Wellness in Nutrition (WIN)
Primary funding sources: OAA Title III -C1 & C2; State WIN
Since 1984, New York State's Wellness in Nutrition Program (WIN) has provided funding primarily for home-delivered meals, to frail older persons who are unable to prepare meals for themselves, in addition to supporting nutrition counseling, nutrition education and congregate meals.
The SFY 2013-14 allocation for WIN was $21,380,000. An additional $5,746,000 from the Human Services COLA funded this program providing total funding for SFY 2013-14 of $27,126,000. Funding in SFY 2014-15 was $27,126,000 with a COLA of $363,000 additional for a total funding of $27,489,000.
While the federal Older Americans Act (OAA) nutrition program is over forty years old, providing this service in New York State predates its inclusion in the OAA. The purposes of the program are to reduce hunger and food insecurity; prevent social isolation; and promote the health and well-being of older adults. In addition, home-delivered meals also represent an essential service for many caregivers, by helping them to maintain their own health and well-being through the provision of nutritious meals to those they care for. By providing access to nutrition and other disease prevention and health promotion services, the program aims to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. (Source: Older Americans Act)
The most recent data from WIN is based on program data from SFY 2012-13. 23 million meals were provided to older New Yorkers with $176,649,596 in funding from federal, state, and local sources. Actual numbers show that 10.3 million congregate meals were provided to slightly more than 119,000 participants and 12.5 million home delivered meals were received by slightly more than 54,000 participants. In addition, during SFY 2012-13 the aging network provided 9,598 hours of nutrition counseling to 6,827 participants with $816,401 in funding from all sources; and, 437,461 nutrition education units to 107,557 participants with $2.1 million in funding from all sources.
Benefits of the Nutrition Program: Analysis done by the Administration on Aging (AoA) indicates that state units on aging are effectively reaching those most at risk of institutionalization, and that Title III services play an important role in helping older adults remain living independently in the community. AoA estimates that participants receiving services through Title III of the Older Americans Act (including meals) are at higher risk of nursing home placement than others in their age group nationally. This conclusion is drawn from client-based data provided by state units on aging, survey methods and common predictors of nursing home entry. Older adults who receive homemaker services, home-delivered meals, and case management appear especially vulnerable. National survey results of program participants show that most participants believe the services help keep them out of nursing homes and in their communities. With the number of older individuals in the United States (and New York State) increasing, the number of people wanting to remain independent in their homes will continue to grow. *Nursing Home placement indicators:
- Demographic characteristics: Older individuals and those who are non-Hispanic white. In NYS for the reporting year 2012-13, 74 percent of our home delivered meal clients were over the age of 75. 78 percent are non-Hispanic white.
- Socioeconomic status: 39.4 percent of the home delivered meals clients reported income below 150% of poverty level.
- Health status and physical functioning: Those with certain health conditions (such as cognitive impairment, cancer, high blood pressure, diabetes, and a history of strokes and falls) and those who have difficulty performing activities of daily living (ADLs). In NYS for the reporting year 2012-13, 25 percent of the home delivered meal clients had 3 or more ADLs and 59 percent had hypertension while 25 percent had diabetes. Forty-two percent of the home delivered meal clients were at high nutrition risk and 82 percent were assessed as frail or disabled.
- Prior health care utilization: Individuals who have spent time in the hospital or in a nursing home. In 2009, (the most recent data available) about 7 percent of state residents 65 or older had one nursing home stay and 23 percent of state residents 85 or older had one nursing home stay. (Source: Nursing Home Compendium 2010 from CMS)
- Living arrangements and family structure: Those who live alone - including widowed and divorced individuals - do not own their home, and have fewer children than their peers not in nursing homes. In NYS for the reporting year 2012-13, 61 percent of the clients receiving home delivered meals lived alone.
- Availability of support: Individuals who lack caregiver support.
People who have difficulty performing three or more Activities of Daily Living (ADLs) are at increased risk of nursing home placement, and Title III participants (especially those receiving home-delivered meals, case management, and homemaker services) are at a higher level of need than the national population based on analysis done by the Administration on Aging. In general, Title III participants also have a higher average number of difficulties with ADLs, and more have been diagnosed with health conditions like stroke and diabetes, which also make nursing home entry more likely.
*Source: Administration on Aging identified predictors of nursing home entry using two comprehensive analyses of predictors of nursing home entry (Gaugler et al. 2007; Miller and Weissert 2000).
Cost/benefit of meals:
Providing home delivered meals and other community-based services prevents nursing home placement and keeps older New Yorkers in their community where they want to be - which reduces nursing home costs for the state by delaying or avoiding costly nursing home care. In SFY 2012-13, 25 percent (or about 13,702 clients) of the home delivered meal recipients had 3 ADL deficiencies or more, which is a significant nursing home placement indicator. If we prolong the stay of 10 percent of the clients at home by one month, the state would save $14,168,540 in potential Medicaid costs*.
* (10% of 13,702 x $10,342 estimated average monthly cost of SNF in NYS for 2014 based on Genworth Cost of Care Survey 2014)
Vignettes of meal recipients:
Albany County: Home Delivered Meals contractor drivers, whether paid or volunteer, are observant to changes in the older adults they serve and care about their wellbeing. While delivering to one woman who lived alone, the driver was concerned that she seemed ill and not herself. Offers made by the driver and other staff to call family or EMS for the older adult was declined. Still concerned, a call was placed to the woman's emergency contact, her daughter. Although her mother was occasionally confused, the daughter decided to leave work early to make sure it was nothing out of the ordinary. Upon arriving to her mother's home, the daughter found her unresponsive. Inside the home, the daughter detected a gas odor and so removed her mother from the home until help arrived. It was discovered that her mother had left the gas stove running. The perceptiveness and diligence of the driver and other Home Delivered Meal program staff was credited for saving the woman's life. The Home Delivered Meal program provides more than a meal; it provides another set of eyes and ears to watch out for older adults living in our community.
New York City (DFTA): An 82 year old male who lived alone contacted a Case Management Program after his roommate of 45 years passed away from pneumonia. The client was never legally married nor did he have any children and all of his informal supports lived outside of NYC. During the course of his time with the Case Management Program he received assistance with applications for NYC 210, HEAP, SNAP, SCRIE, Medicaid Home Care, and a PERS medical alert button. Early on during his relationship with the Case Management Program the client noted that he would attend a senior center when he was feeling well enough to attend. Over time the client's health began to decline and he was having great difficulty making complete nutritious meals on his own and no longer had the stamina to attend the senior center. His Case Manager who consistently monitored his needs encouraged the client to accept Meals on Wheels services. As he had developed a strong, professional, trusting relationship with his Case Manager he agreed to the suggestion and a referral was made right away on his behalf which was greatly appreciated by the client and his supports who unfortunately could not assist due to distance.
New York City (DFTA): A 72 year old male who was living with multiple sclerosis referred himself to a Case Management Program in NYC originally to receive assistance with a SCRIE application. During the in home assessment the client was provided with information on various other services that were available in the community one of which was Meals on Wheels. Client was unable to safely prepare meals for himself. He was referred to the Meals on Wheels program who began the service the next day. The client's assigned Case Manager assisted the client in acquiring SCRIE and also helped with securing a grant from the MS Society which has paid for home care & hands free dictation software. As a result the client has been able to live safely in his own home.
Allegany County: A couple was referred for home delivered meals. A disabled 90 year old man was being cared for by his 85 year old wife. They had been managing independently but she was having some health problems and struggling to give care, prepare meals, get groceries and even take the garbage to the dump. Added to this were financial struggles. They were referred by their daughter living in California. Their home at the end of an unpaved road in the woods was frequented by bears, hence the importance of getting the garbage to the dump.
A comprehensive in-home assessment found that the husband used a wheelchair, had a colostomy and needed assistance with 5 ADLs (bathing, dressing, mobility, transferring and toileting) and 4 IADLs (housework, shopping, laundry, transportation, and preparing meals).
Home Delivered Meals provided much needed caregiver respite and nutritional support for this couple. In addition, as a result of the client assessment a care plan was developed which involved: in-home Caregiver respite, insurance counseling and accessing HEAP benefits. The Medicare insurance counseling and a resulting change of insurance freed up $400 per month. Additionally a volunteer was found to take the garbage to the dump.
As a result of these community-based services and caregiver supports an older adult at high risk for institutionalization in a nursing home was able to remain at home with his spouse for four more years until he passed away.
Broome County: The caregiver of an elderly gentleman, who was living in the farmhouse where he grew up, called the AAA concerned that he would fall. The older adult had, until recently, sold eggs from the chickens he maintains. However, lately he had been having dizzy spells and TIAs. The caregiver, a family friend, was doing the best he could while operating a business. He now realized that he needed some assistance caring for this older adult.
Through efforts of the AAA, this 84 year old, with 1 ADL need and 7 IADL needs, was able to stay in his childhood home. He began receiving home delivered meals, homemaker services and a personal emergency response system (PERS). The remainder of the caregiving duties was manageable and the PERS system provided peace-of-mind to the caregiver who worried that something would happen while he was working. Additionally, a friend from his church was happy to purchase a lift chair when a case manager pointed out how helpful this would be.
Just a few key services made a big difference in this older adult's ability to remain safely at home. The formal services through the AAA supplemented and sustained the informal assistance provided by his caregiver.
Suffolk County: A frail, disabled and legally blind 95 year old woman was living alone without family supports. The fire department responded to her home multiple times for burnt food as she struggled to prepare her own meals. An assessment by the AAA captured that she had a high nutrition risk score and needed assistance with 3 ADLs and 7 IADLs. A daily HDM provides her with a nutritious meal and addresses the safety issues related to her cooking.