Food Safety in Nursing Homes: A Beginner’s Guide

Nursing homes — also known as skilled nursing facilities (SNFs) — provide care to people who cannot be cared for at home or in the community.

Part of this care involves cooking and serving these people — called residents — at least three meals daily along with snacks.

Because nursing home residents are more likely to develop foodborne illnesses and experience health complications from them, there are certain precautions you must take to ensure food safety.

This article explains everything you need to know about food safety in nursing homes to keep your residents safe from foodborne illnesses.

Nursing home residents are a highly susceptible population

Nursing home residents are considered a highly susceptible population, meaning they are more likely than the general population to experience a foodborne illness (1).

Other highly susceptible populations include preschool-aged children (age 5 years and younger), pregnant women, and people with conditions that weaken the immune system (immunocompromised) like cancer, diabetes, and kidney disease.

Nursing home residents are more likely to experience foodborne illnesses because as people age, their immune system becomes less robust, making it difficult to fend of the disease-causing organisms called pathogens like bacteria and viruses that cause foodborne illnesses.

Many nursing home residents are also highly susceptible to foodborne illnesses because they have conditions like cancer, diabetes, and liver and kidney disease, or undergo medical treatments like chemotherapy that weaken the immune system.

Guidelines for food safety in nursing homes

Regardless of the population you serve, following safe food handling practices is essential.

However, because nursing home residents are considered a highly susceptible population, there are additional food safety precautions you must take to reduce the risk of foodborne illnesses — both for food you prepare in-house and food provided from outside sources.

Bare hand contact

Handling ready-to-eat (RTE) food like sandwiches and washed fruit with your bare hands is allowed in rare situations but it’s never allowed when working with a susceptible population like nursing home residents.

This is because, even with proper handwashing, a small number of bacteria can still remain on your hands and be just enough to make nursing home residents ill since they have a weakened immune system (1).

Thus, there must always be a barrier between your hands and RTE food.

This barrier is most commonly single-use gloves but it can also be deli tissue, tongs, spatulas, or other dispensing equipment.

Handling RTE foods with bare hands is one of the most common mistakes food handlers make in nursing homes.

Raw and undercooked eggs, meats, and seafood

Eggs have the potential to carry Salmonella, which can survive if they are not cooked through.

For this reason, you cannot serve eggs where the yolk is runny like over-easy or sunny-side-up eggs to nursing home residents (1).

However, you can make them using pasteurized eggs, which are heat-treated to kill off Salmonella and other bacteria that may be present.

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

Like eggs, raw and undercooked meats and seafood may be contaminated with pathogens that can cause a foodborne illness.

Therefore, you can only serve meats and seafood that have been cooked to their safe minimum internal temperature.

This means no rare or medium-rare steaks, unfortunately.

Learn more about food temperature regulations in nursing homes.

Juice and raw seed sprouts

You can only serve juice that has been pasteurized or treated in a different way to kill harmful bacteria to nursing home residents (1).

While most juice is pasteurized, some health food stores, grocery stores, and farmers’ markets sell packaged juice that was made onsite without undergoing pasteurization to kill any pathogens that may have been present.

Untreated juice products must contain the following warning label:

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 so be careful during outings or day trips to apple orchards or farmers’ markets.

Raw seed sprouts are also unsafe to serve to nursing home residents since they are grown in warm, humid conditions where pathogens thrive.

Food reservice

Once you serve packaged food like crackers or condiments to a resident in isolation or quarantine, you cannot reserve those same items to another resident — even if they’re unopened (1).

A resident may be put in isolation or quarantine if they have or have been exposed to a virus like influenza or have C. diff (Clostridioides difficile), a bacterial infection that infects the bowels.

This is because the food can become contaminated from the first resident and then serve as a vehicle for transmission to the next resident.

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

At the same time, you cannot reserve food packages from residents outside of isolation to residents who are in isolation.

Power outage

Power outages are a threat to food safety in nursing homes since unlike a restaurant that can close their doors, nursing home residents depend on you to serve them meals.

As such, you should always be prepared for a power outage, especially if you live an area where high winds from hurricanes, tropical storm, or tornadoes are common.

You can prepare by regularly reviewing your disaster menu and ensuring you have several days’ worth of nonperishable food and bottles or gallons of water.

The bottom line

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

For this reason, you must take additional food safety precautions when preparing and serving food to nursing home residents.

Avoid handling RTE foods with your bare hands and always cook animal products to their safe minimum internal temperature.

Additionally, you cannot serve unpasteurized juice or raw seed sprouts or reserve packaged food to or from residents who are in isolation or quarantine.

Review your disaster menu regularly, especially if you live an area where severe weather can cause power outages.

Conducting regular food safety and sanitation audits is a great way to ensure the proper guidelines are being followed.