1

2017 Grantee 

Improving Client Service 

Through Advanced DataCard Technology in Missouri 

Summary: 

To improve service delivery and cost-effectiveness of nutrition 

programs for older adults at risk of malnutrition, the MidAmerica Regional Council and Aging Ahead Area Agency on 

Aging deployed artificial intelligence-enabled speakers, 

Amazon Echo Show, to clients' homes to reduce access barriers 

to good nutrition.
2 

Table of Contents

Intervention Manual................................................................................... 3

Summary Brief ............................................................................................... 4
3 

Intervention Manual

Manual containing all participant training and 

communications materials for intervention 

implementation. 
Version: FINAL 1

ACL Innovations in Nutrition Grant

Intervention Manual

Connecting Home-Delivered Meals Clients to Food Pantry Resources Using Smart Speaker 

Technology

I. Participant identification and recruitment

II. Measures

III. Device installation and participant training

i. Steps for delivering operable device to client’s home

IV. Food ordering and delivery process 

i. Food Ordering

ii. Food Order Processing

iii. Food Delivery 

V. Service continuity

VI. Future Development

Appendices

A. Informational Flier

B. Call Script

C. Informed Consent Form 

D. Technology Use Agreement

E. Measurement Battery

F. Participant Manual
Version: FINAL 2

Participant Identification and Recruitment

Participants were recruited and selected from current home-delivered meal 

recipients by community partner organization, Shepherd’s Center Central (SCC). All 

clients are presumed to be high-risk because of current enrollment in MARC’s Older 

American Act Title IIIB Home-Delivered Meals program.

SCC sent out an informational flier (see Appendix A) about the project to home 

delivered meal clients who receive their meals from volunteer delivery drivers. 

Interested clients contacted SCC for more information or to schedule an 

appointment to complete the pre-intervention measurement and to sign the 

informed consent form. SCC home delivered meal clients also received information 

about the project during their annual in-home assessments, and asked if they would 

like to participate in the program. 

Due to changes with the SCC agency, recruitment was varied throughout the project period, 

and more participants were needed. Therefore, the recruitment area was opened up to all 

of Jackson County, Missouri. Additional participants were identified by calling Older 

American Act Title IIIB Home-Delivered Meals program participants, explaining the 

project, and asking if the would like to participate. The call script can be found in 

Appendix B. 

Interested participants were asked if they currently had wireless internet in their 

home. If not, they were informed that MARC could provide it to them. The 

participants were then scheduled for a time to complete the pre-intervention 

measurement, sign the project informed consent document (see Appendix C), the 

technology use agreement (see Appendix D), and have the Amazon Echo Show set 

up in their home.

I. Measures

A measurement battery (see Appendix E) was taken upon initial enrollment, and 

upon conclusion of the participation in the project (2 measurement periods). 

Shepherd’s Center Central and MARC completed the measurement battery with 

participants. The measurement packet should be clearly marked as pre-intervention 

or post-intervention. As indicated on the measurement forms, some questions will 

only be asked at either pre- or post-intervention.

II. Device installation and participant training

Amazon Echo Shows were ordered, catalogued, and tracked by MARC.
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SCC and MARC shared responsibility for device installation and training, during the 

pre-intervention measurement session. A participant manual has been developed 

and distributed to increase comfort and understanding of the intervention, and use 

of the device (Appendix F). 

For homes without wi-fi, or internet, a wireless hot spot device was provided to the 

participant. 

Steps for delivering operable device to client’s home

1. New client is identified.

2. Shepherd’s Center Central (SCC) or MARC generates a new email address 

for the client –even if client has a personal email. Email is how their 

account is authenticated. 

▪ Kcpantry###@marcaging.org (### = client ID number 001...002...003)

▪ Password: 53Y#vghPqRHx

▪ Note: Set administrative (showmepantryorder@gmail.com) email as 

recovery email address. Password: Aclgrant2018

3. Use newly created email account to set up an Amazon account (use the 

same password).

4. Create new user in the dashboard (backend database) KC Show Me 

Pantry Dashboard

Their level of access is “user” not “administrator” Showmepantry.org/dashboard

• Manage Users

o add new user

• Make note of log in info

o Username: kcpantry###@gmail.com

o Password: generated by dashboard

5. Enable skill 

6. Log in to Amazon using newly created account using PC

7. Log in to alexa.amazon.com using PC

8. Search for ShowMe Pantry skill, enable (beta test only: log-in using 

information provided in beta test invitation)

9. Plug in device - Amazon Echo Show 

10. Go through the prompts

11. Connect to Wi-Fi

12. Log-in to the device using assigned Amazon information

13. Test to see if ShowMe Pantry skill has been enabled on the device.

14. The device is ready for deployment and can be taken to the user.
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15. At deployment, the user is trained on appropriate use.

III. Food ordering and delivery process 

Food Ordering

Food ordering can occur twice each month for the 3-month enrollment period, or 6 

times maximum. Food items are delivered on the 1st and 3rd Thursday of the month. 

A protocol and calendar were developed for each participant to show them the 

maximum amount of food that they can order, and when it can be ordered. This 

protocol and calendar are within the Participant Manual (see Appendix F).

The Alexa Skill, ShowMe KC Pantry, will guide ordering according to requirements.

Clients can call MARC to check on their order status.

Food Order Processing

After submission of the order through the Alexa Skill (ShowMe KC Pantry), the order 

becomes available to MARC and SCC staff through the background database. MARC 

or SCC then checks the order for basic compliance, and submits the order to the 

food provider. When the order is fulfilled, the pantry will email MARC and SCC. SCC 

and MARC will verify the client and order at the pantry, and then make the final 

delivery to the client.

The order must be submitted by the Monday prior to scheduled delivery to ensure 

the pantry has time to prepare the order, and SCC and MARC can secure volunteers 

to make the delivery.

Database access: 

You can look at the dashboard which is the site where orders have been registered.

Go to www.showmepantry.org/dashboard

Log in with username James and password waterline

Food Delivery

Orders were delivered on the first and third Thursday of the month, by volunteers 

or, if needed, MARC staff. For each deliver routes were created based on who 

ordered and where they lived. Then this information was communicated to the 

volunteers and staff delivering food items.

IV. Service Continuity

Throughout the project, clients are fully informed that they are helping test a new 

idea, and there may be some hitches or issues that need to be resolved along the 
Version: FINAL 5

way. Moreover, clients should be notified that the service is on temporary, although 

they will continue to receive their home-delivered meal.

At post-measurement all participants are reminded once again that they remain 

clients at Jewish Family Services (JFS), the food pantry partner for this project. 

Although participants are not able to order food items via Amazon echo or have 

items delivered, they are able to have a friend or family member pick-up a pantry 

order on their behalf. Additionally, participants are provided with additional 

resources regarding food pantries and other community services, and are 

encouraged to continue use the other features of their Amazon Echo Show. 

V. Future Development

Presently, we are in conversation to support a new ACL Innovations awardee and 

transfer knowledge and product to enable efficiencies and effectiveness within their 

project. In addition, we are working with yet another ACL Innovations awardee, 

Eskenazi Health, to adapt their technology to support scaling in our region. A core 

tenet of the project was enhancing consumer choice in food items. That technology 

would offer choice even in our traditional home-delivered meals programming, and 

we are ardently pursuing an agreement with Eskenazi to develop the technology for 

our region.
Version: FINAL 6

APPENDIX A

Informational Flier

Innovations in Nutrition 

MARC 

MIO•AMERICA REGIONAL !s_hepherd'scenter 

Aging and Adult Services OF KC CENTRAL 

Jewish Family Services of ( 

Community 

Dear Meals on Wheels Participant, 

Shepherd's Center Central has a new pilot project we are working on in conjunction with the Mid-America 

Regional Council and funded through Americans for Community Living (the same partners that help to fund 

home delivered meals) to help provide easier access to food and other resources through the use of a smart 

speaker device called an Amazon Show. 

This project will provide you with the ability to order food from Jewish Family Services Food Pantry through 

the device and receive free delivery from volunteers twice per month. We are in the process of signing up 

participants and we are starting to deliver the first few devices to homes for a trial period 

No previous computer experience needed, all devices are provided free of charge. Participation in t his program does not impact your current meal delivery. 

We will provide the device to you, and train you on how to use it. Would this be a project you are interested in participating in? 

If so, please call Kayla at 816-753-7039 to schedule a time to get signed up, or if you have any questions! 

_ Amazon Show
Version: FINAL 7

APPENDIX B

Call Script

Hi this is _______________from MARC – Aging and Adult Services.

You are part of our home delivered meals program and we are looking for participants for a 

pilot project called Innovations in Nutrition.

This project would provide you with a smart speaker device called an Amazon Echo Show, and 

12-month internet access (if you don’t already have internet). Through this device you can 

order grocery items from a local pantry and have them delivered.  This project is designed to 

provide 6 deliveries over approximately 3 months.

Would this be something you are interested in?

If so, please set up a time to complete initial paperwork and take them a device. Plan for 

approximately 60-90 minutes.
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APPENDIX C

Informed Consent Form

INFORMED CONSENT FORM

Please read, and if you agree to this consent, please and sign and date at the bottom of the 

page.

Brief Project Description

Title: MA4 ACL Innovations in Nutrition Project - Technology Interventions to Improve

Congregate and Home Delivery Nutrition Programs for High Risk Seniors. The goal of this 24-

month project is to use technology interventions to improve service, delivery, and costeffectiveness of nutrition programs for older people at high risk of malnutrition. Participants

involved in this project and served by Mid-East Area Agency will participate

in the use of CHOICE Access advanced data card technology while those in the Mid-America

Regional Council area will participate in the use in-home artificial intelligence enabled speakers.

Consent

My participation in this research project is completely voluntary and I understand that I can

withdraw my participation at any time with no consequences. I recognize that participation in

this project could present potential risks including but not limited to feeling uncomfortable

sharing certain information, and marginal risk in information security as a result of activities,

products and equipment used. I release Missouri Association of Area Agencies on Aging, MidEast Area Agency on Aging, Mid America Regional Council, and their agents, representatives,

employees, volunteers and any sponsors (here forth referred to as “agencies”) from any and all 

damages, causes of action, claims and liability that might arise from my participation in this

project. I understand that I will take part in pre-and post-surveys and any information I choose

to provide before, during, or after this project will be held in strict confidence. I agree that

agencies may use and reproduce anonymously compiled survey results, including any

information I may have provided, for purposes of program evaluation, presentations,

communication and publication.

I understand that any information that can identify me will remain confidential. I hereby

understand confidential information has limited risk of identification in small sample and agree

unintentional use will not result in any liability to these parties for payment to any person or

organization, including myself. The information in this study will be used only for quality

improvement purposes and in ways that will not reveal who you are. Federal or state laws may

require us to show information to government officials who are responsible for monitoring the 

safety of this study. You will not be identified in any publication from this study.

I have read the foregoing information and I have had the opportunity to ask questions. I

understand that if I have any questions about my participation, I will inform the project director
Version: FINAL 9

Lydia Kaume, Ph.D., RDN, at 479.283.8185, consultant@professionals-consulting.com OR Site 

Directors, James D. Stowe, Ph.D, MARC, Director, Aging & Adult Services at 816.701.8263 or 

jstowe@MARC.ORG; or Aging Ahead’s, Jean Sotomayor Community Programs Specialist at 

636.207.0847 or jsotomayor@agingahead.org

_____________________________________ ________________

Signature Date

_____________________________________

Name (please print)
Version: FINAL 10

APPENDIX D

Technology Use Agreement

Mid America Regional Council

Technology Equipment Use Agreement

Staff Member assigning equipment: _______________________________

Check Out Date: _________________ Completion Date: __________________

Item Serial # Inventory Tag # Model/Brand

Amazon Echo Show

Requirements for Use:

I agree to take responsibility for technology hardware/software listed above in exchange 

for the use of the equipment and for the participation in the Administrative and 

Community Living (ACL) pilot program through Mid America Regional Council (MARC).

1. I understand I am responsible for maintaining the equipment/software in working 

condition while it is in my possession.

2. I agree to promptly report any problems with the device.

3. I agree to not remove or interfere with the serial number or identification placed 

on the device.

4. I agree and understand that if the technology equipment and/or other related 

items are stolen, vandalized, misplaced, destroyed, etc that said equipment will not 

be replaced and that my participation in the ACL Grant through MARC will be 

terminated.

5. I agree and understand not to give out my personal information, particularly 

financial information or password(s) to anyone.

6. I agree and understand that once my participation in the ACL pilot program 

through MARC is complete, the equipment will be given to me to continue to use as I 

see fit and will no longer be owned by MARC. 

7. I agree and understand that once my participation in the ACL pilot program 

through MARC is complete, internet access/continued usage of the device(s) will be 

my sole responsibility.
Version: FINAL 11

Staff Member’s Signature Date

Client Signature Date

(ORIGINAL DOCUMENT REMAINS WITH MARC; COPY TO CLIENT)
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APPENDIX E

Measurement Battery

MA4 ACL Innovations in Nutrition – MARC Site 

Enrollment Form 

Contact Information 

Last Name First Name MI 

Address City Zip 

Phone Gender ☐M (1) ☐F (2) DOB (mm/dd/yyyy) 

Email Client ID 
Version: FINAL 13

Client Measurement D Pre-Intervention D Post-Intervention 

Demographic and Background Information 

Lives Alone? Yes (1) D No (0) County 

Marital Single (1) D Married (2) Divorced (3) Partnered (4) Separated (5) Widowed (6) 

Status 

Race Afr Am (1) Am Ind/Nat AK (2) Asian (3) Nat HI/Pac Island. (4) White (5) Other (6) 

Hispanic, Latino, or Spanish Origin? Yes (1) No (0) 

BMI What is your weight? lbs. What is your height? ft. in. 

Age 85+? Yes (1) No (0) 

At risk if 85+ At Risk (1) 

Homebound derived from Musich et al., 2015 (Geriatr Nurs., 36, 445-450)

How many days do you leave your home each week? ☐0-1 (1) ☐1-3 (2) ☒3+ (3) 

If you left your home, was it difficult? ☐Yes (2) ☐Somewhat (1) ☐No (0) 

Assistance required to leave your home? ☐Yes (1) ☐No (0) 

At risk if leaves only 0-1 times/week; discontinue interview if ≥ 1/week w/o difficulty ☐At Risk (1) 

SNAQ (Simplified Nutritional Assessment Questionnaire) Source SLU Rapid Geriatric Assessment 

My appetite is ☐Very poor (1) ☐Poor (2) ☐Average (3) ☐Good (4) ☐Very good 

(5) 

Food Tastes ☐Very bad (1) ☐Bad (2) ☐Average (3) ☐Good (4) ☐Very good 

(5) 

When I eat I feel full after eating... 

☐ few mouthfuls (1) ☐ ~1/3 meal (2) ☐>1/2 meal (3) ☐most meal (4) ☐Hardly ever full (5) 

I I 

I I I 

I 

I 

I 

I 

I 

I 
Version: FINAL 14

Normally I eat ___ meal(s) per day ☐<1 (1) ☐1 (2) ☐2 (3) ☐3 (4) ☐>3 (5) 

Score of 0-14 indicates significant risk of at least 5% weight loss within 6 months ☐At Risk (1) 

FRAIL Questionnaire 

Fatigue: Are you fatigued? ☐Yes (1) ☐No (0) 

Resistance: Can you walk up one flight of stairs? ☐Yes (0) ☐No (1) 

Aerobic: Can you walk one block? ☐Yes (0) ☐No (1) 

Illnesses: Do you have more than 5 illnesses? ☐Yes (1) ☐No (0) 

Loss of weight: Have you lost more than 5% of your weight in the last 6 months? ☐Yes (1) ☐No (0) 

Scoring: 3+ = frailty (at risk) ; 1 or 2 = prefrail ☐At Risk (1) 

SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls) Screen for Sarcopenia (Loss of Muscle) 

Difficulty lifting & carrying 10 lbs? ☐None (0) ☐Some (1) ☐A lot or unable (2) 

Difficulty walking across a room? ☐None (0) ☐Some (1) ☐A lot, use aids or unable (2) 

Difficulty transferring from a chair/bed? ☐None (0) ☐Some (1) ☐A lot or unable w/o help (2) 

Difficulty climbing a flight of ten stairs? ☐None (0) ☐Some (1) ☐A lot or unable (2) 

How many times have you fallen in the last year? ☐None (0) ☐1-3 Falls (1) ☐≥4 Falls (2) 

Total score of 4+ indicates at risk (Sarcopenia) ☐At Risk (1) 

Choice: Healthy Living for Seniors Source: Mid-East AAA Choice program 

8. My overall health is: ☐ Excellent (5) ☐ Very Good ☐ Good (3) ☐ Fair (2) ☐ Poor (1) 

(4) 

9. Since I began this project, my overall health has: ☐ Improved ☐ Not Changed (2) ☐ Declined (1) 

(3) 
Version: FINAL 15

10. In general, I have been 

feeling: 

☐ Excellent (5) ☐ Very Good (4) ☐ Good (3) ☐ Fair (2) ☐ Poor (1) 

11. Since I began this project, the way I’ve been feeling in 

general has: 

☐ Improved ☐ Not ☐ Declined (1) 

(3) Changed (2) 

12. As a result of my participation in this project (select all that apply), ... 

☐ I am ☐ I am living ☐ I have a better understanding of how ☐ I have taken advantage of new socializing 

more a healthier to access information, including resources in the community. (4) 

(1) life (2) community resources (3) If so, which ones? ___________ 

☐ I have a better understanding of nutritional ☐ I have a better understanding of health information 

information (e.g., nutrition labels and dietary (e.g., directions from healthcare providers and 

recommendations (5) prescriptions (6) 

AD-8 Dementia Screening (Galvin JE et al., Neurology, 2005:65:559-564) 

If possible, the AD8 should be administered to an informant. 

Remember, “Yes, a change” indicates that there has been a change in the last several years caused by a 

cognitive (thinking and memory) problem. 

1. Problems with judgement (e.g., problems with making 

decisions, bad financial decisions, problems with thinking 

☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

2. Less interest in hobbies/activities ☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

3. Repeats the same things over and over (questions, stories, 

or statements) 

☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

4. Trouble learning how to use a tool, appliance, or gadget 

(e.g., VCR, computer, microwave, remote control) 

☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

5. Forgets the correct month or year ☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

6. Trouble handling complicated financial affairs (e.g., 

balancing checkbook, income taxes, paying bills) 

☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 
Version: FINAL 16

7. Trouble remembering appointments ☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

8. Daily problems with thinking and/or memory ☐ YES, A ☐ NO, No ☐ N/A Don’t change (1) 

change (0) Know (.) 

Score of ≥2, at-risk for dementia ☐At Risk (1) 

Total Risk Low Moderate High 

☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 

Technology 

Do you own a computer? ☐Yes (1) ☐No (0) 

Do you have regular access to the internet in your home? ☐Yes (1) ☐No (0) 

Do you own a smartphone (e.g., iPhone, Samsung Galaxy, etc.)? These phones have apps 

and a screen that you touch rather than actual buttons. 

☐Yes (1) ☐No (0) 

Are you able to use services that require use of a smartphone or the internet? ☐Yes (1) ☐No (0) 

How open are you to new 

technology? 

Not at all 

(1) 

A little bit 

(2) 

Somewhat 

(3) 

Quite a bit 

(4) 

Very much 

(5) 

Post-Intervention Only 

Using your smart speaker (point to device), are you able to order food items on your 

own? 

☐ Yes (1) ☐ No (0) 

How often do you use your smart speaker 

for ordering food 

Never (1) Less than 

monthly (2) 

Monthly (3) Weekly (4) Daily (5) 

How often do you use your smart speaker 

for any purpose 

Never (1) Less than 

monthly (2) 

Monthly (3) Weekly (4) Daily (5) 
Version: FINAL 17

Please tell me what you use your smart speaker for (all uses, not just for ordering food): 

PHQ-9: Geriatric Depression Questionnaire Spitzer, Kroenke, Williams (1999). JAMA, 282 

Over the last 2 weeks, how often 

have you been bothered by any of 

the following problems? 

Not at all (0) Several 

days (1) 

More than half the 

days (2) 

Nearly every 

day (3) 

1. Little interest or pleasure in 

doing things? 

☐ ☐ ☐ ☐

2. Feeling down, depressed, or 

hopeless? 

☐ ☐ ☐ ☐

3. Trouble falling or staying 

asleep, or sleeping too 

much? 

☐ ☐ ☐ ☐

4. Feeling tired or having little 

energy? 

☐ ☐ ☐ ☐

5. Poor appetite or overeating? 

☐ ☐ ☐ ☐

6. Feeling bad about yourself- or 

that you are a failure or have 

let yourself or your family 

down? 

☐ ☐ ☐ ☐
Version: FINAL 18

7. Trouble concentrating on 

things, such as reading the 

newspaper or watching 

television? 

☐ ☐ ☐ ☐

8. Moving or speaking so slowly 

that other people could have 

noticed? Or the oppositebeing so fidgety or restless 

that you have been moving 

around a lot more than 

usual? 

☐ ☐ ☐ ☐

9. Thoughts that you would be 

better off dead or of hurting 

yourself in some way? 

☐ ☐ ☐ ☐

Total score ____=____+____+____ 

Scores of 5, 10, 15, and 20 represent cut points for mild, moderate, moderately severe and 

severe depression.

☐At Risk (5 

or above) 

If you selected any of these issues, 

how difficult have these issues made 

it for you to do your work, take care 

of things at home, or get along with 

other people? 

☐ Not 

difficult at all 

☐

Somewhat 

difficult 

☐ Very difficult ☐ Extremely 

difficult 

Functional Assessment Source: ACL 

Mandatory Levels 

of Assistance: 

0 = Independent – Completes the task independently 

3 = Minimum Assistance – Occasional assistance or supervision may be necessary 

6 = Moderate Assistance – Assistance or supervision is always necessary 

9 = Maximum Assistance – Totally dependent on others 
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Activities of Daily Living (ADLs) 

Eating ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Bathing ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Grooming ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Dressing ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Toilet Use ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Mobility ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Transferring ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Instrumental Activities of Daily Living (IADLs) 

Laundry ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Shopping ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Light Housework ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Heavy Housework ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Telephone ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Financial Management ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Transportation ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Meal Preparation ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Medication Management ☐Ind (0) ☐Min (3) ☐Moderate (6) ☐Max (9) 

Satisfaction with Social Roles and Activities Source: PROMIS Health Organization and PROMIS Cooperative Group, 2016 

Please respond to each item by 

selecting one box per row 

Not at all 

(1) 

A little bit 

(2) 

Somewhat (3) Quite a bit 

(4) 

Very much (5) 
Version: FINAL 20

I am satisfied with my ability to do 

things for my family 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to do 

things for fun with others 

☐ ☐ ☐ ☐ ☐

I feel good about my ability to do 

things for my friends 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to 

perform my daily routines 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to do 

things for fun outside my home 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to 

meet the needs of my friends 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to do 

the work that is really important to 

me (include work at home) 

☐ ☐ ☐ ☐ ☐

I am satisfied with my ability to 

meet the needs of my family 

☐ ☐ ☐ ☐ ☐

Stanford Chronic Disease Self-Management study questions 

Health care utilization/Hospitalization Source: Lorig, et al. (1996). Outcome Measures for Health Education and other Health 

Care Interventions, Thousand Oaks, CA: Sage Publications 

During the past 6 months... 

How many visits have you made with your doctor, including ER visits? 

Number of hospitalizations? 
Version: FINAL 21

Number of nights spent in the hospital? 

PEPL Fall Question Source: Lamb et al. JAGS. 2005: 53;1618-1622. doi:10.111/j.1532-5415.2005.53455.x 

In the past month, have you had any fall including a slip or trip in which you 

lost your balance and landed on the floor or ground or lower level? 

☐Yes ☐No (0) 

(1) 

Three-Item Loneliness Scale Source: Hughes et al. Res Aging. 2004; 26: 655-672 

Lead-in and questions are read to the respondent.

The next questions are about how you feel about different aspects of your life. For each one, tell me how often 

you feel that way. 

First, how often do you feel that you lack companionship? 

☐Hardly ever (1) ☐Some of time (2) ☐Often (3) 

How often do you feel left out? ☐Hardly ever (1) ☐Some of time (2) ☐Often (3) 

How often do you feel isolated from others? ☐Hardly ever (1) ☐Some of time (2) ☐Often (3) 

NHLBI We Can! Questionnaire, 

short 

Source: Ways to Enhance Children’s Activity and Nutrition national movement. 

How many total servings of fruits 

and vegetables do you eat each 

day? 

☐ At least 2 

(1) 

☐ At least 5 

(2)

☐ At least 9 

(3)

☐ At least 

10 (4)

☐ I don’t 

know (5)

The foods that I eat and drink now 

are healthy 

☐ Yes, all of the time (2) ☐ Yes, sometimes (1) ☐ No (0)

Do you ever eat high fiber cereal? ☐ Almost always or always (2) ☐ Sometimes (1) ☐ Almost never or 

never (0)

Do you ever eat whole wheat 

bread? 

☐ Almost always or always (2) ☐ Sometimes (1) ☐ Almost never or 

never (0) 
Version: FINAL 22

Do you ever drink 100% fruit 

juice? 

☐ Almost always or always (2) ☐ Sometimes (1) ☐ Almost never or 

never (0) 

Do you ever eat fruit for lunch? ☐ Almost always or always (2) ☐ Sometimes (1) ☐ Almost never or 

never (0) 

Do you ever eat vegetables for 

dinner? 

☐ Almost always or always (2) ☐ Sometimes (1) ☐ Almost never or 

never (0) 

Where do you 

usually get your 

food? 

☐ Corner 

Store (1) 

☐ Larger 

Grocery Stores 

(2) 

☐ Pantry 

(3) 

☐ Online 

(4) 

☐ Delivery 

Services (5) 

☐ In organic 

food stores (6) 

☐Other (7) 

_______________________ 

What type of food do 

you prefer? 

☐ Pre-Cooked 

Foods (1) 

☐ Fresh Foods 

(2) 

☐ Frozen Foods 

(3) 

☐ Canned Foods 

(4) 

☐Other (7) 

________________________ 

Post-Intervention Only

This project has provided you 

with a “smart speaker,” (name 

product), to learn about 

ordering food to be delivered 

to you. Overall how satisfied 

are you with this project? 

☐ Not at all 

(1) 

☐ A little bit 

(2) 

☐ Somewhat 

(3) 

☐ Quite a bit 

(4) 

☐ Very much 

(5) 
Version: FINAL 23

APPENDIX F

Participant Manual

Innovations in Nutrition Resource Book 

Table of Contents 

Copy of Informed Consent page 2 

Copy of Technology Agreement page 3 

Passwords page 4 

Delivery Schedule page 5-6 

How to order your food page 7 

Food Item Choices page 8 

Things to try with you Amazon Alexa page 9-12 
Version: FINAL 24

Informed Consent Form -- COPY

Brief Project Description

Title: MA4 ACL Innovations in Nutrition Project - Technology Interventions to Improve Congregate 

and Home Delivery Nutrition Programs for High Risk Seniors. The goal of this 24month project is to 

use technology interventions to improve service, delivery, and costeffectiveness of nutrition 

programs for older people at high risk of malnutrition. Participants involved in this project and 

served by Mid-East Area Agency will participate 

in the use of CHOICE Access advanced data card technology while those in the Mid-America Regional 

Council area will participate in the use in-home artificial intelligence enabled speakers. 

Consent

My participation in this research project is completely voluntary and I understand that I can 

withdraw my participation at any time with no consequences. I recognize that participation in this 

project could present potential risks including but not limited to feeling uncomfortable sharing 

certain information, and marginal risk in information security as a result of activities, products and 

equipment used. I release Missouri Association of Area Agencies on Aging, MidEast Area Agency on 

Aging, Mid America Regional Council, and their agents, representatives, employees, volunteers and 

any sponsors (here forth referred to as “agencies”) from any and all damages, causes of action, 

claims and liability that might arise from my participation in this project. I understand that I will take 

part in pre-and post-surveys and any information I choose to provide before, during, or after this 

project will be held in strict confidence. I agree that agencies may use and reproduce anonymously 

compiled survey results, including any information I may have provided, for purposes of program 

evaluation, presentations, communication and publication. 

I understand that any information that can identify me will remain confidential. I hereby understand 

confidential information has limited risk of identification in small sample and agree unintentional 

use will not result in any liability to these parties for payment to any person or organization, 

including myself. The information in this study will be used only for quality improvement purposes 

and in ways that will not reveal who you are. Federal or state laws may require us to show 

information to government officials who are responsible for monitoring the safety of this study. You 

will not be identified in any publication from this study. 

I have read the foregoing information and I have had the opportunity to ask questions. I 

understand that if I have any questions about my participation, I will inform the project director 

Lydia Kaume, Ph.D., RDN, at 479.283.8185, consultant@professionals-consulting.com OR Site 

Directors, James D. Stowe, Ph.D, MARC, Director, Aging & Adult Services at 816.701.8263 or 

jstowe@MARC.ORG; or Aging Ahead’s, Jean Sotomayor Community Programs Specialist at 

636.207.0847 or jsotomayor@agingahead.org
Version: FINAL 25

Mid America Regional Council Technology Equipment Use Agreement 

COPY

Staff Member assigning equipment: _______________________________ 

Check Out Date: _____________________ Completion Date: ___________________ 

Item Serial # Inventory Tag # Model/Brand 

Requirements for Use: 

I agree to take responsibility for technology hardware/software listed above in exchange for the use 

of the equipment and for the participation in the Administrative and Community Living (ACL) pilot 

program through Mid America Regional Council (MARC). 

1. I understand I am responsible for maintaining the equipment/software in working condition 

while it is in my possession. 

2. I agree to promptly report any problems with the device. 

3. I agree to not remove or interfere with the serial number or identification placed on the 

device. 

4. I agree and understand that if the technology equipment and/or other related items are 

stolen, vandalized, misplaced, destroyed, etc that said equipment will not be replaced and that my 

participation in the ACL Grant through MARC will be terminated. 

5. I agree and understand not to give out my personal information, particularly financial 

information or password(s) to anyone. 

6. I agree and understand that once my participation in the ACL pilot program through MARC is 

complete, the equipment will be given to me to continue to use as I see fit and will no longer be 

owned by MARC. 

7. I agree and understand that once my participation in the ACL pilot program through MARC is 

complete, internet access/continued usage of the device(s) will be my sole responsibility. 

(ORIGINAL DOCUMENT REMAINS WITH MARC; COPY TO CLIENT)
Version: FINAL 26

Innovations in Nutrition Project – Login Information

Please keep this information in a safe place. This information is crucial to 

the participation in this project. Never give out your passwords. 

MARC is not responsible for keeping track of your passwords. 

Email Login and Amazon Login Information 

Email Address 

Password 
Version: FINAL 27

Delivery Schedule 

This project will provide you with 6 deliveries over approximately 3 months. After 

your 6th delivery a post intervention questionnaire will be given – very similar to 

the one completed when you first enrolled. 

1

st Delivery Date: ______________________ 

Last Delivery Date:_____________________ 

(Please see next page outlining your ordering and delivery schedule) 

You will keep your device and any accompanying technology that was provided 

to you; however we will not be able to continue the food delivery. 

You are welcome to remain a food pantry client of Jewish Family Services (JFS). 

You can go to their location at 425 E. 63rd Street, KC MO, 64110 and shop for 

food once per month, or you can send someone on your behalf to shop for you. If 

you would like to continue as a JFS pantry client and send someone to shop on 

your behalf please call (913) 730-1725. 

If you need additional resources, please contact MARC to speak with one of our 

Integrated Care Specialists who can help you explore additional options to meet 

your needs. 816-421-4980 
Version: FINAL 28

Delivery Schedule – Continued 

Food will be delivered on the 1st and 3rd Thursday of the month in the afternoon. 

1

st Order: Completed when device is installed in home. 

1

st Delivery: ______________________ 

2

nd Order Due: ______________________ 

2

nd Delivery: ______________________ 

3

rd Order Due: ______________________ 

3

rd Delivery: ______________________ 

4

th Order Due: ______________________ 

4

th Delivery: ______________________ 

5

th Order Due: ______________________ 

5

th Delivery: ______________________ 

6

th (Last) Order Due: ______________________ 

Last Delivery: _____________________ 
Version: FINAL 29

Ordering Your Food

To “wake up” the device say “Alexa.” 

You must say “Alexa” before the device will respond to your commands. 

Speak slowly and clearly. 

To start the ShowMe Pantry skill say: 

“Alexa, open ShowMe Pantry” 

• To ensure you have your food ordered on time please submit your food 

order by 5:00 pm on Monday prior to your scheduled delivery. 

• Food will be delivered by volunteers on the 1st and 3rd Thursday of the 

Month. 

• You or someone else must be home to receive your food – there will be 

perishable food items. 

Please remember that this is a pilot project and these items are subject to change. 

We will provide as much notice as possible. We are all learning together! 

Please call the Mid-America Regional Council (MARC) with questions: 

816-421-4980 
Version: FINAL 30

ShowMe Pantry Choices 

To order say “Alexa, open ShowMe Pantry” 

Fresh Vegetables 

□ Carrots (3 servings per package) 

□ Potatoes 

□

Fruit 

Zucchini 

□ Apples 

□ Peaches (3 servings per can) maximum order of 1 

□ Apple Sauce (3 servings per can) maximum order of 1

Canned Vegetables maximum order of 3 total cans

□ Peas 

□ Corn 

□ Green Beans 

Grains 

□ Rice (1 pound bag) maximum order of 1 

□ Bread Loaf 

□ Pasta(8 servings per bag) maximum order of 1 

Protein 

□ Assorted Fresh Meats – type is based on what is available maximum order of 1

□ Can Tuna maximum order of 1

□ Dry Beans (8 servings per bag) maximum order of 1

□ Eggs (dozen) maximum order of 1

□ Can Black Beans maximum order of 1

□ Can Chicken maximum order of 1

□ Peanut Butter maximum order of 1

Dairy 

□ Shelf Stable Milk 

□ Cheese 

□ Yogurt 
Version: FINAL 31

Things to Try

Ask Alexa... 

• "How are you?" 

• "Why are you called Alexa?" 

• "Do you prefer cats or dogs?" 

Ask about Alexa's favorites 

• "What's your favorite color?" 

• "Who is your favorite actor?" 

• "What's your favorite sci-fi movie?" 

________________________________________ 

Useful Phrases 

• "Turn up the volume" 

• "What time is it?" • "What's up?" 

• "What can I say?" 

________________________________________ 

Questions & Answers 

Ask about science, math, and geography 

• "What are Newton's three laws of motion?" 

• "What is 100 divided by 16?" 

• "Who is the Prime Minister of Denmark?" 

________________________________________ Translations 

• "How do you say 'I love you' in French?" 
Version: FINAL 32

• "How do you say 'good morning' in Japanese?" 

• "How do you say 'thank you' in Italian?" 

________________________________________ 

Jokes 

"Alexa, tell me a joke" 

________________________________________ 

Fun with Alexa 

"Alexa, sing a song" 

Alexa has many ways to keep you entertained 

• "Sing a country song" 

• "Tell me a limerick" 

• "Beatbox for me" 

• "Flip a coin" 

• "Tell me a story" 

________________________________________ 

Weather 

"Alexa, what's the weather?" 

Ask about local, national, and international weather 

• "Will it rain tomorrow?" 

• "How's the weather in Seattle this weekend?" 

• "What's the temperature in Austin?" 

________________________________________ 
Version: FINAL 33

Flash Briefing 

"Alexa, play my flash briefing" 

Listen to news and content from popular broadcasters 

________________________________________ 

To-do Lists 

"Alexa, add 'feed pets' to my to-do list" 

________________________________________ 

Shopping Lists 

"Alexa, add milk to my shopping list" 

________________________________________ 

Reminders 

"Alexa, set a reminder" 

Alexa can help remind you about things 

________________________________________ 

Timers 

"Alexa, set an egg timer for 3 minutes" 

Set timers and also give your timers names 

________________________________________ 

Alarms 

"Alexa, set an alarm for 6:00am" 

Alexa can wake you up and also let you snooze 

• "Wake me up in the morning" 
Version: FINAL 34

• "Set a weekday alarm at 7:00am" 

• "What alarms are set?" 

• "Snooze..." (enjoy 9 more minutes of Zzz...) 

________________________________________ 

Listen to Music 

• "Play country music" 

• "Play rock music" 

 Control the music 

• "Turn up the volume" 

• "Rewind 15 seconds" 

• "Repeat this song" 

• "Stop the music" 
4 

Summary Brief

Snapshot of project and findings. 
ORGANIZATION:

Mid-America Regional Council and 

Aging Ahead Area Agency on Aging

CONNECTING HOME-DELIVERED MEALS CLIENTS TO FOOD 

PANTRY RESOURCES USING SMART SPEAKER TECHNOLOGY

ABOUT US

Mid-America Regional Council (MARC) is a nonprofit association of city and county governments and the 

metropolitan planning organization for the bistate Kansas City region. Governed by a Board of Directors made 

up of local elected officials, we serve nine counties and 119 cities. We provide a forum for the region to work 

together to advance social, economic and environmental progress. MARC is funded by federal, state and 

private grants, local contributions and earned income. The Mid-America Regional Council promotes regional 

cooperation and develops innovative solutions through leadership, planning and action.

Aging Ahead Area Agency on Aging is one of 10 Area Agencies on Aging in Missouri, providing supportive 

services in St. Louis, St. Charles, Franklin and Jefferson counties since 1973. Adults 60 and older count on 

Aging Ahead to provide warm, nutritious meals, connection to resources and supportive services like Meals 

on Wheels, Community Centers, Caregiving Services, Community Options Consulting and Case Management.

PROJECT PURPOSE

MARC

To improve service delivery, and cost-effectiveness of nutrition programs for older adults at risk of malnutrition. 

For this portion of the project, artificial intelligence enabled speakers, Amazon Echo Show, were deployed to 

participant homes to reduce access barriers to good nutrition. 

Aging Ahead

The Choice Counts Meal Program’s purpose was to improve service, delivery, and cost-effectiveness of 

congregate nutrition programming for older adults at high risk of malnutrition. The Choice Counts sought to 

provide participants access to Title IIIC meals three times a week, including one weekend day (in partnership 

with key project partner, Frick’s Market in rural Missouri) to give older adults choice, convenience, and education.

PROJECT LENGTH

• Two years

KEY PARAMETERS

MARC

• Population targeted: Participants of Mid-America Regional Council’s Older Americans Act Home 

Delivered Meal Program

• Geographic setting: Urban 

Service delivery setting: Participant home

Services offered: Technology-aided home meal delivery services

Number of staff/FTEs dedicated to innovation project: 0.53 FTE

Total grant funds received: $94,604

Total funding leveraged from organization (cash/in-kind): $58,295

Number of staff/FTEs dedicated to innovation project: 0.53 (in additional community partner and 

contract staff: 089 FTE)

ADMINISTRATION FOR COMMUNITY LIVING INNOVATIONS IN NUTRITION PROGRAMS AND SERVICES CAPSTONE SERIES

1
Aging Ahead

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Population targeted: Adults age 60 years and older eligible for Title IIIC meal program

Geographic setting: Rural setting

Service delivery setting: Through partnership with partner food retailer (Frick’s Food Market)

Services offered: Food retail store based congregate nutrition program

Number of staff/FTEs dedicated to innovation project: 0.57 FTE

Total grant funds received: $26,530.91

Total funding leveraged from organization (cash/in-kind): $12,117.61

Number of staff/FTEs dedicated to innovation project: Two staff members/0.57 FTE

The project increased access to meals for older adults in a rural setting.

The Choice Counts program increased exploration of technology among rural seniors and increased 

staff confidence to try innovative, technology supported programming.

PROJECT COMPONENTS

• 

• 

• 

• 

In-home artificial intelligence enabled speaker technology used to support client choice, convenience 

in meal ordering and facilitate nutrition education.

Alliance between an Area Agency on Aging (MARC), a food delivery organization (Shepard’s Center and 

MARC), and a local food pantry (Jewish Family Services) to facilitate home delivery of nutritious foods to 

homebound older adults.

Engagement of a food retailer (Frick’s Market) to serve as a novel congregate nutrition programprovider.

Collaboration with the University of Missouri Extension to host monthly educational workshops.

SUCCESSES AND LESSONS LEARNED

MARC

• 

• 

• 

• 

• 

The project team learned that high-risk, homebound older adults are ready and willing to use technology to 

receive services. Many participants had a smartphone and were somewhat familiar with using the apps. 

The project team observed nutritional systems impact and transformation through this project. The project 

demonstrated that an alliance among the AAA, food delivery organization, and local food pantry was possible.

The project also dispelled the myth of homebound home-delivered meals recipients being unable to prepare 

some of their own food items – unassisted or with the assistance of a formal or informal caregiver.

Findings indicate that the project intervention had health benefits including improved perceived overall health, 

reduced nutritional risk, and reduced depression scores. 

Participants reported increased openness to technology and an improvement in skills needed to utilize a 

smartphone and internet.

Aging Ahead

• 

• 

The project increased access to meals for older adults in a rural setting.

The Choice Counts program increased exploration of technology among rural seniors and increased staff 

confidence to try innovative, technology supported programming.

PROJECT IMPACT

• 

• 

Comparisons of pre- and post-measurements among participants who have completed the intervention 

noted that they reported decreased depression scores. Additionally, over half of the clients reported that they 

felt better since completing the intervention. 

Clients reported they are using the smart speaker device for more than just food ordering, many citing music 

as one additional use of the device.

Participant self-reported outcomes of improved sense of taste and appetite, as well as reduced depression, 

were also noted.

• 

2
ADVICE FOR PEERS

MARC

• 

• 

If an organization conducts a project that involves the implementation of new in-home technology to be 

used by senior service recipients, consider including budget support for in-home technical support to 

address needs as they arise as seniors develop their capacity to use the new technology. Throughout the 

project there were technological problems that came up for a variety of reasons – so “tech support” house 

calls to participating seniors were made. This additional assistance added over 20 hours of manpower 

during the course of the project. Although there were participants who required additional and ongoing 

assistance, there were many participants who needed no assistance after the initial set up. This success 

seemed to depend on how familiar the participants were with technology prior to the project. 

The project team believes that older adults are ready and willing to utilize technology to receive services. 

Many participants had a smartphone and were somewhat familiar with using the apps – perhaps in the 

future a program such as this could be delivered via technology that the participant is already familiar with, 

such as their smart phone, home computer, or tablet. 

ADVICE FOR PEERS

Aging Ahead

• 

• 

• 

Organizations are advised to anticipate “pent-up demand” and higher than anticipated requests to 

participate in a program that increases food/meal access to a vulnerable population at risk. 

The project team would advise that agencies acquire a technology system to enable tracking of enrollment 

and participation. An additional suggested function of the tracking system is the ability to facilitate interactive 

feedback and client engagement in personal nutritional/health. Without a good tracking system, the ability to 

monitor and manage program cost is weakened and the program may become cost prohibitive. 

Enrollment numbers for Choice Counts program grew quickly to 650 in two years, and the unanticipated 

enrollment and growth resulted in a budget impact. The project team recommends the promotion and 

collection of client donations to help cover meal costs. Also, the project team recommends the development 

and negotiation of vendor meal rate(s) that allows for incremental adjustments relative to increases in 

volume/participation.

This project was supported, in part by grant number 90PPNU0001 from the U.S. Administration

 for Community Living, Department of Health and Human Services, Washington, D.C. 20201

nutritionandaging.org 3