Food safety in assisted living: new skills needed; With more open dining arrangements than nursing homes, assisted living requires skilled food-safety specialists.
Compared with that of nursing homes, the dining model of assisted living as·sist·ed living
A living arrangement in which people with special needs, especially older people with disabilities, reside in a facility that provides help with everyday tasks such as bathing, dressing, and taking medication. is diverse. Residents may eat in common dining areas, restaurants, snack bars, or at home. Meals may travel farther and longer for delivery to apartments--with inherent sanitation risks. Staff involvement with meals often extends beyond the foodservice worker to a range of support personnel because home-delivered meals warrant monitoring to ensure temperature control and safe handling after delivery. And all of this occurs in a backdrop of heightened vulnerability.
Risk-management wisdom in this field dictates the presence of a qualified leader who recognizes hazards and knows how to control them. Under that person's auspices, a comprehensive sanitation program is also critical to risk management. It requires dynamic proficiency to synchronize policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental with evolving FDA FDA
Food and Drug Administration
n.pr See Food and Drug Administration.
n.pr the abbreviation for the Food and Drug Administration. guidance and to implement proactive infection-control systems like Hazard Analysis A hazard analysis is a process used to characterize the elements of risk. The results of a hazard analysis is the identification of unacceptable risks and the selection of means of controlling or eliminating them. Critical Control Points (HACCP HACCP
hazard analysis critical control points. ) (see "Protecting residents from foodborne illnesses" by Jamie Stamey, RD, LDN LDN London
LDN Loi sur la Défense Nationale
LDN Listed Directory Number
LDN Lynds' Dark Nebula
LDN Low Dose of Naltrexone
LDN Licensed Dietician/Nutritionist
LDN Local Directory Number (Cisco)
LDN Lebanon Daily News , CFSP CFSP Common Foreign and Security Policy (European Union)
CFSP Certified Funeral Service Practitioner
CFSP Certified Food Safety Professional (NEHA)
CFSP Customs Freight Simplified Procedure , Nursing Homes/Long Term Care Management, June 2006, p. 48, for a full discussion of HACCP). Not only is resident welfare at stake, but also the reputation, continued licensing, and core business survival of the facility.
Who are the likely candidates for this leadership role? With decades of experience serving elders food-safe meals, dietary managers are the logical choice for the FDA "person in charge."
Food in Assisted Living
Food is pivotal to the assisted living industry. It tops nearly every consumer checklist for facilities and, if done right, serves as a marketing magnet. But as assisted living facilities pioneer innovative meal-delivery models to woo and wow residents, a foodborne illness outbreak is always a looming crisis waiting to happen. It is a reality that has hit hard in several assisted living communities (as well as nursing homes) in recent years.
This is unsurprising, given the basic facts of the situation: Seniors are exceptionally susceptible to foodborne illness. Once afflicted af·flict
tr.v. af·flict·ed, af·flict·ing, af·flicts
To inflict grievous physical or mental suffering on.
[Middle English afflighten, from afflight, , they are more likely to be hospitalized, with mortality rates climbing up to 10 times higher than those among the general population, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. data from the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. .
Some victims suffer long-term complications. The Food and Drug Administration (FDA) estimates that 2 to 3% of foodborne illnesses lead to chronic conditions, such as major organ damage, or Guillain-Barre syndrome Guil·lain-Bar·ré syndrome
See acute idiopathic polyneuritis. , the progressively paralyzing nervous system condition that sometimes follows a foodborne Campylobacter Campylobacter
Genus of gram-negative spiral-shaped bacteria infecting mammals. Many species, especially C. fetus, cause miscarriage in sheep and cattle. C. jejuni is a common cause of food poisoning. Sources include meats (particularly chicken) and unpasteurized milk. infection.
The FDA places older adults in a category called highly susceptible populations--i.e., those most likely to suffer from a foodborne illness and to suffer serious complications or mortality as a result. Reasons for this vulnerability may include a natural decline in immune response immune response
An integrated bodily response to an antigen, especially one mediated by lymphocytes and involving recognition of antigens by specific antibodies or previously sensitized lymphocytes. with age, altered senses of taste and smell, poor digestive function, reduced stomach acid, poor nutrition, dehydration, medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. , and medications.
Assisted Living Regulations
Realizing that a foodborne illness outbreak can devastate dev·as·tate
tr.v. dev·as·tat·ed, dev·as·tat·ing, dev·as·tates
1. To lay waste; destroy.
2. To overwhelm; confound; stun: was devastated by the rude remark. an assisted living facility's reputation and can even generate lawsuits, sound foodservice sanitation serves as insurance against such a catastrophe. Regulations focus on this. Although assisted living regulations vary by state, nearly all refer assisted living administrators to state and local health codes for relevant sanitation standards.
In turn, these localized standards draw their guidance from a common source, the FDA Food Code. The FDA offers its code as a "model," to be adapted and adopted as science-based guidance for preventing foodborne illness in retail and institutional foodservice settings.
Recently, the FDA added stringent precautions to its advice for serving susceptible client groups. For example, in a nursing home or assisted living facility, only pasteurized pas·teur·ize
tr.v. pas·teur·ized, pas·teur·iz·ing, pas·teur·iz·es
To subject (a beverage or other food) to pasteurization.
pas eggs may be used in large-quantity recipes, juices must be pasteurized, and risky foods such as raw seed sprouts or undercooked burgers are taboo. More rigorous guidelines also apply to restricting activities of ill employees when they are serving susceptible groups.
In assisted living regulations state by state, a key common element is required staff training. Some states, such as Arkansas, Massachusetts, and Pennsylvania, require foodservice sanitation training for all employees as part of orientation. Many states in general do not limit foodservice sanitation education to foodservice workers, but apply it to additional staff members who may be providing hands-on care in the resident's home. In view of the challenges, some states direct administrators to bring in qualified experts to manage food safety.
"Person in Charge"
In fact, recent revisions of the Food Code have strengthened general requirements for a qualified person in charge of foodservice operations. Among other things, this leader must tackle five failures most likely to cause foodborne illness:
* unsafe sources
* improper holding time/temperature
* inadequate cooking
* poor personal hygiene personal hygiene person n → Körperhygiene f
* contamination of equipment, food, or work areas
Moreover, as outlined by the FDA, risk management is a one-two punch:
1. Establish and enforce standard operating procedures standard operating procedure Medtalk A technique, method or therapy performed 'by the book,' using a standard protocol meeting internally or externally defined criteria; a formal, written procedure that describes how specific lab operations are to be performed. designed to ensure safe practices in all phases of food management, including employee health and hygiene.
2. Have a "proactive manager" who implements risk-management strategies through all phases of food management.
As noted, the FDA endorses the systematic approach called HACCP, which constitutes sound prevention because it focuses on prioritizing and managing critical process components that can go awry, leading to foodborne illness. Today, the certified food protection manager has an expanded role in steering the operation clear of a multitude of sanitation pitfalls.
Not only food, but people, can transmit foodborne illness. Consider this example last year from an assisted living operation in the Midwest: County health experts investigating a foodborne illness outbreak pinpointed the likely source as a foodservice worker permitted to prepare food while suffering from diarrhea. The outbreak peaked three days later, by which time 10 residents were stricken, and 4 were hospitalized.
Rather than an exception, this is a paradigm for foodborne illness outbreaks. It has happened in nursing homes and in schools, on college campuses and on cruise ships, in every state of the nation.
Responding to numerous outbreak scenarios, the FDA beefed up guidance concerning employee health in 2005. The FDA required a documented health policy for food handlers, documentation of routine handwashing, signed employee health agreements, and stringent precautions for keeping ill employees clear of foodservice operations. For example, a foodservice employee with diarrhea is not allowed to work in the kitchen of an assisted living facility, according to the FDA guidance.
Rising to the Challenge: CFPP CFPP Cold Filter Plugging Point (of diesel filter)
CFPP Concept Formulation Program Plan Credentialing
As a professional organization whose members serve the eldercare eld·er·care
Social and medical programs and facilities intended for the care and maintenance of the aged. industry, the Dietary Managers Association (DMA (1) (Digital Media Adapter) See digital media hub.
(2) (Document Management Alliance) A specification that provides a common interface for accessing and searching document databases. ) rises to the challenge with its food protection credentialing program. Now nearly a decade old, the certified food protection professional (CFPP) credential is required of every dietary manager wishing to achieve certified dietary manager (CDM 1. CDM - Content Data Model
2. CDM - Code Division Multiplexing ) status. Today, more than 12,000 CDMs/CFPPs work throughout the United States. Many dietary managers have built a broad base of experience in nursing homes, where they answer to both local health officials and state surveyors. Today, however, many CDMs/CFPPs are crossing over to the assisted living industry to apply their hands-on sanitation-management expertise in this more open setting.
The DMA training program, offered at colleges throughout the country, requires a core minimum of 16 hours of classroom training in foodservice sanitation, as well as 20 hours of supervised experience implementing food-safe management. To obtain the credential upon completion of training, a candidate must pass a national certification national certification Lab medicine A voluntary form of regulation that affirms that a person has the knowledge and skill to perform essential tasks in a given field, in the lab or in nursing; NC is granted by nongovernmental agencies or associations with exam administered by ACT, the testing company responsible for the American College Testing program. The exam is built on competencies (table), with content drawn from the FDA Food Code.
Certified dietary managers achieve other competencies, as well. Their training in human resources management, education, and food-service systems translates into an ability not only to "know" the rules, but to devise viable foodservice systems and coach a work team to achieve ongoing regulatory compliance.
To maintain the CDM/CFPP credential, a dietary manager must complete 45 hours of continuing education continuing education: see adult education.
or adult education
Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). every three years, including at least 5 hours in sanitation and food safety. The DMA offers extensive education for its members, with online courses, monthly magazine columns, and other publications designed to help credentialed members keep pace with techniques for protecting America's elders from foodborne illness.
If assisted living administrators ask themselves, "To find certified dietary managers, do I need to recruit from nursing homes?" The answer is an emphatic "No!" CDMs aren't found, they're developed, and the raw material for this is already in your facility. With the training and certification described above, you can post food safety sentinels for your facility from within your existing staff.
Robin Gaines, CDM, CFPP, is Vice-President of Support Services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services for Bartels Lutheran Retirement Community and chairperson of the Certifying Board for Dietary Managers. For further information, phone (319) 352-4540. To send your comments to the author and editors, please e-mail email@example.com.
BY ROBIN GAINES, CDM, CFPP
Dietary Managers Association, www.dmaonline.org
FDA Food Code, www.cfsan.fda.gov/~dms/foodcode.html#get05
FDA Food Code Adoption (by state), http://vm.cfsan.fda.gov/~ear/fcadopt.html
FDA report on foodborne illness risk factors in foodservice (2004), www.cfsan.fda.gov/~dms/retrsk2.html
National Center for Assisted Living Regulatory Review, www.ncal.org/about/statsum.htm
Table. Certified Food Protection Professional (CFPP) Competencies 1. Purchase, receive, and store food following established sanitation and quality standards. 2. Protect food in all phases of preparation, holding, service, cooling, and transportation using HACCP guidelines. 3. Manage personnel and employee health according to the FDA Food Code. 4. Manage physical facilities to ensure compliance with safety and sanitation regulations. 5. Implement a food safety system that addresses crisis management. Source: Certifying Board for Dietary Managers