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

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

Ongoing MTAM research supported by the Gary and Mary West Foundation and the Gary and

Mary West Health Institute

Session Objective

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

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

Improved client health outcomes of Meals-plus model

Demonstrate healthcare savings

Driving the Change

The More Than a Meal Journey

Partners: Gary and Mary West Health Institute,

Brown University and Meals on Wheels America

Goal:

o Improve the health, safety, and well-being of seniors through an enhancement of Meals on Wheels current meal-delivery service and wellness check

More Than A Meal—3

Aim:

Understand the workflow and capabilities of MOW programs

Research Questions:

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?

The More Than a Meal Journey

More Than A Meal—3

•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

The More Than a Meal Journey

MTAM3 – Phase 1

The More Than a Meal Journey

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

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

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

The More Than a Meal Journey MTAM3 – Phase 2

The More Than a Meal Journey

M T A M 3 – P H A S E 2

Pilot Site 1:

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

The More Than a Meal Journey

M T A M 3 – P H A S E 2

Pilot Site 1:

Implementation 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

Health

(Physical/Mental)

Self-Care/ Personal

Safety Mobility Nutrition Home Environment

Social

Engagement/

Community

Connection

Emergency

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

APS

Legal Assistance

Clothing

Smells badly

Disheveled

appearance

Suspected signs

of neglect or

abuse

Financial

Exploitation

Benefit from

Home

Health/Personal

Care Aide

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

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

Call

911

Call the

office

Use of this

emergency

alert is for

tracking

purposes

only

SAMPLE Wellness Alert Indicators--Cheat Sheet: Alert

Categories and Examples of Corresponding

Observations

The More Than a Meal Journey

M T A M 3 – P H A S E 2 Pilot Site 1:

Learnings to date:

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

The More Than a Meal Journey

M T A M 3 – P H A S E 2 Pilot Site 2:

Learnings to date: 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

The More Than a Meal Journey

M T A M 3 – P H A S E 2

Broader Implications

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.

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

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?

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!

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 43725 Tel: 740-439-6681 Fax: 740-439-7478

Toll-Free: 1-866-534-2349 Email: sgress@guernseysenior.org Website: www.GuernseySenior.org