Dysphagia & inclusive dining options for young and old.

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SAVOURY BAKED CUSTARD WITH BACON PARMESAN & FRESH HERBS -

Dysphagia & inclusive dining options for young and old.

Savoury custards I don't feel get enough recognition in the realms of dysphagia dining. They're so incredibly comforting - silky and luxurious, they're just so yum! Steeping is an incredible way to reintroduce flavours that may be somewhat lost when we loose the ability to swallow "regular" textures safely. Today I'm sharing my Savoury Baked Custard with Bacon, Parmesan & Fresh Herbs recipe - perhaps this is something you could try? Its the kind of dish that bridges the gap between textured & regular cuisine - almost everyone on PU4 through RG7 diets could enjoy this dish and its so simple to make. This could be easily created at home for an inclusive dinner dish and REALLY simple for a progressive cafe, bistro or restaurant interested in providing meal options for some of the 500 million people world wide living with dysphagia. The reality is - not everyone who deals with swallowing difficulties are elderly and/or residing in care homes - both young and old are out in our communities, they're suffering silently, unheard and somewhat un-catered for. They too deserve beautiful food options and should be able to partake in the simple pleasure of dining out with family & friends

Serves 4

Ingredients

2 cups Full Cream Milk

3 large eggs

2 egg yolks

100gm Streaky Bacon

3 Sage Leaves

1 Sprig of Thyme

4 Chives

2 Garlic Cloves

1 Parmesan Rind or 30gm Parmasan

Salt

Pepper

Modification Utensils

Nil

Steps

  1. In a fry pan cook bacon strips until they develops colour.

  2. While the bacon is cooking place milk, herbs & garlic cloves (bruise these to release flavour) parmesan, salt and pepper into a saucepan. Once the bacon is browned, transfer into the milk infusion mix.

  3. Over a low to medium heat bring the milk to a gentle simmer. Once this occurs, remove from the heat, set aside and steep for 30 min.

  4. During this time pre heat oven to 160 degrees and boil kettle

  5. Once milk infusion has steeped for 30 min, strain through a sieve.

  6. Whisk the eggs then slowly pour in milk infusion - while continuing to whisk

  7. Pour custard mix into individual ramekins and place in a baking dish. Pour boiling water from the kettle into the baking dish until 50% full to create a water bath

  8. Carefully place baking dish into the oven and bake for 15-25 min or until custard is just set.

  9. Carefully remove from the oven and set aside to cool for 5 to 10 min before serving.


Get adventurous - what other yum flavour profiles can you dream up? 

Texture Modified Food Solutions is running workshops Australia wide. Upcoming workshops in Perth 15.10.19 & Avondale Victoria 29.10.19 on sale now through https://texturedfoods.com/class-bookings 

For enquiries, private workshops, group bookings and events you can contact us at info@texturedfoods.com.au

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Fear - Drowning out your voice?

Taking a side step here with this blog post….

Last week I was engaged in conversation with a young gentleman who said to me “You’re so brave putting yourself out there and doing what you’re doing.” I was quick to say that I really wasn’t and perhaps just slightly mad……..But it really got me thinking

Failure is a pathway to evolution - through failure we learn. It's what we do with that experience that truly matters. 

One of the most valuable lessons (through failure) I've learnt in the last few years as a young(ish) woman out on her own is this; 

Don't let your voice & inner voice fail you. Do not drown it out if you truly believe in what you're doing.

I didn't have the confidence to use my voice or follow my instincts out of fear. Fear of loosing my job, fear of not being able to pay my rent, be able to afford my bills, put food on the table, you know real world fears! Then I realised - to me, the only thing scarier than all that was not sharing & not helping to bring about change. 

It was a risk, it still very much is! But it's a risk I was/am willing to take - because I believe in what I do wholeheartedly. 

Don't hide your passion, drive or enthusiasm for what you do because the others don't believe. These might be the people you work for, maybe friends, perhaps your family, sometimes it's industry colleagues or the general public. It's okay that they don't understand, but don't let it hold you back. 

Stay true to your message, your ideas & be integral in what you believe. Keep your eyes and ears open, grow, learn, beware the wolves in sheep's clothing. Ignore the laughs, ignore the snide remarks, the whispers, eye rolls and the gossip. These only designed to distract. Don't fall into the trap. Rise above it and own what you do and why you do it. 

Empower rather than tear down, share honestly and openly, be kind, be grateful and above all be you. 

You will never be everyones "cup of tea" and thats okay!

Texture Modified Food, The 4 Shades of Brown - A Cooks Story

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!

Why Are we Forgetting the Flavour? - Aged Care and Hospital Food

I’ve been circulating the Aged Care Circuit for a little while now, speaking directly with CEOs, Food Companies, Dining Experience Experts, Equipment Manufactures, Clinical Staff, Chefs, Cooks, Carers, Caterers, Individuals of all ages with dysphagia & swallowing difficulties, Speech Pathologists, Residents and their Families and the thing that keeps coming up is the lack of clean identifiable flavour in texture modified foods, textured food options and the fact everything tastes or smells the same.

What I've noticed, and correct me if I'm wrong, I see a great deal of kitchens doing a great job at achieving the correct texture level for their consumers...this is wonderful and keeps them safe - Though the issues I see and question stem from the following :

How does the modification taste?

How does it smell?

How has the modification been enhanced and fortified to incorporate beautiful flavour?

Are these modifications created purposefully for the texture modified diets or are they created from leftovers that have been held for 1 hour plus in Bain Maries and hot boxes?

Always Potato flake as a thickener?

Cooking and holding times & what does the food look, smell and taste like when it reaches your residents?

Ask yourself and be honest...would I eat that? 

What if texture modified food was my only option, my only choice...how would that affect my quality of life? 

This is the reality for so many that we feed AND WILL BE the reality for so many of us as we age.

There are so many simple things we can do right now to remedy some of these issues. To create your modified meals with the purpose to inspire and delight your consumers.

  1. Don't mass modify "manky" leftovers - the nutritional content is all but gone from the long holding times not to mention the flavour! No human being residing in a hospital or care should ever be fed a diet souly of leftovers from previous meal services... This is completely unethical, undignified and just "ick".

  2. Minimise cooking times - eg. blanch peas, corn, spinach to retain colour, flavour and nutrition. Taste your mods as you blix them...does it require more seasoning, could some sautéed onion and garlic lift this dish? Feta, ricotta, butter, mint jelly, cheese sauce, cream, stock, butter, reductions does it require some sweetness or some acid to lift the dish? Flavour isn't rocket science...its what we are trained to create as Chef and Cooks, texture modifications should never be an acceptation.

  3. Don't be frightened of trying new things. You guys are talented and capable, think outside the box. We can modify mushrooms, peas, corn, chickpeas, legumes, artichoke, pineapple, beans, fennel, some nuts & seeds and modify these very successfully it just requires an additional step in our mod process. Sieving...We need to be finding ways to reintroduce flavour and food options, not continuously eliminating them.

  4. Thickening with potato flake- this makes everything taste the same...its the same concept of the instant brown gravy we see/saw (pre IDDSI) being served on every meal regardless of suitability. If modifications are too viscous I'll often use things like chickpeas, legumes, ricotta, cashew nuts, roast vegetables that compliment the puree being crafted to thicken the consistency. In some cases i'll use a touch of xanthan gum or Resource Thicken Up to assist. Potato flake isn't always the only option. Perhaps you could try some of these solutions?

  5. Heat modified meals in the combi on steam 15 to 20 min before they depart for the dining room if sending hot as to maximise the nutrition, colour, aroma and flavour.

We all know the rates of malnutrition in the Aged Care Sector are sky high. We can help combat this by looking at our cooking processes. We CAN create modified meals that look appealing - without the use of food moulds & shaping powders if they aren't within your budget. We CAN create beautiful flavour that will encourage consumption & surprise and delight our consumers. We CAN offer a genuinely dignified dining experience at meal times. WE CAN and eventually WE WILL succeed... after all, we are talking about real people, real people whom have been entrusted into our care. Let's do the right thing by them. 

There are so many beautiful providers out there doing incredible things and achieving, but there are many that are still struggling...

QUALITY OF FOOD, QUALITY OF LIFE & DIGNITY GO HAND IN HAND REGARDLESS OF AGE & SWALLOWING ABILITY.

WE CAN ALWAYS DO BETTER

WE WILL DO BETTER

WE MUST KEEP STRIVING

Industry Classes & Collaboration - Its time to creating real change

Are you working at ground level? Responsible for feeding those with dysphagia and swallowing difficulties? Do you work in aged care? A hospital? Perhaps in the disability sector? Are you and the ones charged to your care frustrated by the lack of food options and clean exciting flavour profiles for textured diets? 

We want to share our techniques and ideas, we want to collaborate & are now taking registrations of interest for hands on industry classes Australia wide! These classes are open to anybody who wants to improve the quality of texture modified food, who want to bring back flavor, excitement, love, joy and respect to mealtimes. This is a shout out to all of you who what to create change, to show the vulnerable that we do care and their food does matter, that they're meals aren't an afterthought, they are a priority.....To register your interest email us at info@texturedfoods.com or visit our website www.texturedfoods.com and reach out. Together we can start to create real change......

Aged Care & Hospital Cuisine - Gravy and Sauce

When creating texture modified meals getting clean, identifiable and tasty flavours is one thing, but what about the sauce and gravy? How can we create sauce options that are delightfully rich and that compliment these meals? 

I often hear the same issue coming from care home and hospital kitchens. 

 

“We don’t have time” or “we don’t have the budget” to do this or that….

 

Whereas I often hear from residents, families and care staff that the sauce options and gravy are always the same regardless of the meal being served, mostly instant & often flooding the plate. 

 

So I thought i’d share some of the super simple solutions I used to overcome these issues!

 

Firstly, sending sauce/gravy out in small jugs to be poured onto textured meals at the table in front of the resident or patient. This gives them the control to communicate more, less or none at all, it also adds a lovely personal touch to meal times.

 

Secondly, cooking off meat and homemade sauce or gravy in one pan. It’s something as cooks we all know how to do, however when we’re under pressure in the kitchen, monitoring diets, timing, paperwork, compliance, staff, rostering, ordering etc. we sometimes forget some of these simple techniques. 

 

Perhaps you could try some of the following?

 

When roasting pork arrange sliced apples, pears, onion, herbs, garlic, wine or balsamic vinegar, brown sugar and stock in the base of the pan. Place the roast pork on top and cook as per normal. Once the pork is cooked, set it aside and pour the pan juices/braising liquid into a pot, adding additional stock if necessary, stick blend until smooth, then thicken with flour or suitable gravy powder and cook over a medium heat on the stove. 

 

An alternate base I love to use for pork is stone fruit opposed to the pears and apples, a touch of star anise and ginger also adds a beautiful flavour profile to this sauce. Remember, use what’s in season it keeps costs down, look at what you have on hand.

 

You can apply the same principles to roast lamb, chicken, turkey & beef using suitable flavour profiles for braising. 

 

For casseroles, I set aside half a jug of unmodified casserole, add additional fluids and flavour enhancers such as stock, cream, wine, herbs, garlic and a touch of gravy mix or flour, stick blend until smooth and finish the sauce on the stovetop….

 

Deglazing pans is also a great way to create quick sauce options

 

How about a smooth basil pesto combined with a touch of cream perhaps? 

 

Gorgonzola cream sauce?

 

What about creating chutneys and relishes from seasonal produce? This is always a big hit! Puree these down to create something a little different & surprising! 

 

With a little forward planning and thought, creativity and love we can make some incredible sauce options to compliment the meals we create for the individuals we feed. 

Tips For Enhancing The Flavour Of Texture Modified Foods

Below are some of the basic, affordable and accessible flavour enhancing techniques I use when creating texture modified meals…..And yes, its all very simple!

Roasting vegetables to intensify flavour

Butter! Butter is your friend! Garlic butter, herb butter, burnt butter, infused butter even plain regular melted butter adds the additional calories our residents need…..and lets face it….butter tastes AMAZING!!! 

Feta purees down beautifully with complimentary vegetables – try peas, spinach, beetroot & avocado. 

Infused Oils – Fry off garlic & lemon zest & fresh herbs in olive oil and add this to green beans – its delish!  Side note – when using blanched frozen beans squeeze excess fluid and reintroduce any required moisture using stock.

Mint Jelly to pea puree – Avoid using a vinegar based mint sauce, the acid continues to ‘cook’ the peas causing them to discolour.

•Season roast vegetables with complimentary herbs and spices suitable for modification and never under estimate the power of simple salt and pepper!

•Cashews, peanuts, pine nuts – cashews pureed down with fresh cooked beetroot, salt, pepper & lemon is absolutely incredible. 

Legumes! Lentils, chickpeas, split peas etc. the nutritional benefits are endless!

•Liquids-When adding liquids to purees, use stock, milk, cream, juice, yoghurts etc. rather than water 

•Sauces- Dijon/mustards, honey, chutneys, jams, fruit paste, ricotta, wine, verjuice, balsamic etc. can all be used to create fun and interesting flavour profiles. Sauce and gravy should compliment and enhance meals, not mask…..

Remember to consider flavour ratios on the plate

Creating Dining Options For Those With Dysphagia?

With recent studies finding that over 500 million people worldwide struggle with dysphagia, I continue to wonder why more isn’t being done to ensure these individuals have access to delicious, nutritious and interesting food. With so many in need why are there so few dining options available?

 

Socialising and eating go hand in hand. For most of us this is a pleasurable and joyful experience. However, this simple joy is often lost to those with swallowing issues. All too often, these people lock themselves away at home avoiding social situations that involve dining out, eating or just food in general. 

 

With 1 in every 17 Australians dealing with swallowing disorders, wouldn’t it be wonderful if these people could partake in dining at restaurants or cafes with friends & family knowing that they had food options available? We are able to cater to a vast range of dietary requirements and here in Australia we do it so well! We have one of the most exciting food cultures in the world! Perhaps now need to start expanding our minds to Texture Modified Cuisine. 

If you are the proprietor of a progressive, forward thinking café or restaurant, an innovative cook or chef who feels they have the ability to start bridging the gap, we want to help! Feel free to contact us through our website www.texturedfoods.comor email info@texturedfoods.com we would love to hear from you!