Finger foods, feed him, or both?

Marie58

DH has been in MC for 4 months now. While still at home just before he went there, he was eating mostly finger foods. He could sometimes use a spoon and I would sometimes feed him the last bit in the bowl as he couldn't do it himself. Or I'd scoop the food up and hand him the spoon. He has always loved food and never had a weight problem. However, as he got less active due to Alz, he did start putting on weight, about 40 pounds actually.

I'm able to do plexiglass visits and can tell he's losing weight. When I saw him two days ago, he almost looked like he's lost most of that 40 pounds. I've talked to the staff and they say they've had to increasingly give him more verbal and physical cues to eat lately. And a few have told me they've occasionally fed him at least a few bites, even though they're not supposed to because they don't want him to lose the independence he has for self-feeding, which I understand. 

So my question is, how do we know when it's time to take over and just feed him? Or is there another solution? He's not too thin yet, but I am concerned. And he still definitely likes food. 

Anyone else experience this?  Thanks in advance.

Crushed

DW's memory care weighs everyone on a weekly basis in a weighing chair.  I get reports on her weight.   It is absolutely basic medical care.  She has to be hand fed at all times .  joke is that when she eats my brownies its like JAWS--CHOMP and then they check to make sure  she did not bite off the spoon.

Marie58

Thanks Crushed. Yes, they weigh DH too. But how did you know when it was time to feed her rather than just rely on her feeding herself with finger foods? He's not too thin yet, and will eat on his own, even though he often needs cues.

zauberflote

Mom had all of the above going on for the last few months. If she and I were in her MC room, she could handle finger foods. Sometimes I'd have to pick them up and arrange them in her hand for actual delivery. If we were in the dining room, we sat together and were served the regular meal. She wasn't good with utensils at all by that point, so I didn't force her to try/fail/try/fail, I hand fed her. Sometimes she'd grasp the (usually) spoon handle, sometimes not. When I wasn't there, I am pretty sure for those last few months she was seated at the hand-feeding table. Mom definitely liked her food until the last few days.  Our joke there was that a certain gifted aide could keep two spoons in each hand and successfully feed four people at once. Small MC, very small staff by that point. 

I would say both. Allowing him independence (will they, for example, let him eat spaghetti with his hands, as I saw one resident at Mom's do?) is good; forcing independence on him when he's lost the brain cells that govern the complex coordination needed is a different thing. 

Hand feeding can be a hot button topic here, but I have had no problem doing it for my mom, who was clearly enjoying the meal. When she was done eating, she'd just say "no thank you" (ah how the social niceties can be preserved) and I wouldn't urge her at all. When she was done eating for good, for the rest of her life, that also was very clear. MIL also faded through these stages, but took longer in the "lost interest in food" part. MIL had 24/7 in-home care for 5 years. At the beginning, the caregivers would ask her what she'd like for breakfast, and she'd say, oh, just a cup of coffee and a piece of toast dearie, not wanting to put them to any trouble. We convinced those morning shift folks to make a full "bacon and eggs plus" repast and present it to her as a fait acommpli. They were pretty surprised that she'd clean her plate right up!

JJAz

40 pounds is a lot.  He generally needs to finish what's on his plate.  If he can do it on his own (given enough time) then he's OK to feed himself.  Otherwise, the staff should assist him in finishing his meal. They shouldn't take the plate to the kitchen when it's half full.

Another problem with some men in a care facility is that they are offered fewer calories than they ate at home.  The kitchen prepares the plates and the staff often place the same size meal in front of a big man and a small woman.

Also consider supplementing his meals with an Ensure drink as snacks.

star26

The fact that he's lost around 40 pounds (whether this was extra weight or not) and that he's not eating enough on his own when food is in front of him are clear signs he's already "losing the independence he has for self-feeding".  Is this MC equipped to honor dietary restrictions and requirements? If so, "finger foods only" can be part of his dietary order given to the kitchen, along with cutting up food for him before it comes out of the kitchen, and even serving him just from a list of his favored foods. And will the MC agree to feeding him all meals with current staff or do you need to make special arrangements? If someone is assigned to sit with him for feeding, and he's picking up a fish stick on his own and eating it, they're not going to rip it out of his hand and say "no, only I can feed you" (assuming they have common sense). They are there to pick up where he leaves off and do as much assistance is needed for him to eat 80% of what's on his plate. Often, all the PWD that need help feeding are at the same table with one CNA assisting more than one PWD so if he can do some on his own, it's welcomed. I would put your feeding and dietary requirements into the MC facility now and as soon as it's safe, get into the dining room during mealtime.

Crushed

Marie58 wrote:

Thanks Crushed. Yes, they weigh DH too. But how did you know when it was time to feed her rather than just rely on her feeding herself with finger foods? He's not too thin yet, and will eat on his own, even though he often needs cues.

DW weighed 116 pounds when we got married in 1975  She was 120 pounds when she went into MC.  She dropped to 98 pounds early in 2019 and and went on hospice. Her doctor insisted that she simply was not getting enough calories and told us she should get ice cream and cake for breakfast if she would eat it.  Then the Doctor looked at me and said That's for her not for you!! (I'm overweight) 

  So we started on the cookies cake ice cream, pie  and Brownie diet.   SHE THRIVED.  She is still on it.  she was 119 pounds last week.  

by November 2019 she could do nothing to feed herself.  She did not recognize a cookie on a plate. 

Jeff86

Call me a cynic, but I don’t think the MC facility is focused on your DH not losing his independence for self feeding—it’s about devoting the staff time required to do so.  It’s this basic—AD is a progressive disease and our LO’s lose their ability to perform ADL’s.  Then they need help.

It’s way more important that your DH gets the nutrition he needs than that he maintains his ‘independence.’

My DW is not in MC but has begun to have issues around feeding.  Left on her own, she is more likely than not to quit eating, after a couple of bites.  If I feed her, she’ll often finish her meal (well, breakfast and lunch....rarely dinner).  It’s a mighty slow process.  But it’s the difference between having her receive the nutrition she needs...or not.

Just my opinion....and experience.

harshedbuzz

Marie-

We went through this with both my dad and my dear auntie. 

Auntie was in MC for years and progressed slowly. She was very social and enjoyed her food- especially treats. She had had a stroke, so early on her food was cut for her but as she lost the ability to self feed, my other aunt who was her guardian hired someone to feed her at lunch to be certain she got a full meal and dessert in. Staff would do this, but depending on the level of function of the other residents (which is very fluid), feeding could be rushed or end before auntie was ready. Another issue is that those who need to be hand-fed are often grouped at the same table with one or two aides which can be a messy process with swallowing issues. As a consequence, her weight remained fairly stable until the last two years of her life. 

Dad lost quite a bit of weight even before he went into MC; he was further into the disease than my aunt had been on admission. He was still self-feeding and eating meals and snacks but losing weight. His doctor said this was common in later stage dementia and said that a loss of 10% of more in 6 months was associated with a higher rate of mortality. Dad continued to lose weight in MC. He could still feed himself and staff were great about offering a second option if the resident didn't want the hot plate offered for some reason. They also had an early morning coffee and danish, as well as afternoon and bedtime snacks built into the day. Someone visited him daily, usually around lunch, and always with a high calorie treat- Chik-Fil-A and a milk shake, a microwavable serving of dinner from home, treats from the bakery- but he continued to lose weight.

Beachfan

Hi Marie,

I can readily understand your dilemma, although my DH remains at home with feeding issues.  When I envision (eventual) placement for him, his eating/self feeding is a major concern. DH is, and has always been a good eater.   At present, he self feeds with the food cut up, with a plate guard, non slip surface, and with a spoon/ fork placed in his hand.  We eat three meals together regularly and to accomplish “self feeding” on his part requires me to stealthily re-arrange the food, guide food onto his utensil, and finally, feed him the last of the meal.  With finger foods, I have to place the item into his hand (sandwich quarter or burger half), and/or re-arrange the bits of food and guide his hand to pick them up.  I have to put a drink into his hand and tell him to “put it up to your mouth- - it’s a drink.”  He will not ask for food/drink, seek out food or even answer sensibly if I ask, “Are you hungry?”  “I don’t know.”  He cannot snack or drink away from the dining table; it’s too difficult.  

Overall, DH is an “easy” patient, requiring (maybe) a total of 2 hours daily of complete hands-on care.  I have relegated placement decisions to the back burner for now due to COVID, but more so because I can’t justify the out of pocket cost for care that I can provide blindfolded.  In addition to the monthly fee, I envision, like Crushed, an additional cost for a one-on-one aide to monitor each meal. I wish you well with this dilemma; I recall how you agonized over placement.  I have no constructive advice; I just know how hard this is for you.  Good luck.