SpeechPathology.com Phone: 800-242-5183

Progressus Therapy

Modifying the Environment during Mealtime

Amber B. Heape, ClinScD, CCC-SLP, CDP

March 26, 2018



What are some ways to modify the environment at mealtime to assist a patient with dementia?


When assisting a person with dementia during mealtime, numerous modifications to the environment can be made.  First, consider the lighting in the room.  A low-lit environment, such as a candlelight dinner, is not helpful to patients with dementia. If a person has some visual acuity or visual-perceptual deficits, dark items or shadows may appear to be spiders or insects.  If you have a fear of spiders or insects and you have ever awakened in the middle of the night and seen a shadow on the wall that scares you, you have just experienced a little of what your patient with dementia may experience if a meal is provided in a low-lit environment for them.  Also, environments with too much glare can be very disturbing for patients with dementia.

Next is place settings. Placemats are important. They help delineate the patients’ individual space. Place cards are helpful for patients who have preserved reading ability but have very poor orientation, and tend to ask, "Where am I supposed to be?" If they have a place card with their name on it, then that designates that area as their spot. Keep in mind that if a patient has their own spot, make sure no other patient takes it or that could cause major problems between the two residents. 

Contrasting colors between placemats and plates is useful. For example, a brown table, a brightly colored placemat, and a white plate help facilitate visual perception for the patient because they are all contrasting colors. Single-color plates are also important to use for visual-perceptual issues. A pretty plate with a lot of detail around the outer edge may be perceived by the patient as dirty.  We don’t want a patient to think a plate is dirty or there are bugs on the plate, or some type of thought process like that.

Square tables are better than round tables. Round tables just keep going like an infinity symbol. Square tables have sides and corners that help to designate personal space for each patient. No one likes to have someone too close to them while eating.  Having those corners helps the person to understand, “This is my space.” If it is a round table and people are sitting too close to one another, that may bother them and cause them to withdraw from eating.

Always keep the eating area clutter-free. You do not want tons of distractions. Having something small, like a flower, in the middle of the table is fine. But you do not want all of your papers, binder, pens as well as the placemats, patients’ napkins and cups all sitting on the table. When there is too much in the environment, it can easily become overwhelming.

Some facilities use the “red napkin program.” That alerts staff to patients who are at an increased risk of poor intake or weight loss.  If you see a red napkin in a dining room, know that the patient is at risk and needs to be monitored.

Familiar sounds, smells, and sights help create a welcoming environment. Some facilities have used essential oils or have a bread machine, so there is the smell of baking bread. Those familiar smells, sounds and sights may actually help a patient feel less institutionalized and more welcomed into a home-like environment. It may even improve their appetite.

Be sure to not sit residents who have personality conflicts together, just like you would with any other adult. We all know people that we would probably prefer not to go out to dinner with. We are on our own time and on our own accord, so we do not have to go have dinner with those people.  But imagine if you were forced to eat dinner with those people every single night. They may choose to just not eat.

Encourage residents who are highly social to sit with others. Eating can be a very social activity for many patients. For some it may not be, and so those patients may want to be away from others, but with other more social patients, it may benefit them.

Finally, many residents say, "I can't go in there; I don't have any money." They are thinking, “This is not home and I am going in this place. But I don't have any money to pay for my dinner, so I cannot eat.” I have seen patients become very anxious about this. And so in the past we have had “payment” where I give patients some fake money to put in their wallets, and they are then able to pay their certified nursing assistant (CNA) for dinner when the CNA delivers it. You can also provide a meal ticket or receipt, so that the patient feels like he is contributing for that meal.

Please refer to the SpeechPathology.com course, Dysphagia in Patients with Dementia: What's the SLP to Do? - Part 2, for more in-depth information on interventions and suggestions for therapists to improve the quality of life for patients with dementia.   

amber b heape

Amber B. Heape, ClinScD, CCC-SLP, CDP

Amber is a dedicated advocate for the necessity and skilled nature of therapy services with the aging population.  She is the Regional Clinical Specialist for a large healthcare company, where her responsibilities include documentation compliance, clinical education, and clinical programs for PT, OT, and ST.  Dr. Heape  received her doctorate of clinical science degree from Rocky Mountain University of Health Professions.  She is an adjunct professor of masters and doctorate level courses for two universities, has authored numerous continuing education courses, and has presented at state and national conferences across the United States.  Dr. Heape is a Certified Dementia Practitioner and volunteers with organizations that promote and preserve quality care in the elderly. 

Related Courses

Social Isolation and COVID-19 Cognitive Decline: From Zero to Hero!
Presented by Amber B. Heape, ClinScD, CCC-SLP, FNAP, CMD, CMDCP


Amber B. Heape, ClinScD, CCC-SLP, FNAP, CMD, CMDCP
Course: #9514Level: Intermediate1 Hour
  'Great information for all healthcare providers'   Read Reviews
Social distancing and isolation associated with the COVID-10 pandemic have begun to take a toll on patients in residential settings, but SLPs can help mitigate the long-term consequences. This course will discuss the risk factors for and effects of isolation, as well as potential strategies to prevent or reverse pandemic-related cognitive decline.

Dysphagia MythBusters: Tackling the Truths About Patient Choice in Residential Care Settings
Presented by Amber B. Heape, ClinScD, CCC-SLP, FNAP, CMD, CMDCP


Amber B. Heape, ClinScD, CCC-SLP, FNAP, CMD, CMDCP
Course: #10077Level: Intermediate1 Hour
  'Working in skilled nursing, it was very much a topic that built my confidence in that very gray area'   Read Reviews
Are your residential care patients with dysphagia “non-compliant” with their diets? This course provides a deep dive into a patient-centered approach to dysphagia care that also supports safety. Myths and facts surrounding patient choice are identified, and appropriate courses of action for the SLP are discussed.

Using the Yale Swallow Protocol as a Screening Tool in Residential Care Settings
Presented by Amber B. Heape, CScD, CCC-SLP, FNAP, CDP
Live WebinarTue, Apr 16, 2024 at 3:00 pm EDT   Starts in 14h 34m
Tue, Apr 16, 2024 at 3:00 pm EDT   Starts in 14h 34m


Amber B. Heape, CScD, CCC-SLP, FNAP, CDP
Course: #10863Level: Introductory1 Hour
SLPs in residential care settings need an evidence-based tool to use for dysphagia screening. This course teaches clinicians differences between screenings and assessments, how to effectively use the Yale Swallow Protocol as a predictive tool, and its relationship to Minimum Data Set (MDS) Assessment.

Ethical Practice in Aging Care
Presented by Amber B. Heape, ClinScD, CCC-SLP, CDP


Amber B. Heape, ClinScD, CCC-SLP, CDP
Course: #8755Level: Introductory1 Hour
  'Amazing ethics course that was interesting and engaging with relevant case-study examples!'   Read Reviews
As healthcare and reimbursement are changing, therapists often find themselves facing questions of ethics when working with clients who are aging. This course will review the principles of bioethics and how they apply to SLPs working with aging adults. Decision-making scenarios will be presented and discussed for application of knowledge.

Effective Documentation in Aging Care: Cognitive-Communication Disorders
Presented by Amber B. Heape, ClinScD, CCC-SLP, CDP


Amber B. Heape, ClinScD, CCC-SLP, CDP
Course: #8798Level: Intermediate1 Hour
  'Organized presentation'   Read Reviews
Effective clinical documentation has never been more important for the Speech-Language Pathologist than it is in today’s healthcare climate. This course will help SLPs working with the aging population to effectively document skilled care for aging patients with cognitive-communication disorders.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.