Nursing Home Food Safety Violations a Threat

failed inspections

Long-term care experts are expressing concern about nursing home food safety violations that seem to affect facilities across the United States.  Unlike restaurant inspections, food inspections at nursing homes fly largely under the radar.  However, with an increasing focus on elder abuse and the quality of America’s nursing homes, these violations are starting to hit the spotlight. 

Nonprofit news organization FairWarning has been investigating nursing home quality for the past three years.  Their research uncovered numerous quality and safety issues in nursing homes, including bedsores, frequent falls, and medication errors.  They also found that food safety violations are a consistent threat in nursing homes, but are often overlooked. 

Charlene Harrington, professor at the University of California, San Francisco has researched nursing home quality.  She notes,

 There’s a huge under-reporting of food issues.  It’s an accepted practice to have crappy conditions in the kitchen, and people are just totally unaware of it.”

The Untold Truth of Nursing Home Food Safety Violations  

FairWarning investigated nursing homes across the country and found a consistent problem with kitchen safety.  Residents are consistently at risk for foodborne illness due to the conditions many facilities keep. 

Based on inspection reports, interviews, and federal data, FairWarning reports the following:

  • 230 foodborne illness outbreaks in nursing homes between 1998 and 2017.
  • Since 1998, 54 people have died due to foodborne illness, and 532 people have been hospitalized.
  • The Centers for Disease Control and Prevention (CDC) estimates more than 7,600 people have become ill due to foodborne illness.
  • Unsafe food handling violations are the third most common leading to citation in nursing homes.
  • In 2018, 33 percent of American nursing homes were cited due to violations of federal requirements relating to food storage, preparation and service.
  • Since 2016, one-third of nursing homes cited for food safety violations received more than one citation.
  • Since 2016, 10 percent of nursing homes cited received three or more citations for the same deficiencies.
  • The largest for-profit nursing home chain in the U.S., Genesis HealthCare, received citations at 43 percent of its 400 facilities in 2018.  

While these statistics are alarming enough, the type of violations in inspection reports are shocking.  FairWarning found reports of:

  • Cockroaches behind an oven
  • Mouse droppings on a stove hood
  • Mold in ice machines
  • Debris lodged in a meat slicer
  • Flies hovering around hamburger meat
  • Kitchen staff handling raw meat without gloves then touching plates and utensils
  • Months-old expired food left in kitchens
  • Chronic hand-washing deficiencies
  • Stovetops and microwaves “caked” with debris

Finding these deficiencies on an inspection report is enough for anyone to think twice about long-term care. 

Reports Do Not Show the Full Picture of Nursing Home Food Safety Violations

Sadly, the CDC notes that reports like those above are just the tip of the proverbial iceberg.  The CDC doesn’t always get accurate data and often relies on voluntary reporting.  Nursing homes themselves are not likely to report certain violations.  Furthermore, health departments often lack the resources to monitor, document and report outbreaks of foodborne illness.

To make matters worse, nursing homes are not compelled to follow the rules out of fear of punishment.  In 2018, there were 5,621 citations given to nursing homes.  Of those, only 25 facilities – less than one percent – were considered serious enough for a high-level citation. 

A representative at California Advocates for Nursing Home Reform responds,

 By treating life-threatening conditions (in the kitchen) as minor problems, regulators are sending a message to nursing home operators that no change is needed.”

Change is exactly what we need.  In 2016, researchers found that kitchens in long-term care facilities have higher rates of food safety violations than restaurants, schools and jails.  That research suggests our society treats our elderly worse than we do our criminals. 

Texas-based nonprofit Families for Better Care are strong advocates for change.  Executive Director Brain Lee says,

 If you were to go take those exact same problems and stick them in a Taco Bell or a Bob Evans, you would never eat there again.  There would be such a public outcry to get those restaurants closed.  And they would be closed, because nobody would go there again.”

Why is our government and society at large not advocating for our seniors in the same way we advocate for the everyday consumer?

Examples of Foodborne Illness Outbreaks

Any of the above deficiencies are certainly cause for concern.  Concern can easily lead to panic when you consider the severity of some foodborne illness outbreaks in recent years.  Consider the following examples:

  • In 2018, 61 residents and staff members at a Wisconsin nursing home came down with Norovirus. The cause of the outbreak was a failure among kitchen staff to control sanitizer levels during dishwashing.
  • In 2014, 16 residents in a California facility became ill after a dietary aide came to work sick. This aide prepared plates for each resident.  An inspection report notes there was not sufficiently hot water in the facility. 

Foodborne illness is a threat to anyone, but people who are over 65 or who have a weak immune system are more likely to suffer serious illness or complications.  When you consider there are more than 47 million adults over 65 in the U.S.  – 800,000 of whom live in long-term care facilities – that is more than concerning. 

Is the Government Protecting Nursing Homes and Not Residents?

While safety advocates are pushing for more oversight in nursing homes, it seems like the U.S. government is trending backwards in terms of safety guidelines.  In July 2019, the Trump Administration began to roll back certain protections for nursing home residents.  One of the most troubling rollbacks was a proposal lowering the qualifications for food and nutrition directors in nursing homes. 

While the government defends its position that the former requirements are “unnecessary, obsolete or excessively burdensome” the number of foodborne illnesses and outbreaks suggests more regulation is needed.  Certainly not less.  Under the new proposal, food and nutrition directors will not have to have a certain level of education or certain certifications.  Instead, an individual’s experience in the kitchen could be qualification enough. 

Skeptics have been very open in their opinion about the proposal.  Some call it “risky” or “absurd” or a “step backwards in healthcare.” Several states’ Attorney Generals have also made their feelings known, calling for the government to put nursing home resident safety first before cost-savings.  Sadly, not much is changing despite increasingly disturbing reports. 

What Can Families Do to Protect Nursing Home Residents?

If someone you love lives in a nursing home and you are concerned about the quality and safety of food, there are a few things you can do.  At Nursing Home Abuse Center, we recommend the following:

  • Eat a meal with your loved one in the dining area. Take note of the food and cleanliness of the area.  Ask yourself:
    • Is the food hot?
    • Does the food taste fresh?
    • Is the food cooked properly?
    • Are the plates and utensils clean?
    • Do residents seem to be enjoying the food?
  • Speak to a nursing home supervisor or administrator about your concerns.
  • Research ratings and inspections from the Centers for Medicare and Medicaid Services (CMS).
  • Speak to a nursing home abuse lawyer about your concerns.

If you have questions about nursing home food safety and your loved one’s rights, contact Nursing Home Abuse Center.  Our team can help you explore your loved one’s situation and determine how best to protect them.  You can request a free consultation by calling 1-800-516-4783. 


meagan cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to FNHA and our websites, including Birth Injury Guide and