Care & Feeding: Why & How to Start a Healthcare Home Meal Program

Old person and helper

A home meal program can extend care, ensuring eating and healing for at-risk individuals.

Recovery requires fuel, and the fuel the body needs for healing is food.

Under the watchful eyes of caregivers at hospitals, rehab centres, nursing homes, assisted-living units and similar organizations, interventions to improve intake and nutrition can happen quickly and on-site. 

But once a patient is discharged, nourishment can slide. Larry Altier, System Director of Food and Nutrition Services at Lee Health System in Fort Myers, Florida, says this is especially true for “patients—most typically in the 55-plus range—who have some form of acute or chronic disease state that causes them to not get adequate nutrition and who are at risk for malnutrition.” 

Many factors can account for inadequate nutrition and the impact plays out in many ways. “People who are undernourished or don’t eat enough will have a harder time healing,” says Dana Fillmore, Gordon Food Service Healthcare Segment Manager, RD, CP-FS, “and they’re at a higher risk for being readmitted to the hospital.” 

A better solution for both is real food, an approach endorsed by Nourish, a Canadian nonprofit advocating culture change in healthcare foodservice. Now, thanks to new and emerging outreach programs that get good, real food onto the plates of high-risk populations, help is on the way.

Reach out and feed someone

The objective of such programs, Fillmore explains, is “to stick to the role of general good nutrition, to make eating convenient for patients and to make sure they’re not skipping meals. Eating well is key to one’s well-being and ability to heal.”

These programs are more SuperWorks than Meals on Wheels. With Meals on Wheels, meals must follow strict nutritional requirements and institutions are often reimbursed for them. The home meal service programs that target this population offer components of simple, tasty meals for pickup or delivery in small enough portion sizes for households with one or two people. The menu can be flexible, anything from prepared in bulk, pre-portioned and provided shelf-stable to fresh and/or frozen.

For individuals discharged from skilled-nursing or assisted-living settings that offered meal programs, this outreach overcomes obstacles such as acquiring foods and having to prepare them. For these individuals—especially the elderly—who are not ready for Meals on Wheels or who can’t afford commercial meal-kit delivery, outreach facilitates eating, healing and remaining in their homes.

How it works

The following example shows how a home meal service that is targeted to independent living apartments in a continuing care community might look.

  1. Residents place orders in advance, allowing healthcare foodservice operators to plan for inventory needs, scale up recipes for in-house service to meet demand and map out staff needs and workflow.
  2. Meals are prepared in bulk, and packed in microwaveable or ovenable containers in 20-oz. portions (2-4 servings).
  3. Pickups occur and/or food is delivered on a set schedule in shelf-stable, fresh and frozen formats. 

Clinically driven and targeted to specific patient needs, Lee Health’s Flavor Harvest at Home program typically serves those ages 55-plus who have some form of acute or chronic disease that causes them to be inadequately nourished. They also must meet two of the six clinical criteria for malnourishment identified by the Academy of Nutrition and Dietetics. Once a week for four weeks, a combination of fresh, frozen and shelf-stable meal components that support their nutritional needs is delivered by a driver who makes sure the food is secured properly in the home. After 28 days, recipients are re-evaluated. 

After just 18 months, Altier notes, enrollment eclipses 1,000 participants—and it is well-received. “The first week of the program the recipients are reserved; they barely open the door and keep drivers at arms’ length. By week three, there’s a total change in demeanour, health status is elevated and they open the door and engage with the drivers.”

Even better, the results are positive. “About 59% of the patients with similar conditions who didn’t take the meal program were readmitted,” Altier says, “whereas the group that got the meals had a readmission rate below 25%. Flavor Harvest at Home had a positive effect from a variety of different measures. This is not just a food program; this is a medical-care program that incorporates food.”

Dining and dollars

Such programs, Fillmore says, offer opportunities to feed the bottom line and improve an operation’s financial health. Moreover, Altier notes, the cost/benefit ratio can be impressive: Lee Health estimated that the cost of Flavor Harvest at “$231,000 and change,” but assessed the net value at “close to $1.3 million, conservatively.”

Reduced readmissions. “Hospitals are being proactive about improving care by helping with food at home,” Fillmore says. At Lee Health, a significant decline in readmissions yielded significant savings.

Shorter stays. “We found significant reduction in the length of stay for those patients we identified as at risk early in the process,” Altier says.

Marketing. Delivering entrées beyond independent-living villas helps nursing homes and continuing-care communities build awareness of who they are and the services they offer.

Narrow networks. “Hospitals are the ones who refer to rehab, skilled nursing and senior living communities,” Fillmore says. “If they’re going to send someone to a skilled nursing facility, they’ll send them to the one that keeps people healthier longer.”

Sales-driven revenue streams. Fillmore says there may be room “to make money back at minimum and potentially upcharge if you want the program to be revenue-generating.” She adds that if you do upcharge, be sure it’s a nominal amount that the target market can bare. Another option: Scale up production even further to offer the meals as takeout fare for employees and/or visitors. 

The bottom line? “More and more people will be doing this to reduce healthcare costs,” Altier predicts. “It costs less to feed people for 28 days than to bring them back to the hospital.”

Altier adds that “Better basic care doesn’t get any more basic than nutrition.”

Getting started

The following principles, Altier says, laid the foundation for Lee Health’s Flavor Harvest at Home program. 

  • Create an institutional culture.
  • Redefine clinicians’ roles to include nutrition.
  • Recognize and diagnose all patients at risk.
  • Rapidly implement interventions and continued monitoring.
  • Communicate nutrition-care plans.
  • Develop a discharge nutrition care and education plan.

Read more about these principles in the July 2013 Journal of Parental and Enteral Nutrition.

Tips for tapping into takeout

Serve the right stuff. Foods with craveable flavours and soothing mouthfeel comfort and appeal to people of all ages.

Plan for scalability. “Align recipes with the menus you already have,” Fillmore advises.

Cut costs/reduce waste. Cross-utilize ingredients.

Stay safe. Follow food-safety protocols, critical control points for pathogen management and state-specific codes for preparation and delivery.

Assess operational impact. Consider labour needs, traffic flow in the kitchen and where food will be prepared.

Label properly. List ingredients, nutritionals, reheating instructions, portion sizes, etc.

Perfect packaging. Consider food quality, area regulations, green packaging and branding.

Pickup/delivery logistics. Establish pickup areas. Determine who’ll deliver food.

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