The home-delivered meal (HDM) program of the Older Americans Act Nutrition Program (OAANP) has traditionally served frail homebound older adults; however, due to gaps in the continuum of care, enrollment in this program following hospital discharge remains a challenge. Trained interviewers at 6 HDM sites in 6 U.S. states assigned 566 hospital-discharged individuals, ages 60-96 years, into either early (48 hour) or delayed (2 weeks) enrollment groups and assessed their health and nutrition status. Regardless of elapsed time at enrollment, more than 80% reported at least one limitation in activities and instrumental activities of daily living. About 20% had impaired cognition and more than 40% had depressive symptoms. Also, 40% reported fair or poor appetite. Despite intense recruitment from hospitals, only 30% of participants were referred from hospitals. The recently hospital-discharged older adult population may include a higher prevalence of individuals with poor functional status and at nutritional risk than participants in the OAANP HDM program and yet may be underserved by this program.

Little is known about the food safety knowledge, behaviors, environments, and in-home food supplies of the growing population of homebound US seniors who are dependent on home-delivered meals. This cross-sectional study of 725 home-delivered meal recipients used in-home interviews, food inventories, and kitchen audits to examine potential food safety vulnerabilities. Seniors' food safety was compromised by poor home kitchen conditions, inadequate refrigerator/freezer temperatures, vision problems, and a lack of understanding of safe food storage times. The results identify conditions that may place seniors at greater risk for foodborne disease and suggest areas for interventions to reduce this risk.

The objective of this project was to explore the effort necessary to transform the Older Americans Act Nutrition Program (OAANP) into core programs within an integrated health care delivery system that serves hospital-discharged older adults in order to assist them in reintegrating into the community. Six OAANPs in six states were funded and provided technical assistance to develop coalitions with hospitals and community organizations. Each demonstration site was unique and faced many challenges in reaching out to a hospitalized vulnerable population. This project also provided opportunities to try out new initiatives and examine their sustainability within the community.

This article describes the development of the Fire H.E.L.P. tool kit for training selected Meals On Wheels (MOW) staff in Texas to implement a fire safety program for homebound older adults. We used a formative evaluation approach during the tool kit's development, testing, and initial implementation stages. The tool kit includes instructional curricula on how to implement Fire H.E.L.P., a home assessment tool to determine a residence's smoke alarm needs, and fire safety educational materials. During the tool kit's pilot test, MOW participants showed enhanced fire safety knowledge and high levels of confidence about applying their newfound training skills. After the pilot test, MOW staff used the tool kit to conduct local training sessions, provide fire safety education, and install smoke alarms in the homes of older adults. We believe the approach used to develop this tool kit can be applied to education efforts for other, related healthy home topics.