6.3 Assisting with Eating

An important part of the Health Care Assistant’s job is to assist clients with eating. This may include planning and preparing meals, shopping for ingredients, serving food, and assisting with eating. Eating habits and nutrition can be affected by a number of diversity factors, such as culture, personal choices, religions, allergies, finances, aging, and illness.

Food and nutritional decisions are influenced by culture, religion, and belief systems. How and what food is prepared depends on diverse preferences and practices. For example, in some cultures, beef is not commonly eaten. As an HCA, it is important to understand the food preferences and diverse backgrounds of your clients to ensure you are offering person-centred care.

Supporting older adults to meet their dietary needs requires you to understand the effects that aging has on clients’ appetites. Physical changes, vision, hearing, and poor-fitting dentures can all affect their ability to eat. Other factors from chronic illnesses, such as arthritis or cognitive impairments, can impact their control of eating and mealtime.

Considerations

HCAs can provide a pleasant atmosphere during mealtime by ensuring there are no unpleasant odours. Empty trash cans and remove urinals or bedpans from sight. Offer to assist the client to the bathroom and perform oral care prior to eating to make mealtime more comfortable. Ensure clients who wear dentures have them in their mouths prior to eating. This allows the client to better chew and digest their food.

Clients should always be in an upright position during mealtimes. This helps to prevent choking. For clients with swallowing or choking difficulties, they should be kept in an upright position for 30–60 minutes after their meal is complete.

Some clients may only need assistance with preparing food as they are able to eat independently. Many types of adaptive equipment, such as special plates, cups, and eating utensils, are available to help people be as independent as possible while eating. Other clients require complete support during eating, and the HCA will need to assist the client to eat. You should sit next to clients while assisting with eating and offer to keep those who are independent company. Mealtime is a good time to get to know clients. Clients who prefer to pray or have religious or spiritual practices before meals should be allowed to practice these rituals. Give privacy as appropriate and requested (McLain, et al., 2018; Sorrentino, et al., 2019).

HCAs should offer foods that are appealing to their clients, and allow them to choose the foods they would like to eat, as appropriate. Follow care plan guidelines when preparing special diets.

Assisting with Eating

Table 6.3.1 Procedure: Assisting with Eating
STEP ACTION REASON
1.
  • Inform the client that it is mealtime.
  • Provide choices about foods.
2. Perform hand hygiene. Prevents the spread of infection.
3. Assemble equipment needed, such as:

  • bowl
  • plates
  • cup
  • eating utensils
  • napkins
4. Prepare the client’s environment by ensuring there are no unpleasant odours or sights. Makes meal time more enjoyable.
5.
  • Offer oral care prior to eating.
  • Assist with applying dentures.
  • Assist or encourage the client to put on glasses so they can see their food.
 Enhances the taste of foods, helps clients chew more effectively, and lets them see what they are eating.
6. Position the client in a high upright sitting position. Prevents the client from choking or aspirating food or fluids.
7. Allow the client time to pray before eating if they wish. Respects cultural preferences.
8. Arrange food attractively on the plate. Enhances mealtime.
9.
  • Encourage the client to do as much as they are capable.
  • Assist only as needed.
 Maintains independence.
10. Cut food into small, bite-sized pieces if the client is unable to do so.
11.
  • Place a napkin under the chin or a cover-up over the chest.
  • Replace soiled napkins as needed.
12. Inform the client of food temperatures, especially for hot food. Prevents injury.
13.
  • Use a fork and spoon gently when fully assisting the client to eat.
  • Never force food or fluids into a client’s mouth.
 Prevents injury, choking or aspiration of food or fluids.
14. Allow adequate time between bites before offering the next bite. Prevents choking or aspiration of food or fluids.
15. Encourage the client to chew food well before proceeding to taking the next bite. Prevents choking or aspiration of food or fluids.
16.
  • Sit next to or facing the client if assisting with eating or while providing company during mealtimes.
  • Allow the client to eat alone if they prefer.
  • Check on them every 5–10 minutes.
 Mealtime is a good time for HCAs to get to know their clients. Make eating time a pleasurable experience.
17. For clients who have difficulty swallowing, HCAs should limit their conversation while the clients are chewing. Prevents choking or aspiration of food or fluids.
18.
  • Encourage, or assist, if needed, wiping off the mouth or face.
  • Use straws or training cups as appropriate to allow ease of drinking and promotion of independence.
 Special plates with guards, and padded eating utensils, helps to promote independence.
19.
  • Remove uneaten food, liquid, and soiled dishes once the client is done eating.
  • Clean the client’s area and all used dishes.
20. If the client has swallowing problems, keep them in an upright position for 30–60 minutes after eating.
21. Offer hand and mouth hygiene when the client has finished their meal.
22. Wash and dry your hands.
23. Document and report any chewing or swallowing problems, changes in appetite, and amount of food eaten and fluids taken in as intake.

Assisting a Client with Dysphagia

Table 6.3.2 Procedure: Assisting a Client with Dysphagia
STEP ACTION REASON
1. Review the client’s chart to identify:

  • The presence of a therapeutic diet
  • Medical considerations (e.g., cardiovascular accident, Parkinson’s disease, neurological disease)
  • Aspiration precautions
  • Need for or level of assistance
  • Other client specific considerations (e.g., glasses, dentures, hearing aid, table allocation, assistive devices)
 Ensures you are following the correct dietary plan.
2. Perform hand hygiene and gather required equipment if necessary. Prevents the spread of infection.
3. Prepare tray and meal area. Check for:

  • correct diet
  • need to add thickener as ordered
  • utensils
  • napkin
4. Observe the client. Watch for:

  • Signs and symptoms for dysphagia:
    • Gurgling or wet or change in voice
    • Coughing while eating
    • Drooling during a meal
    • Food pocketing in the cheek
  • Comprehension
  • Ability to assist:
    • Monitor throughout the meal
    • Need for assistive eating utensils or dining aids
  • Position:
    • Sitting upright
    • Head slightly tilted forward
    • Chin tucked down while swallowing food
    • Supportive devices as required
 Ensures there are no additional or underlying issues that would put the client at further risk of choking.
5.
  • Offer oral care prior to eating.
  • Assist with applying dentures.
  • Assist or encourage the client to put on glasses so they can see their food.
 Enhances the taste of foods, helps clients chew more effectively, and lets them see what they are eating.
6. Position the client in a high upright sitting position. Prevents the client from choking or aspirating food or fluids.
7. Allow the client time to pray before eating if they wish. Respects cultural preferences.
8. Arrange food attractively on the plate. Enhances mealtime.
9.
  • Encourage the client to do as much as they are capable.
  • Assist only as needed.
 Maintains independence
10. Cut food into small, bite-sized pieces if the client is unable to do so.
11.
  • Place a napkin under the chin or a cover-up over the chest.
  • Replace soiled napkins as needed.
12. Allow adequate time between bites before offering the next bite. Prevents choking or aspiration of food or fluids.
13. Encourage the client to chew food well before they take the next bite. Prevents choking or aspiration of food or fluids.
14. Observe and evaluate the client eating

  • Use small ½ teaspoonful bite-size amounts.
  • Encourage a minimum of two complete swallows to clear food before the next spoonful.
  • Check for pocketing (with tongue depressor, pen light and gloves).
  • Provide prompting, encouragement and direction as needed.
 Prevents choking or aspiration of food or fluids.
15. During the meal

  • Promote independence and autonomy.
  • Create a social environment:
    • Acknowledge client’s preferences.
    • Minimal communication while the client is eating.
 Special plates with guards, and padded eating utensils, help to promote independence.
16.
  • Remove uneaten food, liquid, and soiled dishes once the client is done eating.
  • Clean the client’s area and all used dishes.
17. Keep the client in an upright position for 30 minutes after eating. Prevents regurgitation and risk of aspiration.
18. Offer hand and mouth hygiene when the client has finished their meal.
19. Wash and dry your hands
20. Document and report any chewing or swallowing problems, changes in appetite, and amount of food eaten and fluids taken in as intake.
Review Questions

Self Check Activity Unit 6.3 – True/False

  1. It is very important for a client with a swallowing problem to be in an upright position during mealtime and to be kept upright for 30–60 minutes after eating to prevent choking.
  2. It is okay to pull all the food items together in the blender instead of blending each separately when preparing a pureed diet for a client, as this saves time.

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Personal Care Skills for Health Care Assistants - 2nd Edition Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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