Returning Home After Hospital — Managing Dysphagia Safely

Before you leave hospital, the ward team should complete a discharge swallowing assessment. This typically involves your Speech and Language Therapist (SLT) confirming your current IDDSI diet level, providing written texture instructions for food and drink, and advising on any thickening products you will need at home.

Ask your ward nurse or SLT for a written discharge summary that specifies:

• Your prescribed IDDSI food level (3–7)
• Your prescribed IDDSI drink level (0–4)
• The thickening product and dose to use
• Follow-up appointment date with your SLT
• Warning signs that require urgent review

If you do not receive written instructions before discharge, contact the hospital's speech therapy department directly — most Hong Kong public hospitals have a SLT outpatient hotline.

IDDSI (International Dysphagia Diet Standardisation Initiative) classifies food and drink into 8 levels (0–7). Your hospital SLT will prescribe a specific level based on your swallowing assessment. The most common levels on discharge are:

If you are unsure which level applies to you, use SeniorDeli's free IDDSI guide at seniordeli.com/iddsi or contact your SLT before preparing any meals.

Preparing IDDSI-compliant meals at home requires the right products and consistent technique. Key steps:

1. Stock the correct thickening product. Use the brand and dose specified by your SLT. SeniorDeli's Clear Thickener is designed to achieve IDDSI Levels 1–4 consistently. Always verify texture using the IDDSI fork-drip or spoon-tilt test before serving.
2. Adapt recipes to your prescribed IDDSI level. Use a food processor, gellant, or softener to achieve the target texture. Never rely on visual appearance alone — always test texture before eating.
3. Keep meals nutritionally dense. Modified texture diets can reduce calorie and protein intake. Add fortified products or high-calorie supplements as recommended by your dietitian.
4. Maintain safe eating posture. Sit upright at 90 degrees, remain seated for 30 minutes after eating, and eat in a calm, distraction-free environment.
5. Never crush medications without advice. Some medications are unsafe to crush. Ask your pharmacist for alternatives compatible with your IDDSI drink level.

The EAT-10 is a validated 10-question self-screen for dysphagia severity. Using it regularly at home helps you track whether your swallowing is improving, stable, or worsening since discharge. A score of 3 or above suggests swallowing difficulty that warrants professional follow-up.

SeniorDeli's free app includes a digital EAT-10 with score history, so you can share a trend chart with your SLT at your next appointment. Run the screen once a week for the first month, then monthly thereafter.

Do not wait for your next scheduled appointment if you notice any of the following warning signs. Contact your speech therapist or return to A&E if symptoms are severe:

• Persistent coughing or choking during or after meals despite correct IDDSI texture
• New-onset fever or chest infection (may indicate aspiration pneumonia)
• EAT-10 score rising week-on-week
• Inability to take adequate food or fluid orally
• Significant unintended weight loss (>2 kg in two weeks)
• Drooling, food pocketing, or difficulty managing saliva

In Hong Kong, Hospital Authority SLT outpatient services accept GP referrals. For faster access, private SLT clinics can typically offer appointments within 1–2 weeks. Your hospital discharge team can provide a referral letter.