Meals on Wheels is powered by armies of volunteers, it’s fed millions and saved lives. Yet undernourished, underserved seniors, are increasingly common. With the number of older adults set to double by 2040, Meals on Wheels (MOW) must upgrade and streamline all its systems. MOW 2.0 brings skilled partners together to establish and equip kitchens with new technology, start mailing fresh meals; develop clear data tracking; replace volunteer food delivery tasks with promotora-style provision of information, and other supports, bringing far more social interaction than in the current model; and it will assure every person in need knows how to easily find and use their local MOW. Meals on Wheels has provided a unique, free safety net for more than half a century. MOW 2.0 reweaves it into a preventive network, combining the strong new cords of evidence with the timeless ones of good nutrition and caring, human connection.
“Our most cruel failure in how we treat the sick and aged is the failure to recognize they have priorities beyond merely being safe and living longer” –Atul Gawande.
This may be why 90% of seniors expressly wish to avoid moving to a facility. In the US, 29% of the 46 million community-dwelling elderly live alone, (50% age ≥85 live alone). Neighbors don’t know each other and family members struggle to afford time or money for care.
Myriad new person-centered initiatives are being tested and proffered by the healthcare industry, yet eligibilities are often complex and benefits confusing.
Healthcare systems need a truly community-based arm to address the nutritional and social determinants of health; both reliable predictors of medical usage. However, MOW programs have unfolded in fragmented ways over the years; challenged to partner on the scale needed by healthcare plans. Many MOWs face delivery challenges, and while alleviating isolation is a MOW core belief, volunteers must move on to keep food hot; providing only minor relief. There’s a growing need for special meals, like diabetic and vegetarian but accessibility varies widely. LIFE offers 9 meal options; while its sister agency 15 miles north in Oakland offers only one, and has a waiting list due to high need. MOW’s Care Management quality also varies widely, Elders in the urban and rural pockets of highest food insecurity can be the most difficult to serve with MOW’s traditional model, leading the NIH to find just 5% of eligible seniors actually use MOW.
Big Problems Require Bold Solutions
Solving society’s biggest problems isn’t easy, but it can be done. 100&Change is a MacArthur Foundation competition for a $100 million grant to fund a single proposal that will make measurable progress toward solving a significant problem. 100&Change will select a bold proposal that promises real progress toward solving a critical problem of our time.
“Through 100&Change, we want to inspire, encourage, and support other people’s ideas about how to address major challenges and enable real progress toward a solution.”
— Julia Stasch, President
Meals on Wheels 2.0 (MOW2.0) incorporates mailed meals; giving rural, urban and other underserved recipients access. At least 3 new kitchens in different parts of the country will be established to use Modified Atmospheric Packaging (MAP) to deliver food that stays fresh in the refrigerator for 7-10 days. Kitchens equipped and trained with MAP will provide meals for their own routes and to supplement sister MOWs in different service areas.
However, volunteer routes are not removed, in fact, they become more important. MOW2.0 borrows techniques from community health workers; giving seniors direct access to information about topics like preventing fraud and preparing for disasters. As most MOW volunteers are the “younger old”, this will simultaneously educate them. Screened volunteers are assigned to the MOW recipients closest to where they live and in some cases, bring other neighbors together for informal check-in schedules as needed, with the intent of slowly strengthening support systems.
Our care management home visits by staff remain, too. These are more structured and occur only upon enrollment and annually thereafter. will provide linkages to essential resources; e.g. chronic disease self-management, chore assistance, or benefits enrollment and benefits explanations. In MOW2.0, uniform staff accreditation and the use of certain evidence-based assessment tools and data tracking, will demonstrate MOW2.0’s new capabilities for service partnerships with the health care industry. The data will allow MOWs to keep abreast of where geographical, social, nutritional or other gaps remain so as to address them quickly.
Evidence of Effectiveness
Meals on Wheels 2.0 improves quality of life and health outcomes based on:
Concept 1. Volunteers shifting increased social time and including educational role:
- Eating alone is a statistically significant indicator for risk of malnutrition. [Oct1999 (Atlanta) American Dietetic Association survey-2,200 elderly people]
- Nutrition education has great potential to delay morbidity and mortality and to improve the quality of life for older adults (Amarantos et al. 2001; Sahyoun2004; Silver and Wellman 2002).
- The single largest fraud prevention effort in the U.S.; involved over 500 volunteers; 3 million seniors received a peer delivered message. (Melodye Kleinman, National Telemarketing Victim Call Center)
Concept 2. Care Managers becoming uniformly NCQA accredited
- NCQA’s Long-Term Services and Supports accreditations uses evidence-based standards in conducting comprehensive assessments, managing care transitions, and planning/managing critical incidents.
- Screening, and nutrition intervention may be the most cost-effective and efficient way to reduce avoidable readmissions to the hospital. Washington DC: US News & World Report; 2014. Mar 18,
Concept 3. Increased access to nutrition
- Food insecurity is growing among older adults. The rate for senior households was 8.9% in 2014, (5.5% in 2001). Simultaneously, the percentage of seniors facing the threat of hunger more than doubled. (National Council on Aging Senior Hunger Facts)
- Study reviews nutritional status, dietary intake, well-being, loneliness, and food security levels of seniors participating in MOW delivery service. Improvements across all measures statistically significant after two months in the program. J Nutr Gerontol Geriatr. 2015;
- Food insecure seniors at increased risk for chronic health conditions, even when controlling for factors such as income [NFESH2014, March. Adverse Health Outcomes of Food Insecure Older Americans]
We are Meals on Wheels evangelists
The MOW community has been grappling for several years about to enter the world of evidence based systems without losing that rare, high-touch component. We believe MOW 2.0 meets those criteria, arriving at the perfect time in history.
We sense a slow shifting back to a more connected sense of life after this century-long experiment in extreme independence. Interdependence- where all phases of life have real worth, and all ages need each other -is the natural human condition. MOW 2.0 is designed to foster that interdependence in every way possible; while expanding nutritional options + access and improved healthcare outcomes + access. We are excited about a real chance to make a real difference. We cannot stand still and keep doing the bare minimum as elders fade to nigh invisible in this country. They have been too long deprioritized and so they have our hearts.