Food insecurity is defined as a lack of consistent access to enough good, quality food for an active healthy life. In 2017, 5.5 million of the nation’s older adults were food insecure, many of whom were homebound. Food insecurity is associated with unnecessary and expensive use of the healthcare system. As a result, healthcare entities (e.g., providers, healthcare systems, payers) are increasingly interested in identifying and providing solutions to address food insecurity. Home-delivered meals are one solution to address food insecurity for homebound older adults. There are two main ways that meals are delivered to individuals’ homes: meals delivered daily by a volunteer or paid driver who provides socialization and a wellness check; and meals that are frozen, shipped, and delivered by a postal carrier. This research aims to understand which type of meal delivery is most effective in allowing older adults to remain in their homes (versus the hospital and nursing home) and improve their quality of life. In addition, this project seeks to understand homebound older adults’ preferences for type of meal delivery (i.e., daily-delivered meals versus frozen, mailed meals) and the effect of receiving their preferred meal choices on their ability to continue to live in their homes.

This study will randomly assign 2,300 older adults on waiting lists at six Meals on Wheels programs in Florida, Texas, Rhode Island, and Louisiana into two groups who will receive: (a) daily delivery of meals, five days a week or (b) a shipment of 10 frozen meals, every two weeks. Researchers will examine participants’ Medicare claims to understand if differences in healthcare utilization occur between the two groups within six months after they start receiving meals. Researchers will also ask participants questions prior to receiving meals, and again at three months, to understand how meals impact their ability to obtain food, their feelings of loneliness, and their overall quality of life. The primary study outcome will be the ratio of days spent in institutional settings (i.e., hospital, nursing home) in the six months after participants begin receiving meals. The secondary outcomes include the ratio of days spent in institutional settings in the three months after participants begin receiving meals, food insecurity, subjective isolation/loneliness, quality of life, and health-related quality of life. The team will also examine differences in dietary intake between the two groups as an exploratory outcome.

This research addresses the lack of evidence necessary for understanding the type of meal and meal delivery preference that best ensures the ability for homebound older adults to remain healthy and in their communities. Given the increase in healthcare entities contracting with community organizations to provide meals, understanding which type of meal results in the best outcomes, and for whom, will inform their decision making. Ultimately, healthcare entities and meal delivery programs will be able to use the findings from this study to address the issue of food insecurity among the nation’s older adult population while improving older adults’ health and allowing them to remain in the community. Older adults and their families can use this information to choose the meals that are best for them.

The project team has convened a panel of stakeholders representing healthcare plans, integrated care organizations, geriatric clinicians, researchers, registered dietitians, Meals on Wheels programs, volunteer drivers from Meals on Wheels programs, older adults receiving meals and their family members. The stakeholder advisory panel will work closely with the research team to review research materials and findings, create materials describing the study and its findings in consumer-friendly language, and identify and leverage their networks to broadly share results.