University of Massachusetts Amherst

It's MORE Than A Meal


Planning Healthful Meals & Snacks

keeping foods safe for older adults

In spite of the overall safety of the U.S. food supply, each year millions of people get sick from the food they eat. The symptoms of foodborne illness include diarrhea, vomiting, and sometimes fever. These conditions can be disabling for some people, but are more likely to be devastating and even deadly for vulnerable populations.

In general, people over 65 and people with chronic illnesses are more likely to suffer severe consequences of foodborne diseases. Several factors contribute to this increased risk:

  • A weakened or compromised immune system due to:
    • Aging
    • Existing chronic diseases such as diabetes and kidney disease
    • Major surgery or some cancer treatments.
  • Decreased stomach acidity creating a more neutral environment in which harmful bacteria can survive and increasing the likelihood of foodborne illness.
  • Slowing down of the digestive processallowing time for more rapid growth of pathogens in the gut.
  • Malnutrition increasing the risk of infections.

The onset of symptoms can vary from as short as one hour after consuming the contaminated food to as long as a few days.

If you suspect that a participant has foodborne illness, treat these symptoms much like you would treat the flu. If the person has a chronic illness or has very severe symptoms, contact a health care provider as soon as possible.

How Foodborne Illness Occurs

Foodborne illness can happen when food becomes contaminated and/or when microbial growth is allowed to occur in food. Any food or beverage can become contaminated. However, certain foods are considered to be more risky because they support the growth of pathogens or have been involved in foodborne illness outbreaks.

Foods Associated with Foodborne Illness

  • Ready-to-eat foods are foods that are usually eaten without cooking or additional preparation. They include:
    • raw, washed, cut fruits and vegetables.
    • whole raw fruits and vegetables that can be eaten without peeling.
    • meat, dairy products or other high protein foods that have already been cooked or other foods that can be eaten without washing or cooking.

    These foods may carry microorganisms or other contaminants that can make people sick.

  • Potentially Hazardous Foods (PHFs) are often moist foods with high protein or carbohydrate content and a neutral or slightly acid pH. These components support the rapid growth of microorganisms. According to the 2005 Food Code ( fc05-toc.html) these foods are also designated as time/temperature control for safety (TCS) because they require time/temperature control to limit the growth of pathogenic microorganisms or toxin formation. These foods include:
    • animal foods such as meat, poultry, fish, shellfish, tofu, milk, or cheese
    • plant foods that are heat-treated – such as cooked rice, pasta and cereal grains, cooked vegetables
    • raw seed sprouts, cut melons, or garlic-in-oil mixtures

From a regulatory perspective, participants in adult day health programs are considered to be a "highly susceptible" poplulation. Therefore, your program must adhere to special requirements in food service to protect program participants. The following foods are not allowed to be served:

  • Unpasteurized juice
  • Raw shell eggs, or foods made from raw or undercooked eggs including eggnog, soft cooked eggs, hollandaise sauce or meringue
  • Raw or undercooked animal foods such as raw fish or shellfish, lightly cooked fish, and rare meat
  • Raw sprouts

Additional safeguards prohibit re-serving foods. For more information about these restrictions, check with your local health inspector or contact the state Department of Public Health.

Foodborne Contamination

Contamination occurs when something harmful gets into the food. Bacteria or other harmful substances can travel to food by hands, equipment or utensils used to prepare food.
There are three different types of contamination:

  • Physical contaminants can be seen or felt. They include dirt, broken glass or plastic flatware, toothpick, hair, fingernail, or bandage.
  • Chemical contaminants are found in some of the materials that are used to clean, store or protect foods. They include:
    • Cleaning chemicals, sanitizing agents Chemicals used to clean and sanitize pots, pans or dishes can be a source of chemical contamination if proper cleaning procedures are not followed. If too strong a concentration of sanitizer is used, consumers can get sick from the residue left on the food contact surface.
    • Toxic metals are poisonous compounds that form when high acid foods like citrus or tomato products are left in metal cans or containers.
    • Pesticides that are not used properly can leave residues on foods or food contact surfaces.

    To keep food safe, read labels and follow the directions on any chemicals or pesticides.

  • Biological contamination comes from micro-organisms that occur naturally in some foods or are introduced through cross-contamination with other foods or food contact surfaces. While chemical and physical contaminants can make people sick, it is most often microorganisms that cause foodborne illness.

Most foodborne pathogens fall into four categories:

  • Molds and yeasts usually cause food to spoil. However, molds can be dangerous because they may produce toxins that can make elderly and other susceptible populations ill. These poisons are not removed when mold is cut off foods like cheese, fruit or breads.
  • Parasites have been found in foods produced or processed with contaminated water or handled by people who do not practice good personal hygiene.
  • Viruses are a major cause of foodborne illness. Most of these viruses are carried to people by foods that have been touched by people who are ill with the virus.
  • Bacteria cause most cases of foodborne illness. The FDA “Bad Bug Book” ( provides basic information about dozens of microorganisms and the illnesses they cause. While bacteria and other microorganisms are common in the environment, in people, and in or on food, most of them are not pathogenic. However, when they are allowed to grow to harmful levels, or if they are from virulent strains, older adults can become sick.

Microbial Growth

Food becomes unsafe when bacteria and other pathogens grow to harmful levels. With the right components (protein and moisture) and warm enough temperatures, bacteria can multiply in relatively short periods of time.

  • Temperatures between 41°F and 140°F are considered the “Danger Zone” because bacteria will grow well in this range, with the most rapid growth between 70°F and 110°F. When foods are left in the Danger Zone for more than 2 hours, the number of bacteria can increase to harmful levels.

Neither refrigerator nor freezer temperatures kill bacteria – they just slow down the rate of growth. Bacteria remain alive and viable in the freezer (0-32°F). In the refrigerator (41°F or below) bacteria survive and grow slowly. Some bacteria such as Listeria and certain types of E. coli grow well even in the refrigerator.

Only temperatures above 140ºF will kill bacteria.

How You Can Prevent Foodborne Illness

To prevent foodborne illness, food handlers must follow these two basic rules:

  1. Prevent Contamination
  2. Control Microbial Growth

Prevent Contamination
Habits as simple as washing hands and keeping things clean will help keep pathogens and other contaminants from spreading to food.

Practice Good Health and Hygiene: Humans are the source of many microorganisms that cause foodborne disease. Some bacteria are found naturally on our skin, hair, nose and throat. Many others live or survive in our intestines. These bacteria can easily be spread from one person to another by hands touching foods, food contact surfaces and other household objects like faucets or tables.

steps to wash hand
  • Be in Good Health
    Foodborne illness can be spread when a person who is ill prepares or serves food. If a food worker or server is ill with any of the following symptoms, they should not make or serve food:
    • fever
    • sore throat
    • diarrhea
    • vomiting
    • jaundice (yellow skin and eyes)

  • Wash Your Hands
    Improper or inadequate handwashing is a major cause of foodborne illness. Washing hands can remove bacteria and other pathogens.

Keep Food Contact Surfaces Clean: Cross-contamination occurs when bacteria spread from one food to another. Prevent cross-contamination by keeping foods – especially raw PHFs – away from ready-to-eat foods.

Food contact surfaces are any items that touch food such as cutting boards, can openers, dishes, kitchen utensils and counter tops. When they are washed the “soil” (dried gravy, sauces and food) is removed. Sanitizing adds another step to reduce bacteria to levels where they are no longer harmful.

Approved methods for sanitizing include heat or hot water, and chemicals such as chlorine bleach or quaternary ammonium compounds (quats).

sanitize steps

For chlorine bleach (5.25% sodium hypochlorite), use this recipe:

1 teaspoon of bleach
to 1 gallon of warm water

The concentration of this solution will yield 50-100 ppm (parts per million). The maximum amount of chlorine allowed to sanitize food contact surfaces is 200 ppm; 50 ppm (less than a teaspoon per gallon) is the minimum concentration recommended. If more than the 200 ppm is used, a chlorine residue will be left as a potential source of chemical contamination.

To prevent chemical contamination, use a test strip for the sanitizer to check the concentration of the sanitizing solution.

Keep food safe from contamination at all steps in handling.

  • Use reputable, licensed suppliers.
  • Establish policies for staff or volunteers to:
    • Report illnesses or symptoms like diarrhea or nausea before they work with food.
    • Cover any cuts, burns, sores or skin infections completely with a bandage if they prepare or serve food.
    • Wash hands before handling food or touching clean dishes.

Establish policies and procedures for practices listed below.

  • When you receive or shop for foods:
    • Keep raw meat, poultry and seafood away from other foods.
    • Check packages for tears or leaks.
    • Make sure cans are free from dents and bulges.
  • When you store foods:
    • Store food away from cleaning supplies and other chemicals.
    • Keep all foods covered.
    • Wrap raw meats and poultry or put in containers or dishes. Place below other foods – on the bottom shelf or drawer of the refrigerator.
    • Keep the refrigerator clean.
    • Store food only in containers designed for food. Do not store poison or cleaning chemicals in food containers.
    • Throw away moldy cheese, bread or fruit, fermented juices.
  • When you prepare foods:
    • Always wash hands.
    • Use disposable gloves, mixing spoons and serving utensils to make and serve food instead of using your hands.
    • Wash fruits and vegetables before you serve them.
    • Wash, rinse and wipe tops of cans before opening.
    • Use different cutting boards for raw meats and ready-to-eat foods.
    • If you can’t use separate utensils after they come in contact with raw meat, poultry or fish, then wash and sanitize them.
    • Put cooked meat, poultry or seafood on a clean or different plate than you used for the uncooked foods.
    • Use a clean spoon if you taste foods as you prepare them.
    • Don’t mix (or store) old and new batches of the same food.

Control Pests
Insects and rodents are also sources of contamination. It is important to keep flies, cockroaches, mice and rats away from the food preparation and storage areas.

  • Keep pests out. Put screens on doors and windows. Keep trash cans covered.
  • Keep the kitchen and eating area clean. Clean food crumbs and wipe up even small spills.
  • Use pesticides only if they are absolutely necessary. Store these like any other chemicals away from food in a locked cabinet. Follow the manufacturer’s directions for use.

To control these pests: Throw out any food that shows signs of pest infestation, or has contacted a surface that was contaminated with pesticide.

Control Microbial Growth
Time and temperature play important roles in the growth of bacteria. By controlling the temperature of foods, and limiting the amount of time foods spend in the Danger Zone, you can help prevent bacteria from growing to harmful levels and producing toxins.

To control temperature:

  • Use a food thermometer to check internal temperatures of foods.
  • Insert the tip of the thermometer into the thickest part or middle of the food. Wait for the temperature reading to be steady (at least 15 seconds).
  • Sanitize the thermometer between uses to prevent cross-contamination.
  • Calibrate the thermometer regularly to insure its accuracy.

Keep cold foods cold (41°F or below) at all steps in handling.

  • When you receive or shop for food:
    • Buy cold or frozen items last. Check to make sure frozen foods are frozen and cold foods have been kept at 41°F or below.
    • If you shop for food, pack cold foods in insulated containers when the weather is warm.
  • When you store foods:
    • Set your refrigerator no higher than 41ºF and your freezer at 0ºF.
    • Place a refrigerator thermometer in the middle of the refrigerator or freezer. Check the temperature of your refrigerator each day.
    • Put away potentially hazardous foods into the refrigerator or freezer first.
    • Put raw PHFs in the back of the refrigerator where it is coldest. Use the refrigerator door for condiments and other foods such as jams and juices.
    • Store eggs in their original carton in the refrigerator – not on the door.
    • Make sure the vents in these appliances are not blocked so that cold air can circulate. Don’t overstuff the refrigerator.
  • When you prepare foods:
    • Thaw foods properly.
      In the refrigerator: Place frozen meat or other PHFs in a pan or tray below ready-to-eat foods.
      Plan for enough time for the size of the item. For example, one pound of ground beef or a thin chicken breast may take less than a day to thaw while a 10 pound turkey may take 4-5 days.
      After thawing, use or cook meats within 1-2 days.
      In cold running water: Make sure that the food is sealed in a package or bag.
      One pound of ground meat will take about one hour. For a whole turkey, plan on 30 minutes per pound. It is best to use this method if the food item can be thawed within 2 hours. Foods thawed using this method must be cooked immediately.
      In the microwave: Always cover the food to prevent juices from contaminating the parts of the microwave oven. Follow the directions for the microwave, rotating the food several times to make sure it thaws evenly. Foods thawed this way must be cooked immediately.
      Some frozen foods like frozen vegetables and thin foods such as hamburger patties, fish portions and shaved steak, can also be thawed as part of cooking.
      Always cook thawed foods thoroughly before refreezing.
    • Do not thaw foods at room temperature.
      The outside of the food may reach temperatures above 41ºF while the inside is still icy.
      Bacteria on the surface may grow to harmful levels.

    • Chill ingredients before mixing. Refrigerate ingredients such a mayonnaise, tuna or other ingredients for salads before mixing. Marinate meats in covered containers in the refrigerator.
  • When you serve foods:
    • Keep foods refrigerated at 41ºF or below until just before serving.
    • Check the temperature of the foods to be 41ºF every 2 hours.
    • Throw away any food that has been above 41ºF for more than 2 hours.
    • Use ice and insulated containers to transport foods when taking a trip or outing.
  • When you cool foods:
    • Use a food thermometer to check that hot foods have been cooled according to these recommended methods:
    • Two-stage method: from 140ºF to 70ºF within 2 hours and 70ºF to 41ºF or below within 2 additional hours
      One-stage method: from 140ºF to 41ºF or below within 4 hours

    • Cool foods quickly.
      Divide large amounts of leftovers into small, shallow containers.
      Set large pots of soup, stew or sauce in an ice bath.
      Don’t pack the refrigerator. Make sure there is room for cool air to circulate and keep foods at a safe temperature.

Keep hot foods hot at all steps in handling.
Use a food thermometer to check the temperature of foods to make sure that they are cooked thoroughly and held at the proper temperatures. Be careful not to hit fat or bone in meats.

  • When you receive hot foods:
    • Check the temperature of the foods to be 140 ºF or above.
    • Refuse foods that are below this temperature.
  • When you cook foods:
    • Do not interrupt cooking times.
      Partial cooking can raise temperatures to Danger Zone levels without being hot enough to kill bacteria.
    • Follow the minimum internal cooking temperatures recommended in the Food Code.
  • When you serve hot foods:
    • Check the temperature of the foods to be 140ºF or above every 2 hours.
    • Throw away any food that has been below 140ºF for more than 2 hours.
  • When you reheat leftovers:
    • Bring gravies, soups and sauces to a boil when reheating.
    • Heat other leftovers to 165ºF for 15 seconds.
temperature chart
From FDA Food Code, 1999.

Food Safety Education and Certification

For programs that prepare and serve meals and snacks for participants, some states, such as Massachusetts, require that there be at least one person who can demonstrate knowledge of foodborne illness. This regulation often requires that this person has successfully completed a food manager certification exam. Check with your local health inspector to see if this requirement applies to your program.

Food safety is everyone’s responsibility. All staff and volunteers should have the opportunity to learn about the risks of foodborne illness and what they can do to prevent it. Materials and training resources are listed the Resources section of this manual.  Share this information with caregivers as well.

Regulations for food safety and sanitation may change to reflect new food safety issues, scientific evidence and technologies. For information about any changes or new developments, check with your local health inspector or contact the state Department of Public Health.

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Developed for the Massachusetts Department of Education Child and Adult Care Food Program by the University of Massachusetts Extension Nutrition Education Program. Permission is hereby granted by the Massachusetts Department of Education to copy any or all parts of this document for non-commercial educational purposes. The Massachusetts Department of Education, an Affirmative Action employer, is committed to ensuring that all of its programs and facilities are accessible to all members of the public. We do not discriminate on the basis of age, color, disability, national origin, race, religion, sex, or sexual orientation.