Leveraging Home‐Delivered Meal Programs to Address Unmet Needs for At‐Risk Older Adults: Preliminary Data

Abstract

BACKGROUND Home‐delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social. DESIGN A pilot study was designed to test the feasibility of leveraging routine meal‐delivery service in two home‐delivered meal programs to proactively identify changes in older adult meal recipients’ (clients’) health, safety, and well‐being and address unmet needs. INTERVENTION Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services. RESULTS Over a 12‐month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self‐care or personal safety (12%) and mobility (11%). On follow‐up, a total of 132 referrals were issued, with most referrals for self‐care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution. CONCLUSION Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early‐warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home‐delivered meal programs. J Am Geriatr Soc 67:1946–1952, 2019

Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients

“…Although home-delivered meal providers can serve as “gatekeepers” to other community-based services and supports for older adults ( 46 ), our agency's staff were not sufficiently aware of recommendations and local resources that could be shared with clients who indicated specific frailty needs. Cataloging these resources for staff, prior to the study period, may have facilitated their ability to make recommendations or referrals to other health and nutrition services, thereby improving the “fit” of the HCFS with the mission of our partner agency to maximize older adult health and wellbeing ( 19 , 47 ).…”

“…Although trained health professionals (e.g., physicians, nurse practitioners) can address frailty and its associated risk factors ( 16 ), the assessment of frailty can be time- and resource-intensive ( 17 , 18 ), particularly with older adults, such as home-delivered meal clients, who present with complex needs and chronic comorbidities ( 3 , 19 ). Given that over 70% of home-delivered meal clients experience frailty ( 20 ), innovative approaches are needed to regularly assess and monitor the frailty levels of older adults enrolled in home-delivered meal programs.…”

COVID-19 Vaccination Experiences of Family Caregivers of Persons Living with Dementia in Rural Appalachia

“…Because these healthcare workers are from the community and are familiar with the area’s resources, rural families frequently place their trust in them ( Magilvy & Congdon, 2000 ). Similarly, community service agencies (e.g., Area Agencies on Aging, Meals on Wheels) that employ community members and local volunteers can play an essential role in identifying and encouraging caregivers to sign up for vaccination ( Morris et al, 2019 ). Wherever possible, these trusted organizations should be leveraged to address COVID-19 vaccine-related questions or concerns and assist caregivers in securing vaccines for their relative and themselves ( National Association of Area Agencies on Aging, 2021 ).…”

A Home-Based Care Research Agenda by and for Homebound Older Adults and Caregivers

“…The care of homebound older adults and the delivery of home-based care (Harris-Kojetin et al, 2014) are attracting the interest and attention of the research community in the wake of studies demonstrating the benefits of home-and community-focused delivery models (LaFave et al, 2020). Such models include home-based primary care (HBPC; Stall et al, 2014;Totten et al, 2016), home-based palliative care (Cassel et al, 2016), Community Aging in Place Advancing Better Life for Elders (CAPABLE; Szanton et al, 2019), homedelivered meals (Morris et al, 2019), home-and communitybased services (Valluru et al, 2019), and others. This emerging research finds that such models can improve outcomes and lower health care costs for this population with preventable health care costs (Figueroa et al, 2017).…”