Articles and Information from GA Foods

What Do New Shoes and Home Delivered Meals Have in Common?

Posted by Maureen Garner, MS, RD, LD on Jul 2, 2015 2:25:00 PM

new_shoes_home_delivered_mealsNot too long ago, I was walking through a neighborhood after a thunderstorm had passed by. I noticed an elderly woman with a walker, trying to cross the road.  The recent downpour had created a wide puddle along the street that was several inches deep.  She explained to me that she had new shoes on and she didn’t want to get them wet by stepping into the water.  She needed to cross the street, because the bus that went to the local grocery store would be coming soon. We managed to get her across the puddle with minimal damage to her new shoes.  I waited for the bus with her and found out grocery shopping was her Monday routine.  Actually, it was her routine several times a week.  She doesn’t have family nearby to help with shopping.  During each trip to the grocery store, she buys only what will fit in the basket of her walker.  After 15 or so minutes, the bus had not come.  Since I do not rely on public transportation, it took awhile for me to realize that it was Memorial Day and the busses were not running on their regular schedule.  I offered to get my car and take her to the store, but she decided her best option was to get back over that huge puddle and go back home.  It was unsettling to me that she might not have food at home to eat. Unfortunately, there are too many seniors out there with the same issue.

Almost 10 million seniors face the threat of hunger in the U.S.

The annual report, State of Senior Hunger in America 2013, was released in April 2015. Per the report, a high proportion of seniors in the United States are going without food, despite an improving economy:

  • 15.5% of seniors face the threat of hunger.  This equals 9.6 million seniors.
  • Seniors are more likely to be threatened by hunger if they:
-  Live in the South and Southwest
-  Are a minority
-  Have a lower income
-  Are 60-69 years old
  • Of those that face the threat of hunger, the majority have incomes above the poverty line and are Caucasian
  • The number of seniors experiencing the threat of hunger increased by 45% from 2001 to 2013.

Why are so many seniors hungry?

When I considered the circumstances of my new friend, my initial assessment was a lack of marketing – senior agencies just needed to do a better job of communicating the resources available for the elderly.  Certainly, this woman would qualify for services, if she wanted them.  She lived alone on a fixed income with limited mobility and no family support.  Perhaps, she could get home delivered food or go to a nearby senior center for lunch.  What about local agencies, didn’t they have a list of volunteers that could help her shop once a week? 

However, the reality is this isn’t a marketing problem.  It is a funding problem.  According to the National Association of States United for Aging and Disabilities (NASUAD), funding for seniors is not keeping pace. From 1980 to 2010, the population of seniors (adults 65+) rose 60%, but funding for programs serving seniors declined by 34%.  In 2010, 57.5 million adults (60+) were eligible for services, but only 11 million were served.

The President’s proposed budget for FY2016 expands access to Medicaid and home and community-based long-term care services and supports. It also provides $875 million for Nutrition Services programs, a $60 million increase over the 2015 enacted level, allowing States to provide 208 million meals to over 2 million older Americans nationwide.  However, last week the Senate’s bill for funding nutrition programs in FY2016 did not contain an increase.  The House bill provided only a $6 million increase for Older Americans Act Senior Nutrition Programs.

Food insecurity means additional health challenges and increased health expenditures

Numerous studies have shown that food insecurity1 is associated with poor nutrition and health outcomes among seniors.  Food insecure seniors have worse health outcomes:

  • They are 50% more likely to have diabetes
  • Twice as likely to report fair or poor general health
  • Three times more likely to suffer from depression
  • 30% more likely to report limitations with at least one activity of daily living
  • 14% more likely to have high blood pressure
  • 60% more likely to have congestive heart failure or have experienced a heart attack

The authors of State of Senior Hunger in America 2013 suggest that potential opportunity to curtail the growth of health care expenditures among older Americans is to improve the problem of food insecurity. 

home_delivered_mealsHome delivered meals for seniors as a health plan benefit

Progressive health plans have started adding home delivered meals as a benefit.  More studies are needed to quantify the return-on-investment of those meals. But let’s look at what could have happened to my friend with the new shoes:

Her new shoes were expensive, orthopedic shoes.  She probably had to save or sacrifice something else to buy them.  They were so important to her that she was willing to risk a fall by hopping over the puddle to keep them dry.  What if I had not walked by to help her cross the puddle? What if she had fallen? What if she had broken a hip? What if she was no longer able to remain in her home and had to go to a nursing facility?

A total hip replacement averages about $30,000 in this area, which is 10 times more than providing home delivered meals for seniors for one year. The average annual cost for a person on Medicaid in a nursing facility is $53,593 – more than 17 times the cost of healthy, home delivered meals for a year.

Aging in place

NASUAD reports that 92% of home delivered meal recipients say meals allowed them to remain in their homes. Allowing seniors to age in place is cost-effective.  Perhaps even more important is it improves their well-being.  The security, dignity, and quality of life that a senior experiences in their own homes is invaluable.  Funding nutrition programs for seniors is a small price to pay.

Want more information on the impact nutrition has on patient outcomes?  Download our free ebook here.

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1The USDA defines food insecurity as consistent access to adequate food is limited by a lack of money and other resources at times during the year.
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Topics: Home Delivered Meals

Lower Healthcare Costs with Home-Delivered Meals

Posted by Maureen Garner, MS, RD, LD on Mar 17, 2015 3:30:00 PM


This is the final post of our 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we reviewed original research that shows the impact nutrition care has on patient outcomes.

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In the past few weeks, we have been reviewing research about the effect nutrition care has on patient outcomes. This week we will finish the series with a review of a pilot study that looked at the impact of home-delivered meals and nutrition counseling on the healthcare costs of chronically ill patients.

MANNA (Metropolitan Area Neighborhood Nutrition Alliance) is a nonprofit organization in Philadelphia that cooks and delivers medically-appropriate meals and provides nutrition counseling to individuals that are chronically ill.  Most of the recipients have cancer, renal disease or HIV/AIDS. Socioeconomic status is not a factor in determining who can receive their services, however, most of their clients are Medicaid-eligible.  Each week, MANNA delivers 21 frozen meals to recipients.  They also offer nutrition counseling by a Registered Dietitian.

Researchers evaluated healthcare costs of two sample groups, MANNA clients and a comparison group, matched for gender, age, race, and ethnicity, for a 12-month period.  The comparison group contained members of a local Medicaid managed care organization (MCO).  Because only aggregate data was provided by the MCO, some members of the comparison group may have been receiving food resources.  The authors do not believe any were receiving home-delivered meals.

While the MANNA research was a pilot study, the results1 were still significant:

  • The total average monthly healthcare costs were $28,000 for MANNA clients and $41,000 for the comparison group.
  • The average cost of a hospitalization was $132,000 for MANNA clients and $220,000 for the comparison group.
  • MANNA clients had 50% less hospitalizations than the comparison group.
  • MANNA clients’ length of stay was 37% shorter than the comparison group.
  • MANNA clients were 20% more likely to be discharged from the hospital to their home rather than to long-term care.

Per the CDC, chronic diseases are among the most common, costly, and preventable of all health problems. Providing home-delivered meals to those with chronic conditions is an economical solution.  GA Foods’ home-delivered meals program allows members to have medically-appropriate, easy-to-prepare meals and remain independent in their homes.  Health plans that add post-discharge meals and chronic disease management meals to their supplemental benefits, see a return on investment of 3 to 1.

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1Gurvey, J, et al. J Prim Care & Comm Health 2013;4(4):311-317.

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Topics: Home Delivered Meals, Chronic Disease Management, MCO ROI

Hospital Malnutrition and Discharge Planning

Posted by Maureen Garner, MS, RD, LD on Mar 4, 2015 1:10:00 PM

This is the fourth of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

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Malnutrition is a common health issue

Hospital malnutrition in developed countries is more prevalent than most realize. Here are some statistics1:

- It is estimated that one-third of patients are malnourished upon admission to the hospital.

- If left untreated, approximately two-thirds of these patients will become even more compromised during their hospitalization.

- Roughly one-third of patients not malnourished at admission will become malnourished during their hospital stay.

Malnutrition in the frail and elderly is an important area of concern, because it has been correlated with many poor outcomes2:

- Increased risk of pressure ulcers
- Impaired wound healing
- Increased infection rate
- Muscle wasting
- Functional loss, resulting in more falls
- Longer hospital stays
- Higher readmission rates
- Higher treatment costs
- Increased mortality

Nutrition care improves clinical outcomes

Most of these adverse outcomes are preventable or can be improved with nutrition intervention. The Alliance to Advance Patient Nutrition has developed a model for interdisciplinary nutrition care. (Figure 1) 

static_abbottnutrition_com_cms-prod_malnutrition_com_img_Alliance_Care_Model_2014_v1_pdf Figure 1:  Source:  www.malnutrition.com

The Steering Committee of the Alliance published a call to action that outlines the comprehensive model from hospital admission through discharge.  Their sixth principle, Develop a Comprehensive Discharge Nutrition Care and Education Plan, ensures that nutrition goals achieved in the inpatient setting are not compromised once a patient is discharged1. 

Access to food is an important part of discharge planning

One area the Steering Committee suggests be addressed in the discharge plan is access to food.  This is one area that is frequently neglected in care transition planning and of particular concern for the frail and elderly.  Providing access to food through home-delivered, post-discharge meals allows the frail and elderly to regain their strength and energy sooner.  It also helps reduce unplanned hospital readmissions.  Proactive hospitals and health plans are providing post-discharge meals as part of transition care planning.  The GA Food’s home-delivered meals program allows the frail and elderly to have nutritious, easy-to-prepare meals and remain independent in their homes.

For more information on the benefits of post-discharge meals, see this blog post.

Contact John Siegel at GA Foods

Download free ebook on questions to ask when choosing a home-delivered meals provider.

1Barker, LA. Et al. Int J Environ Res Public Health. 2013; 8(2):514-527.

 2Tappenden, KA, et al. J Parenter Enteral Nutr 2013;37:482-497.

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Topics: Malnutrition in Elderly, Home Delivered Meals, MCO ROI

Does being underweight lead to unplanned hospital readmissions?

Posted by Maureen Garner, MS, RD, LD on Feb 2, 2015 9:19:00 AM

This is the second of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

Underweight_LR

Predictors for Rehospitalizations

Last week's blog post focused on a study that identified risk factors for avoidable hospital readmissions. This week, we will review a study1 that evaluated factors that could be used as predictors for unplanned readmissions. As the authors point out, very few studies have reported predictors of readmissions. The ones that have been published, focus on demographic and disease characteristics. While these studies help identify populations at high risk, they do not provide a basis for developing strategies for individual intervention.

Mudge and her colleagues studied 142 inpatients that were 50 years and older that had 2 or more unplanned hospitalizations within a 6 month period. Patients admitted from long-term care facilities or with a terminal illness were excluded. Patients with language or cognitive difficulties were also excluded.  

Being Underweight has a High Probability

The presence of a chronic disease had the strongest correlation to predicting unplanned readmissions.  Heart failure, renal disease, and diabetes were associated with a higher risk of readmission when present as a primary diagnosis or co-morbidity. When the data was analyzed using odds ratio, being underweight had the highest probability of unplanned hospital readmissionsThe risk of readmission was also increased in patients with depression.  The below chart summarizes the probability of different factors predicting readmission. 

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Factors that did not predict probability of unplanned readmissions include age, sex, medication adherence, length of hospitalization, and functional status impairment.

Post-discharge Meals as a Transition Care Strategy

The researchers concluded that post-hospitalization programs that address management of chronic disease, nutritional status, and depression have the potential to reduce hospital readmissions.  Including nutrition interventions in the transition care plan after a hospital discharge impacts both chronic disease and being underweight.

The need for nutrition intervention is further supported in the Academy of Nutrition and Dietetics' position paper2 on food and nutrition for older adults:

  • Five of the eight causes of death in adults 65 and older have a known nutrition effect.
  • In 2007, 68% of people needing home health care had chronic disease conditions, such as diabetes, heart disease, COPD, and hypertension. All are nutrition-related diagnoses and could be improved with appropriate diets.
  • Quantity of food and caloric intake decreases with age and can result in malnutrition, worsening of health conditions, and frailty.
  • Caregivers may lack the information and skills needed to adapt a diet to meet recommendations for chronic diseases.

Health plans are responding to these findings and many are adding post-discharge meals and chronic disease management meals to their supplemental benefits. The GA Foods' home-delivered meals program allows members to have nutritious, easy-to-prepare meals and remain independent in their homes.  The great news for the health plans adding home-delivered meals, is the return on investment is 3 to 1!  

Contact John Siegel at GA Foods

Download free ebook on questions to ask when choosing a home-delivered meals provider.

1Mudge, AM, et al. J Hosp Med. 2011;6(2)61-67.

2Bernstein, M, et al. J Acad Nutr Diet. 2012;112(8):1255-1277.

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Topics: Malnutrition in Elderly, Home Delivered Meals, MCO ROI

Weight Loss and Hospital Readmissions

Posted by Maureen Garner, MS, RD, LD on Jan 16, 2015 9:52:00 AM

This is the first of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

Readmission Rates and Impact

Last year, 18% of Medicare patients were readmitted within 30 days of being discharged.  It is estimated that these readmissions cost the federal government about $26 billion. According to Kaiser Health News, about 65% of these health care costs came from readmissions that could have been avoided. 

shutterstock_75178354_LR

In October 2012, the Hospital Readmissions Reductions Program (HRRP) was launched as part of the Affordable Care Act.  It requires CMS to reduce payments to hospitals with excess readmissions. As a result, Medicare reimbursement will be reduced for 2,610 hospitals in fiscal year 2015 due to their high rates of readmissions for patients with certain conditions.

One Factor - Weight Loss - Is Preventable

A study published in 2011, evaluated clinical, operational, and sociodemographic factors associated with hospital readmission within 30 days for general medicine patients.1  The study didn’t attempt to predict who would be readmitted, but identified risk factors that would allow providers to target interventions to reduce avoidable readmissions.  The factors associated with hospital readmission within 30 days are:

  • Black race
  • Medicaid payer status
  • Inpatient use of narcotics and corticosteroids
  • Diagnosis of cancer, renal failure, and congestive heart failure
  • Weight loss

Post-Discharge Home-Delivered Meals Reduce Readmissions

Of the risk factors identified, weight loss is the only one that is preventable.  While in the hospital, all patients are screened for nutrition risk.  Care plans are developed to provide nutrition intervention during the hospitalization.  However, transition care plans often do not address nutrition risk after discharge. Weight loss, particularly in the elderly, is common after a hospitalization as a result of decreased energy, depression, and restricted diets for chronic conditions. Often times, the individual isn’t well enough to prepare meals. 

Providing home-delivered meals after discharge, has shown to be effective in preventing weight loss. In a CMS pilot2, post-discharge meals reduced hospital readmissions by 39%.  Home-delivered meals are also cost-effective. A single day in the hospital is 200 times the cost of three home-delivered meals.

For more information on malnutrition in the elderly, click here.

Download free ebook on questions to ask when choosing a home-delivered meals provider.

 

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Allaudeen, N, et al. J Hosp Med. 2011; 6(2)54-60
FMQAI, Florida’s Medicare Quality Improvement Organization, under contract with CMS.
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Topics: Home Delivered Meals, MCO ROI

Malnutrition in Older Americans

Posted by Maureen Garner, MS, RD, LD on Sep 16, 2014 1:09:00 PM

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Most people know that malnutrition is prevalent in developing countries, but most don’t realize malnutrition is also common among the elderly in the United States. This is a growing problem, as the Census Bureau predicts there will be 92 million people over age 65 by 2060. Malnutrition in our elderly population is a serious issue, due to the associated adverse outcomes.

 The causes are multifactorial, but studies have shown nutrition care leads to better outcomes and saves money. 

At-risk individuals that receive nutrition care during and after a hospitalization are 3 times less likely to die.1

Nutrition care can reduce hospital stays by two days.2

Maureen-GarnerIndividuals with weight loss are at a higher risk for avoidable hospital readmissions. The greater the weight loss, the greater the probability of readmission.3

Malnourished patients have 2-3 times more complications than those not at risk for malnutrition.4

Malnutrition was found in 1/3 of inpatients and resulted in poor hospitalization outcomes and survival.5  

59% percent of patients identified with malnutrition risk, were unable to be discharged home with self-care.6

Hospitalized patients discharged with malnutrition are older and sicker. Their inpatient care was 2 ½ times more expensive than those without malnutrition.7

Being underweight is the strongest predictor for hospital readmissions.8

 MCO_Blog_docx_2

 
Post-discharge meals reduced hospital readmissions by 39% in a CMS pilot in Florida.9
 
MCO paid $12,000 per month less for HIV/AIDS members receiving home-delivered meals than comparison group without home-delivered meals.10
 
Nutrition care is an essential element to support the independence of older Americans, reduce their hospital admissions, and postpone nursing home placement. Home-delivered meals have shown to be effective in preventing and treating malnourished individuals. Something to consider when the cost of a single day in the hospital is 200 times the cost of three home-delivered meals.

1 Feldblum I, et al, J Am Geriatr Soc, 2011;59(1):10-17. 
2 Barker LA, et al, Int J Environ Res Public Health, 2011;8(2):514-527.
3 Friedman JM, et al, Am J Clin Nutr, 1997;65(6):1714-1720. 
4 Sorenson J, et al, Clin Nutr, 2008;27(3)340-349.
5 Lim SL, et al, Clin Nutr, 2012;31(3):345-350.
6 Chima C, et al, JADA, 1997;97(9):975-978.
7 Corkins, MR, et al, JPEN, 2014;38(2):186-195.
8 Mudge AM, et al, J Hosp Med, 2011;6(2):61-67.
9 FMQAI, Florida’s Medicare Quality Improvement Organization, under contract with CMS.

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Topics: Nutrition, Malnutrition in Elderly, Home Delivered Meals

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