Are elders in nursing homes doomed to be without fresh picked garden produce forever?
In the mid-west summer means roadside stands overflowing with sweet corn-on-the-cob, tomatoes, cucumbers, zucchini, green beans, onions, and other fabulously fresh produce. Each bite of this tender harvest sends the taste buds into a wild frenzy. Fresh garden fare is so flavorful that my husband, a manufactured-food foodie, can’t wait to pop a raspberry or 10 in his mouth just for the pure enjoyment of its raspberry-ness.
In mid-July an employee of a mid-sized nursing home in Central Illinois proudly shared fresh zucchini from her backyard garden. “My husband used a little too much Miracle Grow this year, so we have plenty to share,” she explained when asked how she had enough to feed 115 residents. The dining services department washed, cleaned, and cooked fresh zucchini not delivered in a big truck, but in the back seat of a car. Without exception everyone enjoyed the seasoned zucchini, except perhaps regulators.
Living with Regulations
In 2009 an updated CMS regulation F371 stated “food must be procured from approved sources.” The intent of the regulation is to prevent food borne illness from eating potentially hazardous food not maintained at the proper temperature or eating improperly canned foods. Potentially hazardous food (PHF), such as shrimp, requires time/temperature control. The average Louisianan may take a chance with their health when buying roadside shrimp, but for an elder – pathogens multiplying in the shrimp could be deadly. So it makes sense that a PHF be purchased from an approved source.
But what makes sense on paper does not always make sense in practice. Providers enforcing this rule had to ask family members to stop brining food to their loved ones. Needless to say this interpretive guidance was not well accepted by residents, family, or providers. In response CMS published CMS Memo 09-39, dated May 29,2009 stating the intent of the regulations allows residents to choose to accept food from visitors, family, friends, or other guests according to their rights to make choices.
But what about residents without guests or residents of our Central Illinois nursing home? The fresh, non-PHF zucchini was donated by an employee. The residents were not given a choice between garden fresh zucchini or food distributor zucchini – everyone selecting zucchini got the garden variety. Well it turns out the facility was within regulatory compliance. According to Wisconsin Department of Health Services in a F325 & F371 Q&A Document, “uncut produce is an agricultural item and agricultural items are not regulated therefore uncut produce does not have to be purchased from approved sources.” The document goes on to say that nursing home gardens are ok if fertilizers and pesticides used follow manufacturer’s recommendations. Each state is different so check your local regulations before planting and serving garden fresh vegetables at your nursing home.
Who knew that growing and serving fresh zucchini to elders living in nursing homes could be so complicated?