consistency (mechanical soft, pureed, etc.) is dictated by ability to chew
and swallow. Inpatient speech therapy recommendations must be transmitted to the
discharge order sheet, and it is recommended for the nursing facilities' own
speech therapist to reevaluate over time. Many patients who swallow poorly in
the hospital, when they improve in strength can have the consistency
restrictions removed or liberalized.
Type of diet; strong evidence demonstrates that the average nursing home patient will actually do better nutritionally, functionally, and in disease management if they are placed on an average nursing home diet. Specialized diets (low salt or low-fat or diabetic) have not shown to impact disease process in nursing facility based frail elderly, and rather have led to weight loss and malnutrition due to less palatable food. Current recommendations are to place the patient on a regular diet and follow forward, adding specialized diets only when significant failure in control of disease process dictates. When dietary supplements are necessary (Boost, Ensure, etc.), it is best to provide them between meals and at bedtime to preserve patients normal eating patterns at meal time.