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    PRACTICE MODELS

    As a result of Dispelling Myths: Support Public Policy for Greater Impact and Sustainability, a year-long research project funded by the Retirement Research Foundation, several common themes were identified. Senior nutrition programs from around the country are actively addressing these misconceptions in a variety of innovative ways and you can learn more about each below.

    LEFTOVER POLICY

    This is one of the most common areas of misinterpretation in the Older Americans Act; As long as state and local food regulations are followed, leftovers are allowed to be taken from congregate dining sites.

    • Tennessee previously had a state policy that required leftovers to be served as a second helping then discarded. The Tennessee Commission on Aging and Disability updated the policy to allow for any food left after second helpings served to be removed from the meal site. Providers were concerned about liability, so the agency gave providers sample liability waivers to have participants sign to address this concern.
    • Meals on Wheels San Diego County, California works on a zero waste principal meaning little to no food is ever wasted. Frozen meals are shipped to “membership” programs in other parts of the county and seniors can purchase meals and take them home or consume with friends at the senior center.
    • The Area Agency on Aging in St. Louis, Missouri serves five frozen meal packs to the majority of their homebound clients. The meals are kept frozen solid during the delivery with the help of a cooling blanket. Once the meal route is finished, the remaining frozen meal packs are returned to the center's freezer and per the state’s nutrition guidelines, leftover hot meals are immediately discarded once the meal deliverer returns to the senior center.
    • Mealtime attendees at congregate meal sites/senior centers at the Northeastern Senior Center in Pennsylvania may take uneaten food home in containers they have brought for that purpose. A center may elect to maintain a supply of takeaway containers (e.g., Styrofoam clamshell containers, cardboard soup cups, etc.) for the convenience of attendees, but no meal site is required to do so. A center may elect to offer the takeaway containers to attendees for purchase.
    • Meals on Wheels of Lancaster, Pennsylvania follows Food and Drug Administration regulations by cooling and freezing leftover food that can be reused the next time that menu item comes up (i.e., meatballs). Some meals are also frozen for free distribution of weekend meals to their most challenged clients for weekend meals. They are also considering purchasing a blast freezer to allow them to freeze weekend meals and make use of all their leftovers.

    NUTRITION REQUIREMENTS

    While dietary Reference Intakes (DRI) and Dietary Guidelines for Americans (DGA) requirements must be followed, that doesn’t mean that menu options can’t be exciting and delicious.

    • Meals on Wheels San Diego County, California developed meals that are low in fat, sodium and sugar in order to streamline their special diet meal offerings. All meals are made with sustainable, local products with little or no preservatives (they even make their own deli meats). Meal ingredients are also sourced from their own sustainable herb, spice and fruit garden to use for meals, and they’ve created a Healthy Latin Entrée menu to meet the needs of the cultural diversity in the community they serve.
    • The Tennessee Commission on Aging and Disability assure compliance with nutrient requirements by using meal pattern approach to plan menus. Per federal regulations, nursing homes must also meet DRIs, and in Tennessee, they do so by using this same approach. This allows for more flexibility in menu planning and allows providers to develop meals that better meet consumer taste instead of simply balancing nutrient requirements on a spreadsheet.
    • Meals on Wheels of Lancaster County, Pennsylvania has a basic menu that meets the needs of clients in need of therapeutic diets. Various meal components including sauces and sides are then added to the basic menu for those who have regular diets. This approach allows Meals on Wheels of Lancaster County to cover a wide range of dietary requirements with minimal added work.
       

    NUTRITION COUNSELING

    Not all senior nutrition programs have a registered dietitian working full-time on their staff. Collaborating with academic partners to identify opportunities for nutrition students can provide senior nutrition programs with additional capacity to support nutrition education and counseling activities.

    • One AAA in the Tennessee Commission on Aging and Disability has developed a partnership with a local university's dietetics program. The AAA works with the program director to coordinate having students conduct telephone nutrition counseling sessions with nutrition program participants.

    FEE-FOR-SERVICE

    Expanding entrepreneurial opportunities can be aided by developing fee-for-service lines of business. By developing fee-for-service lines of business, your services can be paid for by a range of different entities – private pay clients, healthcare organizations, etc. Read how other programs have done this and learn what it can mean for you.

    • Meals on Wheels San Diego County’s fee-for-service model pays for a third of their program. There are variations in the fee structure depending on how many meals a day are served, how many clients reside in rural areas or are of low income, participate in the CalFresh (food stamps) program or demonstrate an inability to pay the full amount. Fundraising makes up the difference whether it is grants, private donations or events. Events are evaluated on a yearly basis to determine their return on investment. The organization seeks to collaborate with community partners on events for which they have a natural alignment on the purpose and target population served.
    • Meals on Wheels of Lancaster County only offers fee-for-service. Their local Area Agency on Aging reimburses them on a per meal/delivery rate each month. Their clients receive an invoice at the beginning of the month with estimated deliveries for the upcoming month. For some clients Meals on Wheels of Lancaster County staff provide them a discounted rate if they demonstrate financial hardship. All of this is facilitated through their Route Management system which handles the complexities of billing, automates the generation of invoices, and tracks meal delivery seamlessly each day.

    PARTNERSHIPS

    Partnering with local healthcare providers or other community based organizations is a great way to expand services to meet the needs of even more clients. See how others are doing it and how your program can apply this approach.

    • Clients of Meals on Wheels of Northampton County, Pennsylvania can use their Supplemental Nutrition Assistance Program (SNAP) benefits to pay for grocery shopping services, and the Chef’s Packs Frozen Meal and Soup Program throughout the year. For clients who do not initially have SNAP benefits, those who are likely eligible are identified during the initial assessment with a Case Manager. These seniors then get enrollment assistance – the Case Manager assists in gathering the necessary documents, filling out the application on-line, and submitting it to the County Assistance Office. The County Assistance Office then conducts a short telephone interview with the client and informs them if they are eligible.
    • The Mid-East Area Agency on Aging, Missouri partnered with local restaurants and library to get seniors to attend informational sessions on various topics relevant to healthy aging such as Medicare, exercise, nutrition, heart health, and more. Meals catered by the local restaurant partners were distributed after the presentations. A $4 suggested donation was asked of participants who then had the option of eating the meals at the library or taking it to go. This innovative idea was successful in bringing together many stakeholders and community partners, to the great benefit of program participants and the Mid-East Area Agency on Aging. 

    MEETING CONSUMER DEMANDS

    Serving seniors nutritious foods that meet their cultural, ethnic and religious preferences is a successful way to meeting their dietary needs. Learn how you can meet the various needs of your clients through these innovative ideas.

    • The Tennessee Commission on Aging and Disability developed a one-pager that suggests how senior nutrition programs can take a flexible approach to a variety of aspect of service delivery including offer vs. serve, alternative meals and foodservice methods such as salad bars and serving breakfast meals (versus lunch) and flexible meal times.
    • Meals on Wheels San Diego County conducts satisfaction surveys with clients regarding their meals and service. Volunteer surveys are also conducted both for satisfaction and informational purposes. New menu items go through vigorous testing. They also have an internship program where San Diego State University Nutritional Studies Program students collaborate with academic faculty to conduct all the nutritional analysis and recipe development.
    • Rhode Island Meals on Wheels, Rhode Island (RIMOW) offers an alternative entrée for all home delivered clients and a 'second choice' (usually sandwich or salad meal) for all congregate clients so they can have a choice of meals available. RIMOW strives to implement any options that have a large number of requests (i.e. an ethnic meal option at the congregate site located in an area heavily populated with that ethnicity; offer a kosher option for clients that keep kosher, etc).
    For more information on these Practice Models, contact research@mealsonwheelsamerica.org.