A review and comparison of current service models for Title III funded home-delivered meals Key study findings Prepared by Wilder Research

Overview of study Scan of literature and programs Description of consumer demographics Provider interviews to describe models Delivery personnel interviews to describe roles Consumer interviews to describe experiences Analysis of unit costs wilderresearch.org

Results Literature Review Much change and experimentation in market Frozen meals being used in many locations and contexts For-profit competition in at least 30 states Comparisons of frozen and hot-meal programs do not show major differences in outcomes wilderresearch.org

Profile of current consumers Age and Gender and Risk Youngest served by Presbyterian Homes Oldest served by Scott/Carver/Dakota CAP Midrange served by VOA and sub-contracts – 78.4 Nearly two-thirds (64%) are female 63% considered high nutrition risk 88% need help with 2 or more IADL’s 47% need help with at least one ADL wilderresearch.org

Profile of current consumers Race, Ethnicity and Poverty Most diverse served by Presbyterian Homes – 61% white Least diverse served by Scott/Carver/Dakota CAP – 98% white Asians are largest ethnic minority 84% of all consumers at or below 200% of poverty Non-white participants more likely to be in poverty wilderresearch.org

Profile of current consumers Receipt of meals Number of meals received mainly based on nutritional risk Typical to receive 5 meals per week but 28% receive 7 or more meals per week Presbyterian Homes clients more at risk and receive more meals – 6 per week CAP clients typically at lower risk and receive fewer meals – 4 per week wilderresearch.org

Current service models Models becoming more blended Traditional model of hot meals delivered by volunteers typical of CAP and VOA providers but flexibility has increased Newer model with mainly frozen meals delivered by paid drivers typical of Presbyterian Homes but use of volunteers is expanding wilderresearch.org

Views of delivery personnel Volunteer drivers – average 7.5 years of service ─ Provide value through contribution of time and transportation costs ─ Gain benefits by being active, engaged, connected to others and useful Paid drivers – average 1.5 years of service ─ Also connected to clients in similar ways ─ Less frequent contact with clients ─ Respond to client needs in ways similar to volunteers wilderresearch.org

Views of delivery personnel Volunteer and paid drivers both… ─ Usually deliver on same routes ─ Spend a bit more time with some clients ─ Rarely help clients with meals other than delivery ─ Take safety checks seriously ─ Occasionally encounter reportable situations ─ Report back to office when something is of concern wilderresearch.org

Consumer feedback survey Completed 209 interviews with a random sample of consumers representing each provider ─ Presbyterian Homes = 88 respondents ─ Scott/Carver/Dakota CAP = 52 respondents ─ Volunteers of America = 69 respondents Respondents were asked detailed questions about experiences with Home Delivered Meals only if they had received a meal within past 30 days (N= 173) wilderresearch.org

Consumer feedback survey Majority (59%) rate health as excellent or good One-third (34%) had been hospitalized in past year 89% rated by providers at medium or high level of nutrition risk Only 16% get no other help for ADL’s or IADL’s Meals per week vary by nutrition risk and need ─ 19% get 1-3 meals per week ─ 60% get 4-6 meals per week ─ 21% get 7 or more meals per week wilderresearch.org

Consumer feedback survey 87% of all respondents rated satisfaction with meals as good or excellent No significant differences in satisfaction by race, gender or age Meal taste is rated most favorably by poorest clients Overall, meals are rated most favorably by those with highest self-ratings of health wilderresearch.org

Consumer feedback survey Few significant differences in meal ratings based on meal type (hot or frozen) or delivery type (paid or volunteer). Hot meals rated somewhat more favorably by consumers who were older, with higher incomes and medium or low nutritional risk Frozen and hot meals rated comparably by consumers who were younger, with lower-incomes and high nutritional risk wilderresearch.org

Unit cost per meal Average across providers is $8.60 per meal Costs range from $7.22 to $10.50 The average participant contribution is $2.09 Average net cost per meal (after participant contribution) is $6.51 Note: Equivalent comparative cost data was difficult to obtain because of differences in record keeping across providers. Caution should be used in drawing conclusions based solely on this unaudited data. wilderresearch.org

Conclusions Movement toward more diverse models of service provision has not had a serious or negative consequence for consumers Models have become more blended during the most recent time period of funding Costs will continue to be important as for-profit providers expand HDM offerings Future consumers will likely want and be well served by a more diverse range of choices wilderresearch.org

Conclusions Nutritional benefit is best achieved when consumers like their meals Volunteers benefit from the vital involvement features of home delivered meals Future innovations in HDM’s should explore strategies that address: ─ Engagement of volunteers ─ serving those with most need and few supports ─ enhancing meal quality and choice wilderresearch.org

Questions/discussion

For additional information contact… wilderresearch.org Greg Owen, Cael Warren or Karen Ulstad Wilder Research