In yesterday’s post I reflected on the importance of Dylan’s weekly programme; Dylan’s activities, I suggested, are a key factor in his successful transition to residential care. As well as continuing the focus on Dylan’s activities, today’s post involves two other factors I consider to be central to Dylan’s transition, diet and communication.
Dylan’s diet needs to be managed in two ways. Firstly, because there appears to be a link between his consumption of sugar and outbreaks of aggressive behaviour, Dylan follows a low-sugar diet. Secondly, Dylan has been a vegetarian since birth. While it can be challenging to follow a low-sugar, vegetarian diet in a group setting, for cultural, health and behavioural reasons it would be good to support Dylan to maintain this if possible.
Although I cannot be sure, I suspect that Dylan’s diet at a day centre he attended prior to moving to residential care was not sugar free. Staff at Dylan’s residential setting, however, have understood the importance of his low-sugar diet and have supported Dylan to manage this. The virtual absence of aggressive behaviour since Dylan moved to the residential setting is the reason I identify diet as a factor in the success of Dylan’s placement (though I realise the improvement in Dylan’s behaviour may be linked to something other than the improved management of his diet).
I have been reassured by the effective management of Dylan’s low-sugar diet but the maintenance of his vegetarian diet at his residential setting has proved harder. I reflected on the possible reasons for this in a recent post on the cultural practice of food. I have previously noted how useful this blog is for thinking through key issues in Dylan’s care and writing the post about food seemed to open up a fresh way forward. Perhaps, I suggested to the care home manager, staff could support Dylan to do his own food shopping? That would prevent a situation where Dylan was being offered vegetarian food he didn’t like and should allay any anxiety that he wasn’t exercising meaningful choice over his diet.
Although this might seem an obvious solution it wasn’t something that had presented itself as a possibility because Dylan has not accessed supermarkets for over a year. Although Dylan used to shop with me each week, and make his own food choices with support, the supermarket environment became too challenging following the switch to a low-sugar diet. Because Dylan didn’t understand why he could no longer select sweet items for the trolley, he became distressed while shopping and I judged it better to shop online. But, I suggested to the care home manager, Dylan was much more accepting of his low-sugar diet now and with skilled support may be able to manage the supermarket environment again.
So Dylan’s programme for today included food shopping as his main morning activity. The supermarket he went to is not one Dylan is familiar with and apparently he was hesitant to go in initially; with the support of his visual schedule, however, and with staff who know him well enough to allow the time he needed, the trip was successful. Dylan pushed the trolley and chose some of his favourite foods, happy to be redirected from sugary products. ‘Hopefully’, the care home manager emailed me this afternoon, ‘this can be a regular activity for Dylan on his programme and it will become something he enjoys’. I have a meeting scheduled tomorrow to review issues around Dylan’s diet but, after today’s shopping trip, I’m already feeling more positive 🙂