Must Know Nursing Home Food Temperature Regulations

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

Nursing home residents are commonly older adults but they may also be immunocompromised due to conditions like diabetes, cancer, and other chronic diseases.

For these reasons, nursing home residents are a highly susceptible population, meaning they are at a high risk of developing foodborne illnesses.

Because of this risk, it’s important that you ensure food reaches a safe internal temperature to kill off any bacteria that could make them severely ill.

This article explains everything you need to know about nursing home food temperature regulations to keep residents safe from foodborne illnesses.

Safe internal food temperatures

The Centers for Medicare and Medicaid (CMS) — the regulatory agency that oversees nursing homes — goes by the Food and Drug Administration’s (FDA) Food Code.

This means that nursing homes follow the same food temperature regulations as restaurants, schools, and other foodservice operations.

Meats and other animal products are common carriers for foodborne pathogens, including Campylobacter species, Salmonella, E. Coli, and Listeria monocytogenes (1).

These pathogens — or disease-causing organisms — can make nursing home residents severely ill.

Therefore, it’s important that you cook food to its safe internal temperature to kill off these pathogens.

In general, the more processing a food receives, the higher its minimum internal temperature requirement since there are more opportunities for contamination with increased handling and processing.

Here’s a look at the minimum internal cooking temperatures to know:

Minimum Internal Temperature	Food
165ºF (74ºC) < 1 second (instantaneous)	• Poultry, including chicken, turkey, and duck • Stuffing made with fish, meat, or poultry • Stuffed meat, seafood, poultry, or pasta • Dishes that contain previously cooked TCS ingredients • Previously cooked TCS foods reheated for hot-holding • Wild game animals
155ºF (68ºC) for 17 seconds	• Ground meat, including beef, pork, and other meats • Injected meats, including brined ham and other flavor-injected roasts • Mechanically tenderized meat • Ground seafood, including chopped or minced • Shell eggs that will be hot-held for service • Ratites, including ostrich and emu
145ºF (63ºC) for 15 seconds	• Seafood, including whole fish and shellfish • Meats, including whole cuts of pork, beef, veal, and lamb • Commercially-raised game like rabbits • Shell eggs served immediately
145ºF (63ºC) for 4 minutes Alternate cooking times: • 130ºF (54ºC) – 112 minutes • 131ºF (55ºC) – 89 minutes • 133ºF (56ºC) – 56 minutes • 135ºF (57ºC) – 36 minutes • 136ºF (58ºC) – 28 minutes • 138ºF (59ºC) – 18 minutes • 140ºF (60ºC) – 12 minutes • 142ºF (61ºC) – 8 minutes • 144ºF (62ºC) – 5 minutes • 145ºF (63ºC) – 4 minutes	• Roasts, including pork, beef, veal, and lamb

The only way to verify whether food has reached its safe internal cooking temperature is with a sanitized, calibrated food thermometer.

Other nursing home temperature regulations to know

Cooking food to its minimum internal temperature is an important food safety principle, but there are additional temperature regulations for time-temperature control for safety (TCS) foods you must know.

You must also follow these regulations for food provided by residents’ families or other outside sources.

Holding

Hold hot food at a minimum of 135º F (57ºC), and cold food at 41ºF (5ºC) or below.

Doing so keeps food out of the temperature danger zone where bacteria grow and multiply to unsafe levels quickly.

If you’re holding food for long periods, check the temperature every 4 hours — but preferably more frequently — to ensure it’s not in the temperature danger zone.

You must throw food that has been kept in the temperature danger zone for more than four hours.

Most hot-holding equipment has a temperature gauge, but it displays the temperature of the holding device, not the internal food temperature.

Remember, the only way to properly determine the internal temperature of food is with a calibrated thermometer.

Cooling

After cooking or hot-holding food, you must rapidly cool the leftovers so that the food spends as little time as possible in the temperature danger zone.

To do this, follow the two-stage cooling method.

In the first stage, cool foods from 135ºF (57ºC) — the minimum temperature at which food must be hot-held — to 70ºF (21ºC) within two hours.

Then, cool from 70ºF to 41ºF (21ºC to 5ºC) within four hours to complete the second stage.

You must cool food quicker in the first stage since bacteria multiply more rapidly between 70ºF and 135ºF (21ºC and 57ºC).

Storing

To slow bacteria and keep food out of the temperature danger zone, maintain all refrigerators at a maximum of 41ºF (5ºC).

Keep freezers cold enough to keep food frozen — usually, around 0ºF (-18ºC).

Monitor the refrigerator and freezer temperatures at least twice daily to make sure they maintain the proper temperature.

Label any food with a use-by date if you plan to store it for 24 hours or longer.

You can store food for a maximum of seven days, with the day of preparation counting as the first day.

To prevent cross-contamination, store food in the refrigerator in descending order based on its minimum internal temperature requirement, with food that requires the highest on the bottom.

Based on the minimum internal cooking temperature, here is the proper storage order for refrigerated foods, in order of top to bottom:

1. ready-to-eat foods (RTE) and leftovers
2. seafood
3. whole cuts of beef and pork
4. ground meats and seafood
5. whole and ground poultry

Reheating

You can serve RTE food or leftovers at any temperature as long as it has been cooked and cooled correctly.

However, if you reheat previously cooked TCS food for later service, you must make sure it reaches at least 165ºF (74ºC) for 15 seconds.

You must reheat food from its cold holding temperature of 41ºF (5ºC) to 165ºF (74ºC) within two hours, otherwise, it's unsafe to serve and you must throw it out.

Never use a crock pot, slow cooker, or hot-holding equipment like a steam table to reheat food since these devices can't reheat food to a safe temperature quickly enough.

Avoid reheating food more than once since it decreases the food quality and increases the number of times it passes through the temperature danger zone.

The bottom line

Nursing home residents are a highly susceptible population, meaning they are more likely to become severely ill from foodborne illnesses.

Cooking food to its proper internal temperature kills pathogens that could make your residents ill.

To minimize the risk that your resident gets sick from foodborne illnesses, you must also use temperature controls to hold, cool, store, and reheat food. Conducting regular food safety and sanitation audits is a great way to ensure proper food safety practices are being followed.

Learn more about common mistakes food handlers make in nursing homes.