MIL refusing Level 6 easy bite meals

[Witch hazel]

Hi All,

MIL has had ongoing swallowing issues for months now. Finally managed to get a SaLT assessment a few weeks ago. Therapist found she has some problems synchronising her chew/swallow/breathe reflex, which is likely causing it, and her restricted diet - she will only eat fish cakes and fish fingers with tinned veg, is too dry and therefore difficult to swallow.

She recommended Level 6 Bite sized meals, which I ordered from Wiltshire. I did suspect MIL would refuse them, but for a week or so she hasn't said much about them - probably because the last time she choked hubby went down and told her she needs to only eat what is recommended, otherwise she will not be able to remain at home alone.

Today her weekly meal delivery arrived, and she apparently told the driver not to come any more as she doesn't want them. He insisted on leaving them as they are already paid for - so she rang me to tell me to tell me to cancel them. I explained its the Speech Therapist's instructions. MIL can hardly remember what happened yesterday, never mind 3 weeks ago, but I did try to make her understand that its not our decision, as we are going on medical advice. I cannot stop them until the ST reviews her again. The ST service is very stretch here, and I suspect this "review" will be a call to me to see how things are progressing, so MIL will have to take my word for it. I will ask if she can visit in person and insist that this is the way forward.

I told MIL the only other option is she will have to go into day care for her meals or permanent residential care where she can be supervised when eating. Neither of which she wants, so she told me "sorry to bother you, I may as well die now" and put the phone down. I hate leaving her upset like this, but the reality is she is NOT safe to be at home and eating without help any more, but she still thinks it is us trying to push her into care. When I said she hasn't choked since she has been on the soft meals, she said she can't remember when she last did choke - last time she had a fish meal as that was what prompted the change. We are the evil ones again when all we want is for her to be safe and not get the call at lunchtime that she has choked on her food yet again.

Please can anyone recommend any other meal providers I could try, as she has already decided that these current ones are just "wet slop" (sorry but thats the idea) so need to find some alternatives to try to get her on board if we can. Thanks

[bowlingbun]

I really sympathise with your mum's problem.
My mum was horribly bent towards the end of her life, to the extent that she couldn't lift her head up properly.
For the last few years she could only ate soft food - mainly Mr. Kipling's cakes!
Mum went through a number of food delivery companies, but also complained that "they all tasted the same".
Mum had lost nearly all her teeth, and said her dentures didn't fit, so she didn't wear them.
Apparently, as we get older our sense of smell and taste diminish, but I think there is also another issue.

I have had serious dental problems. Despite many, many dentists visits, like mum I also have very few of my own teeth, 6 front upper, 5 lower front.
After two extractions last autumn, I couldn't wear my earlier upper denture, I too needed soft food!
The new dentist completely mucked up making a first replacement set of dentures, so in total unable to chew for about 6 months. (Happily, I now have a full set of "gnashers")

Chewing is important not just for making the food easier to digest, it's really important so that you get the taste of the food too.
I cook almost everything from fresh ingredients, so I know exactly what I'm eating. but it's just not the same if it goes into your mouth and you swallow without chewing.
Unfortunately, I don't have any magic answers at all, but hope this insight might give a bit of insight into mum's plight?

[Henrys Cat]

Does she have someone to prepare the meals or is she doing it herself? Going from one very specific meal to something that not only tastes different but is a totally different consistency is moving from one extreme to the other so I wonder if there is a more gradual option for her (with the SL approval of course) as a means to an end. Maybe the tinned veg can be squashed a bit and then squashed more with some juice from the tin and so on. The fishcakes could be made with a much softer mash over time. I know that means someone has to do all this but you could prep a load of stuff and make it into ready meals & it might be easier in the long run. It would be like 'training' a baby to progress onto solid food but the opposite way around!

Also, they probably already mentioned this but a softer diet will have a noticeable change in toileting and might result in needing to get to the loo more quickly...

[Witch hazel]

MIL is housebound and relies on 4x care visits a day. She cannot do anything for herself, is fully hoisted for all transfers and carers prepare her meals. My husband (her son) and I both work and there is no-one else. so popping at am mealtimes is not an option. I have been called away from work far too often as it is, to deal with another choking episode.

We have tried to encourage the care company to meet us halfway with mashing veg, adding butter etc to fish fingers to moisten etc, but they have such a high turnover of staff, some don't even know how to prepare anything properly, never mind make it more suitable for her to eat it. I have asked if someone can stay an extra 20 minutes at lunchtime to supervise he eating and they don't have enough staff to do this.

We don't live with her, so preparing food as "ready meals" in advance is not really an option. The ST has advised this is what she wants her to eat, at least for a few weeks trial period, and if I interfere and start her choking again, I am going against specific advice. I know its a change for mum, but they are the soft bite meals, not fully mashed/pureed so there is some chewing involved. She has never been the most adventurous with food, so its hard to get her to even try anything out of her normal choices.

[Melly1]

Hi Witch Hazel,
I cannot personally recommend anything but I did see https://www.itsmadeforyou.co.uk/take-a- ... n_type=511 do a fisherman's pie level 6 dish that she might like.

Also https://mrgills.co.uk do two fish dishes.

Melly1

[Witch hazel]

Thanks Melly, but fish pie is one of the meals so far that she has told us not to get again. No idea why as she always tells us she loves fish! I keep normal fish pies in our freezer as a quick meal and find them quite nice, albeit not the soft version she has been having. I will look at the links though and see what other options they have.

She rang with her shopping list last night, with all the food that she used to have, but we will just not buy it as we have tried to explain that she cannot have any of this at the moment but it just causes upset. The ST told me to remove all her previous food from the freezer so carers can only give her the soft meals as that is all that is there, in case she asks for the food she is not supposed to be having.

[Melly1]

Fingers crossed you find something. They do a fish hash too ...

Melly1

[Witch hazel]

So, we were at MIL's when her lunchtime carers arrived. One lady is a regular and we have met her before. She asked "what are YOU doing about the Wiltshire meals mum doesn't like?". I said we are aware she was not keen, but we are following advice of the SLT and I couldn't go against this until I speak to her again. "Well she was fine on the fish in sauce she always used to have" ... but she WASN'T as several times I was called down to choking issues and this was what she was eating as I had to throw it away! "Oh but she doesn't like the meals as they have too much gravy/sauce" ... I do know what MIL is like with food as she has been my MIL for nearly 35 years! I said we are doing all we can to overcome MIL's choking issues, as otherwise she will be deemed unsafe to be at home alone when eating and have to go into full time care. This as been discussed with mum several times when she chokes, and she agrees at the time, then a few days later when she hasn't had any issues, she forgets and refuses to talk about it any more. I personally think its very unprofessional for the carer to be talking about this in front of mum, or to be questioning the SLT and suggesting that there is nothing wrong with the normal food mum eats ... was she present at any of the choking episodes? NO ...

Mum can be very confused at times, but will now think the carers are right and WE are wrong! She always implies the carers can do no wrong, refers to some as "like another daughter to me" and anything they say is gospel. She thinks they have nursing or medical qualifications because they turn up in uniform, and they know best ...

I am planning to speak contact the SLT on Monday (if I can reach her as it took over a week last time) to see what she suggests, as she told me to remove all the "old" foods mum used to have, so there are only Wiltshire meals left for lunchtimes. It seems the reason mum hasn't choked since she has been on them is because she simply isn't eating them at all ... I know its not easy, but we want her to be safe and the sometimes 3x a week calls when she was regularly choking were distressing for us too, not to mention inconvenient for me to drop everything and leave work at a moment's notice.

[Melly1]

Witch Hazel, has she lost weight? If so then the GP/ SLT or a dietician need to be involved. However, if she is maintaining her weight then I wouldn't worry too much as she must be eating enough despite the complaints.

It does seem to be an either / or choice. Either eat food recommended by the SLT or go into day care/residential care to be supervised at meal times.

I agree re the paid carer, however, she is at the receiving end of MIL complaining about the meals and probably agreed to raise the issue with you on her behalf. Also if she hasn't seen MIL choking she probably doesn't realise how scary it is (nor appreciate that you can't keep being called out of work, for something that can be avoided if advise is followed.

Melly1