Table 1.

Codes of Resident Nonverbal behaviors in Part III of CUED

Codes		Definitions
Resident Positive/Neutral Behaviors
1.	Using hands to eat or taking over attempts to eat or drink	Resident uses hands to eat or to take over the eating/drinking activity which was initiated/dominated by staff. This includes eating food without a utensil with or without staff’s assistance; and code every time you see its occurrence. This code can be used if resident picks up food item from tray or from their bib.
2.	Leaning forward	Resident’s upper body moves toward or closer to the table and/or feeding assistant.
3.	Affirmative nodding	Resident nods head as a sign of approval, encouragement, interest, or indicating “Yes” to staff’s assistance, request, or question.
4.	Wiping away oral spillage or drool	Resident cleans any oral spillage or drool from his/her mouth, face, hand, body, bib, or clothes.
5.	Indicating end of meal	Resident informs staff of the unwillingness to continue the meal and indicates the status of “done with the meal/food” (e.g., waving hand “no”, non-affirmative nodding, taking off bib, standing up trying to leave the dining table/chair).
Resident Challenging Behaviors
A.	Chewing/Swallowing Difficulties
1.	Leaving mouth open allowing food falls out of mouth (passive)	Staff has placed food/drinks in the resident’s mouth, but resident does not swallow food/drinks but rather, allows the food/drinks to fall out of his/her mouth.
2.	Prolonged/continuous chewing/sipping	Resident chews food or sips drinks for ≥ 10 continuous seconds without swallowing. Start counting in your head when food goes into the resident’s mouth (e.g., count as “1, one thousand; 2, one thousand; 3, one thousand; 4”; and so on). If they are still chewing by the time you get to 10, use this code.
3.	Doesn’t chew/swallow (holds food in mouth)	Staff has placed food/drinks in the resident’s mouth, yet resident does not appear to be chewing or swallowing the food/drinks. Start counting in your head when food is in the mouth. If resident is still holding food in the mouth without chewing and/or swallowing by the time you get to 10, use this code.
4.	Coughing, choking, or gaging on food	Resident coughs or has difficulty in breathing and speaking after taking a bite of food or drinks. This is usually because of a constricted or obstructed throat with food or a lack of air.
B.	Functional Impairments
1.	Difficulty using utensil properly	Resident holds or tries to use a regular/adapted utensil to handle food on the plate (e.g., holding utensil, using utensil to locate and scoop food), and is having trouble to get food from plate to utensil (preloading food), before moving to mouth.
2.	Difficulty transporting food to mouth	Resident has problem with moving food/preloaded utensil through to mouth area and/or putting food into the mouth. This may occur during the process of getting food (in hand or preloaded utensil) to mouth.
3.	Contracture/Limited Range of Motion	Resident has an obvious hand or arm contracture, or when staff is met with some resistance to moving resident’s hand/arm through an intake cycle due to limitation in range of motion.
4.	Taking empty utensil/container to mouth	Resident moves empty utensil/container/hand to mouth, acted as food/drinks was in there.
5.	Spillage	Resident is holding utensil or food/drink item. Food unintentionally falls off the hand/utensil due to resident’s inability to maintain food in the hand/utensil, or resident spills part of or their entire drinks.
6.	Drooling	Resident’s saliva or food falls out from the mouth. This is not necessarily associated with food.
C.	Resistive Behaviors
1.	Doesn’t open mouth (when mouth is empty)	Staff is offering food or drinks, and the resident doesn’t open mouth to receive the food/drinks (e.g., food or beverage item is very close to resident’s mouth, and resident does not open to receive).
2.	Biting the utensil (when food is offered)	Resident holds the utensil tight between teeth and does not let the utensil get into or out of the mouth.
3.	Turning head away/tilting head backward	Resident turns head away or moves head upward facing upper level or the ceiling when food/drinks offered.
4.	Leaning backward	Resident’s upper body moves away from the table and/or feeding assistant.
5.	Pushing away help/food	Resident is engaged in this movement. Resident does not intend to do any harm, just pushes away assistance or the tray to signify they do not want what is being offered at that time. This could also be that the staff is offering a food/drinks item, and resident is engaged in the action but is preventing staff from moving the food/drinks item towards their mouth.
6.	Spitting out food	Resident purposefully ejects food or drinks from the mouth into their own hand, into a napkin, or into the utensil, or at the staff due to the following reasons: ∘ Doesn’t seem to like food/texture – (passive) ∘ Intentionally spits food–(aggressive)
7.	Non-affirmative nodding	Resident is nodding head from side to side to indicate “No” non-verbally.
8.	Disengaging from meal	Resident stops chewing or eating due to the following reasons. Only use this code if any of the following behavior lasted for ≥ 5 seconds: ∘ Closing eyes – Resident seems alert but closes his/her eyes. ∘ Distraction – Resident has difficulty maintaining attention to the meal due to a distraction. Resident is looking around, being attracted by some noise/object/activity/people, and not attending to the meal. ∘ Falling asleep/become drowsy – Resident has difficulty maintaining alertness and/or falls asleep during the meal ∘ Lack of response – resident does not respond to staff assistance, or the food/drinks being offered
9.	Playing with food/utensil	Resident does something with food/utensil rather than eating food or using utensil for eating
10.	Taking food from others	Resident grasps food/drinks from other resident’s plate or tray at the table using hand or utensil. This include the occasions that the resident takes others’ food intentionally (i.e., resident purposively take other’s food/drink items to consume) or unintentionally (i.e., resident does not know which food/drinks is his/hers, and just takes whatever she/he can reach out to).
11.	Attempting to eat inedible object	Resident tries to grasp non-food items and put to mouth to taste and/or eat.
12.	Attempting to leaves the table	Resident gets up and leaves the table before meal is done.