Long-Term Care Survey Alert

One is a hot-potato issue -- literally.

A food safety problem could be lurking in a resident's room or in common foods that can turn deadly if mishandled.

To detect the first problem, take a walk down the hall and see how many residents have leftover perishable food or open beverages, such as milk or nutritional supplements, in their rooms. Then try to figure out how long the food or drink has been at room temp.

Nail Down the Problem and Solutions to Boost Quality

Nursing homes already have problems delivering meals so that hot food stays hot -- and cold food stays cold, says Reta Underwood, a survey consultant in Buckner, Ky. "That's especially true of the breakfast meals and in-between meal snacks," she adds. And if staff leave a resident's partially eaten meal in the room so he can eat more of it later, the facility may have a case of food poisoning in the making. The food has already been contaminated with bacteria from the person's mouth, Underwood notes. And it's never a good idea to leave certain types of food at room temperature for any reason, she emphasizes.

Families also sometimes bring in snacks or meals that they leave behind for their residents. "That's not a problem with fresh, uncut fruit -- but pizza, for example, is a different story," says Julie Albrecht, PhD, RD, professor and extension food specialist at the University of Nebraska-Lincoln. And even if a cognitively intact resident knows not to eat the food hours later or the next morning, someone with significant dementia likely won't.

Solution: Educate residents, staff and families about the dangers of leaving certain foods at room temp.

You can improve personalized care and food safety by providing a kitchenette and fridge on the floor so that staff can prepare snacks and small meals for residents, suggests Underwood. That way, staff can serve food that's hot or cold when the resident wants to eat it. You can also add variety to in-between meals program by offering baked potatoes with a choice of toppings, chef salads, sandwiches, and individual pre-packaged meal choices, Underwood says. These days, some of the pre-packaged offerings are delicious and nutritionally balanced, she points out.

Survey management tip: Check with the state survey agency before implementing this approach as it may require direct-care staff to take a short food preparation training course in some cases. Even so, providing small meals at the point of care so someone can have a sandwich at midnight, for example, can greatly enhance quality of life.

Put the Lid on This Killer

Many residents really enjoy baked potatoes dressed the way they like them. But baking the potatoes in foil can cause botulism if they are held in the danger zone (between 135 and 41 degrees F.) more than four hours, according to the 2005 Food Code, says Albrecht. One reported botulism case occurred due to an improperly held aluminum-foiled wrapped baked potato in a restaurant, she reports. "In another case, someone in a home setting left baked potatoes in the oven but turned the oven off," adds Albrecht. And when someone ate one of the potatoes hours later, he developed botulism.

Know the signs: "The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness," states the Centers for Disease Control & Prevention.

"The problem with botulism in a nursing facility setting is that its symptoms resemble that of a stroke" or other condition, cautions Albrecht.

Solutions: "Removing part of the aluminum foil to allow air inside helps prevent the anaerobic spores from sporelating," says Albrecht. But the point is that facility should have policies and procedures for maintaining foods at the proper holding temperatures, she emphasizes.

"The potatoes either need to be held at 135 F. or higher or quickly cooled to 41 or less," says Albrecht.

Beware: "If you stack a lot of hot potatoes in the refrigerator, they may not cool quickly enough ..."

And potatoes aren't the only threat. In one case, restaurant patrons developed botulism from eating cooked onions served on patty melt sandwiches. The onions had been boiled and then moved to a steam table, and from there to a warm stove where they sat all day, according to an article in FDA Consumer, published by the Food & Drug Administration. Even people who didn't eat the onions contracted botulism due to cross contamination by utensils used to handle the onions, according to the report.

Tip: Develop policies that prohibit families from bringing home canned goods, which can cause botulism, to potlucks and picnics held at nursing home facilities, advises Albrecht (for more on potlucks, see p. 12).