Meal preparation and feeding assistance

What does meal preparation include?

Meal preparation means a caregiver plans, shops for, cooks and serves meals in your parent's home and cleans up afterward. Pennsylvania's home care rules require caregivers who give personal care to show competency in meal preparation and feeding, and meal help is one of the parts of in-home care families ask about most.

The signs that it is needed are usually in the kitchen: a refrigerator with expired milk and little else, frozen dinners stacked up, a pot left on the burner, weight loss you notice at a holiday visit. Sometimes the problem is not cooking at all but remembering to eat, or not wanting to eat alone after a spouse has died.

Can the caregiver cook the way Mom likes to eat?

Caregivers cook from what your parent enjoys. In Lancaster, Lebanon and Berks counties that may mean chicken corn soup, pot pie or a family recipe for chow-chow; in Schuylkill and Carbon counties it may be halupki or homemade pierogies. Caregivers can work from a recipe card, a cookbook, or your parent sitting at the counter giving directions, which many clients enjoy. A good routine is one hot meal cooked during the visit and one or two labeled portions left for later.

The National Institute on Aging notes that taste and smell often fade with age and some medications change how food tastes; herbs, lemon and spices help. Smaller, more frequent meals and easy snacks help someone who fills up quickly.

Can meals follow the doctor's diet?

When a doctor, dietitian or speech-language pathologist has given written diet instructions, the caregiver follows them. Common ones we see:

• Low-sodium for heart failure or high blood pressure: cooking from scratch, reading labels, going easy on canned soups and deli meats. See heart failure and COPD support.
• Carbohydrate-aware meals for diabetes, at regular times, as the care team has explained. See diabetes support at home.
• Modified textures after a stroke or for swallowing problems: chopped, minced or pureed foods and thickened liquids as the speech-language pathologist ordered them.

Caregivers follow these instructions; they do not design therapeutic diets or decide textures. If you do not have written instructions, ask the doctor or the home health team for them before care starts.

Groceries and a safe kitchen

A caregiver can help write the list, shop for or with your parent as the care plan sets out, put groceries away, check dates, throw out spoiled food and keep the refrigerator clean. Families who live far away often arrange grocery delivery and have the caregiver unpack it and plan the week around it. Our light housekeeping and errands page covers the rest of the household help.

Feeding Assistance

Feeding assistance is hands-on help at mealtimes for a person who can no longer eat independently or safely on their own. It is part of personal care, and it is slow, attentive work. The caregiver:

• Helps your parent sit upright in a chair or well supported in bed before eating and for a while afterward.
• Cuts food into small pieces, opens containers, and sets up adaptive utensils, plate guards or a two-handled cup if an occupational therapist has suggested them.
• Offers small bites and sips at an unhurried pace, waits for each swallow, and lets your parent do as much as they can.
• Watches for coughing, a wet-sounding voice, pocketing food in the cheek or tiring partway through, and reports it to the family so the doctor can decide whether a swallowing evaluation is needed.
• Records how much was eaten and drunk in the daily notes.

For someone living with dementia, a quiet table, one or two foods at a time, finger foods, and a caregiver who eats or sits with them can help. Tube feeding is skilled care and is outside non-medical home care.

What about drinking enough?

Thirst weakens with age, and many older adults drink far less than they realize. Caregivers keep a drink within reach, offer fluids through the visit, and note when intake is low. If a doctor has set a fluid limit, as is common with heart failure, the caregiver follows that instead.

Where else can you find help with meals?

Every county Area Agency on Aging in our region, from the Dauphin County Area Agency on Aging at (717) 780-6130 to the Lancaster County Office of Aging at (717) 299-7979, can tell you about home-delivered meals and senior center meals. Many families use delivered meals on some days and a caregiver on others. Medicare does not pay for ongoing meal preparation at home.

To start, call (717) 695-2704. During the in-home consultation we look at the kitchen, the diet instructions and the times your parent usually eats, and build the visit schedule around meals.