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Assisting with
Meals & Fluids

To get all the necessary nutrients, a person needs to eat a variety of foods. No single food or group of foods supplies all the nutrients the body needs. Different types of nutrients include the following:


  • Carbohydrates supply the body with glucose, the body’s most basic source of energy. The most nutritious sources of carbohydrates include whole grains (such as whole wheat bread, brown rice and oatmeal) and fruits and vegetables, because in addition to providing energy, these types of carbohydrates also supply fiber, a substance that helps the digestive tract function properly and lowers risk for heart disease and diabetes. Other, less nutritious sources of carbohydrates include table sugar, white bread, white rice and white pasta.

  • Proteins help the body to build muscle and other body tissue. For this reason, proteins are especially important when a person is healing from an injury or surgery. Proteins are also an important source of energy for the body. Common foods that supply proteins include meat, poultry, fish, beans, eggs and dairy products.

  • Fats are a concentrated source of energy. Fat in the diet helps us to feel full and makes food taste better. Fat also helps the body use certain vitamins more efficiently, helps to keep us warm and protects our internal organs. For good health, however, only a small amount of fat is needed each day, and healthy fats should be chosen over unhealthy ones. Examples of healthy fats include olive oil, canola oil and peanut oil. Examples of less healthy fats include butter, margarine, lard and the fat found in red meats.

  • Minerals and vitamins are small molecules that help to regulate body functions and form cells and tissues. Examples of minerals include iron, calcium, sodium, potassium and iodine. Examples of vitamins include vitamins A, B, C, D, E and K. Minerals and vitamins are found in many different types of foods. Good sources include whole grains, fruits and vegetables, lean meats and dairy products.


People differ in what they eat, when they eat and how they prepare food. As a caregiver, you will play an important role in encouraging those in your care to eat a diet that helps them to maintain or regain health. Knowing about the factors that can affect the choices a person makes about food can help you to respect those choices when you are providing care. This knowledge can also help you identify reasons why a person may not be eating a healthy diet, and take steps to help the person eat healthier. Examples of factors that can affect what and how a person eats include:

  • Personal taste. Each person has certain likes and dislikes when it comes to food. One person may not like green beans, while another may not like chocolate.

  • Allergies and intolerances. Some people may have reactions that can range from unpleasant to life-threatening if they eat certain foods.

  • Culture and religion. A person’s food choices, likes and dislikes are influenced by social customs, religious practices and the availability of ingredients. Culture and religion can also affect how foods are prepared and when they are served.

  • Budget. People make choices about food based on what they can afford.

  • Willingness or ability to cook. Many people rely on prepared convenience foods or restaurant meals because they lack the time, interest, strength or skills needed to cook.

  • Appetite. A person’s desire for food, or appetite, influences what and how a person eats. Physical and emotional factors can cause a person’s appetite to increase or decrease. Anorexia, a loss of appetite, is very common among people who are receiving care. Factors that can contribute to anorexia include pain, nausea (a sick feeling in the stomach often accompanied by the urge to vomit), medication side effects, depression or an impaired sense of taste or smell.


When a person is receiving care, there may be special orders in place. Examples may include using meal supplements and thickened liquids.

Meal Supplements
When a person has not been eating well or is losing weight because of an illness, the person’s doctor may order a meal supplement. These supplements, which are similar in taste and appearance to a milkshake, are usually high in calories, fat and protein. The meal supplement may be given with or between meals, as a snack. If a meal supplement has been ordered for someone in your care, be sure to serve the supplement at the specified time. If the person declines the supplement, be sure and write it in the binder and report it to the person on call or a family member. 


Thickened Liquids
Some medical conditions, such as stroke, may make it difficult for a person to swallow liquids without choking. For these people, the person’s physician may order the use of a thickening agent. The thickening agent is added to liquids to thicken them and make them easier for the person to swallow. Liquids can be thickened to different consistencies:


  • A nectar consistency is like thin, runny syrup. The liquid pours in a ribbon-like stream.

  • A honey consistency is thicker than a nectar consistency. The liquid drizzles slowly when poured.

  • A pudding consistency is very thick. The liquid does not pour and must be eaten with a spoon. 


The person’s doctor will specify which consistency should be used. If you are permitted to use a thickening agent to thicken the person’s liquids, follow the directions on the container of thickening agent exactly. These directions will tell you how much product to add to achieve the necessary consistency.

Meal time can be difficult for a person who is receiving care. As you have already learned, many physical and emotional factors can cause a person who is receiving care to have little or no appetite. For a person who is ill or has a physical disability, the act of eating can require a great deal of physical effort and can be very tiring and frustrating. The person may be embarrassed about needing help with an activity as basic as eating. 

There are two major goals for meal times when a person is receiving care. First, you want to make the meal as positive and pleasurable an experience as possible for the person. Secondly, you want to maintain or improve the person’s food intake. Usually, achieving the first goal can help you to achieve the second. To make the meal as positive and pleasurable an experience as possible: 


  • Involve the person in decisions about when to eat, what to eat and where to eat as much as possible.

  • Support rituals and traditions the person may have related to eating and mealtimes, such as giving thanks before a meal. 

  • Take steps to promote the person’s dignity and self-esteem throughout the meal.

  • Help the person to enjoy the company of others during the meal (even if the only other person present is you).

  • Present the meal attractively (for example, by removing items from the meal tray and placing them on the table to create a more home-like environment if you work in a facility setting, or by planning, preparing and serving visually appealing meals if you work in a home setting).

  • Create a pleasant, clean, relaxing environment for eating. 

Preparing the Person for the Meal

There is more to assisting a person with meals than simply getting the meal and putting it down in front of her. Before the meal is even served, there are several things that must be done to help prepare the person for the meal. Give yourself adequate time to accomplish the following before the meal: 

  • Ensure the person’s physical comfort by assisting her to use the bathroom and wash her hands before the meal.

  • Provide mouth care, because a clean mouth makes food taste better. If the person wears dentures, make sure the dentures are clean and in place.

  • Assist the person with putting on glasses or inserting a hearing aid, if she uses these devices.

  • Create a comfortable, pleasant environment for eating. If the person will be taking the meal in her room, make sure the room is neat, clean and free of odors. Make sure there is adequate lighting.

  • Position the person properly for eating. In many long-term care facilities, residents go to the dining room to eat. Even if they must be taken to the dining room in a wheelchair, they are often encouraged to move from the wheelchair to a regular dining chair during the meal. Whether the person is eating in the dining room or in her room, help the person into a comfortable, upright, sitting position, with her head up and her hips at a 90-degree angle. This position makes it easier for the person to chew, swallow, and manage eating utensils. If the person is seated in a chair, make sure her feet are flat on the floor, and have her rest her elbows or forearms on the table if she needs support.

Serving the Meal
Once these preparations are completed, it is time to get the person’s food. Organize your time so that you can help the person to eat shortly after preparing the meal. Foods are much more appealing when they are served at the proper temperature. 

Assisting the Person to Eat
Many people will be able to eat on their own, if you help them with tasks such as opening cartons, cutting up meat or identifying the location of items on the table and on the plate. At each meal, talk with the person about the amount of help he needs, because he may have different needs at different meals. For example, at lunchtime the person may be able to eat a sandwich by himself, but at dinnertime he may need help cutting his meat.

Always encourage the people in your care to do as much as they can for themselves. Even when a person is totally dependent on you to feed him, involve him in the process as much as possible (for example, by asking him to hold his napkin). This helps to promote independence and protect the person’s dignity and self-esteem. Remember that meals are not just about the food. Being in the company of others and socializing are important during the meal as well. Sit down and take the time to talk with the person during the meal, even if he cannot answer you.


Avoid rushing the person during the meal. Observe the person to determine whether he needs help eating. If the person does not eat a certain food, ask him why. Sometimes people leave part of a meal uneaten because they get too tired to finish. In this case, the person may eat more if you offer to help. Or the person may just not care for the food. If the person simply did not care for the food, ask if there is something else you can get him to eat that he might find more appetizing. 

Knowing why a person did not eat part or all of a meal can help to plan future meals that will be more appealing to the person, or address other issues that may be affecting the person’s appetite. When the person has finished eating, remove the dishes and tidy up the table. Assist the person with mouth care and changing any articles of clothing that became soiled during the meal.


Helping a Person who is Visually Impaired
A person with visual impairment can usually eat independently if he has no other disabilities. To help the person during meal time, you may only need to do the following: 


  • Identify the location of foods on the table and on the plate. Describe their locations as if the plate were the face of a clock.

  • Cut up meats or anything else that needs cutting.

  • Open containers. 

  • Describe the location of the eating utensils.

  • During the meal, occasionally check on the person to see whether he has overlooked some of the food, and if so, offer assistance. 

Helping a Person who has Difficulty Swallowing
A person who has had a stroke that has resulted in speech difficulties may also have trouble swallowing food. A person who has troubles swallowing may be on a soft diet, and there may also be orders to use liquid thickeners. When helping a person who has trouble swallowing during meal time: 


  • Remain with the person while he is eating.

  • If the person is working with a therapist to relearn safe swallowing techniques, make sure you are aware of these techniques so that you can help the person practice them.

  • If liquid thickeners have been ordered, make sure that all of the liquids, including soup, are thickened before serving them.

  • Encourage the person to chew slowly and thoroughly.

  • Eliminate distractions, such as television or several visitors, so that the person can concentrate on eating.

  • Keep the person’s head elevated during eating and for at least 30 minutes after eating. 


Monitoring Food Intake
At most agencies, you will be required to estimate, report and record the amount of food the person ate at each meal. You may be asked to estimate how much of the total meal the person ate, and give a rough percentage. Please be sure to report a food intake of less than 70% to the person on call or to a family member.


For some people in your care, you may be required to estimate the percentage eaten of each food that was served. For example, you might say that the person ate 50% of the pork chop, 50% of the mixed vegetables, 100% of the mashed potatoes and 100% of the pudding. Whichever method you choose, be consistent in writing it in the binder and reporting anything that is out of the ordinary.

Earlier you learned about key nutrients that are supplied by food and beverages. In addition to supplying the body with nutrients, foods and beverages supply the body with water. Water is extremely important to life. A person can actually live longer without food than he can without water. Every cell in our bodies contains water, and water forms the basis for many important body fluids, including blood (which circulates oxygen and nutrients throughout the body), sweat (which helps to cool the body) and urine (which helps to remove waste from the body). We take in the water our bodies need through drinking (water, as well as other beverages) and through eating foods that have high water contents (such as fruits and vegetables, soups, ice cream and gelatin).


Fluid Balance
Fluid balance occurs when the amount of fluids a person takes in equals the amount of fluids the person loses. Each day, we lose fluid in the form of urine, sweat, bowel movements and breath vapor. To maintain a state of fluid balance, we must take in enough fluid each day to equal or balance these losses. When fluid balance is not maintained, the person develops either dehydration (too little fluid in the body) or edema (too much fluid in the body).


Dehydration can result from conditions such as vomiting, diarrhea, fever or severe blood loss. A very common cause of dehydration, however, is simply not drinking enough fluids. Many people who are receiving care have conditions that put them at risk for not drinking enough fluids and becoming dehydrated. 


For example, a person who has problems with mobility or other disabilities may have a difficult time getting up to get a drink. The person may also cut back on fluids because she is trying to reduce the number of times she needs to get up and go to the bathroom, or she is afraid that she will not be able to make it to the bathroom in time. 

Some people who are incontinent of urine may also reduce their fluid intake because they think this will lower their risk for having an episode of incontinence. However, it is important to know that decreasing fluid intake does not decrease incontinence, nor does it decrease trips to the bathroom. In fact, the opposite may be true. As the urine becomes more concentrated, it irritates the bladder and may increase the urge to urinate, resulting in the need to urinate more frequently. As a caregiver, you will play an important role in helping to ensure that those in your care take in enough fluids. 

  • Frequently offer fluids that the person likes at the temperature she prefers.

  • Encourage the person to drink plenty of fluids with each meal.

  • Frequently provide the person with a glass of clean, fresh water. Encourage the person to drink each time you enter the room.

  • Refill the glass if the person cannot do it. A drinking straw or a plastic water bottle with a screw-on lid and a straw may make it easier for some people to drink independently.

  • If the person frequently refuses beverages, check with the care plan to see if you can offer fluid-rich foods instead, such as ice cream, popsicles, gelatin or fruit. 


If a person becomes dehydrated, the person’s doctor may give an order to “encourage fluids” or “push fluids.” This means that the person should be urged to drink as much fluid as possible. Encourage the person to drink each time you enter the room and again on your way out. Keep a record of the amount of fluid the person does drink. 


Edema, or the state of retaining too much water, can result from medical conditions (such as chronic heart failure or kidney disease) that make it hard for the body to rid itself of excess water. The person’s physician may place restrictions on the amount of fluid the person is allowed to have each day. 


When you are caring for a person and fluid restrictions are in place, the care manager should alert you to how much fluid the person is allowed to have over the course of your shift. Offer small amounts of fluid at regular intervals. This will help to prevent the person from becoming too thirsty.

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