Is pureeing food for a dysphagia diet a task that must be done by someone qualified in skilled nursing?


Question for RNs and LPNs. I was told today by representatives of a private duty home care company that pureeing food for a client is considered skilled nursing and can only done by someone qualified as such. Any input on this? I asked a relative about this but was confused at the time and can't recall her answer!

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Sorry to go on, but also a lump of applesauce with pills in it, and thickened Ensure worked well for us.
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PS I am not an RN - sorry - just reread that is who you addressed the question to. In my experience - 2013 to 2016 - no Dr and no RN ever said there had to be skilled nursing for this problem.
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This was in NY State.
My father was diagnosed when he was in the hospital for something else at 88 yrs old. At 87 he had started having repeat pneumonias. He had been pretty healthy up til then. I thought it was viral and washed all bedding, etc. I had never heard of dysphasia - (swallowing problem, usually lots of coughing when eating) - or of aspiration pneumonia - (bacterial infection due to food or liquid getting into your lungs) - or of "silent" aspiration - (where you have a dead spot in your throat and you can't even feel the liquid going down the wrong pipe) .

A rather brusque nurse showed me what to do - like it's just simple, you just do this. "He can't even drink water??" (I pictured him not being able to just go and get a glass of water - he certainly would not be able to do this thickening thing. I was kind of shocked that no he couldn't get water and yes this is what I would have to do.)

The nurse never said a thing about skilled care for this. Later we saw a Speech Therapist, had a flouroscope done and watched. Thin liquid went right down into his lungs.
He had a slow swallow. It should happen in 1 second, his took 2. The "flap" didn't close fast enough. No one could figure out why. Mini stroke that doesn't show on scans? Side affect of cough drops or pain meds? (I asked). No one knew for sure.

The Speech Therapist said his food has to be something that will form a "bolus" - a ball that will slide down his throat without breaking up. And that all liquids had to be "honey thick". That's pretty thick. Later, he actually improved to "nectar thick" for a while.

We also tried electrical stimulation to his throat. Sometimes that does help. And exercises which he hated. He was too old and not well enough to really pursue these. In the end this throat problem was his worst problem and it got worse. That was the reason he passed away.

But anyway - the original question - no I don't think there is a requirement for skilled nursing. All of my father's care in this area was up to me. I had a sheet of things to avoid and a few tips that the hospital gave me.

The nursing home (he was there a few times for rehab) does note this condition and tries to create food that will work. It's very tricky. Even pureed stuff sometimes doesn't work - it gets hung up.
One thing that worked well for my father was lasagne. The cut bite sized pieces seemed to slip right down. He hated pureed stuff and really, it didn't work as well. Bananas and avocados were good - a little catalina dressing in the avocado half. Moist and slippery is good. Dense meat loaf with a lot of ketchup. Strawberry shortcake with ice cream, whipped cream, chopped strawberries with sugar to make a sauce, and those soft commercial cake things. It is a learning curve for sure.

Also we tried a lot of different thickeners. Some are cornstarch, some are a seaweed thing I think. We didn't like the cornstarch ones. The best one, to us, was Nestle's Thicken Up. They have good customer service. They have prepackaged juice, water and milk which I bought and found useful for car trips, emergency rooms, immediate needs...

You have to watch the hospitals closely as the workers make mistakes and give thin liquids when they shouldn't. I tried to be there all the time, especially at meals. Difficult. Even the nursing homes occasionally make mistakes. They actually required me to be with him if we wanted him to eat in the rehab dining room. Otherwise he would have to eat in the main room with the permanent residents. The dining room was nicer.

You just do your best and hope it works. There's only so much you can do.
I sympathize so much with you and wish you and your loved one the very best. It's not hopeless. It can sometimes improve.
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I'm the queen of take-out containers -- my adult children make fun of me. But I have saved (from various restaurants, including Chinese take-out) the type that is the same as you would get a frozen dinner in as well as others with and without lids. And that makes me think of restaurant supply stores. Here we have Gordon Food Service. You'd probably have to buy in bulk, but I definitely wash a reuse and don't see any of the effects to the plastic.
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The food gets hot and melts the plastic, I don't think any plastic container is immune from it, and they all contain chemicals just as problematic as the banned
The thing is, you need to weigh the pros and cons of it all - the bento containers are easier to handle, can go in the freezer, and the compartments keep things separate. They are also relatively cheap, so they can be replaced fairly often.
At his age I doubt that the cumulative effects of microwaved plastic containers are ever going to cause any adverse effects, if it was for a child I would think differently.
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CM, "scuffing" is a better word than frayed. At first I thought it was food residue, but scrubbing and scrubbing couldn't remove it. Then I realized that the scuffing was around the top of where the food would have been. So something must have happened at that level, perhaps the contrast between the heated portion with food and the heated portion above it???

What the company CSR asked me was how long was the container being microwaved. That's when she said 30 seconds, and maybe another 30 seconds, but definitely not more.

The containers are not designed for more than a quick warmup.

She also said not to use the containers any more, as it MIGHT BE that the plastic was deteriorating. She suggested throwing them away. Yikes.

Microscopic bits of plastic in food was my concern as well, which is why I now have over a dozen or so containers that can't be used for anything, well, maybe except storing screws, nails, sewing needles, thread, and things that aren't edible but always seem to escape open containers and wander around the house, hiding out in chair cushions or on the floor.

I too have switched to glass and some ceramics. But they do get hotter and need to be handled a bit differently. Easy for me, but not for Dad.

The only plastics I've used for freezing are ones that I bought years ago, the Ball containers for storing canned foods. When I was dreaming of living more off the produce from my garden and fantasizing that I would soon be digging out a root cellar, I bought a few dozen and have enough to last for years.

At that time I also bought other plastic ware but stopped using it when I saw a little "tail" of plastic separating from the bottom of a container. Those too are relegated for nonfood storage. I guess I'll have to stock up on nails, screws, tape, string, and whatever to make use of them.

I could recycle them, but would they be used for food storage? Who knows?

If you're not seeing any deterioration of plastic, I think they could still be used, but then that raises the issue of whether they were manufactured when BPA was still being used in plastic. I wouldn't be as concerned about the ones that are BPA free. And that raises the issue of the safety of the old Ball containers.

Sometimes I think animals have it all over us. Squirrels just have to bury their food or find a nice hole in a tree. Carnivores either consume food right on the ground, or hide it with brushes or something and come back later.

We humans have to deal with all sorts of safety issues, although at least we don't have to have bearproof containers. Well, maybe that's not so - I've seen some amusing photos of bears in a swimming pool and others not so amusing when they're getting into cars. If they're in the swimming pool, what do they do when someone barbeques?

Molecular chemistry? I literally faint at the thought of trying to understand chemistry. It's waaaaayyyy beyond me!
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GA, I bought what was supposed to be a microwave-proof vegetable dish, and when I say microwave-proof it came with instructions for cooking, not just reheating. Well. It's not fraying or cracking, but the internal base just looks a bit scummy to me - not dirt or food residue, but the plastic surface is sort of scuffed, if you see what I mean. So what's going on with that? - and does that mean that microscopic bits of plastic are skimming off the surface and getting into my broccoli?

So all in all and completely unscientifically, I regard plastic in microwaves as suspect and am now using only glass or ceramic ware. Which is a pain, I realise, if you have to decant everything; but you can get toughened glass or Pyrex containers reasonably cheaply.

I still use plastic for freezing, and I do defrost food in those containers - but then the food isn't getting hot, just up to room temperature, and there's no sign of wear. So I suppose that's all right?

It's at times like this that I wish I'd paid more attention to molecular chemistry (hangs head)...
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Quick question on the Bento plates/boxes bought from Amazon?

Are these fully microwavable for frozen meals? One set of containers I bought, which began to "fray" after being reheated, were perfectly sized, but the plastic "fraying" was a problem.

When I called the manufacturer, a customer service rep revealed that they are microwaveable, but not for more than 30 seconds. That's not much help for reheating meals.

And unfortunately, that limitation wasn't on any of the containers or the packaging, so I had no way of knowing they were for limited use.

Something that's microwaveable for multiple uses is what I want.

Those Bento containers look perfect, but I wonder if anyone has used them to reheat for several minutes, and whether or not the plastic began to deteriorate as if it was scratched.

I checked out another source, where I could probably buy or order locally, and read that the boxes can be used again, but there's also a disclaimer as to the source of the information. Users would, I think, know better from experience.

Thanks again for all the helpful posts. I'll be back for more individual expressions of appreciation.
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Mom has trouble lifting her utensils so thank goodness aides can spoon feed her if need be

Cwillie, you know you can't eat just one potato chip
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In MA we can allow the aides to prepare the food but the aides are not allowed to assist in the feeding of anyone with a swallowing problem.
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