When nutrition and health care work together

March 1, 2016
David Waters, CEO of Community Servings, displays one of the medically tailored meals prepared and delivered by the organization to chronically ill clients. Todd Post/Bread for the World.

Editor’s note: This post is part of a weekly, year-long series called the Nourishing Effect. It explores how hunger affects health through the lens of the 2016 Hunger Report. The Hunger Report is an annual publication of Bread for the World Institute.

By Todd Post

Community Servings provides medically tailored, home-delivered meals to people with acute life-threatening illnesses. Medically tailored meals are at the very top level of food assistance. While less specialized efforts such as the national nutrition programs and emergency food assistance are determined to provide the most nutritious foods they can, the quality of medically tailored meals can be a matter of life and death. Community Servings and other organizations that provide meals tailored to their clients’ medical conditions could be considered a nexus between nutrition programs and health care.

Medically tailored meals are carefully constructed by dieticians and created by specially trained chefs, whose challenge is not only to meet the specific dietary guidelines required for each disease or condition, but also to make the meals tasty. This is vital since a common side effect of the medications that people with life-threatening illnesses are taking is loss of appetite. Chefs also do their best to take into account the unique characteristics of their clients/patients, such as cultural backgrounds, using comforting flavors to remind them of pleasant times spent with family and friends, when none of these may now be within reach.

Community Servings operates a state-of-the- art nutrition facility in Jamaica Plain, a neighborhood outside Boston, producing and delivering 9,600 lunches and dinners per week to individuals and families across 300 square miles in Massachusetts. Clients are enrolled through physician referral. More than 90 percent are living in poverty. All are critically ill, too weak to leave their homes or stand at the stove to cook. Without these meals, they could literally starve to death in their homes.

Community Servings was founded in 1990 while the HIV/AIDS pandemic was raging in the United States. The first generation of antiretroviral drugs had recently arrived, but they were less effective than the ones available today, and they required strict compliance with complicated medication protocols. And, as it turned out, lack of proper nutrition and food insecurity posed a major barrier to metabolizing them. Community Servings was launched by AIDS activists, faith groups, and community organizations to deliver dinners to patients who were too weak to shop or cook for themselves. Other organizations soon formed to do the same. All got a boost when the Ryan White CARE Act was passed in 1990 since it set aside funds for home delivery of medically tailored meals.

Now, more than 25 years after it started, Community Servings has expanded its operations to provide 25 different meal regimens based on clients’ medical conditions. The largest share of meals still goes to people with HIV/ AIDS, followed by meals for people with cancer, renal failure, diabetes, cardio and lung diseases, and multiple sclerosis. 

“In the continuing debate about how to control soaring healthcare costs, poor nutrition and lack of access to healthy food are routinely ignored,” write David Waters, CEO of Community Servings, and Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School. Public and private insurers spend millions of dollars on health care for critically ill patients, but if the patients do not have the right food, there is much less chance of a lasting recovery.

Today the demand for medically tailored meals far outstrips the supply of service providers. Community Servings is one of fewer than a dozen nonprofit organizations across the country that are able to deliver complex, medically tailored meals to critically ill patients. Nursing homes and hospitals can and do provide such meals, but organizations like Community Servings can produce and deliver them at a fraction of the cost. Yet nursing homes, hospital stays, and prescriptions are covered by insurance, while medically tailored meals are not.

As part of healthcare reform, state Medicaid programs could seek permission to experiment with medically tailored meals. As noted above, the vast majority of Community Servings’ clients are income-eligible for Medicaid. The cost savings alone should be enough to grab policymakers’ attention. Researchers found that the monthly healthcare spending on patients who were receiving medically tailored meals was 37 percent lower than the expenditures for those with comparable conditions who were not receiving these kinds of meals. Studies also show that patients receiving medically tailored meals adhere more closely to their medication regimens, miss fewer medical appointments, and are readmitted to the hospital at lower rates. Ninety-six percent of the healthcare workers surveyed by Community Servings reported that the home-delivered meals improved patients’ health.

Todd Post is the Senior Hunger Report Researcher, Writer, and Editor in Bread for the World Institute. This story originally appeared on pp. 64-65 of the 2016 Hunger Report: The Nourishing Effect.

Photo: David Waters, CEO of Community Servings, displays one of the medically tailored meals prepared and delivered by the organization to chronically ill clients. Todd Post/Bread for the World.

Today the demand for medically tailored meals far outstrips the supply of service providers.

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