10 Mistakes Food Handlers Make in Nursing Homes

Nursing homes — also called skilled nursing facilities — provide care to people who cannot properly care for themselves.

Nursing home residents are considered a highly susceptible population, meaning they are more likely than the general public to get sick from a foodborne illness.

For this reason, food handlers — also known as dietary aids in nursing homes — must take additional food safety steps to keep them safe.

Unfortunately, food handlers don’t always practice the basics to keep them safe.

This article lists the top 10 mistakes food handlers make in nursing homes and what you can do to prevent them.

Top 10 mistakes food handlers make in nursing homes

Throughout my years working as a dietitian and employing other dietitians in nursing homes, I have seen my fair share of food safety no-nos.

The Centers for Medicare and Medicaid regulate nursing homes but they, like other foodservice operations, go by the Food and Drug Administration’s Food Code (1).

Here are the top 10 mistakes food handlers make in nursing homes and what you should do instead.

1. They touch RTE food with bare hands

In some foodservice establishments, it’s OK to touch ready-to-eat (RTE) food with your bare hands with special approval from your health department.

However, bare-hand contact with RTE food is never allowed when working in a nursing home.

This is because, even with proper handwashing, your hands may still contain enough bacteria to make nursing home residents sick.

RTE foods don’t require further preparation or cooking before serving.

Examples of RTE foods include:

• sandwiches and wraps
• burgers and hot dogs
• tacos
• pizza
• deli meats and cheeses
• fruits and vegetables that have been washed and cut

There must always be a barrier between your hands and RTE foods to keep them safe.

This barrier may be food-safe gloves, deli tissue, or serving utensils like tongs or spatulas.

However, remember that gloves are a food-contact surface and can become contaminated just like your hands, so change them often.

People who bring food from outside sources like family and friends should also know not to handle RTE foods with their bare hands.

2. They store items on the floor

While it may be convenient to store or leave food items on the floor, doing so can attract pests, lead to cross-contamination, and prevent proper cleaning.

Instead, you must store foods in cold storage off the floor and food and supplies like napkins or single-use utensils in dry storage at least six inches (15 cm) from the floor.

Food that is stored in closed boxes can be stored less than six inches on items like dollies and pallets.

Some states require that you also store food in dry storage at least 18 inches from the ceiling to prevent sprinkler obstruction in the case of a fire.

3. They don’t label and date food

You should always store food in its original container, but when this isn’t possible, you must label the item if it’s not easily recognizable.

This goes for items in both cold and dry storage.

Labeling reduces the risk that you mistake one ingredient for another, which could lead to cross-contact.

Cross-contact is the transfer of food allergens from one food or surface to another.

Failing to properly mark food with a use-by date is another common mistake food handlers make in nursing homes.

For time-temperature control for safety (TCS) foods, mark the date or day by which the food needs to be served, sold, or tossed after opening if you plan to hold it for longer than 24 hours.

You can store TCS foods for up to seven days, with the day you opened the container or package counting as day 1.

4. They don’t keep a clean kitchen

Maintaining a clean kitchen is everyone’s responsibility, but unfortunately, it doesn’t always happen.

Here are places that tend to go uncleaned:

• the microwave
• shelves in cold storage
• range hood vents
• drawers
• under equipment like stoves and cabinets
• vents and ceiling fans
• ice machines

These areas often go unnoticed and therefore become dirty over time, and health surveyors love to check to ensure they are clean.

5. They don’t hold food at the proper temperature

After you cook or reheat food to the proper internal temperature, your work isn’t over.

You must also ensure it stays at a safe temperature during serving.

Hold hot food at a minimum of 135ºF (57ºC) and cold food at a maximum of 41ºF (5ºC).

Food held between 41ºF and 135ºF (5ºC and 57ºC) is in the temperature danger zone, where bacteria grow and multiply rapidly.

Check the temperature of hot- and cold-held food at least every four hours — but preferably every two hours — to ensure it’s not within the temperature danger zone.

You can’t rely on the temperature gauge of hot- or cold-holding equipment since it displays the temperature of the device, not the internal temperature of the food.

Therefore, you must always use a sanitized, calibrated food thermometer.

Learn more about food temperature regulations in nursing homes.

6. They don’t cook eggs through

Many nursing home residents prefer their eggs where the yolk is runny like over-easy or sunny-side-up eggs.

But, because eggs have the potential to carry Salmonella, which can survive if not cooked through, you cannot serve eggs with a runny yolk.

You can, however, serve eggs where the yolk is runny if you use pasteurized eggs, which are heat-treated to kill off Salmonella or other bacteria that may be present.

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

7. They reserve unopened food items

Some nursing home residents must be temporarily isolated or quarantined from others if they have been exposed to a virus like influenza or have C. diff (Clostridioides Difficile), a bacterial infection that infects the bowels.

These residents are confined and isolated to their rooms where they must do everything, including eating.

Therefore, you must provide them with a room tray until it’s safe for them to dine with others.

While you may believe that you are preventing waste by reserving unopened condiments or beverages, doing so can spread the virus or infection that resident has to others.

Therefore, once you serve food to a resident in isolation, it must stay there until they use or toss it.

Similarly, you also cannot reserve food packages from residents outside of isolation or quarantine to residents who are in isolation as doing so could introduce new germs and make the resident more ill.

8. They don’t keep the outside garbage lid closed

The outside garage lid must remain closed at all times to prevent the scattering of garbage by birds, the breeding of flies, or entry or rodents.

You might not think that state surveyors check to ensure you keep the lid closed, but they frequently do.

You should also regularly clean the outside of the garage container and the area around it and keep the drain plug in place to prevent leakage to further detour pests.

Don’t forget to wash your hands once you return to the kitchen after taking out the garage.

9. They store food incorrectly in the refrigerator

Keeping TCS food in cold storage slows the growth of bacteria but it’s not enough to keep it completely safe.

You must also ensure that you store it correctly to avoid cross-contamination, which can happen if you store raw animal foods above RTE foods.

In this scenario, the juices from animal foods can drip onto and contaminate the RTE food with bacteria.

To prevent cross-contamination, store foods based on their minimum cooking internal temperature in descending order, with those that require the highest on the bottom.

For example, poultry requires the highest internal cooking temperature and therefore should be stored on the bottom shelf.

In contrast, RTE foods don’t need cooking and therefore should be stored on the top shelf.

Here is the proper storage order for refrigerated foods, in order of top to bottom:

1. RTE foods and leftovers
2. seafood
3. whole cuts of beef and pork
4. ground meats and seafood
5. whole and ground poultry

10. They don’t wash their hands when they become contaminated

While listed as the number 10 mistake, this is easily the most common food safety mistake food handlers make in nursing homes.

It’s easy to forget to wash your hands during meal service or if you’re down a few team members, but it’s essential that you do when they become contaminated to prevent foodborne illnesses.

Wash your hands:

• when entering the kitchen and before food preparation
• before putting on gloves and between glove changes
• before preparing a special order for someone with a food allergy
• before handling clean equipment and utensils
• when changing tasks, such as switching from handling raw foods to working with RTE foods
• after handling soiled dishes or utensils
• after touching your face or other body parts
• after coughing, sneezing, blowing your nose, or eating or drinking
• after using the restroom

Only wash your hands in a sink designated for handwashing — never wash them in sinks used to prepare foods, wash dishes, or dispose of mop water.

The bottom line

As a highly susceptible population, it’s important to take extra precautions to keep nursing home residents safe from foodborne illnesses.

Unfortunately, many food handlers make these common — but easily preventable — food safety mistakes.

Earning your food handler card is a sure way to prove to health surveyors and your manager that you know how to keep your resident safe from foodborne illnesses.

Some states even require food handlers to earn their card when working in nursing homes.