? If not you should. Then you can understand why she won't eat it. Most of that stuff is horrible. I tried Luz's and it was awful. Only the french toast was what I would call edible.
I would suggest you bring in some soft foods she might eat. Like puddings, etc. Or maybe you could find the right seasoning to give it some descent taste.Experiment with it at home. Sweet potatoes Maybe, etc.
Good luck.
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NeedHelpWithMom Apr 16, 2019
Does the flavor change or is it the texture change makes it unappetizing?
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Isn’t sometimes not eating also a result of wanting to let go? I tend to think if this happens to me I’ll be the stubborn old lady who says, “This is what life is now? Oh honey, I’m ready to go then.”
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cetude Apr 18, 2019
do not assume that, and I cringe when I read posts like this giving others that idea without knowing the full picture. It could be UTI, upper respiratory infection..or simply she needs to be fed with infinite patience. Maybe the food is nasty. My mom will not eat unless I feed her and takes way over an hour per meal requiring infinite patience. Then again good luck finding a nursing home attendant who will spend that kind of time feeding them. Not going to happen. That's why I keep my mom away from the nursing home. They will let her starve instead and simply chart "refused".
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Honey thick refers to her fluids, her solids would be one of the National Dysphagia Diet Levels:

NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).
Regular (all foods allowed).
Modified Regular Food Diet

If this is new they may still be experimenting to see what works best and willing to alter things a little. Try to meet with the dietitian to see what changes you can make, and ask for a supplement to boost calories.

I've got to say that wrangling over the food was one of my constant stressors in the nursing home. Lunches were the most awful because the meal mostly included things like sandwiches and salads - these do not puree well🙄. Because of the way meals are structured it was impossible for the dietary aides to be flexible and allow variations to the diet plan, so although my mom could handle some items that were not pureed they were never offered - I just rolled my eyes and said I understood and took responsibility as I fed her crackers with her soup or asked for a side of potato chips. You may find that she's doing better with her other meals, breakfast oatmeal isn't too different when pureed, mashed potatoes are familiar, soups should be acceptable etc.

Just popping back to add that I watched a couple of ladies whose families over rode the advice of the dietitian and insisted on a regular diet - the poor dears couldn't eat at all and staff were powerless to do anything about it.
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I used to make mom smoothies made with ice cream, yogurt, frozen banana, milk, frozen strawberries/peaches, and 1/2 packet of Carnation instant breakfast. She enjoyed it quite a bit. I would also try various "cream of" soups (add thickener if necessary.)
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Sometimes dysphagia is part of the dementia progression. As the illness progresses, the complex muscle control needed for swallowing fades away. I don't know where she is in her end-of-life process, but there also comes a point where the body isn't making use of the food and where food can even cause discomfort because the belly isn't digesting it well. Obviously I don't know this patient's situation, but I have too often seen nursing-home patients who compliantly eat when someone they love is feeding them, and then refuse food at other times, complaining that they're not hungry and really don't want to eat.

It's a tough time for all concerned.
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My father had some problems chewing and sometimes swallowing, partially because of the deterioration of his teeth and partially because of Parkinson's. For Dad, just cooking things to a very tender stage was enough; he hated pureed anything. I basically boiled beef and chicken in some savory broth until it would separate and mush with little effort, then use that meat in recipes since most vegetables cook soft enough. Vegetable beef soup, chicken noodle soup, meatloaf, beef tips, chicken and dumplings, chicken pot pie, etc. along with vegetables cooked until soft with seasonings and butter to add flavor and very ripe fruit became diet staples. Dad loved baked potatoes (white and sweet) and baked apples so he would also eat those. Soups had very little broth so the were more like stews. He also loved puddings, milk shakes and smoothies. When Dad went into MC, I prepared food at home and delivered frozen single servings to the MC each week for his dinner and the staff would reheat. My brother purchased his lunch from grocery store hot bars during the week until CHF got bad enough Dad needed very low sodium, then brother purchased fruit and we added other foods at the MC. He could and would eat some food the MC served, but preferred to depend on something we brought in as his main meal. Not sure if he liked my cooking that much or just the extra attention from requesting "something my daughter fixed".

We were lucky that Dad remained able to feed himself so the MC staff was willing to spend a little extra time heating something up in the microwave; the 24/7 kitchen was a "feature" of his MC so getting a milkshake or smoothie was included in the basic service/price. It probably also helped that my brother went almost everyday for about 6 hours.

I hope some of this is helpful.
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Toward my mother's end, it was too much effort to chew a lot. So the home she was in made sure the food was soft- cooked things rather than raw, etc. There was a time when she failed a swallowing test and was ordered thickened liquids. She would not drink. With quality of life and her love of black coffee important for someone whose situation would only get worse, we overrode the thin liquid, realizing that she could aspirate. I am glad we did that as for the next 5 years, she never had aspiration pneumonia. Up until the end, food was about all she enjoyed and sometimes needed assistance eating and sometimes did not. The last week of her life she was not really interested in eating and seemed to have lost the ability to swallow. She was in a small memory care/assisted living place (I detest the word facility) with Hospice support for two years. Not all food is bad and not all care homes are uncaring as you suggest. You just haven't found the right one.
Many times there is not a clear idea of what our loved one would want. While we might understand DNR or no tube feedings; the whole feeding thing is stressful. I believe let them eat whatever they want whatever the risk. What is the point of anything else at this point in life?
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My friend had dysphagia also and refused the puréed foods. My belief is quality of life vs quality when they are 89 or older. So I let him eat regular food. He went for a year like this when he became sick in Jan 2018. After a week in the hospital which they gave him puréed foods only and then isolation in Skilled Care where he received puréed foods, he didn’t know that regular food existed anymore. Once back in the dining room, I kept fresh flowers on his table so he had a hard time seeing what other people ate. He lived another 15 months on purée and just passed away last month. I was happy I didn’t force the purée on him. I think he lived a lot longer. I fed him lunch and dinner every day and watched others wither away. You do what you can do, but at 89 I would let her eat what she wants. Make her happy. To me that’s all that counts. If she is happy it will make your life much easier. God Bless.
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My mom also on puree food and this is not true that NH does not feed the patients, they do have speech therapists, who do this especially with a new patients on puree. For my mom, who has a dementia and does not understand that she can not eat not a puree food the main thing is to be seated only with those who eat also puree. If she saw somebody eating normal food, then the hell started...Sometimes helps when I tried her food and say thats its eatable. But its eatable, at least in her NH. But overall its very hard, especially if its happened suddenly. I suggested to find a speech therapist there and work with her.
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