CHST- Mealtime Assessment Tool

Difficulties with Meal Time Behaviour
Observed behaviour / Tick if applicable / Suggestion for dealing with behaviour / Initial and date / Comments
Slow eating and prolonged mealtimes. / Serve food on warmed plates.
Give small portions and offer second helpings or consider giving the person 5 smaller meals per day instead of 3 larger ones.
Eats too fast. / Serve one item at a time; high calorie/high protein first.
Hoards, hides or throws food/plays with food. / Consider monitoring/observing at meal times, verbal cues to eat or removing items if necessary. Keep the number of items on the table to a minimum.
Verbally refuses to eat or states “no more”, “finished” or “not hungry”. / Remove meal for 5-10 minutes,keep warm then serve again. Investigate cause i.e. food preference.
Interrupts servers or wants to help. / Give the person a role in meal service e.g. setting up table/pouring water. Ensure adequate staff at meal times.
Demonstrates impatient or agitated behaviour during or before meals. / Serve their meal first.
Minimise waiting time.
Allow them to eat where they feel most comfortable/relaxed.
Unable to sit still for meals/easily distracted. / Minimise distractions e.g. turn radio/tv off. Separate residents that require help. Use simple plates with colour contrast between plate and table. Verbal or manual cues by carer e.g. placing cutlery in hand and prompting to eat/drink. Finger foods may be appropriate. Making the room calm and quiet, ensuring the person has everything they need before sitting comfortably (e.g. has been to the toilet, has their dentures, hearing aid etc.)
Reduced dietary intake. / Refer to MUST high risk care plan and consider food fortification, extra snacks and nourishing drinks.
Eats other people’s food. / Keep other people’s food out of reach. Sit by and encourage the person to eat from their own plate.
Eats non-food items. / Take non-food items away and replace with food/drink or another distraction. Consider solid teething ring. Make sure diet includes good sources of iron and zinc every day.
Stares at food without eating. / Regular prompting with verbal and manual cues.
Active walking/strolling around home. / Place finger foods in hand to eat on the go (high calorie/high protein types).
Difficulty using utensils/cutlery and oral behaviour
Observed behaviour / Tick if applicable / Suggestion for dealing with behaviour / Initial and date / Comments
Difficulty getting food on to utensils. / Verbal or manual cues/help and assist with feeding. The person may benefit from additional aids/devices. Liaise with OT. Trial finger foods/feeding.
Incorrect use of cup/glass. / Trial non spill cups. Offer a cup with handles/straw. Trial verbal cues.
Spills drinks when drinking. / Offer a smaller amount of fluid at a time in a stable cup with a handle that the person can easily grip or trial 2 handled cup. Frozen ice lollies may help.
Plate wonders off table. / Use suction plate/non-skid mat.
Unable to cut up meats. / Provide cut meats, soft meat i.e. stewed. Knives with rocking movement may help somebody with reduced strength.
Bites on spoon. / Use plastic coated spoon.
Difficulty chewing. / Dental check, check dentures correctly fitted and not loose/missing. Provide a softer diet to chew.
Prolonged chewing without swallowing. / Liaise with SALT, use verbal cues to chew and swallow.
Does not chew food before swallowing. / Use verbal cues to chew. If choking is a hazard then liaise with SALT and consider puree diet.
Holds food in mouth. / Use verbal cue to chew. Massage the cheek gently. Offer smaller amounts of different foods and flavours.
Spits out food. / Check the food is liked, that the temperature is appropriate and that the food is the correct texture.
Doesn’t open mouth. / Use verbal cues to open mouth. Softly stroking someone’s arm and talking to them about the food can help. Touch the lips with a spoon with desired food on to see if they accept and trial taking drink to lips or use straw.

Care Home Support Team contact details:030 30034347