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Why Favourite Foods Matter in Hospice Care

When someone is dying, the clinical priority of nutrition and caloric intake diminishes. What rises in importance is quality of experience: comfort, pleasure, connection, and dignity. Food is one of the most powerful vehicles for all of these things.

Research in palliative care consistently shows that patients near the end of life who can access foods that carry personal, cultural, or emotional meaning experience greater well-being and report higher quality of remaining life. For family caregivers, providing a beloved food — however small the amount, however modified the texture — is one of the most meaningful acts of care still available to them.

This page offers practical guidance for adapting common Hong Kong comfort foods to IDDSI texture levels suitable for patients with dysphagia in hospice or end-of-life care settings.

Understanding the IDDSI Framework in This Context

In comfort feeding contexts, IDDSI levels provide a clinical safety baseline. The SLT’s IDDSI recommendation tells caregivers the minimum safety threshold — the texture at or above which the risk of aspiration is acceptably managed. However, in palliative care, decisions about exceeding this threshold are made by the patient and their care team together.

For this guide, we provide IDDSI adaptations for each dish — the safest version the patient can eat. Whether to offer a non-compliant texture should be discussed with the palliative team.

Adapting Hong Kong Comfort Foods

Congee (白粥) — IDDSI Level 3-4

Cantonese congee (jook) is already one of the most naturally dysphagia-friendly foods in Hong Kong cuisine. Plain congee cooked for an extended time (45–60 minutes from raw rice) becomes smooth, thick, and warming.

Adapting to IDDSI Level 3 (Liquidised): Blend the cooked congee until completely smooth, then strain through a fine-mesh sieve to remove any rice fragments. The result should flow slowly but steadily from a spoon.

Adapting to IDDSI Level 4 (Puréed): Blend without straining — the result should hold its shape briefly but collapse under gravity. Does not form a separate liquid pool when plated.

Favourite additions that can be adapted:

Dim Sum Favourites — IDDSI Level 4

Yum cha is culturally central to many Hong Kong families. Some dim sum items can be adapted for patients who can no longer manage yum cha:

Cheung fun (腸粉, rice noodle rolls): Rice noodle rolls are naturally soft when freshly made. For Level 4, steam thoroughly and serve without filling (or with finely minced, fully cooked filling). Test with IDDSI fork test — should squash easily under minimal pressure.

Har gau filling (蝦餃餡): The shrimp filling from steamed shrimp dumplings, finely minced and mixed with a small amount of prawn stock, can approach IDDSI Level 4. The wrapper itself is not safe.

Lo mai gai filling (糯米雞): Sticky rice is not safe for most dysphagia patients. However, the soft chicken and mushroom filling can be blended separately with a small amount of soy-ginger sauce to achieve Level 4.

Egg tart custard (蛋撻餡): The baked custard filling of HK egg tarts, served without the pastry shell, is naturally Level 4–5. A delicious, culturally meaningful dessert.

Roast Goose / Roast Duck (燒鵝／燒鴨) — IDDSI Level 4

Cantonese roasted meats carry enormous cultural significance. Most Hong Kong patients will have strong associations with specific roasters or family traditions.

To adapt: Request the breast meat only (less sinew). Cook the shredded breast meat in a small amount of poultry stock over low heat until completely tender. Blend with the stock to Level 4 — the result should hold shape and have the characteristic flavour even without the skin. The skin itself cannot be safely adapted for most dysphagia levels.

Sweet Soup Desserts (糖水) — IDDSI Level 2-3

Cantonese sweet soups (糖水) are culturally familiar and comforting. Many adapt well to IDDSI:

Soup (湯) — IDDSI Level 1-2

Chinese-style soups — slow-simmered with bones, vegetables, and medicinal herbs — are deeply comforting and culturally meaningful. The liquid broth (without any solid components) is often IDDSI Level 1 (thin) or can be thickened to Level 2 with a commercial thickener.

To adapt: Strain all solids out thoroughly. For Level 2, add a small amount of xanthan gum-based thickener and test consistency. Serve warm. Even a few spoonfuls of beloved family soup can provide significant sensory and emotional nourishment.

Presentation and Atmosphere

How food is presented matters at end of life:

The goal is not nutrition. The goal is a small moment of pleasure, connection, and dignity.