INNOVATIVE NUTRITION PROGRAMS FOR OLDER ADULTS Common Problems and ...

INNOVATIVE NUTRITION PROGRAMS FOR OLDER ADULTS

Common Problems and Innovative Solutions

















Rita Strombeck, Ph.D
Riverside County Foundation on Aging

June, 2005

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INNOVATIVE NUTRITION PROGRAMS FOR OLDER ADULTS
Common Problems and Innovative Solutions



This publication was prepared and published with funding support from the Riverside County
Office on Aging.


Rita Strombeck, Ph.D, author of this report, has written numerous books and articles on a variety
of health and healthcare-related topics, including issues impacting quality of life for seniors. She
has served as principal investigator on 11 federally funded grant projects, has taught and lectured
at major universities, and has been an invited speaker at numerous professional and NIH-
sponsored meetings.


The Riverside County Foundation on Aging is a nonprofit public charity created to ensure that
programs and services provided by the County to its older adults will keep pace with current and
future needs. The Foundation works to strengthen and expand programs offered by the Riverside
County Office on Aging, and supports the work of the Riverside County Advisory Council on
Aging.


Questions regarding this publication, and/or requests for additional copies in print or electronic
format, should be addressed to the Foundation at:

Riverside County Foundation on Aging
6296 Rivercrest Drive
Suite K
Riverside, CA 92507
(951) 776-7792
info@rcfoa.org
www.rcfoa.org






© 2005 Riverside County Foundation on Aging. The contents of this publication can be reproduced and/or copied
and distributed without permission and free of charge. Please site the Foundation and the author as the source.



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Table of Contents



Introduction


1

Part I – Common Problems and Needs Encountered by ENPs

3

Risk
Screening

3
Reducing
Barriers
to
Participation


6
Nutrition
Education
13
Funding 20

Part
II
–
Case
Studies

27

Loaves
&
Fishes
(Oregon)
28
Healthy
Aging
Partnership
(Washington)
29

Senior Services of Seattle/King County (Washington)

35

Healthy Aging Coalition of Northern California


37

Delaware Division of Services for Aging and Adults With
39
Physical
Disabilities

Appendix A: Strategies for Reaching Culturally Diverse Older Adults
42


























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Innovative Nutrition Programs for Older Adults


Introduction

The Elderly Nutrition Program (ENP) is the largest nutrition assistance program in the US
Department of Health and Human Services. More than 4,000 ENP nutrition projects provide
congregate and home delivered meals, nutrition education, nutrition counseling, and nutrition
screening and assessment, and in some cases, health promotion and referral services to
approximately 3.2 million older adults, many of whom have health problems and functional
impairments. As the elderly population continues to grow and as funding becomes scarcer,
ENPs are being increasingly challenged to effectively and efficiently meet the needs of their
clients.

A number of ENPs across the country have implemented various innovative strategies and
activities to address the current challenges. The following report presents an overview of some
of the activities that have been undertaken by senior nutrition programs across the country to
create innovative public-private sector funding partnerships and to reach underserved, low
income, minority, isolated and at-risk seniors. Approximately 200 nutrition programs were
assessed, based on Web-site information, recommendations from nutrition professionals, and
recognition by professional organizations for innovative programming.

In Part I, common problems and needs encountered by ENPs are identified and examples
provided on how these issues have been addressed. In Part II, case studies of specific innovative
ENPs are presented in greater detail.

Part I. Common Problems and Needs Encountered by ENPs

A number of common problems and needs are encountered by ENPs across the country that
include the need to:
• Screen for nutritional risk
• Eliminate barriers to participation
• Provide nutrition education, especially culturally sensitive programming
• Secure additional funding for nutrition services

Part II. Case Situations

In this section, 5 exemplary programs are reviewed in detail; these include:
• Loaves & Fishes (Oregon)
• Healthy Aging Partnership (Washington)
• Senior Services of Seattle/King County Washington
• Healthy Aging Coalition of Northern California
• Delaware Division of Services for Aging and Adults with Physical Disabilities

Millennium March to Wellness

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Risk Screening

Because the demand for nutrition services, especially by frail homebound seniors, continues to
exceed resources, regular nutrition risk assessments should be performed using accepted
nutrition risk criteria to prioritize services, particularly among those with health disparities.
Home-delivered meal recipients need to be re-evaluated on a regular basis using objective
nutrition risk criteria to allow those with greater need to receive services sooner.



New York State Office for Aging
Working with the Center for Policy Research at the University at Albany, Nelson A. Rockefeller
College of Public Affairs and Policy, the NYS Office for Aging produced an evaluation report of
the Home Delivered Meals program (1999-2000). The report, entitled "Home Delivered Meal
Services for Older New Yorkers: A Three County Longitudinal Surveillance Study, " was the
first longitudinal assessment of home delivered meal services for seniors in New York State.
The study examined the nutritional status of recipients of home delivered meal (HDM) services
in three counties of New York State. It did so by looking at recognized and accepted indicators
and measures of nutritional health including:
• Nutritional functional impairments -- help needed with cooking, shopping and other
activities;
• Nutritional risk indicators -- poor diet and other nutritional health risks;
• Chronic illnesses and conditions -- diseases of the heart, diabetes and others;
• Food security -- nutritionally-related economic concerns and worry; and,
• Weight status -- Body Mass Index (BMI) measures of underweight, normal, overweight
and obesity status.
Findings were used for planning and policymaking purposes to determine how well the HDM
services in the representative counties studied are achieving their objectives and goals in:
• Targeting services to seniors most in need and at greatest risk - including elderly and
minority and low-income elderly;
• Serving seniors who require the assistance of HDM services in preparing or cooking
meals, and/or shopping due to acute or chronic impairments;
• Screening seniors for alternative assistance who need more intensive support and
personal care;
• Reducing food insecurity and rationing and economic worry about food purchases among
otherwise eligible seniors; and,
• Maintaining the weight, and preventing unhealthy, precipitous weight loss, among HDM
recipients.
The findings also showed that the targeted population of those most in need and at greatest risk
has changed markedly. To a greater extent than in past years, HDM services now intervene in
support of early hospital discharge practices and serve seniors with higher prevalence of chronic
illnesses and conditions.

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A full report of this study, complete with risk assessment guidelines, is available at:
http://aging.state.ny.us/explore/nutrition/hdms/chapter1.htm
Spokane
County
(Washington)
As part of The Washington State Community Nutrition Assessment Education Project
(http://depts.washington.edu/commnutr/home/contents.htm), Spokane County undertook a project
called Assessing the Nutritional Health of Seniors. The overall goal of the assessment was to determine
the nutrition risk status of seniors in Spokane County.
The tool selected for this assessment was developed by the Nutrition Screening Initiative, an
initiative of the American Dietetic Association, the American Academy of Family Physicians, and
the National Council on Aging.

Results of the nutrition screening were shared with the Area Agency on Aging, the Spokane
Regional Health District Assessment Center, and non-profit groups working with seniors in
Spokane in order to provide collaborative agencies with support as they seek additional funding.
This approach to community nutrition assessment has proven to be valuable and effective. The
nutrition screening assessment has been expanded to other counties to allow additional
comparisons between rural and urban participants. The data has enabled the lead agency to
qualify for the national pilot program, Morning Meals on Wheels. This was a six month study
that was conducted in collaboration with Florida International University under an agreement
with the Administration on Aging. An evaluation of this pilot program demonstrated that it was
effective in meeting previously unmet needs in the senior population.
A full report of this study, complete with risk assessment guidelines is available at:
http://depts.washington.edu/commnutr/cases/spokane/s-description.htm
Excellent step-by-step guidelines and a toolkit on how to conduct a community nutrition risk
assessment are available at: http://depts.washington.edu/commnutr/home/about.htm
Geisinger
Clinic
(Pennsylvania)
Geisinger Clinic is a nonprofit physician group practice that serves more than two million people
in northeastern and central Pennsylvania. Its service area has one of the largest concentrations of
rural elderly in the United States: more than 20% of residents in many counties are over 60 years
of age.
With a grant of $40,970 from The Robert Wood Johnson Foundation (RWJF), Geisinger
established a regional nutrition screening initiative for more than 5,000 of its enrollees to identify
high-risk elderly people and link them with nurse care managers prior to intervention. The
nutrition screening program was started at more than 100 clinics in the first year of the project.
Grant funds were used to analyze the data collected through the screening initiative, evaluate the
screening process, and pilot test and evaluate the case manager model at a single clinic.

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Since the project ended, Geisinger Clinic has continued the cohort study with the support of the
USDA Agricultural Research Service as the Geisinger Rural Aging Study.
More information about the study is available at:
http://www.rwjf.org/portfolios/resources/grantsreport.jsp?filename=026939.htm&iaid=144
Florida International University – National Policy and Resource Center on Nutrition and
Aging (NPRC)
There are new nutrition assessment and monitoring tools for older adults that are available. The
National Policy and Resource Center (NPRC) on Nutrition and Aging at Florida International
University recommends that home delivered meal recipients be regularly re-evaluated using
objective nutrition risk criteria to allow those with greater need to receive services sooner. The
NPRC provides an excellent compendium of research, reports, resources, assessment and
monitoring tools and links that deal with nutrition screening and assessment in older adults. This
information is available at:
http://www.fiu.edu/~nutreldr/SubjectList/N/Nutrition_Screening_Assessment.htm















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Reducing Barriers to Participation
Despite the availability of nutrition programs for low-income older adults, many seniors do not
participate. While lack of adequate transportation is a major issue, other barriers to participation
exist as well. Studies show that many older adults feel a certain “stigma” of charity related to the
Elderly Nutrition Program and may be reluctant to participate. In addition, older adults from
different cultural backgrounds often feel that meals offered at nutrition sites do not meet their needs
or tastes. A number of innovative programs have been undertaken across the country to address these
barriers.

Transportation

Hartford
Food
System
(Connecticut)

The Hartford Food System in Connecticut runs a program for seniors in partnership with a local
supermarket to provide phone order grocery service. Funded by the North Central Area Agency
on Aging and other local businesses and churches, delivery is free for participants, making the
service a competitively priced way for elderly people without cards or with disabilities to have
access to a variety of fresh, quality food.

King
County
(Washington)

In King County, Washington, several innovative transportation programs are available to transport
older adults to congregate meal programs. Created in 1997, Senior Shuttles now offers 14 van
programs throughout King County. Senior Shuttle transports seniors to hot meal programs, medical
appointments, senior centers, grocery stores, and other local destinations. The service provides
seniors with an opportunity to socialize with other seniors and stay active within their communities.
There is no charge for rides, but donations are accepted.
Volunteer Transportation was formed in 1975 to help meet the transportation needs of King County
seniors and their families. Over 350 volunteers use their own vehicles to drive seniors to medical and
other essential appointments. The volunteers provide a personalized, one-on-one transportation
service. They drive seniors to and from appointments, waiting with them until they are ready to return
home. There is no charge for Volunteer Transportation services.
Nutrition Transportation Program staff work with seniors to find the best way to get them to
lunch. They coordinate transportation services with many different providers to improve access
to the lunch programs. The services include:
• Assistance applying for Metro's ACCESS program
• Troubleshooting difficulties with any transportation provider
• Arranging rides on ACCESS while awaiting ACCESS eligibility certification
• Arranging rides with volunteers driving their own vehicles
Additional information about transportation programs in King County is available at:
www.seniorservices.org/vts/vts.htm

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- Mobile Market. Within the Seattle City limits, eligible Meals on Wheels participants
also have the choice of receiving a variety of reasonably-priced groceries delivered to their home
through the Mobile Market Program. Mobile Market is available outside the city limits of
Seattle - however, it is limited to Liquid Nutritional Supplements. Grocery lists are available
online and individuals interested in applying for the program can also do so via the Internet.
The Senior Farmers’ Market Nutrition Program
The Senior Farmers’ Market Nutrition Program (SFMNP) was established by the USDA’s
Commodity Credit Corporation (CCC) to provide grants to states for pilot projects modeled on the
Women, Infants, and Children (WIC) farmers’ market program. Low-income seniors in these
projects receive coupons that may be exchanged for eligible food at local farmers’ markets,
roadside stands, and community supported agricultural programs. Many of the SFMNP provide
bus transportation to the farmers’ markets.

For fiscal year 2005, California has been awarded $604,603 in grant funds to provide coupons to
low income seniors that they may exchange for eligible foods at farmers’ markets, roadside
stands, and community supported agriculture programs.

For information on the California Senior Farmers’ Market Nutrition Program, contact Carole
Cory, California Dept of Aging, 1600 K Street, Sacramento, CA 95814-4020. (916) 322-9184,
ccory@aging.ca.gov.



Area Office on Aging of Northwestern Ohio

At the Area Office on Aging of Northwestern Ohio, older adults pick up coupons at their local senior
center on a first-come, first-served basis. Six $5 coupons are valid for June and July. In August,
September, and October, older adults can come back to the center to get 4, $5 coupons each month.
Since each month’s distribution is first-come, first-served, on a monthly basis, the annual benefit
amount for each older individual for the entire program ranges from $30 to $90 during the season in
Ohio. Bus transportation is provided to the farmers’ market from various locations. If a participant
is homebound and unable to pick up coupons and shop for produce, he or she may designate a proxy.

To encourage selection and usage of a wide variety of fresh fruits and vegetables in Ohio,
nutrition education is provided along with the coupons. Educational programs include full color
handouts, with in-depth information and recipes highlighting a particular fruit or vegetable.
Innovative recipes, preparation and storage tips are included in the handout. Bus trips to
farmers’ markets provide a captive audience for a nutrition educator who can stimulate
discussions regarding seasonal fruits and vegetables, the benefits of consuming them, and
selection, preparation, and storage techniques. Cooking demonstrations and tastings are
provided at coupon distribution sites and/or at the farmers’ markets.

The Area Office on Aging of Northwestern Ohio supports 57 senior dining sites throughout 10
counties of Northwestern Ohio. Transportation is provided to most senior dining sites. In one
county, seniors may receive a special bus card to use for transportation to the meal sites. Home-
delivered meals are available Monday through Friday and are delivered by volunteers. In

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addition, several counties are served by a Mobile Market. At specified senior sites and low
income housing complexes, Mobile Market provides an “at your door” grocery delivery service
with one phone call.

Additional information on this program is available at:
http://www.areaofficeonaging.com/aoanutri.html



Chelsea (Michigan)

The Chelsea (MI) Farmers’ Market and the Chelsea Area Transportation System (CATS) have
developed a partnership to bring senior citizens to the Chelsea Farmers’ Market on Saturday
mornings. The CATS bus is an “on demand” service, but on Saturdays it runs a scheduled route
to three senior centers in town and drives individuals to the market at 9 a.m. and picks them up
an hour later for the return trip.

Additional information about the Senior Farmers’ Market Nutrition Program is available in the
publication USDA Senior Farmers’ Market Nutrition Program available from the NPRC at Florida
International University www.fiu.edu/~nutreldr/Ask_the_Expert/SFMNP/SFMNP.htm;
and at: http://www.nemw.org/farmersmarkets/senior.html.

Information on how to promote the Senior Farmers’ Market Nutrition Program in the community
is available at http://nutrition.wsu.edu/markets/ideas.html



Washington State Senior Farmers’ Market Nutrition Program

To implement the Senior Farmers Market Nutrition Program in Washington, a broad-based
partnership was developed with Washington State University Extension, the Aging and
Disability Services Administration, the Department of Health WIC FMNP, 11 Area Agencies on
Aging, the Washington Association of Senior Nutrition Programs, the WA Farmers Market
Association, farmers’ market managers, county public health and department of health offices,
and other SFMNP supporting agencies.

The SFMNP provides fresh fruits and vegetables to low-income older adults in WA State. WSU
Extension provides supporting nutrition education materials and fosters nutrition education
activities at the local level such as cooking demonstrations at farmers’ markets. WSU Extension
has also created a state “FMNP” website that includes both Senior and WIC FMNP supporting
materials. Educational materials are available in nine different languages and are available at:
http://nutrition.wsu.edu/markets/
Restaurant Voucher Programs
Congregate nutrition services in the form of a restaurant voucher program are available in several
areas. Dining in a restaurant tends to remove the stigmas of "charity" and "aging" often
associated with congregate site participation and makes dine-out participants feel "more valued",
i.e. equal to other restaurant consumers. Dining in an environment of people of mixed ages and

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