IDDSI IS Best Practice
Lori Reamer, RDN • June 1, 2026
People often ask if IDDSI is mandatory...
The Academy of Nutrition & Dietetics (AND) Dietetic Practice Group, Dietetics in Healthcare Communities (DHCC) featured an article in their Spring 2025 newsletter entitled “The benefit of implementing IDDSI from an Administrator and RDN perspective” by Jennifer M. Wood, MS, RDN, LNHA, CSG and Jeanette Ely, RDN, LD.
This article shares:
- Many facilities have not changed to IDDSI recommendations.
- Administrators often state they won’t change to IDDSI until the Centers for Medicare and Medicaid Services (CMS) make it mandatory.
- CMS references the State Operations Manual (Rev. 225; Issued: 08-08-24) §483.60 for current standards of practice. It states that menus must meet the nutritional needs of residents in accordance with established national guidelines. According to CMS, “Current standards of practice” refers to approaches to care, procedures, techniques, treatments, etc., that are based on research or expert consensus and that are contained in current manuals, textbooks, or publications, or that are accepted, adopted or promulgated by recognized professional organizations or national accrediting bodies.
- The AND is the recognized professional organization for trusted nutrition information.
- The AND website states: It is imperative that all healthcare providers globally implement IDDSI, both to ensure patient safety and to maintain current standards of practice. AND is pleased to announce beginning October 2021, IDDSI will be the only texture-modified diet recognized by the Nutrition Care Manual (NCM®). The NDD and associated resources will no longer be included in the NCM® past October 2021.
Additionally the following professional organizations involved in the care of individuals with dysphagia also support IDDSI as best practice:
- American Speech-Language-Hearing Association (ASHA)
- Association of Nutrition & Foodservice Professionals (ANFP)
Translation: Although CMS does not directly state IDDSI is mandatory, it refers to Current Standards of Practice and AND, ASHA and ANFP all maintain that IDDSI is that current standard.
Choosing to follow IDDSI is the best and current standard of practice and is the best decision you can make on behalf of the population you serve to ensure their safety. Choose best practice and start taking steps towards IDDSI implementation.
Food plays a central role throughout Caribbean culture and is often tied to celebration, hospitality, family gatherings, and community connection. Across Caribbean communities, meals are commonly shared experiences that bring people together for holidays, celebrations, music, storytelling, and everyday family life. Caribbean cuisine is known for: Bold herbs and spices Fresh seafood and tropical fruits Rice, beans, soups, and stews Slow-cooked meats and flavorful broths Vibrant colors and layered flavors Many Caribbean meals are rooted in cultural traditions that reflect a blend of African, Indigenous, European, Latin American, and Asian influences. Examples of common Caribbean food traditions include: Large family-style meals shared during celebrations Outdoor cooking and community gatherings Soups and stews served as comforting communal dishes Rice dishes paired with seasoned proteins and vegetables Use of fresh herbs, citrus, coconut, and warming spices to build flavor Popular Caribbean-inspired dishes can include: Jerk chicken Rice and peas Caribbean fish soup Plantains Curry dishes Coconut rice Tropical fruit desserts In healthcare dining, incorporating culturally inspired foods can help create more inclusive and meaningful dining experiences while introducing residents to new flavors and traditions. Even small additions—such as tropical fruit flavors, seasoned rice dishes, broth-based soups, or Caribbean-inspired herbs and spices—can help celebrate culture through food. Because meals can nourish both the body and the sense of community around the table. For more cultural menu inspiration and resources, visit our Culinary Toolkit page.
Implementing IDDSI successfully requires more than simply modifying textures, it requires consistency (no pun intended!). One of the biggest challenges healthcare communities face is ensuring foods are prepared the same way across all shifts, employees, and locations. This is where quality standardized recipes become essential. Well-developed IDDSI recipes help: ✔️ Create more consistent meal preparation ✔️ Reduce confusion among staff ✔️ Improve confidence during food preparation ✔️ Support safer swallowing practices ✔️ Simplify staff onboarding and ongoing training In many ways, quality recipes act as an ongoing training tool for employees. Instead of relying on verbal instruction or individual interpretation, staff have a clear, repeatable guide they can follow. This becomes especially important in environments with staffing shortages, turnover, or agency staff. Standardized recipes help create consistency even when teams change. Strong IDDSI recipes should include: Clear preparation instructions Texture modification guidance Moisture recommendations Testing procedures during preparation and before service (as texture can change with holding time) Visual consistency expectations Standardized yields and portions (as portion sizes can change during the texture modification process) Having ready-to-use recipes can help communities begin implementing IDDSI more confidently and efficiently. To help support your team, we offer an IDDSI Starter Recipe Kit Packet filled with IDDSI-ready recipes communities can begin using right away. Consider subscribing to our Roots Recipe Keeper to access this collection on our interactive platform where you can scale and customize the recipes in your recipe library. Explore the IDDSI Starter Recipe Kit Because successful IDDSI implementation starts with consistency, education, and the right tools.
Food is deeply woven into the traditions and celebrations of many Asian American and Pacific Islander cultures. Meals are often viewed as a way to bring people together, honor family traditions, and celebrate community. Across many cultures, food is more than nourishment, it represents hospitality, respect, remembrance, and connection. Examples of how food is celebrated throughout AAPI cultures include: In many Chinese traditions, long noodles symbolize longevity and are often served during birthdays and celebrations. Japanese meals frequently emphasize balance, seasonality, and presentation, with dishes thoughtfully prepared to reflect harmony and simplicity. Filipino gatherings often center around shared meals and large family-style dishes that encourage togetherness and hospitality. Hawaiian and Pacific Islander cuisines commonly celebrate fresh ingredients and communal dining experiences tied to family and cultural heritage. Korean meals often feature multiple side dishes, creating a shared dining experience that emphasizes variety and connection. To help bring these traditions to life, we’ve included an infographic featuring recipe examples inspired by several Asian American and Pacific Islander cultures, including dishes such as Vegetable Lo Mein, Chicken Adobo, Sinangag (Garlic Fried Rice), Bulgogi Beef, Teriyaki Chicken, Kalua Pork, and more. “How Food is Celebrated Across Asian & Pacific Islander Cultures” These traditions highlight how food can create meaningful experiences and strengthen community bonds. In healthcare dining, incorporating culturally inspired meals can help residents feel recognized, respected, and connected to comforting memories and traditions. Even small additions, such as offering culturally inspired sauces, rice dishes, soups, or seasonings, can create more inclusive dining experiences. Celebrating culture through food helps remind us that meals can nourish both the body and the spirit. For more cultural menu inspiration and resources, visit our Culinary Toolkit page.
Food allergy management in healthcare dining goes beyond safety, it’s also about inclusion. Residents with food allergies should still be able to enjoy meals that feel familiar, satisfying, and as close to the regular menu as possible. Inclusive dining helps residents feel less isolated and creates a more positive dining experience. In many cases, this can be achieved with simple ingredient modifications rather than creating an entirely separate meal. Examples of easy allergy-friendly modifications include: Using gluten-free breadcrumbs to prepare gluten-free meatballs Substituting dairy-free milk and butter alternatives in mashed potatoes Using egg-free mayonnaise in salads and dressings Preparing gluten-free pasta versions of featured entrées Using allergen-friendly thickening agents in soups and sauces These small adjustments allow residents with allergies to enjoy meals that closely resemble what is being served to the rest of the community. Inclusive dining also helps: ✔️ Improve resident satisfaction ✔️ Support dignity and quality of life ✔️ Reduce feelings of exclusion at mealtime ✔️ Create more consistent dining experiences It’s also important for every healthcare community to have a clear policy and procedure for how food allergies are managed within the dining department. This policy should outline: How allergies are identified and documented How dietary updates are communicated between departments Procedures for allergy-friendly meal preparation and service Cross contact prevention practices Labeling and tray accuracy processes Staff training expectations Steps for handling allergy concerns or incidents Having a standardized process in place helps improve consistency, reduce risk, and ensure all team members understand their role in protecting resident safety. At the same time, safe food preparation practices remain essential. Clear labeling, preventing cross contact, staff communication, and standardized preparation procedures all play an important role in protecting residents with allergies. With thoughtful planning and simple modifications, healthcare dining teams can create meals that are both safe and inclusive. Because every resident deserves to feel included at the table. For more information on safe food substitutions for the Top 9 Food Allergens, visit https://allergyasthmanetwork.org/food-allergies/living-with-food-allergies/safe-food-substitutions
In healthcare dining, creating flavorful meals can sometimes feel challenging, especially when working within dietary restrictions such as sodium limits or modified textures. This is where herbs become essential. Herbs offer a natural way to enhance flavor without relying on salt, sugar, or heavy sauces. They add depth, aroma, color, and freshness to dishes, helping make meals more enjoyable for residents. Why herbs matter: Improve taste and aroma Support reduced sodium initiatives Enhance visual appeal Add variety without increasing complexity Using herbs effectively: Add hardy herbs early in cooking to build depth Use fresh herbs at the end for brightness Combine herbs to create layered flavor profiles Use spices like turmeric to add warmth and color Easy Herb Pairings to Enhance Everyday Dishes: Incorporating herbs doesn’t require reinventing your menu, small additions can make familiar dishes more flavorful and appealing. Proteins: Chicken → thyme, rosemary, parsley Fish → dill, parsley, lemon + herbs Beef → rosemary, oregano Vegetables: Roasted vegetables → thyme, rosemary Green beans → garlic + parsley Carrots → dill or parsley Grains & Starches: Rice or pilaf → turmeric, parsley, cilantro Potatoes → chives, rosemary, parsley Soups & Sauces: Tomato-based sauces → basil, oregano Cream soups → thyme, chives Broths → bay leaf, parsley stems These simple combinations can elevate dishes without adding extra steps or complexity for your team. Incorporating herbs into your menu doesn’t require a complete overhaul, just a thoughtful approach to seasoning. Flavor plays a key role in satisfaction, and when meals taste better, residents are more likely to enjoy and consume them. For more tools and recipe inspiration, visit our Culinary Toolkit page.
April 29th recognizes Stop Food Waste Day , an important reminder that every ingredient in our kitchens has value. In healthcare dining, reducing food waste is about more than sustainability, it directly supports food cost management, efficient production, and responsible use of resources. The good news is that small operational changes can make a big impact. Our Food Waste Tips Poster highlights five simple ways to reduce waste and save resources . 1. Take an Inventory Before placing new orders, check what is already on hand. Taking inventory helps prevent overbuying and ensures ingredients already in stock are used first. 2. Estimate Production One of the most effective ways to reduce waste is to forecast accurately. Taking meal orders ahead of time or tracking the number of meals served each day can help guide future production and minimize overproduction. 3. Serve a Soup of the Day Leftover roasted vegetables, proteins, and grains can often be transformed into a delicious soup. This not only reduces waste but can also support resident intake by offering an additional comforting option. 4. Track Dates Make it easy for your team to identify which foods should be used first. Place items with the earliest use dates at the front of refrigerator and freezer units so nothing gets forgotten. 5. Repurpose Staple Foods Leftovers can often become something new. For example, leftover mashed potatoes can be transformed into flavorful potato pancakes with fresh herbs, a creative way to reduce waste while keeping menus interesting. These simple practices help kitchens reduce food waste, lower costs, and support sustainability goals while continuing to provide quality meals. Small changes create big impact. For more recipe ideas and upcycle inspiration, visit our store for recipes with built-in upcycle tips. Explore Upcycle-Friendly Recipes
In healthcare communities, food plays an important role beyond nutrition. Meals can offer comfort, familiarity, and a sense of belonging. Celebrating culture through food helps residents feel seen, valued, and connected to their heritage. One of the best ways to begin is by talking with residents and their families . Ask questions such as: What is your cultural background or heritage? Are there foods that were part of your family traditions? What meals bring you comfort or happy memories? Are there holiday dishes you would love to see celebrated? These conversations can provide meaningful inspiration for menus and special events. A wonderful next step is to host a community tasting event inspired by the dishes and traditions shared during resident interviews . Use the information gathered to create a menu featuring foods that reflect the cultures, memories, and family traditions of the people who live in your community. For example, if residents share memories of Mediterranean lemon chicken, Middle Eastern roasted eggplant, Asian noodle dishes, or traditional Southern comfort foods, these can become featured tasting stations or small plated samples during the event. This transforms the event into something much more personal than simply offering global cuisine, it becomes a celebration of the people you serve and the stories behind the food. Invite residents, families, and staff to taste the dishes, share memories, and celebrate the diverse backgrounds that make your community special. These experiences foster connection, spark conversation, and create joyful moments around the table. Food is one of the most powerful ways to honor culture and create a sense of home. For more cultural menu inspiration and resources, visit our Culinary Toolkit page.
One of the most common challenges in healthcare dining isn’t the food, it’s execution. Recipes are often built with ideal conditions in mind: full staffing, ample prep time, and experienced team members. But in reality, many kitchens are working with limited staff, time constraints, and varying skill levels. That’s where the disconnect happens. When recipes don’t reflect how food is actually being prepared, it can lead to rushed prep, inconsistent results, and unnecessary stress for your team. The solution isn’t more complexity, it’s alignment. Evaluating your staffing and adjusting your recipes accordingly is one of the most effective ways to improve kitchen operations, consistency, and team performance. A Simple Framework for Evaluating Recipes Based on Staffing This framework breaks recipes into three practical categories: Ready-to-Use (RTU) / Ready-to-Bake (RTB) Best suited for limited staffing or high-pressure situations Minimal ingredients and prep required Helps maintain consistency when time and labor are tight Semi-Scratch A balanced approach for moderate staffing levels Combines prepared items with fresh ingredients Allows for some culinary flexibility without overwhelming your team Scratch (Homemade) Ideal when staffing is stable and team members have strong culinary skills Requires more ingredients, prep time, and oversight Best used when your operation can fully support it Why This Matters: When you match your recipes to your staffing reality: Your team works more efficiently Training becomes easier and more consistent Food safety practices are easier to maintain Stress and burnout are reduced This isn’t about lowering standards, it’s about creating systems that work in real kitchens. Strong leaders understand that success doesn’t come from doing everything from scratch, it comes from making smart, strategic decisions that support both the team and the people they serve. When your recipes reflect your operation, everything runs smoother.
This ANFP Member Appreciation Week, we want to shine a light on the incredible work you do every day. As dietary professionals, you play a crucial role in ensuring safe, nutritious, and enjoyable meals for residents and patients, meals that can profoundly impact their health, happiness, and quality of life. Your work truly makes a difference. But we also know the demands of your role are high. Between menu planning, managing teams, ensuring regulatory compliance, and serving residents, burnout can be real. That’s why taking time for yourself isn’t just nice, it’s necessary. When you care for your own well-being, you become a stronger leader, a more creative problem-solver, and a better advocate for your team and the people you serve. Ways to Celebrate Yourself and Your Team: Self-Care: Take small moments each day to recharge, whether it’s a short walk, a favorite beverage, or a quiet break. Team Recognition: Celebrate accomplishments with your staff, acknowledge wins, share praise, or have a small team gathering. Community Engagement: Invite residents, families, or colleagues to recognize your work during ANFP Member Appreciation Week. A thank-you note, shared story, or social media shout-out can go a long way. Professional Development: Reward yourself with learning opportunities or exploring new recipes that inspire creativity in your menus. At RecipeTree.pro, we celebrate you and the difference you make. Thank you for your dedication, leadership, and heart, you’re the driving force behind healthier, happier residents every day.
When we ask healthcare dining managers where they typically go for recipes, the most common answer is simple: “The internet.” It makes sense. Online recipes are easy to access, visually appealing, and offer endless variety. With staffing challenges and time constraints, pulling a quick recipe from a website can feel like the most efficient solution. But here’s the problem: Most online recipes are not designed for healthcare foodservice. They aren’t built for volume. They don’t account for therapeutic diets. And they rarely include the structure needed to ensure consistency, safety, and compliance in a regulated environment. What works in a home kitchen doesn’t always translate to a healthcare setting. Consistency Isn’t Just a Preference, It’s a Requirement In healthcare dining, food plays a much larger role than simply providing a meal. It supports: Resident health and nutrition Clinical outcomes Safety and compliance standards That means every plate needs to be consistent, not just in taste, but in portion size, texture, and nutritional value. Without standardized recipes, that level of consistency is nearly impossible to maintain. One cook may prepare a dish slightly differently than another. One shift may serve larger portions than the next. Over time, those small variations create big inconsistencies. What Online Recipes Are Missing Most online recipes are created for home cooks, not for healthcare operations. They often lack: Defined portion sizes Accurate yield for large-scale production Nutrition information aligned with therapeutic needs Texture modifications for IDDSI levels Food safety guidance such as CCP/HACCP steps While they may look appealing, they leave too much room for interpretation in a setting where precision matters. The Problem with “Eyeballing” In many kitchens, experienced staff rely on instinct. They’ve made similar recipes before. They know what “looks right.” They adjust as they go. In a home kitchen, that flexibility works. In healthcare, it creates risk. “Eyeballing” ingredients or portions can lead to: Inconsistent taste and quality Incorrect portion sizes Nutrition inaccuracies Increased food cost and waste And perhaps most importantly, it makes it difficult to ensure that every resident receives the same level of care. Small Changes, Big Impact It doesn’t take much for a recipe to go off track. A little extra oil. A heavier scoop. A skipped step. These changes may seem minor, but across dozens or hundreds of servings, they can significantly impact: Caloric intake Sodium levels Texture consistency Budget performance In healthcare foodservice, small inconsistencies don’t stay small. Why Standardization Matters Standardized recipes provide structure. They ensure that: Ingredients are clearly measured Yields are accurate for your census Portions are consistent Nutrition information is reliable Safety steps are built into the process They also make it easier to train staff, maintain consistency across shifts, and prepare for surveys with confidence. Instead of relying on memory or guesswork, your team has a clear system to follow. Even “Simple” Recipes Need Structure A dish like roasted carrots or baked chicken might seem straightforward. But without defined measurements, portion sizes, and preparation guidelines, results can vary widely from one batch to the next. What starts as a simple side dish can quickly become inconsistent in flavor, texture, and nutritional value. In healthcare kitchens, there’s no such thing as “just a simple recipe.” From Inspiration to Implementation Online recipes can still be a great source of inspiration. But they shouldn’t be used as-is in healthcare settings. They need to be adapted, structured, and standardized to meet the demands of: Foodservice operations Clinical nutrition requirements Regulatory compliance That transformation is what turns an idea into a reliable, repeatable solution. The Bottom Line Relying on online recipes without standardization creates unnecessary risk in healthcare kitchens. Consistency, safety, and accuracy depend on more than just good intentions, they require structure. Because in healthcare foodservice: Consistency isn’t optional. It’s essential. Ready to Take the Guesswork Out of Your Kitchen? At RecipeTree, we transform everyday recipes into standardized, healthcare-ready solutions so your team can deliver consistent, compliant, and high-quality meals every time.
