1. Nutrition Care Process in the Community Foodnet Meals on Wheels Sarah Guilbert srg229@cornell.edu Cornell Dietetic Intern NS 4420 October 31, 2011

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

3. Foodnet Office 2422 Triphammer Rd, Ithaca, NY

4. 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

5. Foodnets 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 dignity independence

6. 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

7. 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

8. 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

9. 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

10. 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)

11. Foodnet Services and Overview

12. Organizational Structure Board of Directors Executive Director Stephen Griffin Assistant Director/ Registered Dietitian Carolyn Arnold Food Service Operations Manager Joe Fort Nutrition Outreach Worker Betsey Spencer Site Managers Cathy Traver Clara Bush Linda Tallman Lead Cook Gary Armstrong Home Delivered Meals Coordinator Mary Mente CU Dietetic Intern 2011 Sarah Guilbert IC Outreach Intern 2012 Assistant Cook Kathy Boronkay Food Service Worker & Receiving Clerk Pete Tubman Tray Assemblers and Outreach Drivers Site Assistants Substitute Site Mgrs Community Meal Site Volunteers Administrative Services Manager Jon Carlton Receptionist/Secretary Luann Morgan

13. 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

14. 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

15. 9 routes Delivery to all of Tompkins County Our Services: Home Delivered Meals (HD)

16. 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

17. 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

18. 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

19. Our Services: Blizzard Bags Weather emergency preparedness Shelf stable foods in case Foodnet cannot deliver Volunteers pack soups, crackers, cereal, juices, UHT milk

20. 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

21. Our Services: Sample Lunch Menu OFFICE: 2422 N. Triphammer Rd. Ithaca, NY 14850-1014 Phone : (607) 266-9553 Fax : (607) 266-9461 Website : www.foodnet.org Email : info@foodnet.org Meals served at Noon at Sites: Ithaca: Titus Towers 800 South Plain St. 273-5297 Groton: Center Village Court 200 West South St. 279-9145 Lansing: Woodsedge Apartments Woodsedge Drive 279-9146 Trumansburg: First Baptist Church Seneca Road East 387-3015 (Different Menu) 2011 OCTOBER MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY 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

22. Whats for lunch today? Appetizer: Pineapple Juice Entrée: Chicken Scampi Substitute:Breaded Fish Side dish:Rice Pilaf Vegetable:Beans & Greens Dessert:Orange Olive-Oil Cake

23. 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

24. 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

25. 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

26. 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

27. NCP: Assessment Nutritional 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 more Moderate risk = 3-5 Low risk = 2 or less

28. 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

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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

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

36. Questions?

37. Acknowledgements Resources 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 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 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.