The Tele-Nutrition Saga

Georgia provides older adults with virtual nutrition care services

Social Determinants of Health:

Social determinants of health (SDOH) are the conditions in the 

environment where people are born, live, work, play, worship and age. 

They affect a wide range of health, functioning, and quality of life 

outcomes and risks.

Open Hand Atlanta in Georgia focuses on the following SDOH 

objectives:

1. Decreasing household food insecurity and hunger

2. Increasing health literacy of the population 

3. Increasing number of community organizations that provide 

prevention services

Overview of the program: Healthy People 2030

Open Hand Atlanta is one of the largest community-based providers of home delivered meals and 

nutrition services in the Southeast United States. They serve a diverse population with unique nutrition 

needs through:

● Evidence-based nutrition education programs: 

Chronic Disease Self-Management Education (CDSME), Diabetes Self-Management Education, (DSME), 

Cooking Matters

● Medically tailored and culturally appropriate meal programs for low-income and older adult 

clients including:

o meal programs for Medicaid Elderly and Disabled Waiver clients, 

o congregate and home-delivered meals for older adults, 

o post-discharge meals for people experiencing care transitions, 

o people living with HIV/AIDS, 

o pregnant mothers with gestational diabetes.

Open Hand Atlanta is working to modernize nutrition care across Georgia for older adults participating in 

a pilot project for telenutrition services. This new protocol allows for the delivery of cost-effective 

nutrition care services for older adults who are at highest nutrition and food security risk.

The objectives of the project include:

1) Improving the health of seniors who are at 

highest nutrition risk by referring older adults 

to Medical Nutrition Therapy (MNT) provided 

by a Registered Dietitian Nutritionist (RDN) via 

a telenutrition platform. 

2) Developing and evaluating monthly 

nutrition presentations via a telenutrition 

platform presented to older adults at senior 

centers.

Partners:

In addition to a long list of community partners, Open Hand Atlanta has key partnerships with multiple 

organizations. Through these partnerships, the number of community organizations that provide 

prevention services has increased.
Visiting Nurse Health System

Open Hand Atlanta receives referrals from Visiting Nurse Health System, a case management agency 

for Georgia’s Elderly and Disabled Medicaid Waiver program. Approximately 25 to 30 percent of clients 

served by Open Hand Atlanta are funded through the Medicaid Waiver program. 

The Food is Medicine Coalition

Open Hand Atlanta is a flagship member of the Food is Medicine Coalition, an organization setting the 

standard for medically tailored meals and groceries. Executive Director Matthew Pieper is a member of 

the Food is Medicine Coalition Advisory Board. The Food is Medicine Coalition provides advocacy for 

public policies including a Medicare pilot program to address the critical link between diet, chronic 

illness, and the health of older adults. This program would provide the outcomes data to build a more 

resilient and cost-effective health care system. Open Hand Atlanta is committed to expanding 

partnerships by advocating for improved access to medically tailored meals and nutrition education. 

Open Hand Atlanta is actively reaching out to legislators to inform them and encourage them to cosponsor policies. 

Grady Health System

Atlanta’s Grady Health System opened the Jesse Hill Market, an innovative Food as Medicine 

collaboration in partnership with the Atlanta Community Food Bank and Open Hand Atlanta. This 

provides access to healthy, affordable food to all members of the Grady community. It is also a teaching 

kitchen for nutrition education and a food pharmacy where patients with chronic conditions can fill food 

prescriptions with fresh produce. Grady Health System and Open Hand Atlanta have a longstanding 

relationship. Open Hand Atlanta has provided meals for patients in Grady Health System clinics, healthy 

snacks for patients, and nutrition classes as part of Open Hand Atlanta’s Administration for Community 

Living (ACL) CDSME grant. Grady Health System serves as a strong referral partner and enrolls patients 

into Open Hand Atlanta programs.

Funding and Sustainability:

Open Hand Atlanta applies to federal, state, county, and philanthropic sources to provide nutrition 

services to address food insecurity for all age groups. 

Funding Sources:

o Older Americans Act (OAA)

o Ryan White Part A 

o SNAP-Ed funding for Cooking Matters 

o Medicaid Waiver funding

o Funding for other programs such as a produce 

prescription program 

o Medicare for MNT

Some grant partners include but are not limited to: 

o Anthem Blue Cross Blue Shield for Fruit and 

Vegetable Prescription Programs 

o Kaiser Permanente 

o Bank of America 

o Healthcare Georgia Foundation 

o City of Atlanta for Housing Opportunities for 

Persons with AIDS (HOPWA)

Additionally, Open Hand Atlanta’s social enterprise brand “Good Measure Meals” provides healthy meals 

and corporate wellness to the public to help fund meals and nutrition education for the Open Hand 

Atlanta clients in need. Competition in this area led to innovative partnerships such as the YMCA. Good 

Measure Meals now offers delivery and the clients feel good about supporting the non-profit work that is 

provided to their neighbors.

Open Hand Atlanta’s advocacy work along with that of their partners is key to sustainability. All are 

informing healthcare providers and building relationships with health plans to secure sustained funding 

for medically tailored meals within a medical model. As part of their ACL Innovations in Nutrition 

Programs Services (INNU) grant, Open Hand Atlanta has hired an Evaluation and Data Manager to help 

demonstrate Return on Investment (ROI) and bring payors to the table. 
Timeline

1988

• Non-Profit Status: Open Hand Atlanta established nonprofit status as an AIDS Service Organization 

(ASO).

2000 

• Older Adults: Expanded services to include older adults and other individuals with chronic disease.

2002

• Partnerships: RDNs began providing MNT and education to the community. 

2004

• Social Enterprise: Launched social enterprise Good Measure Meals to help fund other nutrition 

services.

2015

• Statewide Footprint: Began expansion outside Atlanta, establishing a statewide footprint upon 

becoming a state administrator for Cooking Matters (SNAP-Ed program)

2020

• Expansion: Expanded services to Area Agencies on Aging (AAAs) in NW Georgia and SW Georgia 

when existing providers closed due to COVID, shipping meals across the state. 

• Launch: Launched Jesse Hill Market with Grady Health System. 

2024

• Continued Growth: Target date for moving to a new building to support growth and statewide 

expansion (capital campaign underway)
Advice for Replication: 

“Start building relationships NOW, because it can take a while. It can help with starting a project as 

well. If it’s a new partner, it can take months to bring them on board and help them understand what 

you’re trying to do. We had the support of the State Dietitian who is a tremendous advocate of our 

project.” 

Aleta McLean | Senior Director of Client Services & Outcomes

“Make sure you understand how these agencies like the AAAs work in your state. Be flexible. Things 

will change. Expect the unexpected.” 

Laura Samnadda MS, RDN, LD | Director of Nutrition Services

Tools and Resources:

It was noted that some senior centers involved in the ACL Innovations project have struggled with 

technology and needed upgrades. Some centers piloted the use of projectors and screens with 

tablets, but for others, it became too complex. The project has found that using Smart TVs often works 

best for delivering telenutrition services via Zoom in this setting. Additionally, plans are to pilot the use 

of Claris Tablets for providing MNT and nutrition education by the Dietitian via the telehealth platform, 

Healthie.

Open Hand developed pre and post tests to measure effectiveness of the intervention, showing 

improvement in knowledge and satisfaction. Early results and feedback are positive. The results will 

be incorporated into the business case for the intervention. 

It was noted that each AAA presented nutrition education differently, and the tools and resources 

developed by Open Hand Atlanta are intended to streamline education so that everyone has access 

to the same quality resources and will see similar outcomes. The intent is to package these resources 

for ease of use and consistency, so those providing the education can focus on quality delivery of 

these services. 

Additional resources:

1. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention 

and Health Promotion. Retrieved July 27, 2022, from https://health.gov/healthypeople/objectivesand-data/social-determinants-health

This project was supported in part by grant number 90PPNU0002 from the U.S. Administration for Community Living, 

Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government 

sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, 

necessarily represent official ACL policy.