Page 65 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
state, local, tribal and territorial regulatory agencies. Food Code adoption and implementation in all jurisdictions are important for achieving uniform national food safety standards and for enhancing the efficiency and effectiveness of our nation’s food safety system.” (FDA, 2009)
I spoke with a state surveyor regarding villagers’ cooking/baking groups. She said that it was wonderful for villagers to participate in these activities. But, they would need to have their hair covered, wash hands and wear gloves, and follow all food preparation and food safety guidelines. Since there is no guarantee where their hands have been, only those involved in the cooking/baking group should eat what they prepared. The food should not be served as part of the meal or snack for their peers. It is best to throw the food away, and make the same food items in the kitchen and serve it. That way the residents wouldn’t be offended and the food would be safe to eat.” An RD
We have taken a stand to treat our residential kitchens as home kitchens. Our policies and procedures support that residents and staff do not wear hairnets when working with food. We make sure that everyone’s hair is pulled back and out of the way, everyone washes their hands as often as needed and has on clean clothing. We don’t want to make the resident and/or staff “gown and glove” to enjoy the opportunity to cook and eat together in their households. But a neighboring facility across the state line had a federal surveyor with their state survey team this summer and they really went after everything that they were doing in their kitchens. Their staff came for a tour shortly after their survey and were completely deflated as a result of it. We have to remember that food is the center of home – everything centers around food – we need to do things safely, but we need to know that in order to truly have an environment of home, those who live here must have true choice and control over how they live in the environment. It can’t be home if they can’t be part of the life of the kitchen. Whatever we do with regulations, we need to figure out how to safely encourage residents to be an active part of that life. (Oelfke, 2009)
The subject of bare hand contact with food is easily one of the most challenging compliance issues today. Are universal precautions not adequate? Is there a greater risk from bare hand contact with a piece of toast than with a medication? The issue of state survey variability arises on this subject, with some states requiring gloves be worn when assisting a resident in eating a piece of toast, while others will allow the use of deli paper. Of course, tongs and flat wear can be used, but how normal is eating a piece of toast with a fork? Perhaps this is a dignity of risk issue, but can it be resolved through the residents’ right to self-determination? All current indications are that few, if any, state agencies are compromising enforcement. But no residents have been heard to express preference or support for the “safeguard.”
I would hope that we could use some common sense in the interpretation and requirement for residents and staff involved in the kitchens. We have never had a food born illness that I know of. We have never had a deficiency related to the cross training of staff or infection control or safety. I’m always concerned about that as there are so many opportunities for cross contamination. Our RNCC listened in on a conference with state surveyors and providers not long ago. They spent 20 minutes debating how to assist a resident to eat toast without touching it...seems like we have more important issues?? She couldn’t believe that was the biggest issue we had to discuss. (Oelfke 2009)
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