TABLE 4.

Summary of foodservice changes in TMD provision between pre- and 6 mo postintervention¹

Category	Pre-intervention	Postintervention	No. of sites
Dietary variety	No suitable light meal (dinner), teatime options for MM and PU	Was able to modify the teatime options following IDDSI guidelines for all TMD levels	4
	Only have supplement/smoothies/yogurt for MM and PU at teatime	Added options by using a combination of commercial packaged PU dessert and freshly made modified snacks	4
Texture	Commercially packaged MM and PU meals were too sticky	Added thickened gravy to help achieve the correct consistency	2
	Meals/desserts were not cut into suitable sizes for SB	Meat, vegetables, and cakes were cut into appropriate square pieces in the kitchen	3
	The soup was not blended to smooth texture before serving to MM and PU residents	The soup was blended to no lumps; otherwise, was not served to PU	2
Thickened fluids	Used thickened powder or gum as thickening agents without mixing properly; lumps in the drink	Changed to alternative products (liquid thickening agent or branded thickened powder)	2
	Unsure about resident thickened fluid level, and no standard measurement tool or mixing proportion methods	Resident requirements were printed and posted in the dining room; thickening powder/liquid came with a standardized scoop/pump; staff were able to look up and follow mixing instructions	4

¹IDDSI, International Dysphagia Diet Standardization Initiative; MM, minced and moist; PU, puréed; SB, soft and bite-sized; TMD, texture-modified diet.