IDDSI Training USA can help long-term care, skilled nursing, assisted living, dietary and foodservice teams build a clearer understanding of dysphagia, texture-modified foods and thickened liquids. Supporting people with dysphagia requires communication, consistency and a clear understanding of each individual’s eating and drinking recommendations.
For staff working in long-term care, skilled nursing, assisted living, dietary services and foodservice, the International Dysphagia Diet Standardisation Initiative — better known as IDDSI — provides a common framework for describing texture-modified foods and thickened liquids.
But what exactly is IDDSI? Why is it relevant in the United States? And what should care, dietary and foodservice staff understand about it?
This practical guide explains the fundamentals and provides a useful starting point for organisations looking to strengthen staff awareness.
Looking for online training? FlexiLearnHub provides flexible online Dysphagia Awareness & IDDSI Framework Training for individual learners and organisations across the United States.
What Is Dysphagia?
Dysphagia is the medical term used for swallowing difficulties.
It can involve problems with different stages of the swallowing process and may affect a person’s ability to manage food, drinks, saliva or medication.
Dysphagia can have significant consequences. The American Speech-Language-Hearing Association (ASHA) identifies potential consequences including malnutrition, dehydration, aspiration pneumonia, compromised general health and choking. Eating and drinking difficulties can also affect enjoyment, dignity and social participation.
For this reason, dysphagia assessment and management are clinical matters requiring appropriately qualified professionals.
Awareness training has a different purpose. For care, dietary and foodservice staff, it can help build an understanding of dysphagia terminology, the importance of individual recommendations, appropriate professional boundaries and the need for consistent communication.
What Is the IDDSI Framework?
The International Dysphagia Diet Standardisation Initiative (IDDSI) developed an internationally standardised framework for describing texture-modified foods and thickened liquids.
The framework consists of eight levels, numbered 0–7, covering drinks and foods of different thicknesses and textures.
Rather than organisations using different terms to describe similar food textures or drink thicknesses, IDDSI provides common terminology and detailed definitions that can be understood across different care and healthcare settings.
IDDSI also provides testing methods that can help determine whether foods and drinks have the characteristics associated with particular levels.
As of September 2026, the current official IDDSI Framework and Detailed Level Definitions is Version 2.2, while the current IDDSI Testing Methods is Version 2.0.
For the latest definitions and resources, always refer to the official IDDSI documentation:
Is IDDSI Used in the United States?
Yes. IDDSI has substantial professional support in the United States, although an important distinction needs to be made between professional adoption and a universal legal requirement.
ASHA states that it supports the IDDSI Framework. The Academy of Nutrition and Dietetics, Association of Nutrition & Foodservice Professionals and ASHA have supported collaborative implementation of IDDSI in the United States since its official US launch in 2019.
IDDSI is also the standardised texture-modified diet framework used in the Academy of Nutrition and Dietetics’ Nutrition Care Manual.
However, ASHA specifically notes that neither ASHA nor US payors mandate adoption of IDDSI. Some facilities may operate their own protocols.
This distinction is important for employers and learners.
Completing an IDDSI awareness course should not be presented as automatically making an organisation “US compliant.” Staff should work within their organisation’s policies, procedures, clinical governance arrangements and applicable regulatory requirements.
Why IDDSI Training Matters in US Long-Term Care
IDDSI Training USA can help relevant long-term care, dietary and foodservice staff develop a shared understanding of the terminology used around texture-modified foods and thickened liquids.
Depending on the setting and the individual’s needs, this might involve speech-language pathologists, dietitians, nurses, caregivers, dietary staff, foodservice managers, cooks and other members of the multidisciplinary team.
A recommendation made following an appropriate assessment ultimately has to translate into the correct food or drink reaching the correct individual.
This makes clear communication and consistent terminology especially important.
When different departments understand the terminology being used, there is a stronger foundation for communicating an individual’s documented requirements accurately.
IDDSI awareness should therefore not be viewed solely as a kitchen issue or solely as a clinical issue.
Different professionals have very different responsibilities and competencies, but relevant staff can benefit from understanding the terminology they encounter in their role.
Understanding Texture-Modified Foods
Some people with dysphagia may be recommended foods with modified textures following appropriate assessment.
The IDDSI Framework includes different food texture levels, including terms such as Pureed, Minced & Moist, Soft & Bite-Sized and Easy to Chew.
The important principle for care and foodservice staff is that an individual’s appropriate food texture should not be guessed or selected simply because that person has dysphagia.
Individual recommendations depend upon assessment and the person’s particular circumstances.
ASHA advises that decisions around diet texture modification should take account of comprehensive assessment findings, evidence, clinical judgement, overall health, preferences and goals.
Staff should therefore follow the individual’s current documented recommendations and their organisation’s procedures rather than independently changing a person’s food texture.
Understanding Thickened Liquids
IDDSI also provides standardised terminology for drinks of different thicknesses.
Where an individual has been recommended a particular drink consistency, staff involved in preparing, serving or supporting that person need to understand the documented requirement and follow the appropriate procedures.
The distinction is important because informal descriptions such as “a little thicker” or simply “thickened” are open to interpretation.
A standardised framework provides much more precise terminology.
It is also important not to assume that thickening a drink automatically removes all swallowing risk. ASHA notes that texture-modified foods and thickened liquids may not eliminate the risk of aspiration and associated pneumonia.
This reinforces why individual assessment and professional recommendations remain essential.
IDDSI Testing Methods
One of the practical features of the IDDSI Framework is its testing methodology.
Different tests can be used to examine characteristics such as the flow of drinks, food texture, softness and particle size.
These methods provide a more objective approach than simply deciding that something “looks about right.”
The exact method depends upon the IDDSI level and the food or drink being assessed.
The official IDDSI resources should always be used for the current testing definitions and procedures:
IDDSI Framework and Testing Methods
Understanding an IDDSI testing method does not, however, give a staff member clinical authority to decide which IDDSI level an individual requires.
Those are two different responsibilities.
The Importance of Communication Between Care and Foodservice Teams
Consider the journey of a single texture-modified meal.
An appropriately qualified professional may assess an individual and make recommendations.
Those recommendations need to be documented.
Relevant information needs to reach the appropriate staff.
The kitchen or foodservice team needs to know what has been requested.
The meal needs to be prepared according to the relevant specification and organisational procedures.
The correct meal then needs to reach the correct person.
Care staff supporting the individual also need access to the relevant instructions.
If information is misunderstood or lost at any stage, consistency can be affected.
This is why a shared basic understanding of dysphagia and IDDSI terminology can be useful across different departments, even though the precise level of training and competency required will depend on each person’s role.
Common IDDSI Awareness Gaps
Organisations supporting people with dysphagia may find it useful to consider whether relevant employees understand several basic principles.
Understanding Dysphagia
Staff should understand what the term dysphagia means and why swallowing difficulties require appropriate professional assessment and individual recommendations.
Understanding the IDDSI Framework
Relevant staff should recognise IDDSI terminology and understand the basic purpose of standardising food textures and drink thicknesses.
Understanding Your Role
A member of the care or foodservice team needs to understand both what they are responsible for and what lies outside their professional role or competency.
Awareness training should reinforce those boundaries rather than blur them.
Communicating Individual Recommendations
Organisations need reliable processes for communicating individual food and drink requirements to the people who prepare, serve and support meals.
Knowing When to Escalate a Concern
If something appears inconsistent with a person’s documented recommendations, staff should know how to raise the concern through the appropriate organisational process rather than improvising or independently changing the person’s prescribed consistency.
IDDSI Awareness Is Not Clinical Dysphagia Competency
When considering IDDSI Training USA, it is important to distinguish between awareness-level education and clinical dysphagia competency.
A dysphagia and IDDSI awareness course can help learners develop knowledge of subjects such as:
- Dysphagia terminology
- The structure of the IDDSI Framework
- Texture-modified foods
- Thickened liquids
- IDDSI testing principles
- Individual recommendations
- Communication and consistency
- Professional responsibilities
It does not qualify somebody to diagnose dysphagia, conduct a swallowing assessment, prescribe an IDDSI level or independently alter an individual’s prescribed food or drink consistency.
ASHA describes speech-language pathologists as preferred providers of dysphagia services and integral members of the interprofessional team involved in diagnosing and managing oral and pharyngeal dysphagia.
Online awareness training should therefore complement appropriate professional assessment, workplace procedures and role-specific competency — not replace them.
Watch: IDDSI Training USA
Looking for flexible online IDDSI and dysphagia awareness training?
FlexiLearnHub provides online training for individual learners and organisations, including people working in long-term care, skilled nursing, assisted living, dietary and foodservice environments across the United States.
Online IDDSI & Dysphagia Awareness Training
FlexiLearnHub’s Dysphagia Awareness & IDDSI Framework Training provides an accessible introduction to dysphagia and the IDDSI Framework.
Training is completed online and at the learner’s own pace, making it suitable for individual professional development as well as organisations looking to support staff awareness.
Course topics include dysphagia awareness, the IDDSI Framework, texture-modified foods, thickened liquids, IDDSI testing awareness and the importance of following each individual’s documented recommendations.
FlexiLearnHub is a UK-based online training provider, and the course is available internationally, including to learners in the United States.
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Frequently Asked Questions
What Does IDDSI Stand For?
IDDSI stands for the International Dysphagia Diet Standardisation Initiative.
It developed a standardised international framework for describing texture-modified foods and thickened liquids.
Is IDDSI Used in the USA?
Yes. The IDDSI Framework is supported by major US professional organisations including ASHA, the Academy of Nutrition and Dietetics and the Association of Nutrition & Foodservice Professionals.
However, ASHA states that neither ASHA nor US payors mandate IDDSI adoption, so organisations should also consider their own policies and applicable requirements.
Who Should Receive IDDSI Training?
Training requirements depend upon the person’s responsibilities and the organisation.
Staff involved in preparing, serving or supporting food and drinks for people with dysphagia may benefit from appropriate awareness of dysphagia, IDDSI terminology and their organisation’s procedures.
Role-specific competency requirements may go beyond general awareness training.
Does IDDSI Awareness Training Qualify Me to Assess Swallowing?
No.
Awareness training does not qualify a learner to diagnose dysphagia, conduct swallowing assessments, prescribe IDDSI levels or independently change an individual’s food texture or liquid consistency.
Can IDDSI Training Be Completed Online?
Yes.
FlexiLearnHub’s Dysphagia Awareness & IDDSI Framework Training is completed online, allowing learners to study flexibly and at their own pace.
Build Stronger IDDSI Awareness Across Your Team
Supporting someone with dysphagia requires more than simply recognising an IDDSI number.
It requires clear communication, individualised recommendations, consistent preparation and an understanding of professional responsibilities.
For care, dietary and foodservice teams, appropriate IDDSI awareness can help staff understand the common terminology used around texture-modified foods and thickened liquids while reinforcing the importance of following each person’s documented recommendations.
If you or your organisation would like to strengthen staff awareness, explore FlexiLearnHub’s online training.
Online IDDSI & Dysphagia Training USA
Course Price & International Payment
Course price: £15 GBP
FlexiLearnHub is a UK-based training provider and welcomes learners from the USA. International card payments are accepted securely through Stripe. Your card provider will convert the £15 GBP payment into US dollars $ using its applicable exchange rate.
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