In April 2018, I was offered the roll of Chef Manager at a dementia specific care home in Perth Western Australia. It was explained by my manager, as the care home was undergoing expansion the kitchen was located in a 20ft sea container. As my background in catering was largely in remote work, the sea container kitchen suited me fine! I was both nervous and excited to be taking on this new roll.
Having no preconception as to what ‘aged care’ cuisine was, I quickly discovered during training, there were a number of areas that required improvement. Particularly cooking and holding processes, especially when it came to texture modified cuisine. The break neck speeds that leftover and/or overcooked vegetables were placed in a Robot Coupe Blixer and modified with little more than some butter didn’t feel right so I started asking questions.
Approaching my employer I asked who do we have that’s incredible at texture modified meals? I’d love to speak with them, get some ideas & information on how to do this better. I was told that unfortunately due to the lack of freezer space (we had 2 house hold freezers already packed to capacity) at our home so shaping moulding wasn’t really an option for us. Some of their suggestions were to use little ramekins, make roulades etc. which were some really cool ideas!
I started looking for outside resources & individuals to reach out to for ideas, again with very little luck. People were reluctant or too busy to talk to me and again the only solution being offered up by the few that would engage was Food Moulding - It wasn't until much later on when I started looking on Linkedin I came across amazing people (Just to name a few) like Andrew Dunne, Dysphagia Chef & the crew at Oak House Kitchen. - If you haven't already seen their work I strongly recommend you check them out.
A month or two into my employment, I was circulating the dining rooms during lunch service chatting with residents, families and care staff. Regularly I saw residents during these rounds on texture modified diets staring blankly at their plates unwilling to eat. Care staff trying their hardest to coerce them to consume their meal... This when I came across Mrs J.
Mrs J had recently been placed on a (then texture c) diet while her new dentures were being crafted. She was crying, looking at her uninspiring texture c (level 4) scoops of orange, white, overcooked green & protein in a lip plate. Kneeling down next to her I asked her if she was okay. Her response was expected - she absolutely gave it to me....
“This looks awful, I can’t eat this, I just want some nice food.”
And then the words came that would haunt me, and will drive me for the rest of my career...
"What did I do to deserve this?!"
Ashamed, I promised her I would do everything I could to make it better. I returned to the kitchen, admittedly quite teary, (I may have hid in my car and cried for solid 15 min) I’d completely let our Residents down- some of the most vulnerable people in our community. Shaping and moulding can’t be the be all and end all, can it? What resources do we have? Piping bags, plastic piping nozzles, cling wrap, & some imagination.
So, for dinner service that evening, the texture modified components were piped into the lip plates, wrapped and placed in the combi oven and sent out for service. Unfortunately, due to holding in the combi for too long, it didn’t hold form very well.... The focus was then on heating time to maintain shape and form whilst reaching the required temperature.
Over the coming weeks, I kept questioning & pushing myself. The food we were producing was still not "right" the plates still looked sad, flavour wasn't there, the food smelt strange and the food experience for our Residents was still overwhelmingly "brown" we could do better. I was falling far short of "nailing it"
Why are we only modifying orange, green and white veg? Why not other funky, cool colourful vegetables? Why aren’t we maintaining colour and flavour? What can we use to additionally fortify textures with real food? Why not enhance flavours with easy to access affordable ingredients? How can we make ingredients that aren’t currently being texture modified safe to consume? How do we bring enjoyment and a bit of theatre back to meal times for these individuals enduring in silence? Why are their meals treated any less important? Why is flavour sacrificed? All of these questions needed to be answered.
Very quickly as this system started to develop (and continues to do so every day), each issue troubleshot, we were finally having some success! Our residents on texture modified diets began consuming more to all of their meals with much less cohesion. Care staff weren't recoiling at the site of the TM meal they were about to feed their Residents, Residents on regular diets were excited to see the TM meals being delivered & served in dinning rooms, feeds became more an exploration of flavour, not a "a shovelling exercise" as it was once described to me ( NOTE : feeding should NEVER be a shovelling exercise - regardless). The feedback from residents, staff and families became overwhelmingly positive, the impact this had - I could never have imagined….
Quite often family members would pop by the sea container kitchen and ask
"What was in the beetroot puree today? Could I have the recipe?"
" The colours on Mum's plate today were gorgeous"
"What was in that sauce? It was delicious!"
"Mum's lunch smelt and looked delicious"
As a Cook my heart and head became somewhat at peace - I knew I was doing everything I possibly could for our residents with the resources available at that juncture....
But what about everyone else? The other Cooks and Chefs who are lost, unsure, fearful of trying new things, unsure of what they can do, wanting to do more for their Residents? Those who don't have access to food moulding - who need something, an immediate solution the can start doing right now? Who is supporting, empowering and sharing practical skills with these people on the ground?
It was around this time that I received a message through one of my social media channels from The Maggie Beer Foundation wanting to discuss the work. I remember staring at the message in disbelief (initially I thought perhaps someone might be toying with me) but on further investigation the message was legitimate. After a number of meetings, emails and a tasting session a beautiful relationship began to form and I was invited to attend as a presenter at "Creating an Appetite for Life" in Melbourne. To share and learn from each other openly to improve quality of food and life for those in care is something thats so desperately needed by our sector. Food is one of the ultimate pleasures in life, that doesn't need to cease when our elders enter into care.
As we all know, the aged care sector is under the microscope, I don’t feel that as an industry, Chefs and Cooks don’t care about TM cuisine, I believe that kitchen staff feel somewhat helpless. Lack of training in creating delicious TM cuisine is a very real issue.
Texture Modified Cuisine can be fun fabulous and delicious! We CAN reintroduce flavours that have been lost to many for years, We CAN create excitement and desire to eat again. Food is one of the greatest pleasures in life and it still can be for those with dysphagia. If we as Chefs and Cooks simply switch our thoughts from what we can’t do/ don’t have to what we can do, this has the power to transform not only meal times but lives.
It’s time for all of us to make every resident feel loved, included, respected and cared for through the food we serve them.
To the Cooks, Chefs & Care Providers - Don't be scared of sharing the beautiful things you're doing to provide lovely food options and dining experiences to those in your care.
Together through sharing we can make the institutionalised 4 Shades of Brown a thing of the past.
Texture Modified Food Solutions & www.texturedfoods.com was established to support Cooks, Chefs and Carers to provide fun delicious food options for those we care for.
We are hosting our next Public Workshop in Perth WA on the 15.10.2019 & in Melbourne VIC on the 29.10.2019. We would love for you to join us!