Wednesday, February 16, 2011

Daily Living Skills Series: Meal Preparation Interventions

This is another blog in the series of blogs that I started this year to discuss the different interventions used to help people learn, or find a way to do their daily living skills. Despite all the discussion of approaches to take and theories to use, it seems very few service providers are discussing the specifics of what they actually do to help people in these areas. This series is meant as a starting point where I will discuss some interventions that I have found helpful.

Building on last week's blog about nutrition and menu-planning, today I will talk about meal preparation.

Meal Preparation Assessment

Meal preparation is an area that we are frequently called in to assess, as it can make a significant difference to a person's safety living independently. Meal preparation assessment is always difficult - just because you see someone do something well one time cannot ensure the person can do it well all the time, and vice versa. Although I want to mostly stick to talking about interventions, I want to make a few quick points about meal preparation assessment:
  • Cooking is an area that I have found that people are incredibly unreliable in their self-report of their proficiency. I have had many people tell me they are excellent at cooking and then observed several serious safety issues while watching them cook. I have had people tell me they are not very good at cooking, and then showed me that they are much better than they stated. The only way to know for sure is to actually watch someone cook.
  • You cannot judge if someone can cook safely by watching him or her make tea and toast or boxed macaroni and cheese. I usually ask the client to make a dish that involves using the stovetop and handling raw meat (if they are not vegetarian). Spaghetti and Hamburger Helper are favorites. This way, I can observe fire safety as well as cross-contamination prevention. I once had a well-educated client tell me she was an excellent cook. She took her hands out of raw ground beef to grab her snack and take a bite, and then continued with the ground beef. Then she proceeded to cook the meat on high without stirring, which managed to burn it as well as leave part of it raw and did not feel this was a problem. Yet I'm sure she could have made tea and toast or boxed macaroni and cheese just fine.
  • Always ask about past fires. You will be surprised at some of the answers you get. Remember that past behavior is often a good predictor of future behavior unless there is a significant force of change.
  • Remember to ask where the person would store the leftovers, and for how long. Again, you will likely get some surprising answers.
Meal Preparation Interventions

Skills-Teaching

One of the most common interventions when someone has difficulty with cooking is skills-teaching. This can be quite time-consuming, but can be quite helpful when your client is motivated. Often I have chosen four or five simple recipes to practice with a client until the client feels he or she has mastered them. Along the way, I have taught safe food-handling and cooking practices. This approach seems to be most helpful when the person has relatively good judgement, but has not had much opportunity to learn how to cook. Fightbac has a lot of printable information on safe food handling.

Physical Interventions

When physical disabilities are a barrier, there is a whole range of equipment available to help. Check out this article on kitchen safety for some ideas on modifications to activities. Medical supply stores usually have many different products you can check out. Funding for equipment can sometimes be difficult, depending on where you live and what your situation is.

Cognitive Interventions

I find it helpful to provide simplified recipes. I have not yet found a great source for these, as even recipes that claim to be simple seem to often be too complicated or use expensive ingredients. Recipes can even be placed in plastic sleeves so you client can check off each step with a washable marker. Here are some of the criteria I use when choosing and modifying recipes:
  • Starting by asking the client his or her preferences
  • Very few ingredients (4 or 5 max.)
  • Inexpensive ingredients, preferably ones commonly given out by the food bank
  • Directions broken down into small, concrete steps
  • No fancy cooking terms
If fire safety is a concern, there are some things that can be done to reduce the risk. I always encourage clients to remain in the kitchen the whole time they are cooking, and encourage them to use timers. I recommend and sometimes assist with reducing kitchen clutter. For some clients, I recommend using the microwave only, and not the stove, as there is less fire risk with the microwave. However, then I have to ensure the client has enough microwave meals he or she knows how to make.

A StoveGuard system can help ensure peace of mind. It is a motion detector that is installed by your stove that will shut off the stove if it does not detect motion in the kitchen during a specified period of time. This way it eliminates the problem of someone putting something on the stove, and then going to another room and forgetting about it. However, it is not always an easy process to have one installed, and can involve getting the help of an electrician.

Another product I find really interesting but that I could not find in Canada is the Stovetop Firestop. Basically you mount it under your rangehood, and if a stovetop fire occurs, it will release a fire-suppressing powder to extinguish it. It seems fairly inexpensive, which is an added bonus.

When Cooking is not an Option

Sometimes your client does not want to cook, or is unable to cook safely. This does not need to be a barrier to living independently. There are many different options for obtaining food.

Some services deliver hot meals every day. Others deliver frozen meals that can later be re-heated. Some apartment buildings offer congregate meal programs. I have had some clients choose to eat at soup kitchens on a daily basis. One client I recently had described going to the soup kitchen as going to a restaurant that he did not have to pay for. Some people choose to buy frozen dinners from the grocery store and re-heat these. It may not be ideal nutrition, but for many people independence is much more important than ideal nutrition.

I hope some of these ideas are helpful. I think that finding what will work in each situation really depends on the individual. If you have safety concerns, I recommend consulting a qualified medical professional such as an Occupational Therapist. I would love to hear of any other ideas.

2 comments:

  1. Hi! I was so thankful to read the following: "Despite all the discussion of approaches to take and theories to use, it seems very few service providers are discussing the specifics of what they actually do to help people in these areas." I'm a current OT student and I've been really frustrated with my program specifically because it seems like it's all talk, generalalities, and so few specifics on actually how we DO these things! THANK YOU FOR THIS BLOG!!!

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  2. I am an OT student at a state hospital and we do work with 1 client weekly on meal interventions. Originally we were going to offer recipes and go from there but tailored it to having this client master specific meals they preferred. We are also offering nutritional and safety education for cooking to help this client stay within their dietary restrictions (obesity, diabetes, and other general medical issues). It has been a great experience with it and it would be nice to hear from more OTs in the community with these skills.

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