Dietary Supports & Mealtime Practices

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin



This Information Bulletin clarifies the services and supports that must be in place to ensure safe dining & mealtime practices in all Division of Developmental Disabilities (DDD) funded residential settings, as well as all Community Day Service (CDS) programs.


Meals should be prepared and served with dignity, deference to the personal preferences of the individuals and in accordance with their health and physical needs as outlined in their Personal Plan and Implementation Strategy. Individuals with developmental disabilities may have factors that increase the risk of choking. Because of the risk factors associated with choking, it is critical that care givers ensure adequate supervision of individuals, are trained, and familiar with the needs of the individuals they serve. Providers should have policies in place to maintain safe dining practices as well as guidance as to what to do if an individual starts choking.

Some people may feel embarrassment when they choke and move away from others. This places them at an increased risk because they are less likely to be near people who can help. When food is served, be alert for those who leave without warning and check on them to ensure they are not in need of assistance. Do not hesitate to call 911 if someone is in need of immediate medical assistance.

Process & Procedures:

Mealtime Support

  • DDD funded residential and CDS providers should ensure that meals served are per the individual's preference (likes and dislikes) and prescribed dietary requests. Food consistency should be individual-specific and not restrictive for those individuals who do not need modifications.
  • Residential Staff should involve the individual in meal planning to ensure that personal preferences for meals are accommodated. If the individual desires, they should be involved in meal planning, food shopping and meal preparation.

Prescribed Diets

  • The residential provider is responsible for ensuring any individual with a specialized, modified or prescribed diet from a physician, or special equipment or adaptive supports for mealtime practices has the appropriate evaluation or other documentation in their file.
  • Their prescribed diet must also be documented in the Implementation Strategy of any service provider. This could include the following:
    • Pureed
    • Mechanical Soft
    • Ground Diet
    • High Fiber
    • Diabetic Diet
  • The residential provider should report any prescribed diet or adaptive equipment to the Independent Service Coordination agency to include in their Personal Plan when they are made aware of the change.

Supporting the Prescribed Diet

  • DDD funded residential and CDS providers must ensure that an individual with a prescribed diet receives consistent support and assistance with regards to safe practices for increased independence in dining. Dining supports include, but or not limited to:
    • Levels of supervision and/or assistance an individual needs during meals
    • Encouragement for greater independence during meals
    • Food and/or fluid consistency modifications
    • Positioning needs during and after meals
    • Special adaptive equipment for meals (i.e. modified utensils, scoop dish, cup with weighted base)
    • Allergy/food sensitivity precautions
    • Nutritional modifications /therapeutic diets (i.e. calorie-controlled diet, low fat, low sodium, high fiber, no concentrated sweets, renal diet)
    • All staff should be trained on the specific prescribed diet for each individual as listed in the Implementation Strategy
  • During the on-the-job training portion of staff's training, the staff should be observed preparing the prescribed diet. Personalized training on the prescribed diet should be documented and maintained in the individual's records as well as on the staff's on-the-job training documentation form.
  • If a new diet is prescribed, additional on-the-job training should be completed and documented in the individual's records as well as on the staff's on-the-job training documentation.

Residential Providers Only:

  • The residential provider is required to educate the individual on the benefits of following the prescribed diet and the risks to his/her health and well-being if the prescribed diet is not followed.
  • All efforts to assist the individual with understanding and adhering to the prescribed diet should be documented in the individual's record and communicated to the physician who ordered the prescribed diet.
  • If the individual chooses not to adhere to a prescribed diet, the residential provider should discuss with the physician and team for appropriate follow up supports.

Factors That Affect Swallowing and Choking:

Note: The Independent Service Coordination agency should include these risk factors in the individual's Personal Plan.

  • Positioning during and after mealtime
  • Poor posture while eating
  • Neurological and muscular disorders such as cerebral palsy and seizure disorders
  • Side effects from medications
  • Few or no teeth
  • Dentures
    • They can make it difficult to sense whether food is fully chewed
    • Poorly fit dentures may be uncomfortable and prevent proper chewing
  • History of previous choking incidents or difficulty swallowing

Medical Issues and Evaluation

Residential Providers Only:

  • Swallowing issues accompany many medical conditions (some are listed below). The residential provider should consult with the individual's primary care physician to determine if the individual is in need of an additional evaluation.
    • GERD
    • Diabetes
    • Other medical and metabolic issues
    • New or worsening swallowing issues should be communicated to the nurse trainer for determining the urgency of further evaluation.
  • Monitor Individual Weight
    • Weight should be obtained at least monthly or more frequently as ordered by a physician on all individuals living in a DDD funded residential setting. This should be kept in the individual's record.
    • In the event an individual is noted to have unexplained weight loss or weight gain (5% loss or gain of baseline weight over a period of 6 months), an appointment with their primary care physician should be arranged to reassess any known medical issues and to identify any new medical issues. The residential provider should reach out to a medical professional, within 30 days, to attempt to make an appointment and/or seek guidance.
  • Any individual who demonstrates swallowing or choking behavior should be referred to a medical professional to determine if the individual requires a swallowing study from an appropriate physician or therapist.
    • The swallowing study must include recommendations that identify the food texture, liquid consistency, and specific instructions for supporting the individual with safe eating practices.
    • This plan should also be documented in the individual's Implementation Strategy.

Effective Date: