By Julia Werth
Until a few years ago, when I heard the word “diets” I always thought of weight loss. Cutting calories, cutting fat, cutting whatever foods and beverages it took to lose weight. As I spent more time in nutrition classes and hospital settings (especially during my clinical rotation) diets came to be defined by disease state: diabetic, renal, cardiac, etc. But as I began my food service rotation at a the Maryland VA long term care facility, the meaning of “diets” again began to change.
It came to be defined by textures: pureed, dysphagia-mechanical (also sometimes known as ground), mechanical and the occasional regular (but in reality still pretty soft).
Instead of worrying about calories, carbohydrates or grams of protein, the constant refrain became “is that too tough? Can they chew that?”
Are chicken tenders rethermed with or without a cover the proper texture? Is pulled pork okay for a mechanical diet? How do you make pureed anything look appetizing?
In a facility focused on providing veterans with care and comfort in a place that feels at least a little more like a home, patients are not kept on strict, carb-controlled diets. They can order snacks, second servings or a soda every single day – but if they can’t chew regular-textured food without risk of choking then a modified texture is necessary.
As my partner Adam and I began planning a Luau themed meal for the veterans, we wanted to ensure that all residents no matter their texture would be able to attend. We chose foods that could be easily ground or pureed, that tasted good without a crisp outer edge and that could look appealing in any form. We added alternative veggies that wouldn’t be too crunchy and made color-coded menus for all the food service staff to help us stay organized during the restaurant-style event.
We decided on pulled pork – because it could be enjoyed by regular, ground and mechanical. We picked pineapple rings, because pureed versions were available. We learned that rice is always a great choice because it truly looks yummy whether the grains are really fine or not.
As we plated the food during the meal, I was starting to second guess myself. Maybe the residents on regular-textures would resent the lack of bread? Maybe the veterans requiring purees would notice that their pineapples weren’t grilled? Maybe the sweet potato casserole really didn’t go with the rest of the meal?
Despite my worries, however, the meal seemed to be progressing well. A few peeks into the dining room gave me a view of over half of the veterans who live at Loch Raven digging into our Hawaiian themed food, but the next day was the true litmus test.
“So, did you attend the Luau yesterday?” Adam and I asked several veterans on a variety of textures throughout the morning after. “What did you think? Did you like the food?”
And far more often than not, regardless of texture, the answer was “Oh the Luau? That was delicious!”