1. Dining Assistant- Feeding Techniques

2. Swallowing process The teeth chew by cutting it, then chopping and grinding it into smaller pieces. Saliva softens and moistens the food and begins chemical digestion The tongue pushed the food around between the teeth, making it ready for swallowing, then pushed it to the back of the mouth triggering a swallow reflex

3. The swallowing reflex passes the food through the pharynx. This connects the mouth to the esophagus. At the same time the larynx closes and breathing stops to prevent food or liquid from entering the lungs. The esophagus’ muscles move the food along through contractions called peristalsis(takes about three seconds) into the stomach.

4. Making dining enjoyable Check the environment. Comfortable temperature, no unpleasant odors, keep noise levels low. Encourage use of dentures, glasses, hearing aides. If dirty or damaged or missing, notify the charge nurse. Residents should be clean and well groomed, have been offered trip to the bathroom, and also an opportunity to wash their hands.

5. Residents should be properly positioned. Correct height of table, sitting upright. If resident is slouching or falling, notify the nurse. Resident should be at 90 degrees. Seat residents near their friends, encourage conversation. Be cheerful, positive and helpful. Make simple conversation.

6. Serving meal trays Depends on the facility as to the manner: trays or carried on plates from the kitchen Work quickly so it doesn’t cool, and residents aren’t waiting. Serve all residents at one table before serving another. Wash your hands first. Identify the resident to make sure they get the proper meal/diet order.

7. Preparing the food Only do what the resident is unable to do for themselves. Remove the food and drink off of the tray and set it out on the table. Cut meat and vegetables if necessary, if possible do this prior to taking it to the table. Open cartons and put in the straw if they use one, or pour into a cup. Butter roll, bread and vegetables if desired. (don’t touch, use gloves or hold with a fork) Open condiment packets. Offer to season the food. Offer a napkin (or clothing protector at some facilities) if they wish to use. Do not insist on this.

8. How to assist Some will not need any assistance Some will only need help setting up the meal Some will need checked on from time to time to see if they need help

9. Some will need some physical and verbal cues to help direct them. – Hand over hand approach (physical cues) – Short and clear verbal cues, one at a time Pick up your spoon Put some carrots on your spoon Raise the spoon to your lips Open your mouth Place the spoon in your mouth Etc.

10. Some will need total assistance, being unable to feed themselves at all – Never treat the resident like a child – Be supportive and encouraging – If the patient requests it, allow time for prayer – Verify ID, and correct diet – Encourage them to do what they can, like finger foods – Sit at resident’s eye level facing them

11. – Cut foods and pour liquids as needed – Identify the foods, even pureed foods, “would you like green beans?” – Ask the resident which food they prefer first (even if it is dessert) – Do not mix foods together – Offer hot foods/liquids carefully – Do not rush, be relaxed and give the resident time to chew and swallow.

12. – If the resident wants something else, honor this request, ask for an alternative – If the resident can not do it for themselves, wipe food from the resident’s mouth or hands as necessary during the meal. – Make simple appropriate conversation without asking many questions, talk positively about the food. – Give the resident your full attention, do not talk over the resident’s head or with other staff.

13. – Alternate offering food and drink. – Alternate cold and hot foods or bland foods and sweet to help stimulate appetite.

14. If assisting a resident in their room – knock first and wait for permission to enter. – make sure they are sitting upright and you are at eye level. – Identify yourself – Follow all of the guidelines as assisting in the dining room. – Before leaving, place the signaling device within the resident’s reach. – Before removing the food tray, check to make sure no eyeglasses, dentures or other personal items are on it.

15. Adaptive equipment or assistive devices Special cups with nose area missing to enable to tip cup without tipping head back. Curved handle utensils Weighted utensils Built up utensils Plates with built up edges or scoop edges

16. For visually impaired residents use the face of an imaginary clock as a guide to explain the position of their food and drink. For residents with “blind spots” place the food where they can see it. For residents with hemiplegia or hemiparesis, place the food in the unaffected side of their mouth

17. Dysphagia- difficulty swallowing You will not be assigned to feed residents who have dysphagia. If you suspect a resident has dysphagia or has shown signs of swallowing problems, notify the charge nurse. Alert the charge nurse immediately if any problems occur while feeding the resident. NEVER continue to feed someone who appears to be having swallowing problems Dining assistants may NOT by law assist residents with swallowing disorders.

18. Signs of swallowing problems Coughing during or after meals Choking during meals Dribbling saliva, food or fluid from the mouth Food residue inside the mouth after meals Gurgling sound in voice during or after meals Slow eating Avoiding eating Spitting out pieces of food

19. Several swallows are needed per mouthful Frequent throat clearing during and after meals Watering eyes when eating or drinking Food or fluid comes up into the nose Visible effort to swallow Shorter or more rapid breathing while eating Difficulty chewing Difficulty swallowing medications