Food Safety Practices and HACCP Implementation in Assisted Living for the Elderly

Specific objectives are to: 1. Determine current food handling practices and implementation of HACCP and its related prerequisite programs in assisted living across the U.S. 2. Develop and adapt sample HACCP resources appropriate for assisted living and use Iowa State University's Food Safety web site for national distribution of those resources. 3. Increase managers' and employees' knowledge of food safety and improve their food handling practices in assisted-living facilities. 4. Determine food handling practices in rooms/apartments of residents in assisted living. 5. Increase the knowledge and improve food handling practices of residents.
A modified Delphi process will be used to develop a written questionnaire to determine consultant dietitians' perceptions of current food handling practices, HACCP and prerequisite program implementation, and barriers to HACCP implementation in assisted living. All Iowa and a random sample of national consultant dietitians in healthcare facilities will be surveyed. Interviews with residents in 40 assisted living facilities in Iowa will determine food handling practices in their individual living quarters. Educational materials will be developed for residents and an educational session will be presented. A pre-test/post-test research design will be used to determine changes in employee knowledge, attitudes, and food handling practices as a result of the 2-year intervention. Audits of 40 assisted-living facilities, including microbiological analysis, will be conducted both pre- and post-intervention. Training in basic food safety and HACCP and technical assistance will be provided to foodservice employees during the intervention. Resource materials will be developed for distribution to the 40 facilities in the study and more widely on the ISU Food Safety web site.
The elderly are vulnerable to foodborne illnesses and there is little information about food safety practices and HACCP implementation in assisted living. The primary goal of this proposed project is to assess current food handling practices and HACCP implementation in assisted living for the elderly and provide training programs to improve food safety.
Data collection instruments were developed for review by the advisory board at its first meeting. The advisory board includes a representative from the Dietary Managers Association, Consultant Dietitians in Healthcare Facilities, Extension nutrition/health field specialists, Iowa Department of Elder Affairs, Iowa Assisted Living Association, National Center for Assisted Living, and the Food & Consumer Safety Bureau of the Iowa Department of Inspections & Appeals as well as assisted living facilities directors/foodservice directors. The data collection protocol was pilot tested at an assisted living facility. Two rounds of a modified Delphi technique were conducted with a national sample of consultant dietitians in health care facilities (CD-HCF) to determine content for a questionnaire designed to assess consultant dietitians' perceptions of current food handling practices, prerequisite programs needed for HACCP implementation, and barriers to HACCP implementation in assisted living facilities. Forty assisted living facilities in Iowa were recruited for the project. Thirty-nine facilities were visited to conduct an initial assessment that included observation of food handling practices of and HACCP implementation by foodservice employees, microbiological evaluations of food contact surfaces, employee knowledge and attitudes about food safety, and demographic information about the facility. Five residents in each facility were interviewed about their food preparation techniques in their apartments and personal hygiene (i.e., washing hands). Databases were developed and an individualized report for each facility was written. Coordination with Extension Nutrition and Health Field specialists who will provide ServSafer training has been done.
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It is expected that the 40 assisted living facilities in Iowa will improve practices and implement more HACCP components than they currently practice. Foodservice directors who are part of a larger company are expected to share HACCP principles and practices with other assisted living facilities within the company. Education materials for residents developed as a result of this study may improve their food handling practices within their apartments.