IDDSI Training in the USA: A Practical Guide for Long-Term Care & Foodservice Teams
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. Explore IDDSI Training USA 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: Official IDDSI Framework Documents 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