Nutrition, Food Handling and Sanitation


As a direct care staff person involved in helping residents with their daily activities, you will have a big impact on the residents’ health through their diets. Eating a well-balanced, healthy diet will help the residents and you from catching an illness from a virus or an infection. When our bodies are well fed, we are able to help fight off sickness. Residents of personal care homes may have serious illnesses such as Parkinson’s disease, heart disease, diabetes, cancer or respiratory illness. Residents need regular and nutritious meals to balance medications and maintain proper body weight.

What is dehydration?woman drinking water

Water is absolutely necessary to life. It is found in all body cells, and accounts for two-thirds of total body weight. Water helps the dissolving and digestion of food and in the elimination of waste products. It is found in all beverages and in many solid foods. Many times people don’t want to drink too much water because they are afraid they will have an accident or wet themselves. Also, the body’s ability to detect thirst diminishes with age. This is a problem because residents need water to prevent dehydration. Dehydration occurs when a person is either not getting enough liquids (about 6-8 cups daily) or is discharging too much urine.

Signs and symptoms of dehydration:

  • Headache — the most common symptom.
  • Dry mouth and tongue.
  • Cracked lips.
  • Dry skin.
  • Sunken eyes.
  • Nausea, vomiting, diarrhea (these cause dehydration).
  • Dark, strong smelling urine.
  • Weight loss.
  • Fast heart beat.
  • Low blood pressure.
  • Confusion, light-headedness.
  • Disorientation.

Some medications can cause dehydration. Dehydration can lead to confusion, behavior problems, weakness, respiratory failure, kidney failure and even death. So, as you can see, it is serious, especially for the elderly. It is important to report possible dehydration to your supervisor when you see any of the above symptoms.

Drinking water should be available to residents at all times. If a resident has an impairment that affects their ability to drink, you should encourage or assist them to drink some water often throughout the day. You will need to offer the resident water often throughout the day and evening and try to coax the resident to drink. You may need to offer water through the use of a straw or by small sips from a cup. Soda, lemonade, coffee, iced tea and fruit juice taste so good, but they often replace the intake of water. Many of these drinks, such as coffee, tea and soda, contain caffeine. Caffeine is a stimulant, and the body uses up some of its precious stores of water to flush the caffeine out of the cells. Drinks that contain caffeine cause increased urination which may lead to slight dehydration. Alcohol is another fluid that draws the water out of the body and should not be considered a source of liquids.

A resident may not feel thirsty, even when he/she needs fluids. Without a constant flow of fluids, bacteria will grow in the bladder or urinary tract causing infection. A resident should drink 8 glasses of water per day. A glass of cranberry juice daily can also help combat infection. Cranberry juice has a substance in it that makes it difficult for bacteria to adhere to the walls of the bladder and urinary tract. The bacteria are then flushed out in the urine.

Finally, water helps with constipation. When there’s not enough water for all of the other functions of the body to run correctly, the colon, part of your intestines, removes some water from the stool so it becomes dry and harder to pass. This is constipation, which can be very painful and cause “fecal impaction.” Fecal impaction is a large mass of hard feces that cannot be passed from the bowel. Fecal impaction can require hospitalization and can be avoided by drinking a lot of water.

What is daily food intake?

The daily food intake or meal plan is a guide for each resident to determine what food and how much should be consumed each day. Six nutrients are supplied by food: water, protein, fat, carbohydrates, vitamins and minerals. Protein, fat and carbohydrates are the three that provide calories, which is the amount of energy or fuel in the food. There are recommended Dietary Allowances or amounts that are needed of protein, vitamins, minerals and calories for each person to maintain good health.

Residents spend most of their time sitting or laying down so they don’t need a large amount of calories.

Older adults need what is referred to as foods “dense in nutrition.” These foods have a lot of nutrients per calorie. Residents should be encouraged to avoid junk food and eat fresh foods with little processing. Also, if residents are inactive, the best solution is to increase activity. In fact, exercise is now considered part of the national food guidance system.

Eating healthfully:choose my plate

Nutritionally well-rounded meals include foods that have protein, such as meat, poultry, fish, dairy products and eggs. This is essential for the repair of tissue and for maintaining good health. People who are on vegetarian diets (who do not eat meat) can still get some protein from plant foods like dried beans or peas, grains and cereals, but they often require additional foods to make their meals complete. Proteins, as well as fluids, are restricted for residents who are having difficulty with their kidneys. It is important to know if a resident has kidney disease so that you can offer them foods that fit his/her particular meal plan and fluids at certain times of the day. Always check the support plan to see if there are any dietary restrictions before giving a resident snacks.

If a resident has been diagnosed with heart disease, he/she may be kept on a lower fat diet. Again, it is important for you as a direct care staff person to know which residents are on special diets so that you do not offer them a food that is not allowed in their meal plan.

Vitamins are needed for healthy body processes and to help digest other nutrients. Vitamins are found in many foods in a healthy meal plan, especially in fruits, vegetables and whole grains. If illness or poor eating habits are present, a multi-vitamin may be beneficial for the resident to get the recommended daily amount of vitamins. Minerals are needed for building body structures like tissue, bone and muscle. Minerals are found in dairy products, protein foods, whole grain foods and dark green leafy vegetables. If a person has “iron poor anemia” he/she should increase their intake of iron rich foods such as green leafy vegetables, dried fruits like raisins, meats and cereals fortified with iron.

A good balanced diet normally supplies enough nutrients for a person’s daily needs plus some extra. It is recommended that the daily menu plan include the five food groups in suggested amounts to maintain an individual’s ideal weight. The five groups are the fruit group at 2 cups per day, the vegetable group at 2 ½ cups , meat, eggs and beans group at 5-5 ½ ounces, the grain group at 6 ounces and the milk or dairy group which also includes yogurt, and cheese for the equivalent of 3 cups per day for a 2,000 calorie diet.. The oil group is not an official food group but it appears on the new “My Pyramid” to remind us that fats from oils are necessary for the body in small amounts.

Each serving would be a particular portion size. For instance, an ounce of grain is equal to a ½ of bagel, a small muffin, or a serving the size of a baseball. A three-ounce serving of meat is about the size of a deck of cards. A cup of fruit the size of a baseball would equal one serving. These visuals should help you to approximate how much food the resident is getting and/or eating.

portion size meat equals a deck of cards  portion size cup of fruit equal to a baseball

When do you offer alternative food choices?

A resident who refuses to eat or has a poor appetite may be acting this way for several reasons. They could be ill, or the medicine they are taking may have had an effect on their appetite. For example, an individual going through chemotherapy for cancer may lose weight and have a poor appetite. Another cause for poor appetite might be swallowing or chewing difficulty from oral surgery, stroke, poor fitting dentures or gum disease. If a resident refuses to eat or drink continuously during a 24-hour period, the personal care home should notify the resident’s primary care physician and the resident’s designated person. While a resident may not be forced to eat food, it is important to understand the reason and address the resident’s concern to help him/her eat an adequate diet.

Another issue that you need to be aware of is the possibility of choking on certain foods. Residents who have these concerns may need to have help with eating and have alternative food choices. Some helpful hints for alternative food choices or preparation methods might include:

  • Cutting or grinding food or turning it into a cream sauce (if permitted on the resident’s support plan).
  • Serving a rich soup or blended meats and vegetables to increase calories.
  • Using mashed or pureed fruits and vegetables or their juices to make dry foods more edible.
  • Using gelatins, ice creams, puddings, custards or milk shakes to replace hard-to-chew or hard-to-eat foods.
  • Offering liquid or soft supplements (if appropriate) such as health shakes, Ensure or fortified cookies.


What do you do if a resident refuses to eat certain foods?

The first thing you must do is determine why a resident is refusing to eat the food. Is it because he/she doesn’t like the taste of it or how it is cooked? Is the resident depressed? Has the resident’s medications changed recently? Is it because of his/her cultural or religious beliefs? Specific foods mean different things in different cultures, but most cultural groups use food for similar purposes like celebrations. There are times when eating certain foods go against a resident’s beliefs and he/she should be offered an alternate food choice. For instance, a person who practices Judaism may not eat ham or pork products. A vegetarian may need an alternative protein food other than meat. A resident may not be forced to eat food. As a direct care staff person, you must be sensitive to a person’s personal eating habits based on beliefs and not cause him/her to be embarrassed. You will learn more about different religious and cultural beliefs in the module called "Meeting the Care Needs of Residents in a Culturally Diverse Environment."

How do you make sure that the food served is safe to eat?

This is where food safety becomes part of your responsibility during the service, storage and preparation of meals. The most important food safety precaution is proper hand washing. Frequent and thorough hand washing before food preparation, before serving food, before assisting a resident with eating and after food handling is important to prevent illness. As for storage of foods, you must properly label food with dates when a food was prepared and when it was put into the freezer. You should follow the “first-in first-out” rule. In other words, the food purchased last should be put behind the older foods on shelves in dry storage or in the cold storage so that the freshest is used last. Additionally, you need to check expiration dates on products such as milk and eggs since they are more likely to contain harmful bacteria than dry goods like breads and cereals. The other important items you want to check daily are the temperatures of the refrigerator and freezer units. If a food is kept above the temperature of 40 degrees Fahrenheit for many hours it will spoil and could cause food-borne illness, especially in the elderly whose immune systems are not as able to fight food infections. Food kept in the home including food in a resident’s bedroom must be kept in sealed containers.

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