Nutrition Care Process in the Community

FoodnetMeals on Wheels

Sarah Guilbertsrg229@cornell.edu

Cornell Dietetic InternNS 4420

October 31, 2011

Outline

• Introduction-Foodnet• Who do we serve?• Foodnet services and overview• Nutrition Care Process• Foodnet in relation to NCP• 2 sample clients• Questions

Foodnet Office 2422 Triphammer Rd, Ithaca, NY

So..is it Foodnet?

Or Meals on Wheels???

Answer: Both!

The We Are Meals On Wheels slogan and logo are registered trademarks of the Meals On Wheels Association of America, Inc. and are used with permission. All rights reserved.

1967: home-delivered meals start at local church

1974: congregate meals through Tompkins County Nutrition Program for the Elderly

1987: Foodnet established as independent organization

2000: Local Meals on Wheels partners with Foodnet

“Foodnet” name remains due to its history in Tompkins County

Foodnet’s Mission and Vision

Vision: “We envision a Tompkins County community in which senior hunger is eliminated, supportive services are readily accessible, and our neighbors enjoy independence without isolation.”

Mission: “To provide meals and other nutrition services that promote dignity, well being and independence for older adults and other persons in need in Tompkins County”

Mission: “To provide meals and other nutrition services that promote dignity, well being and independence for older adults and other persons in need in Tompkins County”

“dignity”

“independence”

Who do we serve?

“older persons”

• 60+ = program eligibility

• 76 = average age of clients

• Spouses (regardless of age)

• Disabled persons < 60

< 60 and healthy = Foodnet select ($$)

“other persons in need”

Senior in the Community• 51 years

– American Association of Retired Persons (AARP)• 51-70 and 70+

– Dietary Reference Intakes• 60 years

– Older Americans Act– USDA programs

• 65 years– Medicare

• 67 years– Social Security

History of US Nutrition Programs

• 1965: Older Americans Act– Established Administration on Aging (AoA)

• To administer grant programs for community planning and social services

• 1972: Title VII – vulnerable elderly rights– Authorizes funds for national nutrition program

for elderly• 1974: Tompkins County Nutrition Program for the

Elderly established

History of US Nutrition Programs

• 1978: Title III– Offices For the Aging created and nutrition programs

consolidated under Title III• 1987: Foodnet

– Founded by group of concerned citizens in Tompkins County

– Provided congregate and home-delivered meals• 2000: Foodnet Meals on Wheels

– Local Meals on Wheels program consolidated with Foodnet

Aging in the United States

• 39.6 million people 65+ (2009 Census)

– 2030 projection: 72.1 million

• In 2011, the first members of the Baby Boom reached age 65

• Median income of older persons = $25,877 (males) and $15,282 (females)

• App. 3.4 million below the poverty level in 2009

(Administration on Aging, USDHHS)

Foodnet Services and Overview

Organizational Structure

Board of Directors

Executive DirectorStephen Griffin

Assistant Director/Registered Dietitian

Carolyn Arnold

Food Service Operations Manager

Joe Fort

Nutrition Outreach Worker

Betsey Spencer

Site ManagersCathy TraverClara Bush

Linda Tallman

Lead CookGary Armstrong

Home Delivered Meals Coordinator

Mary Mente

CU Dietetic Intern 2011Sarah Guilbert

IC Outreach Intern 2012

Assistant CookKathy Boronkay

Food Service Worker & Receiving Clerk

Pete Tubman

Tray Assemblers and Outreach

Drivers

Site AssistantsSubstitute Site Mgrs

Community Meal Site Volunteers

Administrative Services Manager

Jon Carlton

Receptionist/SecretaryLuann Morgan

Our Staff and Volunteers

• Paid staff– 11 full-time, 13 part-time– Administration– Drivers– Cooks– Site Managers– Dietitian– Nutrition Outreach Worker

• Over 100 volunteers– Board members, servers at meal sites, food packing

volunteers

Our Services: Home Delivered Meals (HD)• Foodnet: 9 HD routes• Serves approximately 400 people daily• Homebound and frail elders unable to travel to

congregate sites• Provides social interaction

– Delivery drivers help monitor health and well being

9 routes

Delivery to all of Tompkins County

Our Services: Home Delivered Meals (HD)

Our Services: Congregate Meal Sites (CMS)

• Provide nutritious meals in a social setting• Opportunity for socialization, mental stimulation,

and community involvement• Foodnet: 3 CMS + 1 Partner Site

• Approximately 100 meals served per day• Lansing, Groton, Titus Towers• Partner Site with Seneca County - Trumansburg

Goals

• Enable seniors to stay in their homes longer• Allow seniors to maintain their dignity and

independence• Provide nutritious meals to seniors, regardless of

their ability to pay • Offer participants opportunities to form new

friendships

Our Services: Target Audiences

Home Delivered Meals• Homebound• Income: Some cannot afford

to obtain adequate food• Lack skills or knowledge to

prepare food• Limited mobility• Feeling of isolation or

rejection

Congregate Meal Sites• Titus Towers (Ithaca),

Groton, Lansing• No age requirement• Low income• Some disabled• May lack skills or knowledge

to prepare food

Our Services: Blizzard Bags• Weather emergency preparedness

• Shelf stable foods in case Foodnet cannot deliver

• Volunteers pack soups, crackers, cereal, juices, UHT milk

Our Services: Menu requirements• Lunch alone required to meet (or limit to) 1/3 of RDA

– Calories, Fat, Protein, Vit A, Vit C, Thiamine, Riboflavin, Niacin, Calcium, Iron and Phosphorus

• Combined meals: Lunch and sandwich meals required to meet (or limit to) 2/3 of RDA

• Do not use added salt in cooking• Limit spices and strong flavors• Soft foods

– Meats sliced thin; fork tender– Vegetables well cooked

• Milk or Lactaid served– 1% or skim to limit fat

Our Services: Sample Lunch MenuMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

3 Apple Juice Seafood Creole (or Baked Ham) Red Beans & Rice Spinach Pineapple Upside-Down Cake* *Pineapple Tidbits

4 Green Salad Meatloaf w/ Gravy (or Breaded Fish) Sour Cream & Chive Mashed Potatoes Cabbage & Carrots Sliced Pears

5 Pineapple Juice Chicken-Tomato & Swiss Sandwich (or Beef Patty w/ Gravy) Broccoli Corn Wheat Hamburger Roll Chocolate Chip Cookie* *Sliced Peaches

6 Orange Juice Baked Ham w/ Cider Sauce (or Turkey w/ Gravy) Au Gratin Potatoes Peas & Carrots Banana

7 Macaroni Salad Reduced-Sodium Hot Dog (or Chicken Patty) Green Beans w/ Red Bell Peppers Cauliflower Wheat Hot Dog Roll Cherry-Berry Bars* *Apple

What’s for lunch today?

Appetizer: Pineapple JuiceEntrée: Chicken ScampiSubstitute: Breaded FishSide dish: Rice PilafVegetable: Beans & GreensDessert: Orange Olive-Oil Cake

Our Services: Sample Sandwich Menu

• Turkey• Rye bread• Apple• Choice of Milk• Delivered to approximately 200 clients every day• Provides a cold meal that can be eaten for dinner

Our Funding: Sources

• US Administration on Aging• New York State Office for

the Aging• Tompkins County Office for

the Aging• Contributions from

participants• Charitable donations from

individuals, businesses and foundations

Our Funding: Participants’ Contribution

• “Contributions for meals are completely voluntary. Any contribution you wish to make will be used to expand the program and will be greatly appreciated.”

• Suggested Contribution– Congregate 60+ $3.00– Meal Charge <60 $6.00– Home Delivered $3.00/$6.00– Foodnet Select $6.00– Sandwich $1.00

Role of the Dietitian• Carolyn Arnold, RD• Assistant Director• Establish and expand recipes

– Focus on high protein, low salt,moderate sugar and fat

• Approve monthly menus• Client needs

– Referral– Nutrition education and counseling– Assessment

NCP: AssessmentNutritional Risk Score

1. Does the client eat fewer than 2 meals per day? 3 Points

2. Does the client have 3 or more drinks of beer, liquor, or wine almost every day?

2 Points

3. Does the client have trouble eating well due to problems with chewing/swallowing?

2 Points

4. Does the client sometimes have problems buying food because of income?

4 Points

5. Without wanting to, has the client lost or gained 10 pounds in the past 6 months?

2 Points

6. Is the client unable at times to physically shop, cook, and/or feed themselves (or get someone to do it for them)?

2 Points

High risk= 6 or moreModerate risk = 3-5Low risk = 2 or less

NCP: Diagnosis

• Identify nutrition problems– Ex: Inadequate calcium, protein, or calories in diet

• Medications– Look for interactions with foods

• Identify other dietary habits that may inhibit nutrient absorption

NCP: Intervention

• Food and/or Nutrient Delivery– Balanced meals delivered/served each day

• Nutrition Counseling– Done on a case-to-case basis– During home assessment and phone follow-up

• Nutrition Education– Monthly flyers – topic of interested for population– Group/class presentations 6x/year

• Coordination of Care– Referral to other services (including SNAP)

NCP: Monitoring/Evaluation

• 6 month follow-up and yearly assessment– Monitor health and nutrition status– Determine if other services are needed– Provide time for nutrition counseling and education

• Foodnet dietitian available to speak to clients over the phone whenever necessary

• Annual Satisfaction Surveys

Case Study: Edgar

• Age 65• Lives alone• Low-income• Has trouble with memory• Sometimes cannot prepare meals for himself• Never been hospitalized• Drinks 4 beers/day

Questions

• What would his Nutrition Risk Score be? (low, medium, high)

• What are the key factors to keep in mind?– Regarding health– Regarding Foodnet service need

Case Study: Alice

• Age 63, lives with husband (age 58)• Recent pulmonary embolism• Fracture, right leg; has to use walker• Discharged from hospital 10/25/2011• Height: 65 inches; weight 140lbs• Weight as of 9/3/2011: 165lbs• At discharge, referred to Foodnet by RD• Income level: $2500/month

Questions

• Where does this fit in the NCP?• What would her Nutrition Risk Score be? (low,

medium, high)• What are the key factors to keep in mind?

– Regarding health– Regarding Foodnet service need

Summary

• Introduction-Foodnet• Who we serve• Foodnet services and overview• Nutrition Care Process• Foodnet in relation to NCP• 2 sample clients• Questions

Questions?

Acknowledgements Resources

• Stephen Griffin; Foodnet Executive Director

• Carolyn Arnold; Foodnet Dietitian

• Brianne Schmidt; Cornell Dietetic Intern 2008

• Laura Sugarwala; Cornell Dietetic Intern 2009

• Julia TangCornell Dietetic Intern2010

• http://www.census.gov/population/www/projections/index.html

• http://www.americangeriatrics.org/about_us/who_we_are/faq_fact_sheet/

• http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf

• Thomas DR. Are older people starving to death in a world of plenty? Nestle Nutr Workshop Ser Clin Perform Programme. 2005; 10:15-23; discussion 23-19.

• Position of the American Dietetic Association: Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long term Care. 2005. JADA. 105 (12).

• Bernstein, M. & Luggen, A. S. (2010). Nutrition for the Older Adult. Boston: Jones and Bartlett Publishers.