Food Safety in Nursing Homes: What You Must Know

Following key food safety principles is important no matter the setting but it’s particularly important in nursing homes.

This is because residents of nursing homes are a highly susceptible population, meaning they are more likely than the general public to become severely ill from a foodborne illness.

For this reason, there are additional food safety precautions that you must follow when working in a nursing home to keep residents safe.

This article explains everything you must know about food safety in nursing homes to keep those you serve safe from foodborne illnesses.

Nursing home residents are a susceptible population

Adults 65 years of age and older have a less robust immune system than their younger counterparts making it more difficult for them to fight infections.

For this reason, older adults are considered a highly susceptible population in that they are more likely than the general public to get sick and even die from foodborne illnesses.

Foodborne illnesses are transmitted through food and are usually caused by a disease-causing organism — or pathogen — like a bacteria, virus, fungi, or parasite.

But age isn’t the only factor that makes a person more susceptible to foodborne illnesses.

Chronic conditions that weaken the immune system like diabetes, kidney disease, heart disease, and cancer as well as certain types of treatments like chemotherapy also increase a person’s risk.

These factors are common in older adults but also younger adults who may be receiving care in a nursing home.

Guidelines for food safety in nursing homes

Because nursing home residents are considered a highly susceptible population, there are additional food safety precautions you must take to keep them safe from foodborne illnesses (1).

These additional precautions are developed by the Food and Drug Administration (FDA) and enforced by the Centers for Medicare and Medicaid (CMS) — the federal agency that oversees nursing homes.

Here are the guidelines for food safety in nursing homes:

No bare-hand contact

At no time should you handle ready-to-eat (RTE) food with your bare hands (1).

This is because even with proper handwashing, your hands may still contain enough bacteria to make someone from a susceptible population like nursing home residents sick.

Unfortunately, bare-hand contact with RTE food is a common food safety mistake in nursing homes.

As the name suggests, RTE food is food that is ready to eat — it doesn’t require additional preparation or cooking before it can be eaten.

Examples of RTE foods include:

• sandwiches and wraps
• burgers
• hot dogs
• tacos
• pizza
• deli meats and cheeses
• fruits and vegetables that have been washed and cut
• bakery items like donuts and bread
• any cooked or reheated food

There must always be a barrier between your hands and RTE foods. This barrier is commonly single-use gloves but it can also be deli tissue, spatulas, tongs, or other utensils.

Using deli tissue and other utensils over single-use gloves tends to be a safer option since many food handlers don’t change their gloves when they’re supposed to.

No raw or undercooked animal products

Animal products like meats, poultry, and seafood commonly carry pathogens like Salmonella and E. Coli.

This is why it’s important to cook them to the proper minimum internal temperature, especially when working with nursing home residents (1).

Unfortunately, this means no sushi or medium-rare steaks.

Eggs are also a common source of pathogens like Salmonella, which can survive if they are not cooked through.

Therefore, you cannot serve eggs where the yolk is runny like with over-easy or sunny-side-up eggs unless you use pasteurized eggs.

Pasteurized eggs are heat-treated to kill Salmonella and other bacteria that may be present.

You also cannot serve raw animal products like mayonnaise, tiramisu, eggnog, and Caesar salad dressing unless you use pasteurized eggs.

No untreated juice or raw seed sprouts

When fruits and vegetables are fresh-squeezed to make juice, bacteria from the produce can end up in the juice or cider.

Therefore, unless the juice has been pasteurized or otherwise treated to destroy pathogens, you cannot serve it to nursing home residents due to the risk of it being contaminated (1).

Most juice is pasteurized, but some health food stores and farmers’ markets sell juice that was made onsite without undergoing pasteurization.

You can identify untreated juice by looking for the following warning label on the product:

WARNING: This product has not been pasteurized and therefore may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.

This label isn’t required for juice or cider sold by the glass that you might find at apple orchards or farmers’ markets.

In addition to untreated juice, you cannot serve raw seed sprouts since they grow in warm, humid conditions where pathogens thrive.

No food reservice

Once you serve a resident packaged food like crackers or single-serving condiments to a resident in isolation or quarantine, you cannot reserve those items to another resident — even if they are unopened — or vice versa (1).

A resident may be put in isolation or quarantined if they have or have been exposed to a virus or have a bacterial infection like C. diff.

This is because a resident can contaminate the food and then that food becomes a vehicle for transmission to the next resident when it’s reserved.

Thus, once given to a resident in isolation, the food must stay there until the resident consumes it or you toss it.

Disaster menu and food supply

Unlike a food court or restaurant that can close its doors when disaster strikes, you are responsible to keep them fed and safe.

Therefore, you must keep an emergency supply of nonperishable food and water supply on hand at all times.

You should have enough food and water for at least three days but in some states where disasters like hurricanes are common, you may need a 2-week emergency supply.

Regularly review your disaster menu and ensure you have enough food and water in stock based on your state’s requirements.

Your dietitian can ensure the disaster menu is nutritionally adequate.

Food safety and sanitation audits

Food safety violations are one of the most common tags or deficiencies that surveyors cite in long-term care.

Educating your staff on safe food handling practices can help reduce these tags but it’s also important that you have a corrective and preventative action plan in place.

As part of this plan, you should conduct food safety and sanitation audits monthly, but more often if you identify multiple reoccurring safety concerns.

Conduct these audits at different times, such as during receiving, preparation, and storage, and have other staff members who are not involved in foodservice frequently conduct them to provide a more clear, bias-free picture of food safety concerns.

Here’s a comprehensive food safety and audit form that you can download for free and use in your center:

Use the results from your audit to determine where more education might be necessary.

Also, don’t forget about the required dietary inservice training that nursing homes in South Dakota and other states require.

The bottom line

Nursing home residents are considered a highly susceptible population, meaning they are more likely than the general public to develop foodborne illnesses.

Therefore, you must take additional food safety precautions when preparing and serving food to keep them safe.

Avoid handling RTE foods with your bare hands and cook animal products like meats, poultry, and seafood to their minimum internal temperature.

Don’t serve untreated juice, raw seed sprouts, or packaged food to or from residents in isolation or quarantine.

Review your disaster menu regularly and make sure you have enough nonperishable food and water in stock at all times based on your state’s requirements.