Moving beyond compliance, care homes are reimagining texture-modified dining through the IDDSI framework. With insight from Andy Cullum (The iddsi Guy) and Debbie Kenchington, Lead Speech and Language Therapist at Askham Village, this article explores how innovation, training and culture can transform mealtimes for residents living with dysphagia.
At its best, IDDSI is not restrictive; it is enabling. It provides a shared language and clear structure for producing safe, consistent meals, while still allowing room for creativity and person-centred care. The challenge for providers is no longer simply meeting the standard, but raising it, ensuring meals are not only safe, but also enjoyable, recognisable and dignified.
From Framework to Experience
The IDDSI framework has transformed dysphagia management across the sector, improving safety and communication between kitchen teams, carers and clinicians. Yet, as Andy highlights, it is still too often treated as a “tick-box exercise.”
Meeting minimum requirements does not guarantee a positive dining experience. Residents do not engage with frameworks; they engage with food. If that food lacks visual appeal, flavour or recognisability, it can impact appetite, wellbeing and quality of life.
At Askham Village, this shift from process-led to experience-led dining is supported through close multidisciplinary working. Their in-house Speech and Language Therapy team not only assesses swallowing needs and recommends IDDSI levels, but also works alongside care and catering teams to ensure mealtime experiences reflect both safety and enjoyment.
Elevating IDDSI, therefore, requires a change in mindset, from compliance to experience.
The Power of Presentation and Recognition
Presentation is one of the most immediate and impactful ways to improve texture-modified dining. As Andy emphasises, “texture-modified meals should still look like food.”
This principle is echoed in practice at Askham Village, where specialist moulding techniques are used to reshape puréed foods into recognisable forms. These visual cues help residents identify what they are eating, supporting appetite, familiarity and emotional connection.
A puréed carrot that resembles a carrot is far more engaging than an unidentifiable portion. Achieving this does not require overly complex techniques, but it does demand consistency, attention to detail and a commitment to dignity.
Consistency Without Compromise
Consistency remains one of the greatest challenges in IDDSI delivery. Variations across shifts, teams and environments can affect texture, presentation and overall quality.
IDDSI is not a single task, but a set of practices embedded across the whole team. At Askham Village, this is reinforced through ongoing, hands-on training led by Speech and Language Therapists, ensuring staff understand not only IDDSI levels, but also how to prepare, test and serve food safely.
This includes practical competency in food modification and fluid thickening, as well as testing procedures to confirm compliance before meals are served. Continuous education builds confidence, reduces variation and supports consistent delivery across all settings.
Innovation Driving Efficiency
A common perception is that improving IDDSI quality increases workload. In reality, innovation is helping to improve both efficiency and outcomes.
Modern kitchen equipment enables faster, more reliable texture modification, while moulding systems enhance presentation without adding unnecessary complexity. At Askham Village, innovation is also evident in the catering team’s creativity, producing visually appealing dishes and even modified celebration cakes, ensuring residents can fully participate in special occasions.
Training methods are evolving too. Practical, interdisciplinary training ensures that rehabilitation and care staff can safely prepare food and drink when needed, reducing reliance on specific roles and supporting flexibility across the service.
As Andy notes, innovation is not just about tools, but about adopting a person-centred approach that prioritises both safety and enjoyment.
A Whole-Team Approach
One of the most important insights from practice is that IDDSI cannot sit solely within the kitchen. Dining is a multidisciplinary experience shaped by environment, communication and culture.
At Askham Village, Speech and Language Therapists maintain a presence in dining spaces, supporting staff in making real-time adjustments based on factors such as posture, fatigue, and resident engagement. This ensures care plans remain dynamic and responsive.
Wider environmental factors, including noise, lighting and table presentation, also influence the mealtime experience. A calm, supportive setting can significantly enhance both safety and enjoyment.
When all staff understand IDDSI principles, communication improves, and consistency strengthens, creating a shared sense of ownership across the team.
Preserving Choice and Dignity
For residents on texture-modified diets, loss of choice remains a common challenge. Simplified menus can unintentionally reduce variety and create a sense of exclusion.
Both Andy and Debbie emphasise the importance of maintaining choice through adaptable menus. Wherever possible, residents should receive the same meals as others, modified safely without compromising quality.
At Askham Village, a strong person-centred approach ensures that individual preferences, cultural backgrounds and personal histories are reflected in menu planning. Communication tools, accessible menus, and family involvement further support residents in making informed choices and maintaining independence.
Adaptive equipment, supported by occupational therapy input, also enables many residents to engage more actively in mealtimes, reinforcing dignity and reducing reliance on staff assistance.
Standardisation Meets Creativity
There is a common misconception that standardisation restricts creativity. In reality, strong standards provide the foundation for it.
Clear processes for preparation, testing and presentation ensure safety and consistency, while allowing teams to explore flavour, colour and creativity. As Andy highlights, “people still eat with their eyes first.”
At Askham Village, this balance is achieved through structured training, collaborative working and a shared commitment to high standards, enabling teams to deliver meals that are both compliant and appealing.
Raising the Standard
Elevating IDDSI is not about adding complexity, but refining the approach. With the right training, tools and mindset, care homes can deliver texture-modified meals that are safe, efficient and genuinely enjoyable.
The providers leading in this space are those that treat IDDSI not as a constraint, but as an opportunity. By embedding it into their culture, investing in their teams and embracing multidisciplinary collaboration, they are redefining what texture-modified dining can look like.
The goal remains clear: keep dignity on the menu.
