Amanda Panas RD, LD Nutrition 575 Community Nutrition December 11, 2011

1. Spreading food Security among Sibley Memorial Hospital’s patient population:Hunger Is Not Getting Any Younger Amanda Panas RD, LD Nutrition 575 Community Nutrition December 11, 2011

2. Outline • Introduction & background information • Needs Assessment • Research Findings • Goals & Objectives • Presentation • Evaluation • Conclusion • Questions

3. Introduction • Clinical Inpatient Registered Dietitian working at Sibley Memorial hospital, located within the District of Columbia • Community nutrition course readings highlighted the incidence of food insecurity, especially among the elderly population • Reviewed professional experience of working with hunger • Goal: to increase food security among elderly patients at Sibley Memorial Hospital, connecting those in need with outreach program information

4. Sibley Memorial Hospital Statistics • Initiation of NICHE program at Sibley Memorial Hospital • Designed to meet the specialized needs of geriatric patients • In general, 50% of hospitalized patients are at least 65 years old • 55% of Sibley Memorial Hospitals inpatient admissions are people over 65 years of age • Within 30 years the population over 85 will double to 8.5 million • Average age of Medicare patients is 77 • 19% of patients admitted to Sibley Memorial hospital are over 85 (Vincent, 2011) • The geriatric hospital patient population will significantly increase in the future, practices and procedures need to be adapted to meet the specific needs of this population.

5. Needs Assessment • Completed informal interviews of hospital staff: • Focused on orthopedic units and short term skilled rehabilitation facility connected to the hospital • Charge nurses, Registered Nurses, Nursing Assistants, Unit managers, Physical Therapists, Dietitians, case coordinators • Needs assessment purpose: To obtain information about the current practices and knowledge of hospital health care staff concerning food insecurity among elderly patients and DC area services available to assist this patient population. • Questions Hospital Heath Care staff were asked: • How often they suspect one of their patients are suffering from food insecurity? • What signs are noticed when food insecurity is suspected? • What does the individual do when they believe that a patient is at risk for malnutrition? • Inquired about their level of awareness of local program to assist patients that may be food insecure. • Overall goal to increase the awareness of resources to prevent food insecurity among the patient population, especially adults above 65 years old, living in the metropolitan DC area.

6. Nursing Registered Dietitians Physician Assistants Case Coordinators Needs Assessment Findings: most staff members do not inquire about a patients food security status. Only nurses, dietitians, and occasionally physician assistants have previously inquired about a patient’s level of food security, all disciplines informed case coordination staff of the situation, as their only action. When interviewing case coordinators, only a very basic understanding of local programs was identified. Primarily patients were directed to Meals on Wheels programs.

7. Research Findings • 40 million Americans struggle for enough to eat each day • US poverty rate for adults over age 65 is 9.7% • 3.5 million elderly adults live in poverty (Society, 2011) • 5.3% of the people with food insecurity are elderly and 4.8% are elderly people living alone (Coleman, 2010) • 60% of low income seniors qualified for state or federal nutrition programs are not enrolled (Hunger, 2009)

8. Research Findings • DC consists of 61.4 miles, over 9,000 people live in each mile, 11.9% of this population is over the age 65, 17.1% of the DC population lives under the poverty line (DC, 2011) • 1 in 8 households struggle with hunger, 13% per USDA report 2008-2010 • DC priority to make programs easier to access per Alex Ashbrook, Director of DC Hunger Solutions (Healthy, 2006) • “The Older Americans Act Nutrition program works to improve the nutritional status of participants and helps them to maintain their independence and quality of life • 2 million of the 9 million older adults living alone believe that they have no one to turn to for assistance (Baker, 2005)”

9. Goals & Objectives • Goal 1: Increase the knowledge of signs/symptoms of malnutrition and recognize the growing problem of food insecurity among elderly Americans for case coordinators working at Sibley Memorial hospital. • Objective 1: Case coordinators to be able to identify two potential environmental factors that can lead to food insecurity among the elderly population immediately following the program presentation. • Objective 2: Case coordinators to increase ability to recognize at least twosigns and symptoms of malnutrition among hospital patients over 65 years old following the informational presentation. • Objective 3: Case coordinators to begin specially addressing food security during patient assessment interviews within two weeks of program presentation. • Goal 2: Enhance the level of awareness of food outreach programs for case coordinators working at Sibley Memorial hospital. • Objective 1: Immediately following the program presentation presented at the case coordinator weekly meeting, each case coordinator will be able to identify at least twofood insecurity programs focusing on the elderly population located within ten miles of Sibley Memorial Hospital. • Objective 2: Two weeks following the presentation case coordinators that attending the original presentation will maintain their ability to identify at least two food insecurity programs focusing on the elderly population located within ten miles of Sibley Memorial Hospital. • Objective 3: Following the program presentation, case coordinators will increase their ability to provide their patients in nutritional need with printed materials and applications of at least two programs discussed, in addition to being able to provide eligibility information to these patients.

10. Scheduling & Pre-test • Contacted Dense Thompson, Case Coordinator Manager • Discussed program goals and set up a 30 minute block of time to complete the presentation to case coordinator staff during their weekly 1 hour mandatory meeting • November 9th: emailed 27 case coordinators, informed them of presentation scheduled for the following week, requested personal and professional experiences with the topic, encouraged staff to identify specific information that they feel would be beneficial • Only received one response: inquiring about taste changes among the elderly

11. Presentation • Completed 30 minute presentation November 16th • Presented 14 slides over a 20 minute period • Reviewed resource handout • Answered questions • Requested that audience members complete process evaluation survey

12. Local Food Insecurity Outreach Program Handout • Provided program descriptions & contact information • Overview of both Meals on Wheels and Non-Meals on Wheels Programs • Included hospital RD contact information

13. Evaluation • 15 case coordinators attended the presentation • Received 12 completed evaluations • 92% of participants were able to determine 2 environmental factors (one individual misunderstood the question) • 100% were able to list 2 signs/symptoms of malnutrition

14. Evaluation Results • 92% plan to inquire about patient food insecurity in the future, although 5 people did not explain their reasoning • Only 25% could correctly identify 2 local resource programs • 67% identified a Meals on Wheels site specifically and then proceeded to identify Meals on Wheel as their second answer • Reflection: need to be more clear when explaining that DC meals on wheels program has no main site or universal application, all sites have own guidelines and are considered separate entities • 100% of audience members were able to locate program applications and program eligibility requirement information • 75% of participates considered the presentation very effective (100% grade), 25% rated the presentation a 90% for effectiveness

15. Secondary ProcessEvaluation • Emailed the second survey to case Coordinators via Survey Monkey, two weeks following the presentation • November 30th • Survey was very similar to initial survey, determined information retention • Inquired if case coordinators have asked about patient food insecurity in the past two weeks • Only received one completed survey- individual stated to not have had the opportunity to use the information, recommended that handout information be available on the hospital intranet • Potential reason for lack of response- The Joint Commission arrived at hospital (November 28- December 2)

16. Conclusion • Increased awareness and level of knowledge • Local food insecurity outreach handout will be included in the orientation booklet for all newly hired case coordinators • Handout will also be added into the orthopedic surgery, pre/post surgery, information packet • Overall staff members agreed that food insecurity identification is an area for improvement for the hospital • Continue to distribute handouts to absent case coordinator staff requesting information from the presentation

17. References • Vincent, J. M. Introduction to the NICHE program. Sibley memorial hospital power point presentations. (2011). Washington, DC. • Society of St. Andrew. 2010. Retrieved October 8, 2011, from http://www.endhunger.org/. • Coleman-Jensen, A., Nord, M., Andrews, M., & Carlson, S. Household food security in the US in 2010. USDA. 2011. Retrieved October 3, 2011, from http://www.ers.usda.gov/Publications/ERR125/. • Hunger and the senior: 5 million seniors at risk of malnutrition. Comfort Keepers. (2009). Retrieved October 3, 2011, from http://www.comfortkeepers.org/stop-senior-hunger. • DC Food Finder. Retrieved October 3, 2011, from www.dcfoodfinder.org. • Healthy food, healthy communities. DC Hunger Solutions. 2006. Retrieved October 7, 2011, from http://www.dchunger.org/pdf/healthfoodcomm.pdf. • Baker, E. B., & Wellman, N. S. Nutrition concerns in discharge planning for older Americans: a need for multidisciplinary collaboration. J Am Diet Assoc. 2005(105),603-607. Retrieved October 8, 2011.

18. Questions?