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In 2016, to demonstrate the importance of identifying and addressing social determinants of health, Meals on Wheels America, the Gary and Mary West Health Institute and a research group at the Brown University Center for Gerontology and Healthcare Research launched the More Than a Meal® Process Evaluation (formerly referred to as the More Than a Meal 3 project). This study focused on improving the health and wellness of seniors through meal-delivery service enhanced with technology-supported change of condition monitoring. We have since been working to effectively expand and improve the technology-supported process established and tested through that initial study in our More Than a Meal Process Expansion effort. Read on to learn more about each of these components.



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The More Than a Meal Process Evaluation began with exploratory research across six Meals on Wheels America Member programs in diverse settings across the country. During intensive conversations with program staff and volunteers, researchers aimed to understand how different programs conducted health and safety screenings, identifying both service gaps and opportunities for expansion. Based on those learnings, researchers then moved into the next phase of this study, assessing the use of a client change of condition mobile application across pilots with two Member programs. In each pilot site, Meals on Wheels drivers were equipped with mobile devices that enabled them to report changes of client condition in a timely fashion while on their delivery routes and relay any immediate needs to emergency personnel and their program’s care coordinator. The care coordinator was then able to follow up with each client and take action as needed (e.g., connecting the client to social services, health providers, transportation, etc.).

The goals of the More Than a Meal Process Evaluation collaborative research project were three-fold:

  1. Understand the workflow and capabilities of Meals on Wheels programs that includes safety and wellness checks performed by Meals on Wheels meal delivery drivers;

  2. Identify the needs of the healthcare market as it relates to daily monitoring of homebound, older adults; and

  3. Develop and test an innovative and enhanced meal-delivery service that includes standardized health and safety screening assessments that can be readily conducted by those delivering meals and care coordination to connect clients to support services – the Core Client Change of Condition Protocol.
Preliminary findings from the More Than a Meal Process Evaluation suggest that the tested Core Client Change of Condition Protocol – in optimizing the Member programs’ meal delivery mission and infrastructure – has much potential in enabling clients to maintain their independence and remain in their communities of choice. Research findings are currently being synthesized, and we will share more information as it becomes available.


Through research, education, and public service, the Brown University School of Public Health strives to improve the health of individuals as well as populations. Working within all of Brown University, and the wider community, students benefit from substantial opportunities to gain and apply knowledge, while faculty members put their findings into practice to impact local, state, and national policy.


The Gary and Mary West Foundation is a private, 501(c)(3) non-operating foundation solely funded by Gary and Mary West and is dedicated to helping make successful aging a reality for America’s seniors. Working with grantees such as the Gary and Mary West Health InstituteGary and Mary West Health Policy Center and other senior-focused national and community-based organizations, the Foundation’s outcomes-based philanthropy supports initiatives to advance home- and community-based healthcare delivery, services and supports that preserve and protect seniors’ dignity, quality of life and independence. The San Diego-based Foundation is celebrating its 10-year anniversary in 2016 and accepts grant proposals by invitation only. Learn more at, and follow us @GMWFoundation.


By taking advantage of available technology, Meals on Wheels Member programs can enhance the quality and value of the services they offer. In mid-2018, a group of Meals on Wheels programs were chosen to help implement and refine the technology-supported change of condition monitoring process (the Core Client Change of Condition Protocol) that was developed as part of the More Than a Meal Process Evaluation. The following Meals on Wheels programs have been working toward the ability to deliver an enhanced level of service to the seniors they serve and connect them with the community supports they need:

  • Alexandria, VA – Senior Services of Alexandria
  • Anaheim, CA – SeniorServ Meals on Wheels Orange County
  • Athens, GA – Athens Community Council on Aging
  • Baltimore, MD – Meals on Wheels of Central Maryland
  • Houston, TX – Interfaith Ministries for Greater Houston and Galveston County
  • Knoxville, TN – CAC-Mobile Meals
  • Merrillville, IN – Meals on Wheels of Northwest Indiana
  • Syracuse, NY – Meals on Wheels of Syracuse
  • Vero Beach, FL – Senior Resource Association
  • Walnut Creek, CA – Meals on Wheels Diablo Region
Beginning in early 2019, Meals on Wheels America selected additional Member programs to join these forward-thinking programs, aiming to scale adoption of the change of condition monitoring process to help more programs identify, and raise alerts for, changes in health status among homebound clients. 

The following programs have recently joined the More Than a Meal Process Expansion Learning Collaborative, receiving personal peer coaching from original participants, and gaining access to in-depth tools, resources and training:

  • Brooklyn Center, MN – CEAP Meals on Wheels
  • Cleburne, TX – Meals on Wheels of Johnson & Ellis Counties
  • Colorado Springs, CO – Silver Key Senior Services
  • Greenville, NC – Pitt County Council on Aging
  • Honolulu, HI – Hawaii Meals on Wheels
  • Jewett City, CT – Thames Valley Council for Community Action
  • Lebanon, OH – Warren County Community Services
  • Minneapolis, MN – Community Emergency Services 
  • Nanuet, NY – Meals on Wheels Programs & Services of Rockland, Inc.
  • Salisbury, NC – Meals on Wheels Rowan
  • San Antonio, TX – Meals on Wheels San Antonio
  • Suisun City, CA – Meals on Wheels of Solano County
  • Toledo, OH – Mobile Meals of Toledo, Inc.
  • Tulsa, OK – Meals on Wheels Metro Tulsa
  • Tyler, TX – Meals on Wheels East Texas
  • Wilmington, NC – New Hanover County Senior Resource Center



Meals on Wheels America and Inceodia – in collaboration with West Health Institute and Accessible Solutions, Inc. (ASI) – prepared a report to share findings from the More Than a Meal® Process Evaluation and Expansion. How Meals on Wheels America Systematized its Holistic Service Model to Address Clients’ Changes of Condition provides background information about Meals on Wheels programs’ use of a technology-support Change of Condition monitoring protocol that enabled drivers to capture any changes they observed in a senior’s health and well-being at the time of meal delivery using the ServTracker® Mobile Meals mobile application, developed by ASI. This report also explores the research design and methods employed in this effort, key results and implications that the Change of Condition monitoring protocol holds for strengthening local data-informed partnerships.

This report is intended to be disseminated freely. In reproducing any excerpts of this report, please provide a credit that recognizes Meals on Wheels America, such as: “How Meals on Wheels America Systematized its Holistic Service Model to Address Clients’ Changes of Condition was produced by Meals on Wheels America and prepared by Inceodia.”