Dining and Meal Service

For many people, dining is about more than just satisfying nutritional needs. It is also about the social and cultural aspects of sharing a meal with others. The type of food served and the people who gather for a meal can hold significant meaning. However, the dining experience in a nursing facility (NF) can often seem institutional, lacking a homelike atmosphere that supports both staff and those living in the facility.

As the culture of long-term care moves from a traditional medical model to one that is person-centered and person-directed, there is more emphasis on the individual’s rights, choices, and preferences, including the food they prefer eat, when they want to eat and the dining options available to them. This impacts not only regulatory expectations, but also the facility’s policies, procedures, and how its dietary services department operates in general.

Creating a person-centered dining experience involves more than just providing nutritious food. It means creating an environment that feels welcoming and homelike, with the freedom to choose from a range of dining options. It also means recognizing and respecting each individual's cultural and personal preferences when it comes to food and dining. By doing so, NFs can promote socialization, enhance the quality of life, and support the overall well-being of residents and staff.

Resources Developed by HHSC

Best Practices for Dining and Meal Service (PDF) outlines the key elements of evidence-based best practices for dining and meal services in a NF.

Feeding Strategies for Behaviors Associated with Dementia (PDF) provides suggestions that can help overcome feeding difficulties related to dementia.

Fortified Foods and Oral Nutritional Supplements (PDF) discusses methods for adding nutritional value to a standard menu for people with insufficient intake or who are at risk for malnutrition.

Hand Feeding Tips and Techniques for Persons with Dementia (PDF) discusses ways to assist people with dementia in eating, depending upon their physical and cognitive abilities.

Tips and Examples for Finger Foods Preparation (PDF) provides suggestions for foods that can easily be picked up with the hands.

Meal Satisfaction Survey Example (PDF) can be used to conduct surveys of the people living in a NF regarding their satisfaction with meals and their dining experience.

Resources Developed by Other Organizations

Note: Reference to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement, recommendation, or favor of HHSC’s Quality Monitoring Program or any other state or federal agency.

Nutrition Care Manual® is a professional resource for registered dietitians and nutritionists developed by the Academy of Nutrition and Dietetics. Purchase is required to access this resource.

International Dysphagia Diet Standardization Initiative (IDDSI) is a global organization, promoting standardization of the language used to describe foods with modified textures.

What is IDDSI? This poster provides more information about IDDSI and their initiative.

IDDSI Testing Methods includes videos that describe the various levels of texture and provide testing instructions for each level.

Complete IDDSI Framework 2.0 2019 provides a graphic representation of the various texture levels for both foods and liquids.

IDDSI Food and Drink Classification and Testing poster provides extensive details about the classification and testing of food and liquids based on the texture level.

IDDSI Implementation Guide: Cross Sector Master Guide provides suggestions for implementing the IDDSI framework.

Nurses Optimizing Supportive Handfeeding (NOSH) is an on-line training developed by Melissa Batchelor PhD. NOSH was designed to teach caregivers handfeeding techniques that can be used to improve nutritional intake for people with dementia.

LTC Surveyor Pathways (dining, kitchen, infection control) were developed by the Centers for Medicare and Medicaid Services to guide surveyor observations during a certification survey. These tools can also be used by NFs to conduct self-evaluations in these areas.

Pioneer Network – Dining provides resources for transforming NF dining and meal service through a person-centered approach.