Vulnerable nursing home residents face yet another hazard: sickening food

eatingseniors-300x131To the myriad struggles that residents of nursing homes endure, from poor health to inattentive staff, add this new one:  “crappy conditions” in kitchens and other areas where their food gets prepared and served.

Marjie Lundstrom, a Pulitzer Prize-winning reporter, conducted a five-month, nationwide investigation for the consumer web site Fair Warning, with the results also shared by NBC News. The dirty dig found this about nursing home food prep:

“Flies buzzing the under cooked hamburgers. Cockroaches scurrying for cover behind the oven. A moldy ice machine. Mystery debris, clinging to the crevices of a meat slicer. Hundreds of mouse droppings, trailing across the hood of the stove. These incidents are not logged in any restaurant inspector’s notebook. They are among the thousands of food safety violations discovered in the last three years in America’s nursing homes, where fragile residents can least tolerate such lapses. While allegations of elder abuse and neglect dominate the horror stories in long-term care settings — bedsores, falls, medication errors, sexual assaults — food handling remains a consistent and often overlooked hazard …”

Lundstrom said she based her investigation on inspection reports, federal data, and interviews with residents and long-term care experts. She reported that nursing home residents nationwide are at risk for foodborne illness from unsafe kitchens, noting:

“Across the country, 230 foodborne illness outbreaks were reported from 1998 to 2017 in long-term care settings, according to the Centers for Disease Control and Prevention. The outbreaks resulted in 54 deaths and 532 hospitalizations and sickened 7,648 people.”

Nursing home residents are at heightened risk from food-borne illness, Lundstrom reported, noting that people older than 65 are especially susceptible due to weakened immune systems, chronic diseases, immobility and age-related changes in their digestive systems. Further, residents lack options. Unlike diners at restaurants, for instance, they can’t send food back, and they may be pressured to eat when served.

Indeed, in comparison with commercial restaurants, nursing homes’ kitchen regulation can be questionable. Fair Warning quoted health inspectors who said, for example, that repeat offender eateries get shut down, while some nursing home operators nationwide almost seem to treat multiple violation citations as a nuisance, maybe an aggravation and cost associated with their operations.

And while Fair Warning found that “unsafe food handling was the third most frequently cited violation last year inside America’s estimated 15,700 nursing homes, behind only infection control and accidents,” the response by federal regulators has been infuriating.

First, the consumer advocate site found, officials rely in excess in their oversight activity on “voluntary” reporting by institutions and individuals, meaning that any data on foodborne illnesses in nursing homes may be unknown and under-reported. This also is true because such illnesses may not be severe enough, so they get reported. Or they may not be traced to their food origins but attributed, instead, as part of the residents’ other debilitations.

But, second, the federal response to a clear concern — Lundstrom found that a third of the nation’s nursing homes had violations in how they stored, prepared, or served residents’ food — regulators want to lessen not increase their oversight, Fair Warning found:

“In July, the Trump administration moved to roll back a series of protections for nursing home residents, including one proposal that would lower the qualifications for directors of food and nutrition services. The government contends that the changes would eliminate requirements that are ‘unnecessary, obsolete or excessively burdensome.’ ‘They’re clearly weakening the standards regarding food service and the safety of food handling,’ said Richard Mollot, executive director of the New York-based Long Term Care Community Coalition, a nonprofit focused on improving care in nursing homes and other residential settings.”

This is not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on the vulnerable and elderly due to nursing home neglect and abuse. An estimated 10,000 Americans each day turn age 65, as part of a gray wave that will wash over the nation for at least a decade, with many more seniors than had been expected also likely to spend some time in nursing home care. It’s expensive, with a single room averaging in cost around $90,000 annually.

Despite those sky-high prices, nursing homes keep getting called out for their medical care, nursing and other staffing, and deplorable conditions — now including their food service. This is unacceptable. Lundstrom doesn’t mention it. But, of course, the debilitation that forces residents into nursing home care itself also may contribute to food-related nightmares. Due to cognitive and other declines, many age-related, the sick and injured may not have the sensory or cognitive capacities to recognize and reject, well, swill put before them. Shame on those who do so. We’ve got a lot of work to do to ensure the safety, well-being, and dignity of those in nursing homes.

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