There’s something rather extraordinary about the number of people who influence what eventually appears on an aged care resident’s dinner plate.
A speech pathologist assesses swallowing function, a dietitian considers nutritional requirements, the chef prepares the meal, and clinical and care staff help ensure it’s delivered and consumed safely. Somewhere along the way, a catering assistant plates the food, a care worker delivers it, and a resident sits waiting for dinner.
Every one of those people contributes something important, although historically, they haven’t always spoken the same language.
I’ve spent many years working in Aged Care kitchens. I remember when descriptions such as soft, chopped, minced, vitamised and puréed were interpreted quite differently between services, sometimes even between people working in the same kitchen.
When IDDSI began examining international practices, researchers identified 54 different names for food textures and 27 for liquid consistencies. Consider what that meant for someone moving between hospital and residential aged care, where a familiar dietary instruction could mean something quite different at the other end.
More than a common language
The International Dysphagia Diet Standardisation Initiative, IDDSI, gave us internationally consistent terminology, defined food and fluid characteristics, and practical methods for testing them.
It didn’t invent texture modification, nor did it eliminate the complexities of dysphagia (difficulty swallowing). What it did was create a common foundation for clinicians, chefs, foodservice professionals and care workers to understand one another.
I believe that’s one of its greatest achievements.
Dr Julie Cichero and Peter Lam, together with their Australian and international colleagues, deserve considerable recognition for establishing a framework that has fundamentally changed the way our professions communicate about texture-modified food and drinks.
And the work hasn’t stopped.
International Reference Groups, conferences, research projects and educational webinars continue to examine everything from bread and mashed potato to the behaviour of foams and thickened fluids.
These might sound like relatively ordinary kitchen considerations, but they’re precisely the issues that bring clinical knowledge and culinary experience together.
A speech pathologist understands the implications of swallowing particular food textures, while a chef understands what happens to those textures during cooking, chilling, reheating and service.
Neither perspective should operate in isolation.
But what has IDDSI actually prevented?
It’s a question I’ve been considering for some time.
We routinely investigate choking incidents, clinical failures and situations where something has gone wrong, yet we rarely examine the potential incidents avoided because someone identified a problem before the meal reached the resident.
A 2022 study involving five aged care facilities reported a 46% improvement in overall IDDSI meal compliance following targeted education and implementation strategies, with improvements maintained at six months.
That’s encouraging evidence that training and structured implementation can change food preparation practices. But improved compliance doesn’t automatically tell us how many choking incidents, cases of aspiration pneumonia or other adverse outcomes have been prevented.
Perhaps we’re asking a question that’s difficult to answer because we haven’t given enough consideration to what we can actually measure.
So, what could we measure?
Rather than concentrating solely on whether a facility has implemented IDDSI, I’d like to see more attention given to the outcomes and practices surrounding texture-modified dining.
There are several practical opportunities.
Unexpected weight loss
Are residents receiving texture-modified meals maintaining their weight and nutritional status, and are improvements evident following changes to menus, meal preparation and dining support? We should be tracking trends, investigating unintended weight loss and considering the many clinical factors that influence plate consumption and nutritional outcomes.
Meaningful choice
Have we introduced dedicated texture-modified menus offering genuine variety, rather than repeatedly substituting the same few dishes? Are residents involved in choosing their meals, including those who communicate non-verbally? Picture menus, photographs of actual meals and supported decision-making can make a considerable difference.
Food consumption
How much of the meal is actually being eaten? Measuring plate waste and monitoring food intake can tell us far more about the success of a menu than simply confirming that it meets the prescribed texture requirements.
Practical staff competency
Are we providing face-to-face training to the people preparing meals, delivering trays and assisting residents with eating? More importantly, can they demonstrate the required skills in practice, including identifying an unsuitable texture, checking dietary instructions and providing safe, respectful mealtime assistance?
Mealtime safety and satisfaction
Are we identifying and correcting errors before service, reducing incorrect meal deliveries and responding to residents’ concerns? Are residents enjoying their meals, and are we using their feedback to improve what we provide?
Near misses
What did our Chefs, Catering Assistants and Care teams catch before the meal was served? A swallowing or potential aspiration risk that stopped at the pass or servery before being served to a resident should definitely be recorded (and celebrated).
None of these measures, considered individually, will establish that IDDSI has prevented a particular clinical event (aside from recording near misses of course).
Together, however, they could provide a much clearer picture of whether our food and dining systems are improving, where risks are being intercepted and whether residents are experiencing the benefits.
And surely that’s worth investigating.
Beyond the kitchen
Of course, the most carefully prepared texture-modified meal can still be compromised once it leaves the kitchen.
An incorrect tray delivery, inadequate assistance with eating or a failure to communicate changes to a resident’s dietary requirements can undermine everything that preceded it.
That’s why I believe practical, face-to-face training is so important.
We need chefs and catering staff who understand how to prepare and test food correctly, care workers who understand the requirements of safe and dignified mealtime assistance, and clinicians who appreciate the operational realities of delivering those recommendations.
Training attendance alone isn’t enough. We should be observing practice, assessing competency and checking whether improvements are sustained.
The strengthened Aged Care Quality, Standard 6, provides an important opportunity to bring these responsibilities together, with its emphasis on nutritious, appetising food, meaningful choice and enjoyable dining experiences, including for residents receiving texture-modified meals.
It’s a much broader expectation than simply producing food that passes a texture test back to the table. Perhaps we’ll eventually have stronger evidence about the clinical incidents IDDSI has helped prevent, and I hope researchers continue investigating that question.
In the meantime, we have an opportunity to examine outcomes that are already within our reach.
We can measure whether residents are eating more of their meals, enjoying greater choice, maintaining their nutritional status and receiving support from staff who are appropriately trained and competent.
We can also measure whether we’re getting better at identifying problems before they reach the dining room.
IDDSI has given us a common language, but its influence extends beyond the framework itself. It’s helped bring speech pathologists, dietitians, researchers, chefs, cooks, catering assistants, clinical teams and care workers into conversations that previously might have happened separately.
And that brings me back to the resident waiting for dinner.
We’ve spent years discussing what belongs on their plate. One of IDDSI’s greatest achievements may be that we’re now having those conversations together.
Perhaps the next important step is demonstrating what those conversations have actually improved for the person sitting at the table.
This article was originally published on LinkedIn on November 6, 2026.
