Transcript Nutrition Care Process in the Community Foodnet Meals on

Sarah Guilbert
[email protected]
Cornell Dietetic Intern
NS 4420
October 31, 2011
Nutrition Care Process in the Community
Foodnet
Meals on Wheels
Outline
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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
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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
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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
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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
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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
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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
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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
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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
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Introduction-Foodnet
Who we serve
Foodnet services and overview
Nutrition Care Process
Foodnet in relation to NCP
2 sample clients
Questions
Questions?
Acknowledgements
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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
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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.