Abstract
BACKGROUND
Home‐delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social.
DESIGN
A pilot study was designed to test the feasibility of leveraging routine meal‐delivery service in two home‐delivered meal programs to proactively identify changes in older adult meal recipients’ (clients’) health, safety, and well‐being and address unmet needs.
INTERVENTION
Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client’s condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services.
RESULTS
Over a 12‐month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self‐care or personal safety (12%) and mobility (11%). On follow‐up, a total of 132 referrals were issued, with most referrals for self‐care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution.
CONCLUSION
Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early‐warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home‐delivered meal programs.
Accumulating evidence suggests that social determinants of health (SDOHs), or the conditions in which people are born, grow, live, work, and age,1 exert a strong influence on health and well-being.2-7 Taken together with health behaviors, these social, economic, and environmental conditions are associated with up to 80% of one's health and health outcomes, including mortality.4, 8, 9 Health-related social needs, including a lack of community supports, transportation barriers, food insecurity and housing instability, are associated with poor health outcomes and increased healthcare costs.9 This association may be particularly pronounced among vulnerable populations, such as homebound older adults (ie, persons 65 years and older), who, in addition to being medically complex,10, 11 often have a variety of unmet health-related social needs and may require additional assistance to maintain their functional independence.12-14
Community-based organizations have a critical role in identifying and addressing SDOHs for older adults with complex care needs.15-17 For example, home-delivered meal programs, such as Meals on Wheels (MOW), provide an important food resource for homebound older adults and adults with disabilities across the United States, with over 850 000 individuals served in 2017.18 Home-delivered meal programs not only improve older adults' nutritional intake,19 but can also reduce social isolation, falls, hospitalizations, and potentially nursing home placement.20-27 Meal recipients (clients) indicate the service helps them eat healthier foods, improves their overall health, and allows them to live independently and remain in their own home.28 Many of the benefits are hypothesized to derive from the daily interaction between the meal delivery person (driver) and the client.29 This is especially important given that many older clients are isolated, and interactions with drivers may be their only point of socialization each day. In addition to a friendly visit, drivers serve as the “eyes and ears” for clients, providing a daily wellness check as part of the meal delivery service. This provides an opportunity to standardize routine interactions to systematically identify and address unmet needs that, if missed or ignored, could result in preventable adverse health outcomes and costly healthcare utilization.29
This article describes a pilot study of a technology-supported meal-delivery service, which included change of condition monitoring and care navigation support, developed and tested at two MOW programs to assess feasibility. This study was conducted with MOW volunteer and staff drivers who used a mobile application to report changes of condition in clients' health, safety, and well-being observed during meal delivery via an electronic alert. Care coordinators, embedded within the MOW programs, responded to alerts and provided care navigation support to connect clients with health and community services to address unmet needs. We report on the feasibility of the approach, describing the number and types of alerts made by meal-delivery drivers and the follow-up response by care coordinators. In addition, we characterize the experiences of drivers who implemented the technology-supported meal-delivery service.