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Sarah Guilbert [email protected] Cornell Dietetic Intern NS 4420 October 31, 2011 Nutrition Care Process in the Community Foodnet Meals on Wheels 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! 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 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. Foodnet’s Mission and Vision 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” 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.” Who do we serve? “older persons” • 60+ = program eligibility • 76 = average age of clients “other persons in need” • Spouses (regardless of age) • Disabled persons < 60 < 60 and healthy = Foodnet select ($$) 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 Director Stephen Griffin Assistant Director/ Registered Dietitian Carolyn Arnold Nutrition Outreach Worker Betsey Spencer Food Service Operations Manager Joe Fort Site Managers Cathy Traver Clara Bush Linda Tallman Site Assistants Substitute Site Mgrs Community Meal Site Volunteers CU Dietetic Intern 2011 Sarah Guilbert IC Outreach Intern 2012 Home Delivered Meals Coordinator Mary Mente Tray Assemblers and Outreach Drivers Administrative Services Manager Jon Carlton Lead Cook Gary Armstrong Assistant Cook Kathy Boronkay Receptionist/Secretary Luann Morgan Food Service Worker & Receiving Clerk Pete Tubman 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 Our Services: Home Delivered Meals (HD) 9 routes Delivery to all of Tompkins County 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 Menu MONDAY 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: Entrée: Substitute: Side dish: Vegetable: Dessert: Pineapple Juice Chicken Scampi Breaded Fish Rice Pilaf Beans & Greens 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 United Way Annual Fund 3% Donations Federal 12% 20% Participants 20% New York Local State (County + 19% Towns) 26% 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+ Meal Charge <60 Home Delivered Foodnet Select Sandwich $3.00 $6.00 $3.00/$6.00 $6.00 $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: Assessment Nutritional Risk Score High risk= 6 or more Moderate risk = 3-5 Low risk = 2 or less 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 2 Points almost every day? 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 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 • • • • • Stephen Griffin; Foodnet Executive Director Carolyn Arnold; Foodnet Dietitian Brianne Schmidt; Cornell Dietetic Intern 2008 Laura Sugarwala; Cornell Dietetic Intern 2009 Julia Tang Cornell Dietetic Intern 2010 • • • • • • Resources http://www.census.gov/population/www/projectio ns/index.html http://www.americangeriatrics.org/about_us/who_ we_are/faq_fact_sheet/ http://www.aoa.gov/AoARoot/Aging_Statistics/Profi le/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 2319. 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.
