Will you meet the new IDDSI standards?

By Susan Saldibar

I was talking recently with Merijane McTalley, RDN, FAND, and owner of Nutricopia, California’s leading nutrition consultant (and a Senior Housing Forum partner). She told me about a recent lawsuit she was involved with; that of a choking death in a skilled nursing facility. The state slapped a $100,000 Class AA citation penalty on the operator. The amount was ultimately reduced, but the citation most would agree is damaging enough. (And now comes the civil trial!)

The Fourth Leading Cause of Unintentional Injury Death

Choking is a chronic worry for all senior care providers. According to the National Safety Council, it is the fourth leading cause of unintentional injury death. And almost 2/3 of those deaths involve individuals older than 74. These are your residents!

While senior living community operators would love to reduce the potential for choking, it’s easier said than done. Merijane has seen too many communities that aren’t actively doing things they can and should be doing. Nutricopia keeps current on issues like these through active participation in government and private initiatives to improve nutrition and safety. The International Dysphagia Diet Strategic Initiative (IDDSI) is one such initiative that all senior care communities should be familiar with. Especially since they have developed some important new standards in the area of food and fluid textures.

As you may know, get your food and fluid textures wrong and you increase the likelihood for choking. These new standards are scheduled to roll out in May 2019.

Are You Ready?

Merijane urges senior care providers to make sure they are ready for them. “In the past, every facility used different techniques and tools to assess food and fluid texture for dysphagic residents,” Merijane says. “This new IDDSI standardization will help reduce a lot of the confusion and, hopefully, a lot of choking.”

I asked her to share with readers some of the things you can be doing to get a better handle on food and fluid texture standards to not only be in compliance but to help reduce the choking risk for your residents. Here are 5 suggestions:

  1. Learn the new standards. Make sure your staff understands them too. You can download the IDDSI new standards framework document here. “What’s great about these standards is that they enable caregivers and food service workers to be accurate in preparing proper food and fluid texture, no matter where in the world they may be located,” Merijane says.

  2. Train your team. There are several good recorded webinars on the IDDSI website which you can access here. They can be downloaded and shared with the team. “By the way, you should also be training your staff on mouth cleanliness,” Merijane says. “Bacteria in the mouth is the biggest cause of pneumonia, not food.”

  3. Review all your menus. Ask your registered dietitian and/or those who provide your menus when they will be updated to include the new IDDSI standards. Fortunately, many food products are now being double labeled to show the old standards alongside the new IDDSI standards.

  4. Ask a professional dietary consultant for help. Professionals, like the team at Nutricopia, are well trained in the new standards and can help you implement them in real-world settings. It is not always easy to quickly recalculate what is needed. The ongoing training is best accomplished by bringing knowledgeable experts in to help.

  5. Do it now! “If your menus are not up to standards and someone chokes, your community may be deemed negligent,” Merijane tells me. The time to get organized and train your team is now.

As Merijane tells her clients, “We have standards for a reason.” And understanding and adhering to these new food and fluid texture standards has the potential to make a huge impact on the safety of food for all senior living residents, especially those who are struggling with dysphagia.

“This is perhaps the most comprehensive change to nutrition standards that I have witnessed in my entire 35 years as a registered dietician,” Merijane says. “Those who take it seriously and act now will have a much better chance of reducing resident choking episodes. Residents will be happier and healthier and potential lawsuits avoided. This is important. Lives are at stake!”

For more information about Nutricopia, please visit their website:


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