COLLEGE OF 

" AGRICULTURE 

NATURAL 

& 

RESOURCES 

DEPARTMENT OF NUTRITION 

AND FOOD SCIENCE 

Expanded Food Security Screener

Home-Delivered Meals Prioritization Tool 

Developed by the College of Agriculture & Natural Resources Department 

of Nutrition and Food Science at the University of Maryland. 

Grant funds from the Administration for Community Living (ACL), Grant# 90INNU0002 and the Maryland 

Department of Aging (MDoA) assisted in the development of this material. This presentation is solely 

the responsibility of the authors and do not necessarily represent the official views of the ACL or MDoA. 
2 

Introduction

What Is Food Security? 

What is the Expanded Food 

Security Screener? 

How does the FSS·Exp work 

as a Home-Delivered Meals 

Prioritization Tool? 

What does screening mean 

and how Is It different than 

assessment? 

According to the Food and Agriculture Organization, "food security exists when all people, at all times, 

have physical and economic access to sufficient, safe, and nutritious food that meets their dietary 

needs and food preferences for an active and healthy life." 

The four main dimensions of food security are: 

• availability (determined by food production and markets)

accessibility (physical and economic) 

utilization (including the preparation of food) 

stability of the other three dimensions over time 

• 

• 

• 

Current tools for measuring food security only measure the economic access component. However, 

in older adults, and especially the homebound population, there may be physical issues that interfere 

with an individual's ability to obtain and prepare adequate nutritious food. The Expanded Food Security Screener (FSS-Exp) builds on the US Department of Agriculture 6-item Household Food Security 

Survey Module (HFSSM), which is a validated tool used to assess food security based on questions 

that ask about ability to afford food. The FSS-Exp combines this economic access information with 

the other indicators of food security for older adults that indicate need for services: ability to get 

groceries into the home and ability to prepare meals. To fully understand an individual's level of need 

for a meal, the FSS-Exp also takes into account whether the person has help available to accomplish 

these tasks. 

The FSS-Exp quickly gathers information on an individual's economic access to food, their ability to 

get groceries into their home, and their ability to prepare meals, with or without help. This information is used to categorize applicants into one of five priority levels. The categorization scheme for 

these priority levels is based on the issues that could be specifically addressed by a meal delivered to 

the home. This tool provides home-delivered meal (HDM) programs with a concise version of the most 

essential information about each individual's food security needs. HDM programs can use this information to make quick decisions about how to use their organization's resources most efficiently and 

effectively to support the needs of that client. thus allowing the meal program to provide person-centered services. 

A screening tool is used to detect risk quickly and efficiently. When screening, you are trying to find 

those at the highest risk early on, in order to mitigate further decline. Assessment is more in-depth 

and thorough, but takes more time. This is why screening takes place before assessment. in order to 

quickly identify those who may be at high risk and thus in need of intervention. A follow-up assessment with those who are detected during screening will confirm, deny, and/or expand on the needs 

of an individual. Screening is less resource-intensive and tells you where to prioritize your more 

resource-intensive procedures (such as assessment and meals) in order to have the greatest impact. 
Reasons for Use of the 

HDM Prioritization Tool 

Development of the 

HDM Prioritization Tool

Consultation with 

Community Programs 

Selection of the Three 

Criteria for Prioritization 

1. Prioritize initial and follow up services. The priority level generated by the tool will tell you

who is at the greatest need for your services and allows you to provide the most appropriate

type of service to meet the individual's need. People at a higher priority level should receive initial 

or follow-up assessments first, and may need immediate access to resources, as they are likely to 

be the most food insecure. Regardless of waitlist status, the priority level provides information on

what additional or alternative services may be beneficial to a client. Using the tool this way can

help your program make the greatest impact with the limited resources it has.

Demonstrate need for funders and policy makers. Using the HDM Prioritization Tool to track the 

priority level for each client is a quick way to generate a profile of the needs of the population 

you serve, and how many of your clients are high priority. This can demonstrate to funders and 

policymakers the importance of dedicating resources to your program, in order to meet the needs 

of your clients. 

Indicate the need for outreach. The Older Americans Act requires HDM programs to reach 

those with the greatest need and to address food insecurity. This tool can help identify whether 

your program is meeting these goals or whether there may be persons in the community who are 

more food insecure and yet not receiving services. 

2. 

3. 

In the early stages of developing the tool, researchers from the University of Maryland, the nutrition director at the Maryland Department of Aging, and six nutrition program managers from Area 

Agencies on Aging throughout Maryland formed a workgroup around HDM prioritization. The goal was 

to work towards a standardized method for objectively assessing an applicant's need for a meal. The 

workgroup had several meetings to discuss HDM prioritization, and over the course of these meetings, 

the risk factors and categorization criteria for the HDM Prioritization Tool were established 

The basis for the selection of the risk factors used for prioritization is the impact they may have on the 

ability of an older adult to eat a healthy diet. The ultimate goal of the HDM program is to make a healthy 

meal available to those who would not otherwise be able to get one. Therefore, all risk factors identified 

in the literature that can lead to poor diet. and that may be remedied by a healthy meal delivered to the 

home, were identified and included in the prioritization tool. The three factors that specifically indicate 

the need for a home-delivered meal are: 

1. if hot meals can be prepared, whether by the individual or by a reliable helper 

(such as family or hired homecare) 

economic access (being able to afford food) 

physical access (being able to get food into the home, either independently or with help). 

2. 

3. 

There may be other factors that affect whether or not a client is obtaining adequate nutrition (such as 

depression or dental health); however, these factors may not necessarily be addressed by a home-delivered meal, and so they are not considered when prioritizing a client for these services. For example, if 

someone has poor nutrition because they have trouble chewing, a home-delivered meal will not improve 

their health if they cannot chew it. If such risk factors are identified, the client may be referred to services 

that can help address the issue (see the section titled "Creating a referral resource for your program"). 

3 
4 

Reasoning Behind 

Each Priority Level 

The three criteria measured by the tool are combined into 5 different priority levels. The following 

describes each priority level and the reasoning behind the ranking system. The priority level ranking 

assumes that there are limited spots for meals. If there are no limits on meal availability, clients should 

be added to the program first-come-first-served (see the section titled "Recommended Actions Based 

on Each Priority Level"). 

Level A 

Applicants who are categorized into priority level A are unable to prepare meals and do not have help. 

They are considered the highest priority: even if they are able to afford groceries and get them in their 

homes, it is unlikely that they can consistently eat a healthy diet because they are ultimately unable 

to prepare their food. If there is a waiting list, these individuals are priority for follow-up assessments 

and service. 

Level B 

Applicants who are categorized into priority level B are able to prepare meals (with or without help), 

but cannot get groceries into their home and are economically food insecure. If space is available on 

the program, HDM programs could deliver affordable meals. However, if there is a waiting list, these 

individuals may get by if they can obtain both financial assistance and grocery delivery. 

LevelC 

Applicants who are categorized into priority level C are able to obtain groceries and prepare meals 

(with or without help), but are economically food insecure. If HDMs are available, this is an affordable 

way for these individuals to get healthy meals. However, if there is a waiting list. these individuals 

would be able to obtain and prepare meals if they had financial assistance, such as the Supplemental 

Nutrition Assistance Program. 

Level D 

Applicants who are categorized into priority level D are economically food secure, able to prepare 

meals (with or without help), but have difficulty getting groceries into their home. If there is not 

funding to place them on the HDM program, these individuals would be able to prepare meals if they 

receive help with getting groceries (such as from a grocery delivery service). As they are not economically food insecure, they may be able to afford these services from a local grocery store, especially if 

someone is available to assist them in setting up these services. 

Level E 

Applicants who are categorized into priority level E are economically food secure and have the 

ability to get groceries into the home and prepare meals, either with or without help. These individuals 

are eligible for HDMs because they fulfill the basic requirement of the Older Americans Act Nutrition 

Program (being homebound and 60 years of age or older). However, since they are not economically 

food insecure, and are physically able to get and prepare food or have help, they may be considered 

the lowest priority and, in case of limited funds, can be placed on the waitlist and/or referred to 

other services. 
How to Use the Tool 

When the Tool Should 

be Used 

The Different Methods 

of Using the Tool 

Before you use the tool, check whether the person is eligible to receive HDMs based upon your organization's 

criteria. In general, this means the person must be 60 years or older and be homebound. The spouse of an 

eligible person may also receive meals. 

The HDM Prioritization Tool is meant to be used as a screening tool. It should be administered by phone as soon 

as an applicant calls in or is referred to the program. The best method for administration is to incorporate the 

tool into your program's intake procedures. Each program can determine when it is the best time to ask questions 

during the intake conversation. 

Many programs repeat the screen once a home visit occurs. While all of the questions don't need to be repeated, 

staff can check that the first screen collected accurate information. If you receive additional information in a 

follow-up assessment that contradicts the priority level assigned during the screening, the priority level may be 

adjusted based on this information. The client may not have understood the question, or may have represented 

their abilities in a way that is contradictory to what your staff member sees in the assessment. Additionally, their 

status may have changed between the screening and the assessment. For example, if a client that was screened as 

priority level A has obtained a home health aide who cooks for them each day, they are no longer priority level A 

and you should ask the additional questions in the screener to determine if they are priority level B, C, D or E. 

Staff members have access to both a paper copy of the screening tool, a Microsoft Excel form, and a mobile 

application. Any of these can be used to calculate the priority level for a client. The following instructions 

outline each method. 

Paper Tool 

The questions are on one sheet of paper and can be used as follows: 

1. Read the introductory statement

Ask Question la about meal preparation and mark the client's answer. If the Answer to Question la is "No",

you will also ask Question lb. If the client's answer is again "No", stop the questionnaire. This client is

considered priority level A and no further information is needed.

If the client's answer to Question la or lb is "Yes", continue to the next set of questions (Questions 2a-f)

about ability to afford food. Ask these 6 questions and mark down the client's answers.

Ask the Question 3 about ability to get groceries and mark the client's answer.

Finish your intake conversation with the client.

After you finish speaking with the client you can calculate their priority level as described below.

2. 

3. 

4. 

5. 

6. 

• As mentioned in #2 above, if they are priority A, you are finished with the screener.

Otherwise, look at the point values noted next to each answer for Questions 2 a-f. Add up these points

and write the total in the red box.

Look at the client's answer to Question 3, the final question. Below the answer are two boxes, each with

a point range next to it. Select the box with the point range that contains the point total you wrote in the 

red box. This will tell you the priority level for this client. 

• 

• 

Excel Form 

You can access a Microsoft Excel form that displays the questions, allows you to select the client's answers, and 

then calculates the client's priority level and stores it in an Excel sheet. It is simple to use and stores all of your 

client's priority levels in one place. To obtain this version of the tool, send an email to nsahyoun@umd.edu and 

amvaudln@gmall.com, and include the name and location of your program. You will receive an email with the Excel sheet. 

Mobile Application 

There is a mobile application ("app") available that acts as a calculator to generate a client's priority level. You 

can also obtain an Airtable spreadsheet: a spreadsheet that is stored on the Airtable website, and is linked to 

your app so that it will collect the results of the screener for your program. These are generated individually per 

program, and your Airtable spreadsheet will be protected by a user name and password that you generate. 

5 
Instructions for Using 

the Mobile Application 

6 

To obtain an app and spreadsheet for your program's use, send an email to nsahyoun@umd.edu and 

amvaudin@gmall.com and include the name and location of your program. You will receive an email 

with a link to the app, and an email with instructions for downloading the app as well as accessing 

the Airtable spreadsheet that is linked to it. 

1. Open the app. The icon for the app should look like this:

2. On the screen that says "Welcome to the Home-Delivered Meals Prioritization Tool!" tap "Next"

3. Read the introductory statement to the client and then tap "Next".

The screen will now have the first question to ask the client. Read the question and select the

client's answer by tapping on it. You will automatically be taken to the next question to read.

Continue reading the questions and tapping the client's answers. Please note: the questions that

show up for you to ask may be different from client-to-client. This is because the client's answers

to some of the questions determine what additional questions need to be asked to calculate their

priority level. For example, if the client answers that they are unable to cook, and then that they

do not have help, the questionnaire will end. The app will determine this for you, and will show

you the correct questions to ask each client.

If you arrive at the food insecurity questions page, make sure to select an answer for every

question and then scroll down to the bottom of the page and tap "next" to continue. If you do

not answer every question, the priority level cannot be calculated.

If you have to go back to a previous page to change an answer, tap the "back" button at the

bottom of the page you are on. Please note that this will erase all answers for questions that

come after the page you go back to, and you will have to answer these questions again.

After you have selected answers for all of the questions, you will reach a page with spaces to

enter the name of the client and their county. Tap each text box to type in the appropriate information, then tap "Submit". This step is essential for the app to calculate the client's priority level

and submit the collected information to the Airtable spreadsheet. Once you tap "Submit", the

next screen shows you the priority level that has been calculated:

Tapping "Submit" multiple times may result in duplicate records in the Airtable spreadsheet.

If this happens, you can delete the extra record from the spreadsheet.

Tap "Restart" to enter the information for another client. If you are finished, close the app.

To access the information collected by the app, open the Airtable link that was sent to you when

you requested the app. Follow the directions to create an Airtable account for access to the

spreadsheet. Make sure to record your username and password for future access.

Your spreadsheet will be under "Bases shared with me" and will have the same name as the app.

Click the icon to open and view the spreadsheet. which will contain the results from all of the

times you have used the app.

To download your results spreadsheet. click the three dots symbol at the top bar and click "Download

CSV." This will download the information from the table in a file you can open in Microsoft Excel.

4. 

5. 

6. 

7. 

8. 

9. 

10.

11. 

12.
 

 

C 

Recommended Actions Based 

On Each Priority Level 

The priority level will give you information on the best actions to take for each client. Your action will 

also depend on whether or not your program has a waiting list. Below is a description of the best action 

for programs both with and without a waiting list. 

If you do not have a waiting list: 

Every applicant may be eligible to receive meals, regardless of priority level. All applicants may also 

beneft from additional services, such as those noted in the chart below. The applicant’s priority level 

will help guide you towards the appropriate additional services. It is possible these additional services 

may provide enough support to these clients so that they don’t need HDMs, which will create space for 

higher-priority individuals. However, if you have space on the program, all eligible applicants will beneft 

from receiving meals. 

If you do have a waiting list: 

Applicants should be prioritized for service based on priority level, date of application, and availability 

of a delivery route to provide the meals. Priority level A applicants are highest priority for receiving 

home-delivered meals. They should be scheduled frst for a follow-up assessment and should be placed 

next on the waiting list for service (after the other priority level A applicants who were screened 

previously, and pending route availability). Next on the waiting list should be priority level B applicants, 

in order of screening date, then priority level C applicants, etc. 

Applicants who are priority level B through E may beneft from alternative food and nutrition services 

other than HDMs. Your program may be able to facilitate assistance for these individuals that helps 

them get food, even if your program cannot provide them with meals. If these supports are suffcient 

for these applicants, they may not need HDMs, freeing up more space on your program for those who 

have the greatest need for meals. The following table shows the supports that may be helpful to clients 

in each priority level: 

LEVEL RECOMMENDED ACTION POSSIBLE ADDITIONAL OR ALTERNATIVE SERVICES

Home-delivered meals are the most appropriate support for these clients A 

Further inquiries to the applicant may reveal additional 

benefcial supports 

Financial-based nutrition support services such as SNAP 

Help with getting groceries, such as grocery delivery or 

transportation services 

B 

Financial-based nutrition support services such as SNAP 

Help with getting groceries, such as grocery delivery or D transportation services 

Further inquiries to the applicant may reveal the type of support required E 

NWL: Home Delivered Meals 

WL: Highest priority on wait list 

NWL: Home-delivered meals and suggest additional services 

WL: Second highest priority on wait list, suggest alternative services 

NWL: Home-delivered meals and suggest additional services 

WL: Third highest priority on wait list, suggest alternative services 

NWL: Home-delivered meals and suggest additional services 

WL: Fourth highest priority on wait list, suggest alternative services 

NWL: Home-delivered meals and suggest additional services 

WL: Lowest priority on wait list, suggest alternative services 

NWL= No Exsisting Wait List WL= Exisiting Wait List 

7
8 

Creating a Referral Resource 

for Your Program 

How to Document and Use 

the Results In Your Program 

Re-screening 

Each community and each state may have different services available for older adults. An assessment of 

need will indicate which services are most appropriate to assist each client. Creating a reference resource 

will help you smoothly and efficiently refer HDM clients or applicants to additional or alternative services. 

This involves collecting the names and contact information for the organizations (or people within your 

organization) who can start the process of enrolling them with these services. A suggested method is to 

create categories (financial, grocery delivery, and any other additional helpful resources, such as dental, 

mental health, insurance, etc) and list the available services and contact information. Examples of these 

resources are shown at the end of this manual. 

Maintain a record of the priority level for each client. You can do this by adding it to the information you 

keep on that client. and/or maintaining a separate spreadsheet that contains the client's name, the date 

screened, the priority level, and any other information you would like to include (for example, a column 

showing whether or not the client is on the meal program). If you are using the appor the Excel form, they 

will generate a spreadsheet for you with the results of the screener that can be downloaded and modified 

to suit your purposes. 

Looking at the priority levels of your clients can help you identify the need for additional programs or services, which can result in new partnerships or funding sources. For example, setting up a volunteer grocery 

shopping service or initiating the Commodity Supplemental Food Program may be a new program needed 

in your community. 

A spreadsheet can be used to manage enrollment in your program if you have a waitlist. If you have a spot 

open up on your meal program, you can use this spreadsheet to find the person who is at the highest priority. If you have multiple persons at the same priority level, you can choose the one who has been waiting the 

longest based on the date they were screened. And, maintaining the list can identify unmet need in areas 

where you may not have an existing HDM route. 

You can also create a report that shows the levels of need of those being served, and of those who are on 

your wait list (if you have one). This can be used to generate funding and support. If you are serving many 

people who are low priority, this may indicate the need for outreach to see if there are people who are high 

priority in your community but do not know about your services. 

This tool was developed and tested as a screening tool, and is designed to be administered to people 

who are applying for or waiting to receive meals. However, when completing annual reassessments, your 

program may wonder whether the priority level of a client who has been on the program has changed. 

There may be other opportunities for re-screening, such as after a significant change in a person's health 

or living situation (e.g., death of a spouse, return from hospital, etc.), and it is also mandatory during regular 

reassessments in some states. 

The questions in this tool have not been designed specifically for determining the priority level of people 

who are already receiving support from the program. So, when using the screening tool during a reassessment, preface the questions with the following statement: 

"The following questions are about the difficulties you might have if you were not receiving home-delivered 

meal services. Please answer the questions based on what your abilities would be if you were not receiving 

home-delivered meals." 
Sample Report from the 

Maryland Department of 

Aging Showing the 

Distribution of Priority 

Levels Across Maryland

Fiscal Year 2018 

9
 

Sample Referral Table 

from the Maryland 

Department of Aging 

Care Planning 

Components

AAA Referral Programs and Services

Food and Nutrition • Senior Center Congregate Meals

Home-Delivered Meals

Nutrition counseling, education, and care planning

Commodity Supplemental Food Program

Community food resources (pantries, etc)**

Senior Farmers Market Nutrition Program

Malnutrition workshop: Stepping Up Your Nutrition

Post-discharge, medically-tailored meals

•

•

•

•

•

•

•

Housing • Assisted Living (including SALGHS)

Ramp Assistance

Home Modification

Assistive Technology

Durable Medical Equipment 

Congregate Housing Services Program

•

•

•

•

•

Transportation • County or Regional Transit

Cab/Bus Vouchers

Senior Village 

Community for Life

•

•

•

Financial Application assistance for financial aid:

• SNAP

Medicaid

State Health Insurance Program (SHIP_

Energy-assistance programs

Income-tax assistance

Medicare Part A, B, C, D

•

•

•

•

•

• Medicare Billing, Appeals, Denials, Grievances

Medicare Fraud Assistance 

Oral nutritional supplements (Ensure, etc) 

Prescription assistance

Assistance for dental, eye care, hearing aids

•

•

•

•

Utilities • Low-Income Home Energy Assistance Program (LIHEAP)

Electric Universal Service Program (EUSP) 

Universal Service Protection Program (USPP)

Utility Assistance (other)

•

•

•

Personal Safety • Elder Abuse

Legal Assistance 

Emergency Response Systems

Falls Prevention (Stepping On, Matter of Balance, Tai Chi for

Better Balance)

Arthritis foundation classes (Walk with Ease)

•

•

•

•

10
In-Home Care 

Social Supports 

Mental Health 

Health Care Referral

Employment 

Health Education 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Sitters and in-home care services (personal care, chore service) 

Home Care agencies 

Community First Choice 

Senior Care 

Home-delivered meals 

Dietitian referral 

Senior Village 

Senior Center (exercise, socialization, Congregate Meals) 

Telephone Reassurance 

Support Groups: Caregivers, Renal, Stroke, ALS, Parkinson's 

Adult Day Care 

Volunteer opportunities 

PEARLS: Program to Encourage Active, Rewarding Lives 

Enhance Wellness 

Healthy IDEAS 

Behavioral Health Referral (Core Service Agency or Health 

Department) 

Primary Care Physician 

Clinics: Dental, Eye, Physical Therapy 

Community Health Worker 

Adult Medical Day Care 

Local health department 

Home care agencies 

Medical supplies 

Senior Employment 

AAA volunteer coordinator 

Community volunteer opportunities 

Self-management workshops: 

• Diabetes Self-Management (Spanish version available)

Chronic Disease Self-Management (Spanish version available) 

Chronic-Pain Self-Management 

Cancer Thriving and Surviving 

• 

• 

• 

• Falls Prevention (Stepping On, Matter of Balance, Tai Chi for 

Better Balance) 

SAIL(Stay Active and Independent for Life) 

Aging Mastery 

Enhance Fitness 

Lifelong Learning 

Medication Management 

Wellness Center Gym 

• 

• 

• 

• 

• 

• 

Grant funds from the Administration for Community Living (ACL), Grant Number 

90INNU0002 and the Maryland Department of Aging assisted in the development of this 

material. Its contents are solely the responsibility of the authors and do not necessarily 

represent the official views of the ACL or Department. 

11 
Developed by the College of Agriculture & Natural Resources Department 

of Nutrition and Food Science at the University of Maryland. 

Grant funds from the Administration for Community Living (ACL), Grant# 90INNU0002 and the Maryland 

Department of Aging (MDoA) assisted in the development of this material. This presentation is solely 

the responsibility of the authors and do not necessarily represent the official views of the ACL or MDoA. 

COLLEGE OF 

" AGRICULTURE 

NATURAL 

& 

RESOURCES 

DEPARTMENT OF NUTRITION 

AND FOOD SCIENCE 
 

 

 

 

Expanded Food Security Screener 

Home-Delivered Meals Prioritization Tool 

Developed by the College of Agriculture & Natural Resources Department of Nutrition and Food Science 

at the University of Maryland. 

WHO should use this tool? 

Home-delivered meal program 

administrators that: 

A Have a waiting list or limited 

resources to serve all applicants; 

B Want to demonstrate to funders 

and policy-makers the level of 

need in their community; and/or 

C Want to understand if they are 

reaching those with the greatest 

need, or if more outreach is needed 

to identify the most food insecure. 

HOW should it be used? 

As a screening tool as early as 

possible at application or referral 

HOW are the results useful? 

The results show risk factors the 

applicant is experiencing, and the 

level of priority for home-delivered 

meal services, and may inform alternative or additional support services 

that could beneft clients. 

Screening Questionnaire 

and Point Calculator 

provided on reverse. 

The Researchers Behind this Tool 

The research design and the assessment 

model was developed by Nadine Sahyoun, 

professor of nutrition epidemiology, and 

Anna Vaudin, graduate student in the 

college’s Department of Nutrition and Food 

Science. Their work focuses on assessing 

the nutritional status of the older adult 

population and studying the relationship 

between nutrition risk factors and health 

outcomes. 

nsahyoun@umd.edu 

amvaudin@gmail.com 

agnr.umd.edu 

The Procedure 

1. As early as possible after client application/referral and determination of

elegibility for home delivered meals, the screening should be conducted via

telephone or in person.

2. Priority Level is calculated and recorded for each client:

Level A: Highest priority for service and follow-up assessments.

Levels B, C, D, and E: See below for recommendations of support service.

Priority Levels and Recommended Nutrition Service(s) 

 LEVEL CRITERIA PRIORITY LEVEL REASONING SERVICE 

A Unable to cook and 

no reliable help 

Even if food is affordable and in 

the home, it cannot be prepared, 

therefore, it is unlikely there are 

consistent healthy meals. 

Home-Delivered Meals

PRIORITIZED on wait 

list if resources are 

limited. 

B Can cook or has help. 

Economically food 

insecure. Cannot 

obtain groceries. 

Affordablilty and access to 

groceries are both issues. 

With fnancial support and grocery 

delivery, healthy meals could be 

prepared at home. 

Home-Delivered Meals

ALL clients should 

receive home-delivered 

meals if resources are 

available. 

If there is a wait list for 

home-delivered meals 

clients should be

prioritized B - E. 

Regardless of wait list 

status, all clients may 

beneft from additional 

nutrition services: 

USDA Supplemental 

Nutrition Assistance 

Program (SNAP) 

Grocery Delivery 

Services 

Additional State 

or Local Services 

as Needed 

C Can cook or has 

help. Economically 

food insecure. Can 

obtain groceries. 

Affordability is the only issue, 

can obtain groceries and prepare 

healthy meals at home. 

D Can cook or has 

help. Economically 

food secure. Cannot 

obtain groceries. 

Groceries and food delivery are 

affordable, not physically limited 

from food preparation (or help is 

available) therefore healthy meals 

can be prepared at home. 

E Can cook or has 

help. Economically 

food secure. Can 

obtain groceries. 

These individuals fulfll the basic 

eligibility requirements for the home 

delivered meal program; however, 

they are able to afford and obtain 

groceries, and are not physically 

limited from food preparation (or 

help is available), therefore healthy 

meals can be prepared at home. 
 

 

 

 

 

 

 

 

 

	 		 	 

	 		 	 

	 	 

 

	 		 

 

 

Expanded Food Security Screener

Home-Delivered Meals Prioritization Tool 

1 a If you had groceries available, would you

2

be able to use them to prepare hot meals? Client Name 

The following questions ask about your ability to YES NO 

Proceed to Question 2 Proceed to Question 1b get food and prepare meals. You are eligible for 

the service regardless of your income. 

b Do you have reliable help with meal preparation?

Proceed to Question 1a YES 

Proceed to Question 2 

NO >STOP 

Applicant is a Level A Priority

During the last month... 

a ...how often was this statement true? The food that we bought just didn’t last, and we didn’t

have money to get more. 

Often (1 point) Sometimes (1 point) Never (0 point) 

b ...how often was this statement true? We couldn’t afford to eat balanced meals.

Often (1 point) Sometimes (1 point) Never (0 point) 

c ...did you or other adults in your household ever cut the size of your meals because there wasn’t

enough money for food? 

YES (1 point) NO (0 point) 

d ...did you or other adults in your household ever skip meals because there wasn’t enough money for food?

YES (1 point) NO (0 point) 

e ...did you ever eat less than you felt you should because there wasn’t enough money for food?

YES (1 point) NO (0 point) 

f ...were you ever hungry but didn’t eat because you couldn’t afford enough food?

YES (1 point) NO (0 point) 

Add the points from questions 2a – f and enter it here:

3 Are you able to get groceries into your home when you need them? 

YES – Select the point range below: NO – Select the point range below: 

0 – 1 Points Level E Priority 

2 – 6 Points Level C Priority 

0 – 1 Points LeveL D Priority 

2 – 6 Points Level B Priority 

See chart on page one for explanation of Priority Levels and recommended service(s). 

Developed by the College of Agriculture & Natural Resources Department 

of Nutrition and Food Science at the University of Maryland. 

Grant funds from the Administration for Community Living (ACL), Grant # 90INNU0002 and the Maryland 

Department of Aging (MDoA) assisted in the development of this material. This presentation is solely 

the responsibility of the authors and do not necessarily represent the offcial views of the ACL or MDoA. 
Division of Services for Aging and Adults with Physical Disabilities 

Home Delivered Meals Criteria Guide 

Client Name: Initial Date of Assessment: 

Home Delivered Meals Criteria Guide Date Date Date Date Date Date Date Date

I. ADL's (Activities of Daily Living) I A D 

a. bathing

b. walking

c. dressing

d. toileting (bowl/bladder control)

e. transferring

f. eating

II. IADL's (Independent Activities of Daily Living)

a. use telephone

b. shopping

c. meal prep

d. housekeeping

e. travel/transportation

f. following medication directions

g. managing own finances

0 3 5 

0 3 5

0 3 5 

0 3 5 

0 3 5 

0 3 5 

I A D 

0 3 5 

0 3 5 

0 3 5 

0 3 5 

0 3 5 

0 3 5 

0 3 5 

ADL/IADL SUM

III. Prior Nursing Home (or Rehabilitation Facility) Admission

a. within past year

b. within past 5 years

c. greater than 5 years ago

5 

3 

1 

IV. Cognitive Impairment (0=never 1=sometimes3=often)

a. Do you forget to eat?

b. Do you ever begin cooking and then forget you started?

c. Is preparing food confusing or mentally challenging?

V. Diagnosed Mental Disorder (bipolar, schizophrenia, anxiety d/o, etc.) Please 

score if actively problematic and interferes with the ability to shop, prepare or eat

meals. 0=not a problem 3=sometimes a problem 5=often a problem

VI. Living Arrangement/Caregiver Availability/Meal Support Please score degree

of supportive care available (in regard to meals) 0=always 1=sometimes 3=no 

support available

VII. Annual Income

a. at or below current poverty level 3 

b. above the current poverty level 0

VIII. Prior Acute Care Hospitalization

a. Within past 0-4 weeks 5 

b. Within past 1-3 months 3 

c. Within past year 1 

IX. Age

a. 91+ 5 

b. 76-90 3
Date Date Date Date Date Date Date Date

X. Health

Please score if actively problematic and interferes with the ability to 

shop, prepare or eat meals. 

0=not severe 3=moderately severe 5=severe 

a. diabetes (brittle & uncontrolled) 0 3 5

b. hypo or hypertension/heart disease (CHF,

cardiomyopathy, etc.)

0 3 5 

c. cancer 0 3 5 

d. stroke 0 3 5 

e. COPD 0 3 5 

f. renal failure/dialysis 0 3 5 

g. neurological (tremors/palsy/seizure disorder) 0 3 5 

h. physically debilitating condition (please specify): 0 3 5 

i. level of visual impairment

0 3 5 

XI. Fall Risk.

Scoring: 0=no risk 3=moderate risk 5=high risk

0 3 5 

XII. <60 Recognized Spouse NO YES 

XIII. <60 SSI Living in Home NO YES 

XIV. Eligible Spouse >60 NO YES 

<40 refer to Congregate >= 40 refer for HDM TOTAL SCORE 

Recommended for HDM (y=yes, n=no)

Initials: 

1. Do you believe client would benefit from socialization

at senior center? Comments:

NO YES 

XIV. Outreach Worker Additional Thoughts/Comments:

2. Does client need transportation?

NO YES 

3. Do you believe HDM are needed?

why/why not: NO YES 

XX. Food Insecurity Screen: ‘I’m going to read you two statements that people have made about their food situation. For each

statement, please tell me whether the statement was often true, sometimes true, or never true for your household in the last 12

months’:

1. ‘We worried whether our food would run out before we got money to buy more.’ OFTEN SOMETIMES NEVER 

2. ‘The food that we bought just didn’t last, and we didn’t have money to get more.’ OFTEN SOMETIMES NEVER 

If ‘often or sometimes’ is selected for either question, client would benefit from referral to: SNAP, food banks or pantries, or other community-based food assistance resources. 
-

-

-

-

-

-

-

-

-

-

-

-

-

MNA-SF- Mini Nutritional Assessment Short Form 

Guided Interview 

A 

Has food intake declined over the past three 

months due to loss of appetite, digestive 

problems, chewing or swallowing difficulties? 

Ask Client: 

"Have you eaten less than normal over the past 

three months?" 

If so, "is this because of lack of appetite, 

chewing, or swallowing difficulties?" 

If yes, " have you eaten much less than before or 

only a little less?" 

Score 

0= Severe decrease in food intake 

l= Moderate decrease in food intake 

2= No decrease in food intake 

B 

Weight loss during the last 3 months? Ask Client 

" Have you lost any weight without trying over the 

last 3 months?" 

"Has your waistband gotten looser?" 

" How much weight do you think you have lost? 

More or less than 6 pounds? " 

Score 

0= Weight loss greater than 6.6 

Pounds 

l= Does not know 

2= Weight loss between 2.2 and 6.6 

Pounds 

3= No weight loss 

Note: "l= Does not know" this means client does not 

know if they have lost weight. Not that they have lost 

weight but don 't know how much. If they have lost 

weight, they must choose more or less than 6#). 

Though weight loss in the overweight elderly may be 

appropriate, it may also be due to malnutrition. When 

the weight loss question is removed, the MNA-SF 

losses its sensitivity, so it is important to ask about 

weight loss even in the overweight. 

C 

Mobility? Ask Client or Caregiver 

"Are you presently able to get out of bed/chair?" 

Score 

0= Bed or chair bound 

1=Able to get out of bed/chair/ but 

does not go out 

2= Goes out 

"Are you able to get out of the house or go 

outdoors on your own?" 

* Question developed to address "frailty''; consider 

ability to sit-stand or rise from chair; meeting criteria 

such as self-reported exhaustion, hand grip 

weakness, slow walking speed, low physical activity; 

frailty with overweight & obesity 

D 

Has the client suffered psychological stress or 

acute disease in the past three months? 

Ask Client/Professional judgment 

"Have you suffered bereavement recently?" 

"Have you recently moved from your home?'' 

"Have you been sick recently?" 

Examples of acute disease- pneumonia, 

appendicitis, flu, infection, broken/fractured 

bones; other- hospital admissions for CHF, 

Diabetes. 

Examples of psychological stress- marital 

problems, death of a loved one, abuse, financial 

crisis, health problems. 

Score 

0= Yes 

2= No 

Last Revised : April 2018
 Priority: 

1.

2.

3.

Malnourished 

At risk of malnutrition w/ wt loss

At risk of malnutrition w/out wt loss

E 

Neuropsychological problems? 

Score 

0= Severe dementia or depression

l= Mild dementia 

2= No psychological problems 

F 

Calf Circumference (CC) in cm 

0= CC less than 31 

3= CC 31 or greater 

Note: 

• Measure calf even if there is 

evident edema (swelling) 

Measure calf even if client has 

stockings for edema 

If the left leg is amputated, 

measure the right leg. 

A calf measurement must be 

obtained to complete the MNA 

• 

• 

• 

Explaining calf circumference to clients: 

Screening Score (max. 14 points) 

12-14 points: Normal nutritional status 

8-11 points: At risk of malnutrition 

0-7 points: Malnourished 

Ask caregiver/professional judgment 

The client's caregiver can provide information about 

the severity of the client's neuropsychological 

problems (dementia). 

All depression - any form (mild or severe) should 

always be scored a 0. 

Post traumatic stress disorder -rate according to their 

cognitive function . 

If they are depressed, rate a 0. 

If they have no real cognitive impairment, rate a 2. 

Intellectual Disability -relate according to the level. 

If they are severely intellectually disabled and cannot 

care for themselves, rate a O; 

If moderately intellectually disabled and can do self 

care, then score a 1. 

Measuring Calf Circumference 

1. The client should be sitting with the left leg 

hanging loosely or standing with their weight 

evening distributed on both feet. 

Ask the client to roll up their pant leg to uncover 

calf. 

Wrap the tape around the calf at the widest part 

and note the measurement. 

Take additional measurements above and below 

the point to ensure that the first measurement 

was the largest. 

An accurate measurement can only be obtained if 

the tape is at a right angle to the length of the 

calf. 

2. 

3. 

4. 

5. 

Adapted from the MNA-SF: Nestle Nutrition Institute; Adapted by Seanna Marceaux, MS RON LD at 

Meals on Wheels Central Texas, Austin, TX 

Last Revised : April 2018 

"One way we check your nutritional health 

is by measuring your calf. When we don't 

get enough nutrition, we lose muscle. The 

first place we lose muscle is in your calf. 

May I measure your calf?"
USDA Food Security Questionnaire 

Ask Client: Response Score 

1. The food that (I/we) bought just 

didn’t last, and (I/we) didn’t have

money to get more. 

1=Often True 

1=Sometimes True 

0=Never True 

0=Don’t Know or Refused

1=Often True 

1=Sometimes True 

0=Never True 

0=Don’t Know or Refused

2. (I/we) couldn’t afford to eat

balanced meals. 

3. In the last 12 months, since last 

(name of current month), did 

(you/you or other adults in your 

household) ever cut the size of 

your meals or skip meals because

there wasn’t enough money for

food? 

1=Yes 

0=No 

0=Don’t Know or Refused

3a. How often did this happenalmost every month, some 

months but not every month, 

or in only 1 or 2 months? 

1=Almost every month 

1=Some months but not every

month 

0=In only 1 or 2 months 

0=Don’t Know or Refused

4. In the last 12 months, did you 

ever eat less than you felt you 

should because there wasn’t 

enough money for food? 

1=Yes 

0=No 

0=Don’t Know or Refused

5. In the last 12 months, were you 

ever hungry because there wasn’t 

enough money for food? 

1=Yes 

0=No 

0=Don’t Know or Refused

Total: 

Scoring Guide 

0 = High Food Security 

1 = Marginal Food Security 

2-4 = Low Food Security 

5-6 = Very Low Food Security