IDDSI and Why it Matters in Senior Living

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Earlier this month, our Senior VP of Menu Operations, Theresa Arguello-Thomas, joined Michele Kramer, Director of Health & Wellness Programming with LCS Health Services Division, for a Health Care High Wire podcast interview about IDDSI (International Dysphagia Diet Standardization Initiative). The purpose of this podcast was to build awareness about the transition from NDD to IDDSI, especially within the Senior Living industry.

The IDDSI framework was developed by a multidisciplinary, international group of experts to develop a global standarwith terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia. (Kramer)


The new IDDSI Framework is extremely relevant right now because it directly impacts the safety measures used for preparing foods for those individuals with dysphagia. Simply put, dysphagia is the term used to describe the conditions in which one has trouble or inability to process and swallow food. This complication impacts individuals of all ages for varying reasons. Kramer mentioned in the interview that “the American Speech and Hearing Association has formally endorsed IDDSI” and “will be the only texture-modified diet recognized in the Nutrition Care Manual as of October 2021”. Arguello-Thomas confirmed, “In January this year, the Academy of Nutrition and Dietetics announced as of October 2021, NDD and any associated resources will no longer be included in the Nutrition Care manual”. When asked about the most prominent changes seen with the transition from NDD to IDDSI, Arguello-Thomas mentioned the following:

  • Terminology of foods and liquids:

    • NDD has 3 levels of modified food textures and 3 levels of thickened liquid consistencies

    • IDDSI framework is a continuum of 8 levels. The food textures and liquid consistencies have different levels and diet descriptions than what is used on NDD.

  • "IDDSI also has included specific testing protocols for each level of the framework, and we currently don’t have that with NDD."

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Now is the time to prepare for these changes. Crandall Corporate Dietitians is already taking steps to prepare communities we service in the transition to IDDSI. When Kramer asked about implementation measures Crandall is taking, Arguello-Thomas replied, “Our view here at Crandall is that it’s the expectation to provide evidence-based, best practice standards of care. As professional organizations adopt the IDDSI Framework, NDD will be designated as obsolete and eventually there will be little to no support to provide to surveyors that following non-IDDSI diets and terminology is a valid or best practice.”...“For our customers, we have rolled out a specific implementation schedule and send out monthly in-services to help support a smooth transition to IDDSI”. Arguello-Thomas mentioned some tips and resources communities can use in transitioning to IDDSI:

  • “It is best to establish an IDDSI committee. Appoint a few individuals to be IDDSI Advocates and setup an implementation schedule. Get yourself familiar with the various testing methods, and we encourage people to just start playing with your food! For example, if you’re providing puree foods now, get familiar with the testing methods for this level, try them out, just get comfortable and utilize those testing methods, then work your way up!”

  • “There are a ton of resources available at org and the IDDSI YouTube Channel are two of the best resources. There is also a IDDSI Newsletter on their website and an IDDSI App you can download for your phone. We here at CCD, of course are a resource, the Academy of Nutrition and Dietetics also has a lot of information available. Many manufacturers are already dual-labeling products. Reach out to vendors such as Simply Thick® who can help provide some training. You can also look at equipment that would potentially help in the execution of preparing these diets such as cutting boards that have measurement lines on them, or commercial food processors with blades that aid in the chopping and dicing of foods to the appropriate particle sizes.”


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In conclusion, if you haven’t heard what the benefits are to adopting the IDDSI Framework at your Senior Living community, Arguello-Thomas discussed the benefits of adopting the IDDSI Framework with Kramer.

“In my opinion, the first and foremost benefit is resident safety. A lot of research has been invested in developing the IDDSI Framework and adopting IDDSI demonstrates a commitment to improved processes that will help decrease the likelihood of choking risk to residents with dysphagia. So, from a risk mitigation standpoint, I think that’s also very important to providers. Another benefit is having valid measurement techniques to utilize at the community level. And with the staffing challenges our industry is experiencing, it will be extremely helpful for consistency to exist among chef and caregiver knowledge with IDDSI.”

This podcast is the first in a series of upcoming webinars, podcasts and trainings to help with a smooth transition to IDDSI. To hear the interview yourself, listen here or on the Health Care High Wire episodes page!

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