WORKER LACK OF HEALTH INSURANCE CONTRIBUTES TO FOODBORNE ILLNESS IN NURSING HOMES

The New York Times reported today that Nursing Homes in the United States are seeking a reprieve from having to pay health insurance to their workers, claiming they can't afford it. Nor can their workers, given their low wages (about $10-$12 an hour)

I am against such special exemptions for nursing homes. Let me tell you why.

More foodborne illness outbreaks originate in food service operations, such as restaurants, private catered events, schools, hospitals and nursing homes, than in homes (some estimates say it is a 7:2 ratio). Studies have found nursing homes - where people are particularly vulnerable - to be among the most hazardous places to eat (see earlier posts on 2/23/11 and 9/27/10).

There are a number of reasons. A major one is the fact that many food service workers in such places work while they are ill, passing on germs to the people who eat the food they have touched or breathed or coughed or sneezed onto. They don't stay home because they have no insurance, and can not afford to lose the pay. A recent study by the U.S. Environmental Health Service, found that in such food service facilities many more managers (66%) received paid sick leave than did the lower-paid workers (35%).

The fact that a large percentage of workers have no health insurance will also mean that they don't get treatment. As a result, their illness will drag on longer than it should, not only exposing the patients, but also often their fellow workers, who will, in turn, also expose the patients.

This situation needs to be changed. People in nursing homes need safe food.

To your good health!
TSF

CHECKING FOOD SAFETY WHEN CHOOSING AN ALF OR NURSING HOME

It is not a good idea to leave choice of an Assisted Living Facility (ALF), Residential Board-and-Care Home, or a nursing home to the last minute. If you plan ahead for yourself or your aging parent, it is better to have time to check several alternatives out and compare. There are good blogs and articles on line to help you make the decision (for Assisted Living, see for example: http://www.atouchofgrey.com/assited.html, and, for Nursing Homes:
http://www.aging-parents-and-elder-care.com/Pages/Checklists/Nursing_Home_Checklist.html). Such guidance will help you assess amenities, level of care, cost, and those more intangible factors such as people-centeredness.

One issue that many people will not immediately think of when choosing one of these, is whether the facility is likely to serve safe food. But this is important. The unfortunate truth - as statistics show - is that you are much more likely to get a food borne illness in a place like this than you are when living in your own home. There are two reasons: greater vulnerability and less safe food.

After all, people in residential facilities and nursing homes are older adults. Once we get to that stage, the chances are that we will be more susceptible to bacteria and other microbes. Unfortunately, aging usually brings with it a weaker immune systems, serious illnesses and conditions such as poorly operating digestive system, kidneys and liver. This means even small numbers of microbes are more likely to make you ill, and, any illness you do get is more likely to be serious and land you in the hospital.

There is also another factor: the mass preparation of food always creates extra risk in any institutional facility - and, in restaurants. Efforts to keep costs under control may also lead to compromises (such as hiring less well trained staff, keeping utility bills down by setting the refrigerator temperature too high, purchase of cheaper food products, and serving food past its expiry date).

Yes, nursing homes have to meet federal quality standards, and be regularly inspected. ALFs have looser standards, but are also inspected in many states. In fact, common citations by such inspections tend to be related to nutrition and safety of food. But occasional inspections will not catch every problem, especially when advance notice is given and the facility has time to clean up its act. I have watched this happen.

But when checking out ALFs or nursing homes, do try to get hold of that inspection report and see what it found. Also take a look yourself when touring the facility and try to do it just before lunch or dinner is served so you can get a good view of what is going on in the kitchen and dining room. Food safety matters, particularly when you are older and more vulnerable.

TSF

MOST DANGEROUS PLACES TO EAT EGGS

No matter what improvements are made in egg production, the likelihood is that SE will never be completely wiped out of our eggs. There will always be the chance that SE-infected pullets will slip through the net, that contaminated feed will turn up again, that SE-infected rats will contaminate the laying environment, or, that something similar will happen. As a result, we can basically assume that a small fraction of all our shell eggs will always be infected with SE. Given past experience, we can also assume that there will be periods of time when that number will increase dramatically as there is an up-surge in SE infection among laying hens.

Whether we get sick from SE in our eggs will depend on four basic things: how vulnerable we are, how many eggs we eat, where we eat them and how we eat them. Let's turn to the "how" and "where." As we know by now, undercooked eggs and undercooked egg-containing dishes are the risky ones. Studies suggest that fried eggs (sunny-side up) are about the riskiest of all. The safest - well done eggs, pasteurized eggs (even if underdone), and egg dishes and egg-containing dishes made with pasteurized egg product.

As for high-risk places, the worst ones are institutional food-service (such as nursing homes, residential dining rooms, schools, hospitals) and restaurants or other places such as conventions, receptions, where eggs are pooled and large quantities of food are prepared, often in advance. Many institutional food-services have begun to use pasteurized egg products - which are easier to store and use, as well as safer. So have a large percentage of restaurants, but not all. After all, whole eggs taste better. Some restaurants do use pasteurized eggs, but their higher price is a negative.

Studies of egg use in restaurants have also shown that a large percentage continue to have practices that would help any bacteria in the eggs to multiply (such as leaving an omelet mix, or egg-containing dessert mix at room temperature for a while). It could well be that it is getting increasingly less safe to eat out at a good restaurant (more likely to use whole eggs than is a cheap one) than to eat in a nursing home.

Hyvää ruokahalua! (as they say in Finnland)
TSF