More Than a Meal: Demonstrating Value Through Enhanced Service Delivery Senior Malnutrition, Social Determinants of Health, & Changes of Condition

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1 More Than a Meal: Demonstrating Value Through Enhanced Service Delivery Senior Malnutrition, Social Determinants of Health, & Changes of Condition Presented by Shon E. Gress, MSHCS, BSC Ohio Association of Area Agencies on Aging Conference NOVEMBER 15, 2017

2 Successful renewal of a.5 mil/5 Year Meals on Wheels Levy 85.8% (Highest Approval in The State of Ohio-Nov. 7, 2017) Meals As You Mend (Ohio Department of Aging- Southeastern Med Hospital) Pets Enjoy Treats (PET Program) Senior Supplemental Food Commodities More Than A Meal National Research Project

3 Ongoing MTAM research supported by the Gary and Mary West Foundation and the Gary and Mary West Health Institute

4 Session Objective Identify opportunities for addressing senior malnutrition and enhancing Meals on Wheels service delivery, which can also be marketed to healthcare entities.

5 Positioning for the Future Increasing rates of senior malnutrition Federal and government funding cannot keep pace Increase in need for service/waiting lists Increased costs Competition with for-profits Opportunities with healthcare providers Research needed Driving the Change Improved client health outcomes of Meals-plus model Demonstrate healthcare savings

6 The More Than a Meal Journey Partners: Gary and Mary West Health Institute, Brown University and Meals on Wheels America Goal: More Than A Meal 3 o Improve the health, safety, and well-being of seniors through an enhancement of Meals on Wheels current meal-delivery service and wellness check

7 Aim: The More Than a Meal Journey Understand the workflow and capabilities of MOW programs Research Questions: More Than A Meal 3 Are MOW programs already checking on clients and are drivers reporting any concerns/risks? Circle of Knowledge How are concerns/risks addressed and by whom? Is there potential for standardization & replication?

8 The More Than a Meal Journey MTAM3 Phase 1 Data Collection and Analysis Conducted site visits at six MOW programs across the country and completed 84 interviews between July 2016 October 2016 Key informants included: 11 leadership members, 11 coordinators, 15 case managers, 47 drivers What we learned Relationships between MOW clients and drivers More than a Meal, Positive driver motivation, Meaningful to drivers and clients, Value of wellness checks Existing Practices Driver reporting process, Use of technology, MOW program follow-up, Data collection and documentation

9 The More Than a Meal Journey MTAM3 Phase 2 Aim: Pilot an enhanced meal-delivery service that includes a standardized wellness check Information obtained through Phase 1 informed Phase 2 development and selection of two MOW pilot sites

10 The More Than a Meal Journey MTAM3 Phase 2 Goals: Enhance technology-enabled wellness tool established by MOW of Greater Pittsburgh Develop and implement a care navigation model Develop and implement study-related tools Driver and staff training Care navigation toolbox Conduct driver focus group Track and analyze data Engage a healthcare partner

11 The More Than a Meal Journey MTAM3 Phase 2 Pilot site selection is an opportunity for learning from two very different MOW programs Pilot Site 1 Meals on Wheels San Diego County, CA Geography covers large urban, suburban and rural county One paid driver route, over 3,000 volunteer drivers Regional service centers and no case management Pilot Site 2 Meals on Wheels Guernsey County, OH Rural program with all paid drivers delivering meals in several counties Operates senior center that provides congregate meals Transition from paper-based to technology-based practices All delivery routes (18-22) Equipped with technology (600 meals per day) Existing relationship with hospital to provide post-discharge meals

12 The More Than a Meal Journey Pilot Site 1: M T A M 3 P H A S E 2 Pre-implementation Strategy Collected health-related information on clients Hired key project staff Selected six test routes and adopted mobile routing technology Incorporated six wellness indicators in wellness tool Trained drivers and staff on tools

13 The More Than a Meal Pilot Site 1: Implementation Journey M T A M 3 P H A S E 2 Currently testing the training, submission and receipt of wellness alerts and care navigation response on three routes with ~ 60 clients Protocol 1. Driver uses mobile routing app on mobile device to deliver meal and electronically report when delivery has been completed 2. Upon verification of meal delivery, driver receives a prompt to report changes or concerns within 6 wellness domains, and send electronic alert to a Care Navigator embedded in the MOW program 3. Care Navigator is trained to receive and respond to alerts

14 SAMPLE Wellness Alert Indicators--Cheat Sheet: Alert Categories and Examples of Corresponding Observations Health (Physical/Mental) Unusual breathing New bruises Apparent change in mood or behavior Alcohol/Drug Abuse Confusion Swelling Muscle weakness Fatigue Facial droop Change in skin color New communication problem Slurred Speech Terminal Illness/Diag. Suicidal Ailment or pain Self-Care/ Personal Safety APS Legal Assistance Clothing Smells badly Disheveled appearance Suspected signs of neglect or abuse Financial Exploitation Benefit from Home Health/Personal Care Aide Mobility Nutrition Home Environment Recent Fall/Fell New limp Takes longer than usual to answer door Unsteady on feet Less mobile than usual No Transportation Malnutrition Visible weight loss or gain Loss of appetite Concerns about fluid intake Uneaten meals Ill-fitting or lost dentures New dental problem Food Commodities/F ood Pantry Supplemental Beverage Home looks unsafe Dirtier and/or more cluttered than usual Difficulty managing home maintenance (inside/outside) Heating/cooling problem Unsafe electrical, carpet, or other walking surfaces Homemaking Unfamiliar House Guest/Stranger Danger Infestation/Rodents Entering/Exiting Home Access Difficulties Pet Neglect/Abuse Excessive Hoarding Social Engagement/ Community Connection Reported loss of friend, family or pet Loss or change in support from caregiver, family or social network Change in participation in usual social or religious activities Loneliness Isolated Emergency Call 911 Call the office Use of this emergency alert is for tracking purposes only

16 The More Than a Meal Journey Pilot Site 1: Learnings to date: M T A M 3 P H A S E 2 Readiness and organizational culture is important Training volunteers is a challenge Receptivity to technology varies Tipping point between care management and care navigation=part-time Care Navigator Drivers are submitting alerts: 60 concerns/risks identified for 21 clients in ~ ten weeks 20 health-related alerts, 13 safety alerts, 8 social/community isolation alerts

17 The More Than a Meal Journey Pilot Site 2: Learnings to date: M T A M 3 P H A S E 2 Readiness and organizational culture is important--- Circle of Knowledge was already in place Training paid staff has been much less of a challenge Includes 23 Tablets (18 Routes + 5 Satellite Sites) Receptivity to technology was overwhelmingly positive Tipping point between care management and care navigation-full Time Care Navigator Drivers are submitting alerts: 103 concern alerts/risks identified for 58 clients in ~ ten weeks 1 Emergency, 4 Nutrition, 57 Health, 12 Home Environment, 14 Mobility, 4 Nutrition, 13 Self-Care, & 2 Social Engagements

18 The More Than a Meal Journey Broader Implications M T A M 3 P H A S E 2 Opportunity to leverage person-centered, sustainable, contemporary and competitive services and supports that address the social determinants of health (i.e. malnutrition) Opportunity to collect and report data that positions your organization to be the community solution for population health management Opportunity to engage with healthcare entities aligning services to meet payer/provider needs Opportunity to identify and advocate for changes in policies and regulations to support payment of health-related support services.

19 The More Than a Meal Research Series Rigorous research methods Incorporating State of The Art Technology Hands-on stakeholder engagement to better understand the value and impact of Meals on Wheels Support an advancement of partnerships between MOWs and healthcare entities

20 Community collaboration of a full range of involved and committed stakeholders & partners is the best hope and strategy for ending senior hunger together! How Do You Like Them Apples?

21 THANK YOU Thank you for the work that YOU do every day with your partners in your own local communities to help end senior hunger!

22 Contact Information Shon E. Gress, MSHCS, BSC Certified Senior Center Administrator of Aging Services Executive Director GUERNSEY COUNTY SENIOR CITIZENS CENTER, INC. & MEALS ON WHEELS GUERNSEY COUNTY 1022 Carlisle Avenue, Cambridge, Ohio Tel: Fax: Toll-Free: Website:

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