Food Insecurity Webinar Series

Webinar 4

Referrals and Interventions for Older Adults with Food Insecurity

Kathryn Tucker, MS, RD, LD, ACL Contractor

Jennifer Raymond, JD, MBA, Chief Strategy Officer, AgeSpan

October 20, 2022

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Objectives

Identify who can refer participants that are food insecure.

Understand how to develop “warm handoffs” to improve referral engagement.

Identify intervention options available to those who are food insecure.

Provide potential referral options for networks to use when food insecurity is identified.

Identify potential training resources available to providers.

Speakers

Kathryn Tucker 

Consultant

ACL

Jennifer Raymond

Chief Strategy Officer

AgeSpan

What is Food Insecurity?

Food insecurity is defined as “the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.”

Level of Food Security

Low food security 

Poor nutrition quality and limited variety. Little or no indication of reduced food intake.

Very low food security

Reports of skipping meals or not eating. Has reduced food availability.

Who Can Identify Food Insecurity?

Aging and Disability Resource Center staff

Case managers

Telephone reassurance callers

Transportation providers

Meal deliverers

Volunteers

Activity leaders

In-home services providers

Evidence-based program leaders

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What is a Warm Handoff?

A warm handoff is a handoff that is conducted in person, whenever possible, between two agencies, in front of the participant and family if present.

Importance of a Warm Handoff

Engages the participant and family as part of the team.

Ensures participants receive accurate information.

Prevents those in need from falling through the cracks.

Builds relationships and communication between partners.

Provides a safety check for participants, ensuring everyone is on the same page about their needs.

Using Warm Handoffs in Your Organization

Personally introduce participants to others in your organization

Utilize in-person meetings, telephone conferences, or a virtual setting.

Organizations you have referred to can utilize a warm handoff to refer to your agency.

Use with health care providers, food pantries, SNAP, dietitians, and other community-based organizations.

Scenario 1

Ms. Jones has been coming into the senior center to receive congregate meals. She tells senior center staff she will be unable to come back for a few weeks due her car breaking down. She is worried she will not have enough food in the house to eat regularly.

Staff give her a number for the Area Agency on Aging to sign up for transportation and the number for the food pantry. They are very kind and tell her to call those numbers.

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Scenario 1 Question

Did they handle the situation correctly?

YES

NO

Scenario 1 Results 

Did they handle the situation correctly?

NO

Staff could have called the AAA to discuss Ms. Jones’s situation while she was there with them. Then, they could have worked on signing her up for transportation to the center to continue participating in congregate meals. Alternatively, they could have switched her over to home-delivered meals or other nutrition services, like receiving a food box. 

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Scenario 1 Results: What Else Could They Have Done?

Senior center staff could have also called the food pantry to introduce them to Ms. Jones and explain her situation. Then, they could have handed the phone to Ms. Jones so she could speak directly with food pantry staff to discuss next steps. They may also have been able to talk with her about her SNAP benefits. 

Scenario 2

Mr. Smith comes into the congregate meal site to get a meal.  

Staff explains that he can’t be put on a waitlist for a meal because he needed to sign up the day before.  

Mr. Smith nods and leaves. 

Scenario 2 Question

Did they handle the situation correctly?

YES

NO

Scenario 2 Results 

Did they handle the situation correctly?

NO

Staff could have helped Mr. Smith sign up for the next day's meal. Then, they could have introduced him to other participants and shown him around the facility. Additionally, they could have introduced Mr. Smith to other staff members to make sure he is connected to other services. They could have then provided a warm handoff to a local food pantry if needed and followed up with Mr. Smith the next day. 

Referrals and Interventions

Demonstrate value of community-based organizations and community services to internal and external stakeholders

Interventions and Referrals within the OAA

Senior Nutrition Program

In-home services

Telephone reassurance

Transportation

Case management

Health screenings

Health promotion and evidence-based programs

Caregiver programs

External Referral Opportunities

SNAP, SNAP-Ed programs, or other benefit programs

The Commodity Supplemental Food Program and Senior Farmers’ Market Nutrition Program 

Food pantries and grocery delivery programs

Food “Farmacy” programs and community gardens

Case management and Medicaid Waiver programs

Health care providers and care transition programs

Senior community service employment programs

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Types of Referral

Health care provider or case manager

Internal registry

Self-referrals

Referral Workflow

Clarify roles in outreach enrollment process

Identify who is responsible for:

Scheduling workshops

Contacting key staff

Enrolling participants

Collecting and entering data

Following up with participants

Develop HIPAA compliance procedures

Technology-Based Referral Systems

Charity Tracker

Holon Solutions (Partners 4 Community Health)

Activate Care

Vinculo (At Your Service)

WeWa.life LLC (WeWaLife)

Harvard Pilgrim Healthcare (CareRS)

Tracking Data

Outreach efforts

Common needs

Attendance

Completion rates

Satisfaction surveys

Outcomes

Agency & Community Action

Promote “No Wrong Door” approach.

Increase integration of technology in program.

Meet needs of a diverse population.

Ensure I&A services and ADRCs provide information to participants.

Increase social service professionals’ understanding of role.

Provide nutrition education and shopping assistance.

Participate in community campaigns.

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Nutrition and Aging Resource Center

Resources include:

Food insecurity information

Consumer information

Tip sheet for providers

Guides

Webinars

Innovation programs

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Training Resources-FRAC

Food Research & Action Center Free Online Course to Help Health Care Providers Address Senior Hunger

Training Resources-NIFA

National Institute of Food and Agriculture Nutrition Security Webinar Series

Takeaways

Identify those who are food insecure.

Develop internal and external referral options.

Identify interventions available.

Educate staff on using “warm handoff” techniques.

Follow participants throughout services.

Collect data and measure outcomes.

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Food Insecurity Webinar Series & Educational Topics

NRCNA website at https://acl.gov/senior-nutrition/events-presentations

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July 2022: Combating Food Insecurity with Collaboration

September 2022: Identifying and Screening for Food Insecurity

October 2022:Referrals and Interventions for Older Adults with Food Insecurity

August 2022: State Units Food Insecurity Promising Practices

For Dietitians

To receive CPEU credit, go to the CDR website.

Log the program:

Step 2: Activity Log under Activity Type 170 - Lecture/Seminar or Activity Type 171 - Teleseminar/Webinar

Claim 1 CPEU for every 1 contact hour spent during the activity. 

Save all documentation of the webinar and attendance for records.

Questions?

Kathryn Tucker, MS RD LD, Kathryn.tucker@acl.hhs.gov

Jennifer Raymond, JD, MBA, AgeSpan, jraymond@AgeSpan.org

Education Resources

NRCNA Resources:

Assistance with Food vs. Meals Infographic

Grocery Delivery Options by County Template

Partnerships with Foodbanks and Other USDA Programs

Using Groceries and Other Nutrition Services to Meet Senior Needs

Other Resources:

Eldercare Locator

Implementation Quick Start Guide: Warm Handoff (AHRQ)

National Aging and Disability Transportation Center

Social Work Case Management Software Options (Capterra)

Warm Handoffs: A Guide for Staff (AHRQ)

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