Improving Nutrition and 

Health of Rural Older 

Adults Following Hospital 

Discharge

Appendix Documents
Table of Contents

Appendix Documents..............................................................................................................................................................................1

Appendix A......................................................................................................................................................................................................3

Appendix B......................................................................................................................................................................................................4

Appendix C.....................................................................................................................................................................................................5

Appendix D .....................................................................................................................................................................................................6
Appendix A
1

This project was supported, in part by grant number 901NNU0015, from the Administration for Community Living, U.S. 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.

Application Narrative:

Funding:

Funding Agency: Administration for Community Living via Eastern Agency on Aging (lead org) 

Project # NSN928 (GL Project # 5407980 and PARS submission #2019630) 

Title: Older Adult Nutrition Innovation Pilot

1. Summary:

Eastern Area Agency on Aging in partnership with St. Joseph Healthcare, Senscio Systems, and 

the University of Maine, will establish and test an innovative, technology-driven nutrition 

enhancement and self-management program for older adults with multiple chronic diseases. The 

goal of this three-year project is to improve the nutritional and health status of rural adults 60 and 

older with multiple chronic conditions immediately following hospital discharge.

Anticipated outcomes for older adults include: 1) Decreased nutritional risk; 2) Improved health 

and health-related quality of life; 3) Improved ability to age in place; and 4) High levels of 

satisfaction with services.

Significance

The majority of adults 65 and older (80%) have at least one chronic disease. Medicare reports 

that 68% of beneficiaries have two or more chronic conditions and about a third of those 

individuals have four or more chronic conditions.1 Ranking among the top chronic diseases are 

chronic obstructive pulmonary disease (COPD) and heart failure, which each impact 

approximately one in 10 older adults, and diabetes, which affects over one in four 

older adults.2 Chronic conditions result in increased emergency department visits, inpatient 

hospital stays, outpatient visits, and prescriptions. For inpatient stays, 3% of people with no 

chronic conditions will have at least one inpatient stay in a year, compared with 6% of 

individuals with 1-2 chronic conditions, and 24% with five or more chronic conditions.3 It is 

argued that a quarter of hospital readmissions can potentially be prevented using interventions 

“that span the continuum of care, prioritize efforts to prepare patients more effectively for 

discharge, and provide better ability for patients, caregivers, and health care professionals to 

support patients and improve outcomes during the period after hospitalization.”4

In addition to chronic disease, food insecurity is a growing national concern with as

many as one in 10 older adults either at-risk for food insecurity or facing hunger. In Maine, there 

are similar proportions of at-risk individuals currently facing hunger with an additional 16% 

experiencing a threat of hunger.5 Chronic diseases and functional limitations are more prevalent 

in food insecure older adults.6 A variety of health conditions are linked to food insecurity in older 

adults including asthma, diabetes, CHF, osteoporosis, and hypertension.7 Furthermore, a 

powerful link exists between the cost of managing chronic disease and the financial and 

nutritional status of older adults.8 Low income patients are routinely readmitted to hospitals 

because they had to choose between buying food and purchasing medication. This “treat or eat” 

dilemma effects as many as one in three chronically ill older adults yet most self-management
2

interventions do not include nutritional supports.9

An additional challenge is the cost of maintaining a nutritionally sound diet that is aligned

with the clinical guidelines necessary to properly manage chronic disease. For clients with 

chronic disease, managing special diets across co-occurring conditions can be complicated and

costly. Medically tailored meals (MTMs) are currently available to older adult clients through the 

Eastern Area Agency on Aging (EAAA) Meals on Wheels (MOW) program. However, clients 

must self-identify and self-select their meals, leaving room for error in the process, especially 

when that individual has more than one chronic condition. Without the support of a dietician and 

the billing structure to cover costs, it is impossible for EAAA to offer customized MTMs.

The Rural Imperative: Eastern Maine’s low-income older adults are at considerable risk

of food insecurity and accompanying health issues making it a critical location for offering 

nutritional and health innovations. EAAA’s four, largely rural service counties have a significant 

poor older adult population: nearly 49,000 residents are over 65, with poverty rates ranging from 

8.1% to 11.4%.10 A recent study notes 43% of Maine’s older adults are low-income, a risk factor 

for food insecurity and poor health.11 12 Some 16% of Maine households are food insecure. This 

rate of food insecurity places Maine in the top 10 states facing food insecurity.13 Innovations in 

rural areas are needed that are accessible to older adults and are efficiently delivered by host 

agencies. The proposed research project will evaluate an intervention that leverages an 

innovative technology platform to deliver nutritional education and supports in the home. This 

model is especially designed to be less staff intensive and more consumer accessible than 

existing models of in-home nutritional supports and chronic disease management programming. 

Methods

This project will entail testing a new intervention to be delivered by Eastern Area Agency on 

Aging (EAAA) and Senscio Systems. For this project, older adults with chronic disease will be 

identified by St. Joseph Hospital (SJH) and screened for food insecurity (see Appendix A for 

screening language). Those that screen positive based on the Hunger Signs food security screen

will be offered a referral to EAAA. 

Once referred, EAAA will introduce 

the Ibis Program system, an in-home 

system that helps individuals to better 

manage their health. Older adults who 

are interested in receiving this hub 

will receive an informed consent form 

and be randomized into the study. See 

Appendix B for EAAA protocols for 

the study visits.

Figure 1: Project at a glance The study will have two arms: 

Intervention and control group. The 

intervention group will receive medically tailored meals from EAAA based on their chronic 

disease conditions along with the Ibis Program. Those in the control group will receive the Ibis 

Program plus a nutrition tipsheet about maintaining good nutrition (see Appendix C for the 
3

control group tipsheet). Those in the intervention group will also receive enhanced information 

features via their IbisHub including healthy recipes and healthy eating tips. Individuals in the 

control group arm are eligible to receive other available nutrition supports via EAAA. EAAA 

staff will screen and work with these individuals to ensure that immediate needs are met using 

their standard service delivery protocols. See Appendix D for a full study flow chart.

The IbisHub, developed by Senscio, provides self-management support to 

persons with complex care needs. Ibis uses AI to assist individuals in optimally 

managing their health by dynamically planning their daily self-care. Guided by 

the patient’s physician, Ibis creates a personalized daily user care plan. The

care plan consists of a sequence of tasks that need to be accomplished

Figure 2: IbisHub each day including taking medications, meals, exercises, activities of 

daily living, vitals and symptoms monitoring, and appointments to be 

kept. Through simple, large icons, the IbisHub provides step by step instructions on completing 

each task. As each task is completed, the AI analyzes the data to decide whether any additional 

tasks need to be performed to maintain stable health and, if so, will proceed to provide the 

needed guidance. The Ibis Program represents both the IbisHub plus phone-based chronic 

disease management support through a care manager. The information collected via the Ibis unit 

is shared with the individual’s healthcare team and care manager. The system has built-in alerts 

that trigger interventions based on the individual’s condition. The system does not require high 

speed internet access for participants. All connectivity will be provided by Senscio Systems. 

Individuals who enroll in the system complete a care plan with the enrolling physician as well as 

a cognitive screen prior to install to ensure that participants are able to effectively utilize and 

understand the technology interface. Eastern Area Agency on Aging staff will be installing the 

IbisHub technology and will complete a cognitive assessment prior to install.

The study hypothesis is that those in the intervention group (Ibis Program plus medically tailored 

meals) will experience decreased nutrition risk, improved chronic disease self-management 

efficacy, along with decreased utilization of healthcare services, including hospital readmissions, 

urgent care visits, and ER visits. Nutritional support clients will report high levels of satisfaction 

with the meals provided. Chronic disease self-efficacy scores will increase over time for 

intervention participants and there will be a significant difference in scores between the 

intervention and control arms. A reduction in hospitalizations will be noted over time for study 

participants based on healthcare data. Institutional placement tracking over time will demonstrate 

that participants are able to remain in their home throughout the six months post-discharge 

period.

Data collection methods will include a survey packet that is administered at baseline, 3-months, 

and 6-months post-enrollment. The nutrition project coordinator will complete study enrollment 

and baseline-data collection over the phone during their initial telephone visit to introduce the 

Ibis Program. Subsequent data collection (3-month and 6-month) will be collected by phone by 

the Center on Aging graduate assistant. The baseline survey will be completed in paper format 

and transmitted via scan to the Center on Aging. The baseline survey packets and study consent 

hard copies will be mailed to the Center on Aging and data entry into a Qualtrics shell will be 

completed by the project graduate assistant. All subsequent surveys will be completed by phone 

by Center on Aging staff and entered directly into an electronic Qualtrics survey shell. 
4

Demographic Questionnaire (Appendix E): This questionnaire, administered at baseline only, 

consists of 6 questions covering gender, age, primary diagnoses, and ability to cook and prepare 

meals.

Hunger Vital Signs (Appendix F): The Hunger Vital Sign measure is a validated two question 

screen used to identify households at risk of food insecurity. This instrument will be included as 

part of the project referral form used by EAAA as well as the baseline, 3 month and 6 month 

follow-up data collection. 

UCLA Loneliness Scale (Appendix F): The Three-Item Loneliness Scale is designed to quickly 

and effectively measure feelings of loneliness and social isolation.

Mini Nutritional Assessment (Appendix G): The MNA is a 6-item index used to assess nutrition 

risk in older adults. Questions cover topics such as food intake, recent weight loss, mobility, and 

stress.

6-Item Self-Efficacy for Managing Chronic Disease Scale (Appendix H): The Self-Efficacy for 

Managing Chronic Disease six item scale developed by the Self-Management Resource Center 

will be used to measure changes in chronic disease self-efficacy. This scale covers several 

domains that are common across many chronic diseases, symptom control, role, emotional 

functioning, and communicating with physicians. These questions assess the patient’s confidence 

level in managing their illness.

Meals Satisfaction and Consumption Questions (Appendix I): A survey will be used for the 

intervention group to track meal satisfaction among participants. A five-star rating will be 

provided for meal taste and overall appeal. These rating data will be used to tailor meals to meet 

personal preferences. Daily meals data will be collected from the Ibis system based on daily 

prompts that ask “Did you eat lunch today?” and “Did you eat one of your delivered meals?” 

These questions will be delivered and collected via the IbisHub system. 

Project Satisfaction Survey (Appendix J): A survey will be given to those in the intervention 

group to assess the overall project and will include ratings on the IbisHub system and meals 

delivery satisfaction.

Nutrition Knowledge Questionnaire (These questions will be developed when the nutrition 

module is completed): A nutrition knowledge questionnaire that is developed by the project 

dietician and delivered through the IbisHub system. Questions will focus on reading a nutrition 

label, healthy food “swaps,” healthy foods on a budget, and food preparation techniques. 

Data collection from third party partners:

In addition to primary data collection via project surveys, administrative and health data will be 

gathered via secure data transfers. Eastern Area Agency on Aging, Ibis Health, and Senscio 

Systems will obtain release of information forms from research participants prior to data sharing 

(see Appendix L for agency release forms).
5

IbisHub- Disease Exacerbations (collected continuously by the Senscio system): The Ibis 

algorithm is designed to identify disease-specific exacerbations, such as a significant change in 

blood sugar levels and edema, which signal risk for significant health events. These data are 

collected as part of the IbisHub protocol and will be used to measure the extent to which 

participation in the nutritional intervention is associated with a significant decrease is disease 

exacerbations. Disease exacerbations will be quantified across each 3-month reference period.

Additional IbisHub data will be collected as follows:

• The number of Activities of Daily Living limitations reported by an individual will be 

sent from Ibis to the Center on Aging in order to facilitate subject group assignment. 

• The extent to which participants are actively engaging in their coaching calls with Ibis 

staff (quantified by count of calls in the past three months, collected at 3 months and 6 

months) This will be used as a control variable for the analysis. 

• Participant engagement with Ibis as measured by a daily “click” average generated at 3 

months and 6 months). This will be used both as a process measure but also as a potential 

control variable in the study design. 

• External referral: This measure will capture the number and type of referrals made by Ibis 

staff on behalf of the participant. This will also be used as a control variable within the 

analysis.

• Meals ratings: individuals in the intervention group will be asked to rate their medically 

tailored meals (see Appendix I). These ratings will be compared using a within-group 

comparison to assess growth in meal satisfaction as EAAA staff use meals ratings to 

improve individual meal selection for participants.

Healthcare utilization data will be used to identify the number of chronic conditions overall for 

each participant at baseline, hospital readmissions, number of urgent care visits, and the number 

of ER visits among study participants in the last three months. These data will be collected and 

transferred on the baseline, 3 month, and 6 month schedule. These data will help to test whether 

or not participation in the nutrition intervention is connected with decreased healthcare 

utilization and healthcare costs. 

Eastern Area Agency on Aging Data: Data will be collected from EAAA on participant 

engagement with EAAA services as well as administrative tracking of meals delivery dates for 

participants. For engagement with EAAA services, data will be gathered on the number of 

contacts with EAAA staff and the types of programs to which the individual is engaged over 

time. Data from the project referral form will also be transmitted to the Center on Aging. These 

data will be used to assess whether or not agency announcements provided via Ibis to the 

intervention group lead to increased engagement with social services over time. Data will be 

collected at baseline (for 3 months prior), 3 months, and 6 months. See Table 1 for timing of data 

collection efforts.
6

Table 1: Project Milestones and Data Collection

Milestone Type of data collected By Whom? Timing

First IbisHub visit by EAAA 1) Informed Consent 

and baseline 

demographics form

EAAA collects referral forms

from SJH as project referrals 

come in

EAAA collects and 

transmits consentform, 

baseline demographics, 

and a copy of the referral 

form to UM Center on 

Aging.

Original consent form and 

referral form are scanned 

and sent immediately to 

Center on Aging. The original 

paper copy of the consent 

form will be mailed to the

Center on Aging.

Within a week 

of hospital

discharge

Randomization assignment

data collection

ADL/functionalstatus 

information is generated 

during the Senscio intake 

with physician

Senscio transmits ADL 

information to the UM 

Center on Aging

Within 2 weeks

of hospital

discharge

Second IbisHub installation

visit by EAAA

Remaining baseline survey 

packet

EAAA collects and 

transmits to the UM 

Center on Aging.

Baseline packet is 

transmitted by mail.

Within 2 weeks

of hospital

discharge

3month data collection

Participantsin control group 

are receiving the Ibis 

Program services; 

Intervention group is 

receiving Ibis Program and 

weekly meals deliveries

1) 3 month survey 

packet completed by 

phone

Senscio data and EAAA data 

collected for baseline

through 3 month time period

1) Center on Aging 

staff

2) Center on Aging 

electronically transmits 

consent form to partners 

and receives data 

transfers

3 months postenrollment in

the pilot

6 month data collection 1) 6 month survey packet

completed by phone

1) Center on Aging staff 6 months postenrollment in

the pilot

Participantsin control group 

are receiving the Ibis 

Program services; 

Intervention group is 

receiving Ibis Program and 

weekly meals deliveries

2) Senscio data, and EAAA 

data collected for 3 month

through 6 month period

2) Center on Aging 

electronically transmits 

consent form (if needed)to

partners and receives data 

transfers
7

Citations- See Appendix M 

2. Personnel:

Dr. Lenard Kaye is the project Co-PI and will be involved in study oversight. Dr. Kaye is 

Professor of Social Work at the University of Maine School of Social Work and Director of the 

University of Maine Center on Aging. Dr. Kaye has been the principal investigator of numerous 

assessments of innovative community services for older adults, including projects funded by the 

AARP Andrus Foundation, Families USA, Brookdale Foundation, Maine Health Access 

Foundation, Pew Foundation, Bingham Program, John Harford Foundation, and U.S. 

Administration on Aging. He has been the principal investigator of the MeHAF-funded Maine 

Partners for Elder Protection (MePEP), the principal investigator of the Health Services Initiative 

of the Eastern Maine Transportation Collaborative Community Needs Assessment Project and 

has been the co-principal investigator for the Maine Primary Partners in Caregiving Project 

funded through the U.S. Administration on Aging. 

Dr. Jennifer Crittenden will train EAAA staff on project protocols and provide oversight to the 

research project. Dr. Crittenden is the Associate Director at the University of Maine Center on 

Aging and is serving as the subaward co-PI for this research project. Dr. Crittenden has over 

fifteen years of experience in professional and community education, program evaluation and 

program planning. Dr. Crittenden has been involved in implementing and evaluating a wide 

range of research, training, and community service initiatives including serving as the Program 

Manager for Encore Leadership Corps, an innovative volunteer leadership program for Mainers 

50+ and served as Project Manager for the National Institutes of Health-funded Balancing Act 

Clinical Trial, a research study testing a falls prevention program among older adults with visual 

impairments.

David Wihry, Center on Aging Senior Project Manager, will serve as the project data manager 

and will setup the project databases for both survey data and secondary data from Senscio and 

EAAA. David will oversee data transfers and conduct data checks to ensure data integrity. David 

will also oversee data entry in collaboration with the project graduate assistant.
8

Abbie Hartford is currently an MSW student at the University of Maine and has research 

experience working on human subjects projects including interviewing and survey projects. 

Abbie will assist in carrying out 3-month and 6-month data collection. The graduate assistant 

will also help with data entry, data analysis, and reporting in collaboration with David Wihry.

Kelley Morris, CoA Administrative Specialist, will be tracking participants to ensure that timely 

3-month and 6-month assessment appointments are made. She will also be receiving and 

reviewing the signed informed consent forms, data authorization forms, and maintaining a 

contact log with each participant.

Tracy Kinney, EAAA Project Administrative Coordinator will be responsible for introducing 

the study to participants, obtaining informed consent for the project, and collecting baseline data 

from participants. Tracy will start in her position in January 2020 and will complete the IRB 

human subjects training as well as project specific trainings on protocols. All training will be 

completed prior to subject enrollment in March 2020. 

Tom Kenney, EAAA Director of Nutrition Services will be trained to serve as a backup for the 

EAAA Nutrition Coordinator in order to complete study enrollment functions. Tom will 

complete the IRB human subjects training as well as project specific trainings on protocols. All 

training will be completed prior to subject enrollment in March 2020. 

All individuals named above will complete human subjects training prior to subject enrollment in 

March 2020. 

The following individual will receive signed consent forms in order to authorize data transfers 

but will not have access to individual survey packet data: 

Senscio Systems: Mike Charley, Senior VP of Client and Member Services

3. Recruitment:

Recruitment will be facilitated through the established program pathway using scripting at St. 

Joesph’s and EAAA (see Appendix items A & B). Individuals will be recruited from current 

patients within St. Joseph Hospital in Bangor Maine who will be screened and offered 

participation in the pilot project. Each patient is screened for food insecurity by hospital staff as 

part of standard practice prior to hospital discharge. Those older adults (age 60+) who screen 

positive for food insecurity and meet study criteria will be referred to EAAA (project lead) for 

further introduction to the study. In addition, any SJH patient who has experienced a 

hospitalization in the last 90 days will be identified through the care management department and 

screened during routine follow-up contact. All individuals who screen positive for food 

insecurity and meet project criteria (see below) will be sent home with 10 meals to last them 

through the study consent process. For those not currently hospitalized, the meals will be 

delivered to their home or provided by an SJH primary care practice site. If the individual 

ultimately does not consent into the study or is not offered the study enrollment option, EAAA 

will connect them with additional nutritional supports and programming as needed. 
9

Client inclusion criteria for the project is as follows: 1) Age 60 and older; 2) Positive screen for 

food insecurity as measured by the hunger vital signs measure; 3) Two or more chronic 

conditions expected to last longer than 12 months that place the patient at significant risk of 

death, acute exacerbation, decompensation, or other functional decline. Diagnoses must include 

one of the following priority populations: congestive heart failure (CHF), depression, 

hypertension, diabetes, or chronic obstructive pulmonary disease (COPD); 4) Residing in the 

EAAA four-county service area; 5) Followed by a St. Joseph Healthcare (SJH) PCP and 6) A 

discharge plan that includes a discharge home (as opposed to a facility) or currently residing at 

home following a hospitalization within the last 90 days. 

A referral sheet is included in Appendix A along with a sheet about the Ibis Program which will 

be provided to patients who qualify for the study prior to discharge. 

Once referred to EAAA, a staff member will make contact and introduce the study using the 

script provided in Appendix B. An initial telephone visit will be scheduled with the project 

coordinator who will discuss the IbisHub and its features and install. Prior to this visit, two 

copies of the study consent form will be sent to the individual. Those who agree to enroll with 

Senscio and receive the IbisHub will complete the Ibis enrollment package and will be scheduled 

for their install telephone visit with the Ibis healthcare physician who sets up their plan of care.

Part of the Ibis enrollment includes an assessment of cognitive capacity to use the Ibis system. If 

an individual does not meet this threshold, they will not be offered an IbisHub and will not be 

given the opportunity to enroll in the study. EAAA will provide supports to these individuals and 

their caregivers as needed. 

For those who meet criteria and consent for Ibis enrollment, the project coordinator will review 

the study informed consent form with the individual and answer any questions they may have. 

The informed consent is signed and a copy is kept by the participant for future reference. After 

this telephone visit, the informed consent form and a copy of the original referral form will be 

sent to the Center on Aging. Prior to their second telephone visit by EAAA staff, Center on 

Aging will complete assignment to either the control group or the intervention group. All 

participants must successfully complete the Ibis Program enrollment process prior to the second 

telephone visit by EAAA. Participants may receive the Ibis Program while not consenting to the 

research project. Those who do not consent to the study will receive the standard Ibis Program 

offering without medically tailored meals.

Group assignment: Individuals will be assigned to the control or intervention groups using 

minimization assignment. Minimization assignment is a method used to reduce differences 

between different arms of the study based on prognostic factors that are likely to affect the 

dependent variables of interest. The first three individuals will be assigned to groups using a 

simple random number generator. Each subsequent participant after those three will then be 

placed into minimization assignment using the MinimPy software program balancing for the 

following factors: sex (male/female), functional status (based on ADL information provided by 

Senscio), and number of chronic conditions (2-3 versus 4 or more). Only staff from the Center on 

Aging, EAAA, and Senscio will know to which group each individual participant is assigned. 
10

During the second staff visit, EAAA staff will complete the baseline data collection with the 

individual and submit that packet back to Center on Aging staff. At this second visit, individuals 

in the intervention group will start their weekly meals delivery. Individuals in the control group 

will receive a nutrition tipsheet via their IbisHub (see Appendix C). Individuals in both groups 

will be given an introduction to the IbisHub system using phone-based support. Those in the 

intervention group will receive additional training in accessing the nutrition module within their 

IbisHub system. 

It is anticipated that the recruitment pool will include 200 older adults over the course of the 3- 

year project with a gender split of approximately 55% female and 45% male and 98% white and 

2% non-white race based on local demographics. Recruitment will be done without regard for 

gender, race, or ethnicity and will be based on the study criteria noted above. 

For the power analysis, a conservative estimate was made for treatment effects as this is an 

exploratory study. Using a small effect size and an a priori Bonferroni correction for five 

analyses, at least 68 participants are needed to detect a small effect. Given that we will adjust for 

number of chronic conditions, age, gender, and functional status, 100 participants per group is 

likely to be sufficient to detect the presence of at least a small treatment effect.

4. Informed consent: 

For those who meet criteria and consent for Ibis enrollment, the EAAA project coordinator will 

review the study informed consent form by phone with the individual and answer any questions 

they may have. The informed consent is signed and a copy is kept by the participant for future 

reference. After this telephone visit, the informed consent form and a copy of the original referral 

form will be sent to the Center on Aging. Prior to their second telephone visit by EAAA staff, 

Center on Aging will complete assignment to either the control group or the intervention group. 

The informed consent document will be provided to participants by mail, or through a socially 

distanced dropoff by EAAA staff, and will require their signature consenting to participate in the 

study. For individuals being discharged from SJH, staff will discuss the study briefly prior to 

discharge (see Appendix A for scripting) and the study consent materials will be provided in an 

envelope. SJH staff will indicate that an EAAA staff person will be calling to discuss the 

materials and answer questions that they may have. SJH staff will not answer questions about the 

study and will direct all questions to EAAA staff (Tracy Kinney). EAAA staff will be trained to 

review the informed consent document and will direct individuals who have additional questions 

about the study to connect with Center on Aging study staff members. Study participants will be 

told their participation is voluntary and that they are free to withdraw from the study at any time 

(see Appendix K). Individuals in the intervention group who withdraw from the study will not be 

eligible to continue to receive the 10 weekly medically tailored meals. Such individuals will 

receive follow-up from EAAA nutrition services for a Meals on Wheels assessment if nutrition 

continues to be a concern for the individual. Individuals in both groups who withdraw from the 

research study are eligible to continue to receive their Ibis Program services. Individuals who 

unenroll in Ibis services will not be allowed to continue in the research study as the Ibis Program 

is an essential component of the pilot model under study. 
11

Due to study blinding, individuals will not be informed to which condition they have been 

assigned. Some individuals will not receive meals as part of their study assignment and therefore 

the informed consent form does not discuss the receipt of meals as part of the study design. 

Individuals in the intervention group will be informed by EAAA staff about their meals during 

their second home visit. 

5. Confidentiality:

This study is designed to be confidential. All information and data collected will be identified by 

number (not names) and stored on a secure computer at the Center utilizing password protection 

and file encryption. This ID list will be shared with Senscio, Ibis Health, and EAAA so that staff 

can remove names from their file transfers prior to submission to CoA staff. All information will 

be password protected so the information is secure and only those with permission can access the 

deidentified information. The ID list will be maintained in an Excel file that is securely stored 

on Google Drive, shared directly with staff who have data sharing responsibilities, and password 

protected using AES 256 bit encryption in Excel. The deidentified data will be kept by the

Center on Aging indefinitely. Data will be coded and encrypted using industry standards. The 

key linking ID numbers with names will be destroyed at the conclusion of the study (September 

2023) by all project partners (EAAA, Senscio, SJH, and Center on Aging). All study documents 

including baseline and follow-up assessments will be coded using this ID code system. 

All data transferred from Senscio to the Center on Aging will be transferred without identifying 

information using the established participant ID code system. A copy of signed informed consent 

forms will be provided to both EAAA and Senscio which will serve as documentation for the 

consent of release of this information for research purposes. EAAA, Ibis Health and Senscio 

Systems will obtain release of information (ROI) forms from participants (see Appendix L for 

ROI forms) prior to releasing data to the UM Center on Aging. These forms have been 

developed by UM legal counsel and deemed to meet HIPAA requirements. No PHI will be 

released from SJH to UM.

Sponsors, funding agencies, regulatory agencies, and the Institutional Review Board may review 

the research records. Copies of signed consent forms will be maintained by the principal coinvestigator (Dr. Crittenden) for at least 3 years after the project is complete before it is

destroyed (approximately September 2026). The consent forms will be stored in a secure location 

that can be accessed by Center on Aging staff named in the personnel section of this application. 

A copy of each signed consent will be sent to each partner organization to ensure data transfers 

are completed in a timely fashion.

Data reported from this effort will be aggregate in nature and will include a variety of formats for 

lay, professional, and academic audiences including research reports and briefs and conference 

presentations. Data will also be reported out in aggregate format for the funding source via 

semiannual project reports. 

6. Risks to participants:
12

The risks of this study are minimal. Risks include time and inconvenience needed to complete 

the study assessments. Some participants may feel uncomfortable answering personal questions 

about their health and wellness. Participants will be reminded that their involvement in the study 

is completely voluntary and that they may withdraw from the study at any time or skip any 

questions they do not wish to complete. There are also risks with data transfers. To ensure that 

data are carefully protected, no data will be transferred between partners with names or 

identifying information attached. All data will be transferred and analyzed using a unique project 

ID assigned to each individual at project intake. 

7. Benefits: 

All individuals enrolled in the program will receive Ibis Program services (health selfmanagement support). In addition, those within the intervention group will receive 10 weekly 

medically tailored meals for free. All individuals referred to the project will be screened for 

appropriate services and supports from EAAA regardless of the study condition to which they 

have been assigned. In addition, this research will provide valuable insight into interventions that 

have the potential to help older adults to better manage their own health through technology and 

nutrition supports. 

8. Compensation:

All participants will receive a $20 Walmart gift card for participation in each assessment for the 

project (baseline, 3 months, and 6 months). Participants will have the opportunity to earn a total 

of $60 in gift card compensation based on the assessment schedule. Participants will need to 

complete at least half of the assessment packet to receive the gift card compensation.
13

Appendix A: St. Joseph Screening and Referral Protocols
14
15
16
17
18

Appendix B: Eastern Area Agency on Aging Project Protocols for 

First and Second Visits
19
20

Appendix C: Tipsheet for Control Group Participants
21
22

Appendix D: Project Flowchart
23

Appendix E: Demographic Questions (Baseline only) 
24

Appendix F: Hunger Signs & Loneliness Screens (Baseline, 3 

mo., 6 mo.)

Hunger Signs

1. Within the last 12 months we worried whether our food would run out before we got 

money to buy more. (Circle the answer given)

Often true Sometimes true Never true

2. Within the past 12 months the food we bought just didn’t last and we didn’t have money 

to get more. (Circle the answer given)

Often true Sometimes true Never true

UCLA Loneliness Scale

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.

1. First, how often do you feel that you lack companionship: Hardly ever, some of the 

time, or often?

1 [ ] Hardly Ever

2 [ ] Some of the Time

3 [ ] Often

2. How often do you feel left out: Hardly ever, some of the time, or often?

1 [ ] Hardly Ever

2 [ ] Some of the Time

3 [ ] Often

3. How often do you feel isolated from others? (Is it hardly ever, some of the time, or 

often?)

1 [ ] Hardly Ever

2 [ ] Some of the Time

3 [ ] Often
25

Appendix G: Mini Nutritional Assessment (Baseline 3 mo., 6 

mo.)
26
27
28
29

Appendix H:

Self-Efficacy for Managing Chronic Disease 

(Baseline, 3 mo., 6 mo.)

We would like to know how confident you are in doing certain activities. For each of the 

following questions, please choose the number that corresponds to your confidence that 

you can do the tasks regularly at the present time.
30

Scoring

The score for each item is the number circled. If two consecutive numbers are circled, 

code the lower number (less self-efficacy). If the numbers are not consecutive, do not 

score the item. The score for the scale is the mean of the six items. If more than two 

items are missing, do not score the scale. Higher number indicates higher self-efficacy
31

Appendix I: Meal Ratings (collected on the IbisHub system for 

intervention group)

Meal Ratings
32

Appendix J: Program Satisfaction Survey (3 mo. & 6 mo.)

(Questions 1,2,3,4,5,7 for all participants, questions 1-10 for 

intervention group)
33

Appendix K: Informed Consent

UNIVERSITY OF MAINE CENTER ON AGING

Research Informed Consent Form 

Project Title: EAAA Innovations Pilot Project

About This Study

• You are invited to participate in a research project being conducted by Dr. 

Jennifer Crittenden and Dr. Lenard Kaye.

• Staff members at the University of Maine Center on Aging (CoA), Eastern Area 

Agency on Aging (EAAA), Ibis Health, and Senscio Systems are testing a new 

program that provides in-home health support to older adults like you.

• The purpose of this research is to learn more about how different types of 

supports can help older adults with chronic diseases (like COPD, diabetes, heart 

disease) manage their health.

• This research involves completing three survey packets. One you will complete 

during your next telephone visit, one you will do in 3 months, and another you will 

do in 6 months.

• This research project is voluntary, meaning you can stop participating at any 

time.

• Risks include that you may feel uncomfortable answering questions about your 

health.

• Benefits of this study include getting supports to help you manage your health. 

This study will also help us to better understand how to best support older adults 

who have chronic disease.

• The alternative to being in this study is for you to receive standard services 

available through Eastern Area Agency on Aging. You can receive Ibis Program 

services if you decline to participate in the study. However, you will not be eligible 

for additional supports that study participants receive.

This research project is referred to as a “randomized controlled trial,” meaning that there 

is a control group that receives one version of the support program, as well as an 

experimental group that receives a different version. You will be randomly assigned to 

one group or the other and have an equal chance of being in each group, but will not 

know what group you are assigned to.
34

You have been invited to participate in this study because:

• You have two or more chronic diseases

• You are age 60 or older

• You live in your own home or apartment

• You live in one of these counties: Penobscot, Piscataquis, Washington, Hancock.

• You have recently been discharged from the hospital

• You have agreed to receive an Ibis Program system in your home

What Will You Be Asked to Do?

If you decide to participate, you will be asked to complete a survey packet at three 

different times. You will complete one at your next telephone visit with Eastern Area 

Agency on Aging, another one in three months, and another one in 6 months. The 

surveys will include questions about your health and well-being as well as the services 

you are receiving from Ibis.

You will complete your first packet at your next telephone visit with EAAA staff. For 

months 3 and 6, a staff person from the UMaine Center on Aging will be in touch with 

you by phone to complete your survey packet.

Examples of questions we will ask:

• How confident do you feel that you can do things other than just taking 

medication to reduce how much your illness affects your everyday life?

• How often do you feel isolated from others?

You will be randomly selected to one of 2 groups, either the control group that receives 

one support program, or the experimental group that receives the support program that 

the research is designed to test.

You will use your Ibis unit as instructed and receive Ibis health support as needed 

during the pilot project.

As part of the study, the Center on Aging will access a limited amount of information 

about your health and the services you receive from Senscio, Ibis Health, and EAAA. A 

list of this information is included in this form.

What kind of information are you getting from Senscio, Ibis Health, and EAAA?

The Center on Aging is working closely with Senscio, Ibis Health, and EAAA so that we 

can get an accurate picture of the health of our study participants. We will collect the 

following information from these partners during the 6-month study period. You must 

agree to this data sharing in order to participate in the study.
35

Ibis Health: 

• Number of activities of daily living you are currently able to complete

• Hospital readmissions that occur during the 6-month study period

• Number of urgent care visits during the 6-month study period

• Number of ER visits 3-months before the study

• Number of ER visits during the 6-month study period

• How often you are participating in your Ibis support calls

• How many and what types of referrals to other agencies Ibis is making to help 

you manage your health

Senscio Systems: 

• Any health-related alerts you get from the Ibis system (how many and the type of 

alerts)

• How often you are using the Ibis system (number of tasks you do each day)

• Satisfaction ratings and feedback that may be collected by the Ibis system

EAAA: 

• Tracking of any services you receive from EAAA including what type and how 

often

• Your weight and height as provided on your program referral form

• Number of contacts you have with EAAA staff

• The type of chronic conditions you currently have based on your Nutrition 

Innovations program referral.

• Your hunger screen responses provided on your Nutrition Innovations program 

referral form.

• Your sex (male/female) and date of birth provided on your Nutrition Innovations 

program referral form.

Risks

• There is the possibility that you may become uncomfortable answering the 

questions. You may skip any questions that make you uncomfortable

• Because this study will collect information about your health and personal 

conditions, the research team is taking many steps to protect your information 

including removing your name from study files.

• This program is designed to help improve health, and the tasks asked by you do 

not require anything that is considered dangerous.

Benefits

● You will be provided with tools through the Ibis Program to help manage your 

health conditions.

● Regardless of which group you are in (experimental or control) you will have the 

opportunity to be screened and receive additional services through EAAA.
36

● Based on the results of this study, your participation will help us learn more about 

how different supports to improve the health of older adults with chronic illness.

Compensation

● We will provide you with a $20.00 Walmart gift card after each assessment 

period, totaling in $60.00 for the entire study.

● You will need to complete at least half of the study packet questions to receive 

the gift card compensation.

Confidentiality

● This study is designed to be confidential, this means that your name will not be 

connected to the information you provide, instead there will be a number used in 

place of your name.

● The file linking your ID and your name will be maintained by the Center on Aging 

and will be provided to Senscio, Ibis Health, and Eastern Area Agency on Aging 

to help us gather the information needed for the study.

● All information collected (surveys and health data) will be identified by number 

(not your name) and stored on a secure computer at the Center on Aging which 

is only accessible by research staff. All information will be password protected so 

the information is secure and only those with permission can access the 

information.

o Your survey responses will be kept by the Center on Aging indefinitely 

(forever).

o Your healthcare data will be kept indefinitely (forever) by the Center on 

Aging.

o Data will be coded and encrypted using industry standards.

o No individually identifiable information will be collected from EAAA or 

Senscio about you.

o The ID list linking names to ID number will be destroyed at the end of the 

study by UMaine, Ibis Health, Senscio, and EAAA (September 2023)

● A copy of your signed consent form will be kept for at least 3 years after the 

project is complete before it is destroyed (September 2026). The consent forms 

will be stored in a secure location that can be accessed by only certain research 

members. EAAA, Ibis Health, and Senscio will keep a copy of your consent form 

in order to share your information with us. All partner copies of these forms will 

be destroyed by September 2026.

● Sponsors, funding agencies, regulatory agencies, and the Institutional Review 

Board may review the research records. This includes Eastern Area Agency on 

Aging, the University of Maine Orono, Ibis Health, and Senscio Systems.
37

Voluntary

● Your participation is voluntary. Your decision to participate will have no impact on 

your current or future relations with Senscio, Ibis Health, EAAA, and the Center 

on Aging.

● You may skip or refuse to answer any question in the survey packet for any 

reason.

● You are free to withdraw from this research study at any time, for any reason. If 

you do withdraw, you can continue to receive the Ibis Program services.

● You must receive Ibis Program services to participate in the study. If at any time 

you opt out of receiving the Ibis Program, you will be unenrolled in the research 

study.

● If you unenroll from the study, EAAA will work with you to ensure your health and 

support needs are met.

● You will be informed of any significant findings developed during the course of 

the research that may affect your willingness to participate in the research. 

Contact Information

● The researchers conducting this study are Lenard Kaye and Jennifer Crittenden. 

For questions or more information concerning this research you may contact Dr. 

Kaye at 207-262-7922 or len.kaye@maine.edu and Dr. Crittenden at 207-262- 

7923 or jennifer.crittenden@maine.edu

● If you have any questions or concerns about your rights as a research subject, 

you may contact the Office of Research Compliance, University of Maine, 207- 

581-2657 or by e-mail at umric@maine.edu.

Will I receive a copy of this consent form?

● You will sign two copies of this form. One you will keep for yourself and the other 

will be given to the Center on Aging. A copy of your signed form will be kept by
38

EAAA, and a copy will be sent to Senscio Systems and Ibis Health so that they 

can release your health information for the study.

Participant’s Statement

Your signature below indicates that you have read the above information and 

agree to participate. You will receive a copy of this form. Please contact me 

using the information below for study follow-up surveys.

Participant’s signature or Date

Legally authorized representative

Printed name

Best Phone Number to Call for the 3 month and 6 month survey (with area code):

Best E-mail address to use to schedule the 3 month and 6 month survey:

Best Address to use for contacting you about the study:
39

Appendix L: Release of Information Forms (EAAA, Ibis Health & 

Senscio)
40
41
42
43
44
45
46
47

Appendix M: References

1. National Council on Aging. (2016). Chronic disease self-management facts. Retrieved from 

https://www.ncoa.org/news/resources-for-reporters/get-the-facts/chronic-disease-facts/

2. National Council on Aging. (2017). Ten Common chronic conditions for adults 65+. Retrieved 

from https://www.ncoa.org/wp-content/uploads/10-Common-Chronic-Conditions-Older-Adultsncoa.png

3. Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the United States. 

Retrieved from 

https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf

4. Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., Metlay, J. P.,

. . . Schnipper, J. L. (2016). Preventability and causes of readmissions in a national cohort of 

general medicine patients. JAMA Internal Medicine, 176(4), 484

5. Ziliak, J. P., & Gunderson, P. (2017). The state of senior hunger in America 2015: An 

annual report. Retrieved from 

https://www.feedingamerica.org/sites/default/files/research/senior-hunger-research/state-ofsenior-hunger-supplement-2015.pdf

6. Ziliak, J. P., & Gundersen, C. (2017). The health consequences of senior hunger in the 

United States: Evidence from 1999-2014 NHANES. Retrieved from: 

https://www.feedingamerica.org/sites/default/files/research/senior-hungerresearch/senior- health-consequences-2014.pdf

7. Food Research and Action Center. (2017). Hunger & health: The impact of poverty, food 

insecurity, and poor nutrition on health and well-being. Retrieved from http://frac.org/wpcontent/uploads/hunger-health-impact-poverty-food-insecurity-health-well-being.pdf

8. Jih, J., Stijacic-Cenzer, I., Seligman, H. K., Boscardin, W. J., Nguyen, T. T., & Ritchie, C. S. 

(2018). Chronic disease burden predicts food insecurity among older adults. Public Health 

Nutrition, 21(9), 1737-1742. doi:10.1017/S1368980017004062

9. Berkowitz, S. A., MD, Seligman, Hilary K., MD, MAS, & Choudhry, Niteesh K., MD, PhD. 

(2014). Treat or eat: Food insecurity, cost-related medication underuse, and unmet needs. 

American Journal of Medicine, 27(4), 303-310.e3. doi:10.1016/j.amjmed.2014.01.002

10. United States Census Bureau. (2017). 2013-2017 American Community Survey 5-year 

estimates: Demographic and housing estimates; Penobscot, Piscataquis, Washington, and 

Hancock, Maine, Counties.

11. Kaiser Family Foundation. (2018). How many seniors are living in poverty? National and
48

state estimates under the official and supplemental poverty measures in 2016. Retrieved from 

http://files.kff.org/attachment/Data-Note-How-Many-Seniors-Are-Living-in-Poverty-National-andState-Estimates-Under-the-Official-and-Supplemental-Poverty-Measures-in-2016

12. United States Census Bureau. (2017). 2013-2017 American Community Survey 5-year 

estimates: Selected economic characteristics; Penobscot, Piscataquis, Washington, and 

Hancock, Maine, Counties

13. United States Department of Agriculture. (2017). Household food security in the United 

States in 2016. Retrieved from https://www.ers.usda.gov/publications/pub-details/?pubid=84972
Appendix B
Application Narrative:

Title: Older Adult Nutrition Innovation Pilot: Administrative Operations Committee Interviews

1. Funding

Funding Agency: Administration for Community Living via Eastern Agency on Aging (lead 

org)

Project # NSN928 (GL Project # 5407980 and PARS submission #2019630)

2. Summary

A nutritional enhancement and self-management project has been developed by the Eastern Area 

Agency on Aging in partnership with St. Joseph Healthcare, Senscio Systems, and the University 

of Maine. The project innovatively uses technology to improve nutrition for older adults with 

multiple chronic diseases. The goal of this three-year project is to improve the nutritional and 

health status of rural adults 60 and older with multiple chronic conditions immediately following 

hospital discharge. 

Anticipated outcomes for older adults include: 1) Decreased nutritional risk; 2) Improved health 

and health-related quality of life; 3) Improved ability to age in place; and 4) High levels of

satisfaction with services.

Project partners are administering the program and therefore retain valuable information about 

the project implementation project and the value of the project’s work to-date. Therefore, 

interviews with project partners will yield information on project performance. These interviews 

will focus on evaluating planned and actual accomplishments, explore any implemented course 

corrections, identify value added to healthcare and aging services, lessons learned, unexpected 

developments, and opportunities for local and national expansion. 

Background

Over 15% of the Maine population aged 60 or over experience a threat of hunger1. Food 

insecurity has also been found to be more prevalent among those with chronic conditions2

. The 

combination of food insecurity with chronic conditions compounds the poor health outcomes of 

older adults3

. Additionally, limited financial resources can result in hospital readmissions when 

patients are forced to choose between purchasing food or medication4. 

Hospital readmissions can be reduced by providing interventions that continue to support the 

patient after discharge from hospital5, such as by providing increased dietary and nutrition 

supports in their own home. 

Methods

Semi-structured interviews, consisting of 15 open-ended questions, will be conducted with 

project partners via phone call or Zoom. Interviews will be conducted by Rachel Coleman and 

Jennifer Jain, both on graduate assistantships at the UMaine Center on Aging. Interviews will be 

recorded and anticipated to take approximately 30-45 minutes. The questions guiding the 
interview can be found in Appendix A. All interviews will be recorded, transcribed, and 

subjected to thematic content analysis.

These project interviews will be conducted at the conclusion of each project year to monitor the 

development of the project and accumulate lessons learned over the course of the project. 

Citations

1. Ziliak, J. P., & Gunderson, P. (2017). The state of senior hunger in America 2015: An

annual report. Retrieved from

https://www.feedingamerica.org/sites/default/files/research/senior-hunger-research/state-ofsenior-hunger-supplement-2015.pdf

2. Jih, J., Stijacic-Cenzer, I., Seligman, H. K., Boscardin, W. J., Nguyen, T. T., & Ritchie, C. S.

(2018). Chronic disease burden predicts food insecurity among older adults. Public Health

Nutrition, 21(9), 1737-1742. https://doi.org/10.1017/S1368980017004062

3. Garcia, S. P., Haddix, A., Barnett, K,. (2018). Incremental health care costs associated with

food insecurity and chronic conditions among older adults. Preventing Chronic Disease, 15,

180058. http://dx.doi.org/10.5888/pcd15.180058

4. Berkowitz, S. A., MD, Seligman, Hilary K., MD, MAS, & Choudhry, Niteesh K., MD,

PhD.

(2014). Treat or eat: Food insecurity, cost-related medication underuse, and unmet needs.

American Journal of Medicine, 27(4), 303-310.e3.

https://doi.org/10.1016/j.amjmed.2014.01.002

5. Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K.,

Metlay, J. P.,

. . . Schnipper, J. L. (2016). Preventability and causes of readmissions in a national cohort

of

general medicine patients. JAMA Internal Medicine, 176(4), 484. 

https://doi.org/10.1001/jamainternmed.2015.7863

3. Personnel:

Dr. Lenard Kaye, Professor of Social Work and Center on Aging Director, is the project Co-PI

and will be involved in study oversight. Dr. Kaye is Professor of Social Work at the University

of Maine School of Social Work and Director of the University of Maine Center on Aging. Dr.

Kaye has been the principal investigator of numerous assessments of innovative community

services for older adults, including projects funded by the AARP Andrus Foundation, Families

USA, Brookdale Foundation, Maine Health Access Foundation, Pew Foundation, Bingham

Program, John Harford Foundation, and U.S. Administration on Aging. He has been the principal

investigator of the MeHAF-funded Maine Partners for Elder Protection (MePEP), the principal

investigator of the Health Services Initiative of the Eastern Maine Transportation Collaborative
Community Needs Assessment Project and has been the co-principal investigator for the Maine 

Primary Partners in Caregiving Project funded through the U.S. Administration on Aging. Dr. 

Kaye has extensive human subjects experience spanning his 35+ year career.

Dr. Jennifer Crittenden, Assistant Professor of Social Work and Center on Aging Associate 

Director, will train project research staff and provide day-to-day oversight of project activities. 

She will assist with project recruitment, data analysis, and reporting. Dr. Crittenden is the 

Associate Director at the University of Maine Center on Aging and is serving as the subaward 

co-PI for this research project. Dr. Crittenden has over fifteen years of experience in professional 

and community education, program evaluation and program planning and she has over 17 years 

of human subjects experience. Dr. Crittenden has been involved in implementing and evaluating 

a wide range of research, training, and community service initiatives including serving as the 

Program Manager for Encore Leadership Corps, an innovative volunteer leadership program for 

Mainers 50+ and served as Project Manager for the National Institutes of Health-funded 

Balancing Act Clinical Trial, a research study testing a falls prevention program among older 

adults with visual impairments.

David Wihry, Center on Aging Senior Project Manager, will serve as the project data manager 

and will assist in managing interview data and working with the project graduate assistants to 

ensure that project data are properly transcribed, managed, and coded. David has over seven 

years of experience in human subjects research conducting a variety of tasks including human 

subjects recruitment, interviewing, surveying, and data management. 

Rachel Coleman and Jennifer Jain will both conduct project interviews and assist in 

transcription clean-up, data analysis and reporting under the guidance of Dr. Kaye, Dr. 

Crittenden and David Wihry. Rachel is a PhD student in the department of Ecology and 

Environmental Sciences and Jennifer Jain is currently an IPhD student. Both students are 

graduate assistants at the Center on Aging and both have completed their IRB training and will 

receive additional training in interview protocol prior to the start of data collection. Both students 

have at least one year of human subjects experience through involvement in other research 

projects at UMaine.

Jacob Ackroyd will assist in transcribing interviews and cleaning up Zoom recording 

transcriptions. Jacob is a work-study student at the Center on Aging and he has completed the 

human subjects training. Jacob has been a work study student at the Center on Aging for the past 

two years and during that time has provided administrative support to various research projects at 

the Center.

4. Participant recruitment:

All project partners from the project’s Administrative Operations Committee (AOC) will be 

invited to participate in the interview via email. It is estimated that 7-10 individuals will 

participate in interviews each year. As a member of the AOC, Dr. Crittenden will be alerting the 

group that they will be receiving contact from a project graduate assistant to introduce this 

component of the project evaluation. The email to be sent to project partners and consent form 

can be found in Appendix B and Appendix D. All partners are aware of this interview
component as they have all received a copy of the project work plan which includes participation 

in an annual interview process. 

Dr. Crittenden will provide the graduate assistants with e-mail addresses for all AOC members. 

All members are professional staff members and designated staff on this project and thus there 

are no privacy concerns around sharing e-mail addresses.

5. Informed consent

The informed consent form (Appendix B) will be provided to the interviewee as part of the 

recruitment e-mail and this form will also be reviewed at the start of the interview. Consent to 

participate in the study will be attained via email from participants prior to the interviews and 

again orally at the start of the phone or zoom interviews. Follow-up contact indicating interest in 

scheduling an interview will signal initial acceptance of the informed consent and invitation. 

Participation in an interview will indicate consent.

An introductory script is included in Appendix C and will be utilized prior to the start of the 

interview to ensure consent is covered. 

6. Confidentiality:

Interviews will be confidential. Recordings will be stored on a shared Google Drive folder that is 

only accessible to the Center on Aging team named above until transcriptions are completed. 

Once transcriptions are completed, recordings will be destroyed. Recordings will be conducted 

via Zoom and saved to the Zoom Cloud and will be transcribed using the Zoom auto transcribe 

feature. For those participants who choose the call-in option, the Zoom conference call line 

option will be used to capture recordings. These recordings will also be saved to the Zoom 

Cloud. Zoom recordings will be reviewed for accuracy and cleaned by project personnel noted 

above. Zoom recordings will be deleted from the cloud once the transcript has been cleaned and 

finalized and no later than the end of the project (September 2023). Transcripts will be kept 

indefinitely. Reporting will be done in aggregate looking at themes across respondents. Any 

quotes and excerpts shared from project interviews will be deidentified. Sponsors, funding 

agencies, regulatory agencies, and the Institutional Review Board may review the de-identified 

research records. This includes Eastern Area Agency on Aging, the University of Maine Orono, 

Ibis Health, and Senscio Systems. 

7. Risks to participants:

The risks to participants are time and inconvenience. Participants will be reminded that their 

involvement in the study is completely voluntary and that they may withdraw from the study at 

any time or skip any question they do not wish to address. 

8. Benefits: 

There are no direct benefits to the participants from the proposed interviews. One potential 

benefit of the interviews is that interviewees may enjoy providing their perspective and reflecting
on their own work and project accomplishments to-date. Participation will provide an 

understanding of the successes and challenges experienced in the program thus far which can be 

used to improve project activities into the future. 

9. Compensation:

There will be no compensation for participating in the study.
Appendix A – Interview Questions 

Implementation To-Date

1. What is your assessment of project implementation to date?

2. In thinking about the progress made to date, what factors have helped facilitate the 

implementation of this project?

3. What do you see as the major accomplishments thus far of the project?

4. What have been the challenges or barriers to full implementation?

5. What have been the major obstacles with recruiting participants?

6. What do you see as potential solutions to those obstacles?

7. In thinking about your role with the project, have you had to make any course corrections 

thus far? If so, please describe those. 

8. Considering your role within the project, have there been any unexpected developments?

9. If someone were looking to start a project like this one, what advice would you give?

Lessons Learned and Value to the Field

10. What value do you see this project having currently for...

a. The healthcare field

b. Older adults themselves

c. Aging services

11. What lessons have been learned thus far that could be applied to your role within the 

project?

12. What lessons have you learned thus far with regards to the project that could be shared 

with others in the field?

13. Would you recommend any changes if this service were to be expanded and scaled up?

14. Do you see any opportunities for this project to be scaled or expanded either locally, on a 

state-level or nationally?

15. Are there any additional comments you would like to share about the project at this point 

in time?
Appendix B - Informed Consent

UNIVERSITY OF MAINE CENTER ON AGING

Research Informed Consent Form 

Project Title: Older Adult Nutrition Innovation Pilot 

About This Study

● You are invited to participate in a research project being conducted by Dr. Jennifer 

Crittenden, Assistant Professor of Social Work and Center on Aging Associate 

Director,and Dr. Lenard Kaye, Professor of Social Work and Center on Aging Director, 

at the University of Maine.

● Staff members at the University of Maine Center on Aging (CoA), Eastern Area Agency 

on Aging (EAAA), Ibis Health, and Senscio Systems are testing a new program that 

provides in-home nutrition and health support to older adults (Nutrition Innovations). 

● The purpose of this research is to learn more about Nutrition Innovations project 

implementation, challenges, and potential for future replication of this work in the field.

● This research project is voluntary, meaning you can stop participating at any time.

● Risks include that you may feel uncomfortable answering questions about the 

implementation and progress of the program or your role in the program. 

You have been invited to participate in this study because:

● You are a member of the Nutrition Innovations Project Administrative Operations 

Committee

● You are familiar with the successes and challenges that the program has faced so far

What Will You Be Asked To Do?

If you decide to participate, you will be asked to complete an interview, lasting approximately 

30-45 minutes, about how the program is faring so far. 

Examples of questions we will ask:

● What do you see as the major accomplishments thus far of the project?

● What have been the major obstacles with recruiting participants?
You will be contacted by a staff member from the Center on Aging to organize a time for the 

interview.

The interview will be conducted via zoom or phone call. Phone call options will be conducted 

using the Zoom conference call line feature.

Risks

● The only risks involved include your time and the inconvenience.

Benefits

● There are no direct benefits to you for participating in an interview.

● You may find that you enjoy providing your perspective and reflecting your work and 

project accomplishments to-date.

● Your participation will provide an understanding of the successes and challenges 

experienced in the program thus far which can be used to improve project activities into 

the future. 

Confidentiality

● This study is designed to be confidential, this means that your name and other identifying 

details will not be connected to the information you provide. 

● Transcript files with your name and identifying information will be maintained by the

Center on Aging. Only Center on Aging research team members will have access to these 

files.

● The Center on Aging will record and transcribe the interview. The interviews will be 

recorded to the Zoom Cloud. Once transcribed, the recordings will be immediately 

removed from the cloud and destroyed (no later than September 2023). The 

transcriptions will be stored in a shared Google Drive folder to which only assigned staff 

have access. Transcripts will be kept indefinitely. Reporting will be done in aggregate 

looking at themes across respondents. Any quotes and excerpts shared from project 

interviews will be deidentified.

● All recordings are subject to Zoom’s privacy policies.

● Timelines for data storage:

○ Your recording will be kept on the cloud for transcription purposes and deleted 

immediate (no later than September 2023) 

○ Your transcribed interview responses will be kept by the Center on Aging 

indefinitely (forever).

● Sponsors, funding agencies, regulatory agencies, and the Institutional Review Board may 

review the de-identified research records. This includes Eastern Area Agency on Aging, 

the University of Maine Orono, Ibis Health, and Senscio Systems. Because this study will
collect information about your views on the program, the research team will be removing 

your name and identifying information from any reports provided to the public or to 

project partners (EAAA, Senscio, St. Joseph’s Healthcare). 

Voluntary

● Your participation is voluntary.

● You may skip or refuse to answer any question in the interview for any reason.

● You are free to withdraw from this research study at any time, for any reason. If you do 

withdraw, you can still choose to be interviewed in a later stage. 

Contact Information

● The researchers conducting this study are Lenard Kaye and Jennifer Crittenden. For 

questions or more information concerning this research you may contact Dr. Crittenden at 

207-262- 7923 or jennifer.crittenden@maine.edu and Dr. Kaye at 207-262-7922 or 

len.kaye@maine.edu

● If you have any questions or concerns about your rights as a research subject, you may 

contact the Office of Research Compliance, University of Maine, 207-581-2657 or by email at umric@maine.edu.

Consent

By scheduling an interview appointment with a Center on Aging staff and completing an 

interview, you are consenting to participate in this study. 
Appendix C – Introductory Script 

Instructions for Day of Interview

● Make sure that you are in a quiet interview space that allows for a comfortable, 

confidential interview.

● Provide a refresher overview of the purpose of the study. You can use this text:

The purpose of the research is to understand the successes and challenges thus far of the older 

adult nutrition program using the Ibis system. 

● Ask the person being interviewed if they have been able to read the informed consent 

document that was given to them. If they have not, give them time to read it. If you think 

they may have trouble reading it, you can review the sections with them out loud. 

● Even if they say they have read the informed consent document, please review these key 

points with them:

● This research is voluntary and may be stopped at any time.

● The interview will be recorded.

● They do not have to answer all the questions if they do not want to and can skip 

any questions they do not want to answer. 

● The information from their interview will be included in reports to the public and 

the project funder. However, any information that could identify them would not 

be included. 

● Ask if the person has any questions and address their questions if they do.

● Begin interview.
Appendix D – Email Script

Dear , 

Thank you for your participation so far in the Nutrition Innovations project. The University of 

Maine Center on Aging would like to assess the progress of the project from the perspective of 

health partners. As a member of the project Administrative Operations Committee, we would

like to interview you via zoom or phone call to get your feedback on the project. The interview 

will be approximately 30-45 minutes and guided by questions relating to the project; please see 

attached for questions. Your participation will be confidential but we would like your permission 

to record them to enable transcription of the interview for later analysis.

The results of interviews with the Nutritions Innovations project partners will be included in 

public reports, professional publications and presentations as well as reporting made to the 

project funder. 

Please review the attached informed consent form for more information about this evaluation 

component.

If you are willing to participate, then please respond to this e-mail indicating some potential 

dates and times within the next two weeks that will work for you to conduct a project interview. 

We are hoping to complete all interviews by November 13th. 

Thank you for your time. We hope you’ll participate! 

This project was supported, in part by grant number 901NNU0015, from the Administration for 

Community Living, U.S. 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.
Appendix C
Funding: Administration for Community Living via Eastern Agency on Aging (lead org) 

Funding #: NSN928 (GL Project # 5407980 and PARS submission #2019630) 

Title: Older Adult Nutrition Innovation Pilot (Case studies)

1. Summary: 

Eastern Area Agency on Aging, in partnership with St. Joseph Healthcare, Senscio Systems, and 

the University of Maine are testing an innovative, technology-driven nutrition enhancement and 

self-management program for older adults with multiple chronic diseases. The goal of this threeyear project is to improve the nutritional and health status of rural adults 60 and older with 

multiple chronic conditions immediately following hospital discharge. 

Anticipated outcomes include: 1) Improved nutritional status; 2) Improved health and healthrelated quality of life; 3) Improved ability to age in place; and 4) High levels of satisfaction with 

services. Additional outcomes at the program level include increased revenue and use of 

technology in program delivery and decreased food waste. At the systems-level, it is anticipated 

that this project will result in a sustainable partnership and decreased healthcare costs.

In year three of the project, the focus will shift to evaluating the program process to understand 

the extent to which outcomes were achieved by identifying factors that aided or hindered the 

implementation of the project. The current IRB application focuses on interviews with 

participants in the study to inform case studies on the issues of recruitment, retention, and 

participation satisfaction.

Significance

The majority of adults 65 and older (80%) have at least one chronic disease. Medicare reports 

that 68% of beneficiaries have two or more chronic conditions and about a third of those 

individuals have four or more chronic conditions.1 Ranking among the top chronic diseases are 

chronic obstructive pulmonary disease (COPD) and heart failure, which each impact 

approximately one in 10 older adults, and diabetes, which affects over one in four 

older adults.2 Chronic conditions result in increased emergency department visits, inpatient 

hospital stays, outpatient visits, and prescriptions. For inpatient stays, 3% of people with no 

chronic conditions will have at least one inpatient stay in a year, compared with 6% of 

individuals with 1-2 chronic conditions, and 24% with five or more chronic conditions.3 It is 

argued that a quarter of hospital readmissions can potentially be prevented using interventions 

“that span the continuum of care, prioritize efforts to prepare patients more effectively for 

discharge, and provide better ability for patients, caregivers, and health care professionals to 

support patients and improve outcomes during the period after hospitalization.”4 

In addition to chronic disease, food insecurity is a growing national concern with as many as one 

in ten older adults either at-risk for food insecurity or facing hunger. In Maine, there 

are similar proportions of at-risk individuals currently facing hunger with an additional 16% 
experiencing a threat of hunger.5 Chronic diseases and functional limitations are more prevalent 

in food insecure older adults.6 A variety of health conditions are linked to food insecurity in older 

adults including asthma, diabetes, CHF, osteoporosis, and hypertension.7 Furthermore, a 

powerful link exists between the cost of managing chronic disease and the financial and 

nutritional status of older adults.8 Low-income patients are routinely readmitted to hospitals 

because they had to choose between buying food and purchasing medication. This “treat or eat” 

dilemma effects as many as one in three chronically ill older adults, yet most self-management 

interventions do not include nutritional supports.9 

An additional challenge is the cost of maintaining a nutritionally sound diet that is aligned 

with the clinical guidelines necessary to properly manage chronic disease. For clients with 

chronic disease, managing special diets across co-occurring conditions can be complicated and 

costly. Medically tailored meals (MTMs) are currently available to older adult clients through 

the Eastern Area Agency on Aging (EAAA) Meals on Wheels (MOW) program. However,

clients must self-identify and self-select their meals, leaving room for error in the process, 

especially when that individual has more than one chronic condition. Without the support of a 

dietician and the billing structure to cover costs, it is impossible for EAAA to offer customized

MTMs. 

The Rural Imperative: Eastern Maine’s low-income older adults are at considerable risk 

of food insecurity and accompanying health issues making it a critical location for offering 

nutritional and health innovations. EAAA’s four, largely rural service counties have a 

significant poor older adult population: nearly 49,000 residents are over 65, with poverty rates 

ranging from 8.1% to 11.4%.10 A recent study notes 43% of Maine’s older adults are low-income,

a risk factor for food insecurity and poor health.11 12 Some 16% of Maine households are food 

insecure. This rate of food insecurity places Maine in the top 10 states facing food insecurity.13 

Innovations in rural areas are needed that are accessible to older adults and are efficiently

delivered by host agencies.

Methods 

The Center on Aging will be conducting key informant interviews (questions listed in Appendix 

A) in the Spring of 2022 with individuals who have enrolled in the currently ongoing Older 

Adult Nutrition Innovation Pilot study. Key informant interviews will be conducted over the 

telephone and will be approximately 45 minutes in length. Interviews will be recorded using a 

digital recorder. 

References

1. National Council on Aging. (2016). Chronic disease self-management facts. 

Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-thefacts/chronic-disease-facts/ 

2. National Council on Aging. (2017). Ten Common chronic conditions for adults 

65+. Retrieved from https://www.ncoa.org/wp-content/uploads/10-CommonChronic-Conditions-Older-Adults ncoa.png 
3. Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the 

United States. Retrieved from 

https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf 

4. Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., 

Metlay, J. P., . . . Schnipper, J. L. (2016). Preventability and causes of readmissions 

in a national cohort of general medicine patients. JAMA Internal Medicine, 176(4), 

484 

5. Ziliak, J. P., & Gunderson, P. (2017). The state of senior hunger in 

America 2015: An annual report. Retrieved from 

https://www.feedingamerica.org/sites/default/files/research/senior-hungerresearch/state-of senior-hunger-supplement-2015.pdf 

6. Ziliak, J. P., & Gundersen, C. (2017). The health consequences of senior 

hunger in the United States: Evidence from 1999-2014 NHANES. Retrieved 

from: 

https://www.feedingamerica.org/sites/default/files/research/se

nior-hunger research/senior- health-consequences-2014.pdf 

7. Food Research and Action Center. (2017). Hunger & health: The impact of 

poverty, food insecurity, and poor nutrition on health and well-being. 

Retrieved from http://frac.org/wp content/uploads/hunger-health-impactpoverty-food-insecurity-health-well-being.pdf 

8. Jih, J., Stijacic-Cenzer, I., Seligman, H. K., Boscardin, W. J., Nguyen, T. T., & 

Ritchie, C. S. (2018). Chronic disease burden predicts food insecurity among 

older adults. Public Health Nutrition, 21(9), 1737-1742. 

doi:10.1017/S1368980017004062 

9. Berkowitz, S. A., MD, Seligman, Hilary K., MD, MAS, & Choudhry, 

Niteesh K., MD, PhD. (2014). Treat or eat: Food insecurity, cost-related 

medication underuse, and unmet needs. American Journal of Medicine, 27(4), 

303-310.e3. doi:10.1016/j.amjmed.2014.01.002 

10. United States Census Bureau. (2017). 2013-2017 American Community 

Survey 5-year estimates: Demographic and housing estimates; Penobscot, 

Piscataquis, Washington, and Hancock, Maine, Counties. 

11. Kaiser Family Foundation. (2018). How many seniors are living in poverty? National and 

state estimates under the official and supplemental poverty measures in 2016. 

Retrieved from http://files.kff.org/attachment/Data-Note-How-Many-Seniors-AreLiving-in-Poverty-National-and State-Estimates-Under-the-Official-andSupplemental-Poverty-Measures-in-2016 
12. United States Census Bureau. (2017). 2013-2017 American Community 

Survey 5-year estimates: Selected economic characteristics; Penobscot, 

Piscataquis, Washington, and Hancock, Maine, Counties 

13. United States Department of Agriculture. (2017). Household food security in the 

United States in 2016. Retrieved from https://www.ers.usda.gov/publications/pubdetails/?pubid=84972 

2. Personnel:

 

Dr. Lenard Kaye is the project Co-PI and will be involved in study oversight. Dr. Kaye is

Professor of Social Work at the University of Maine School of Social Work and Director of the 

University of Maine Center on Aging. Dr. Kaye has been the principal investigator of numerous 

assessments of innovative community services for older adults, including projects funded by the 

AARP Andrus Foundation, Families USA, Brookdale Foundation, Maine Health Access 

Foundation, Pew Foundation, Bingham Program, John Harford Foundation, and U.S. 

Administration on Aging. He has been the principal investigator of the MeHAF-funded Maine 

Partners for Elder Protection (MePEP), the principal investigator of the Health Services Initiative

of the Eastern Maine Transportation Collaborative Community Needs Assessment Project and 

has been the co-principal investigator for the Maine Primary Partners in Caregiving Project

funded through the U.S. Administration on Aging. Dr. Kaye has 30+ years of experience in 

research with human subjects.

 

Dr. Jennifer Crittenden will provide oversight to the research project. Dr. Crittenden is the 

Associate Director at the University of Maine Center on Aging and is serving as the subaward 

co-PI for this research project. Dr. Crittenden has over seventeen years of experience in 

professional and community education, program evaluation and program planning. Dr. 

Crittenden has been involved in implementing and evaluating a wide range of research, training, 

and community service initiatives including serving as the Program Manager for Encore 

Leadership Corps, an innovative volunteer leadership program for Mainers 50+ and served as 

Project Manager for the National Institutes of Health-funded Balancing Act Clinical Trial, a 

research study testing a falls prevention program among older adults with visual impairments.

Dr. Crittenden has 17 years of experience in research with human subjects.

 

David C. Wihry, MPA, Senior Project Manager at the UMaine Center on Aging will be 

analyzing project data. David has 11 years of experience in research with human subjects 

through numerous grant-funded research and evaluation projects on issues important to older 

adult health and wellbeing including falls, transportation, home-based services, and age-friendly 

communities. 

 

Jennifer Jain is Graduate Research Assistant with the UMaine Center on Aging. Jennifer has 

three years of experience with human subject research. She has worked on Aging farmers (2018-

20); technology and learning (2020-21) and grant funded projects for the Center on Aging. 

Jennifer will be recruiting participants, conducting interviews and transcribing interview 

recordings. 

 
All staff have completed required training on research with human subjects. 

3. Participant recruitment: 

Approximately 12 participants will be recruited from the pool of participants who either 

completed or withdrew from the ongoing Older Adult Nutrition Innovation Pilot. Participants 

will be older adults, age 60 and older, who were originally recruited from St. Joseph Hospital in 

Bangor, Maine, upon discharge or within 90 days of discharge during 2020-2021. The proposed 

number of participants is determined by the number of individuals who completed the study (8), 

and those who had difficulty meeting the criteria of the study and were discharged, such as 

maintaining meal delivery or ability to use technology such as recording meals on the provided 

tablet (4). Participants who transitioned to assisted living, long term care facilities, or end of life 

care during the study period, will not be considered for recruitment. We anticipate at least 8 

individuals will agree to participate. 

To assist with recruitment, a staff member from Senscio Systems will send out a study 

information letter (Appendix B) along with the informed consent form (Appendix C) to potential 

participants to notify them that a staff member from the University of Maine Center on Aging 

(CoA) will contact them to inquire about participation in a follow-up interview. Senscio Systems 

is the provider of the Nutrition Innovations intervention and has close and regular contact with 

the pool of potential research participants. The goal of the letter from Senscio Systems is to give 

participants foreknowledge that the Center on Aging will be contacting them, as well as to 

support study recruitment by having a trusted source initially introduce the study. Within a week 

of participants receiving the packet with informed consent and study information letter, Center 

on Aging staff member Jennifer Jain will contact the individual via phone (script in Appendix D) 

and they can either agree or opt out of participating. If they agree the staff from CoA will set-up 

a time to complete the recorded interview. The prospective participant’s phone number is on file 

with the Center on Aging. Individuals in the original Nutrition Innovations study authorized the 

phone number to be given to the Center on Aging for follow-up data collection. 

4. Informed consent: 

The informed consent form will have been mailed to the participant with the recruitment letter. 

The participant will be asked to give verbal consent after the staff member from CoA 

summarizes the study informed consent form (Appendix C) immediately preceding the recorded 

session. The staff member will answer any question the individual may have prior to the 

interview. The individual will be told their participation is voluntary and that they are free to 

withdraw from the study at any time. If the individual doesn’t give verbal consent, then the 

interview will not proceed. 

5. Confidentiality: 

This study is confidential. For the purposes of this study, a key will be established that 

links the participants’ name and phone number to a unique ID. The key will be 

maintained in an Excel file that is securely stored on a Center on Aging Google Drive, 

shared only with staff named in this application. The Excel sheet would be password-
protected using AES 256 bit encryption in Excel. The names and phone numbers of 

potential participants are already known to the Center on Aging from their 

participation in the ongoing Older Adult Nutrition Innovations pilot where they 

provided consent to have their name and contact information shared with the Center on 

Aging for the purposes of follow-up data collection. The key linking ID numbers with 

names will be destroyed at the conclusion of the study (August 31, 2022). 

Conversations will be recorded using a digital recorder placed next to a speaker phone. 

At the completion of the interview, Jennifer Jain will upload the audio file to a Google 

Drive folder for storage and delete the recorder file within four hours of the interview. 

The Google Drive file folder will be accessible only to individuals named in this 

application. Files will be named using the unique ID of the participant. The Drive 

folder will also be separate from the folder containing the key. The audio file will be 

transcribed by Center on Aging staff. Audio files will be deleted upon study 

completion by August 31, 2022. Transcripts will be kept indefinitely in a Center on 

Aging Google Drive folder. 

6. Risks to participants: 

The only risks of this study are participants’ time and inconvenience. 

7. Benefits: 

There are no direct benefits to individuals from participating in the research. Overall, this 

research may help inform how older people with chronic conditions can be better supported 

using tools like the Ibis tablet.

8. Compensation:

All participants will receive a $50 Hannaford gift card for participating in the study. Participants 

will receive a gift card even if they only partially complete an interview. The card will be mailed 

to participants.

 
Appendix A - Questions

Thank you for taking part in the interview today. Before beginning, I’d like to review a few points 

about how this study is being conducted. 

• This study is confidential – we will not have your name attached to any information when 

reporting results.

• I’ll be recording the interview – we will be securely storing the audio recording and will be 

deleting it once we have a transcription of the conversation, no later than August 31, 2022. 

• You can skip any questions you don’t want to answer, and you can end the interview at any time.

Do you have any questions before we begin? 

Do you consent to proceed with the interview?

Recruitment 

1. Why did you choose to participate in the project? 

Follow-up questions/prompts

a. Did you have anyone, like a family member or provider who motivated or 

discouraged you from participating in the project? 

i. Who? 

ii. What were the reasons or concerns? 

b. Did name recognition of EAAA, UMaine and St. Joe’s influence your 

participation? How so? 

c. What, if anything, did you find attractive about the meals and the Ibis system? 

2. Tell me about how you were approached to participate in program to receive meals on 

wheels and use the tablet. When were you asked to join and by whom? 

a. Was the timing to participate convenient for you? 

b. If not, when would it have been a better time introduce these resources to you? 

c. If yes, why did the timing work for you? 

3. In general, do you think there is a better time to recruit participants into the program? 

a. When? 

b. Where? 

4. What was your experience with paperwork required to sign-up for the program? 
a. What worked well about the sign-up experience? 

b. What would you recommend we do to improve the sign-up experience? 

Retention 

5. Did you feel the Ibis tablet and meals were helpful in managing your health conditions? 

6. Did you have a caregiver, family member, or friend who helped you with the program? 

a. Such as help record your meals 

b. Use your tablet 

7. What was your experience using the IBIS Hub? 

Follow-up questions/prompts

What aspects of using the Hub did you find most difficult? 

What aspects of using the Hub did you find to be most easy? 

If you could improve the Ibis Hub experience, what would you recommend? 

a. Internet connection 

b. Recording meals (for those in the intervention group) 

8. What parts of the IBIS hub and meals did you enjoy the most? What did you enjoy the 

least?

9. Was the amount of food delivered through the program too much, just right, or not 

enough? 

Follow-up questions/prompts

a. Did you share your meals with anyone? 

b. Did you have leftovers or did you save meals? 

c. Do you have any recommendations in regards to customizing meals? 

Satisfaction 

11. Was your experience with Ibis and meals different from what you thought it would be 

when you were first introduced to the project? 

12. What do you feel worked best for you to stay motivated to use the Ibis tablet? 

13. Were there any aspects of the program that you could have done without? 
14. Do you have any suggestions to improve the supports that are offered to others? 
Appendix B Study Information Letter

Dear ______, 

I’m writing to let you know about an opportunity to give feedback related to your experience 

with the Ibis Hub. The University of Maine is asking people who took part in the Ibis Hub 

research study if they would be willing to give 45 minutes of their time to have a conversation 

about what they liked and think could be improved about the Ibis supports and the research study 

process. The interview would be done over the phone and would be recorded. UMaine will be 

providing a $50 Hannaford gift card for those participating. We hope you consider taking part in 

the study. If you decide you don’t want to be interviewed, this will not impact your current 

services through Ibis. 

Jennifer Jain from the University of Maine Center of Aging will be calling you in the next couple 

weeks to answer any questions and to set up a time if you are interested in participating in the 

follow-up interview. 

If you’re interested in learning more, the attached informed consent document has additional 

details.

Thank you.

Sincerely, 

Grace Ellrodt

Program Manager / Member Advocate 

Ibis Program / Senscio Systems

(207) 401-2300 Ext. 5 
Appendix C - Informed Consent 

Research Informed Consent Form

You are invited to participate in a research project being conducted by Dr. Len Kaye and Dr. 

Jennifer Crittenden, researchers at the UMaine Center on Aging. The purpose of the research is 

to learn about how satisfied participants were with the Ibis research project and ways that 

supports for older adults with chronic conditions could be improved in the future. 

What Will You Be Asked to Do? 

If you decide to participate, you will be asked to take part in a 45-minute phone interview with a 

staff member at the UMaine Center on Aging. The interview will be recorded. The interview will 

ask about your experience with participating in the Ibis research project and your satisfaction 

with the project.

Sample questions: 

1. Why did you choose to participate in the project? 

2. What was your experience with paperwork required to sign-up for the program? 

3. What aspects of using the Hub did you find most difficult? 

Risks

Except for your time and inconvenience, there are no risks to you from participating in this 

study.

Benefits

While this study will have no direct benefit to you, this research may help us learn more about 

how older people with chronic conditions can be better supported using tools like Ibis. 

Compensation

You will receive a $50 Hannaford’s gift card via mail for taking part in the interview. You will 

receive the gift card even if you do not want to answer all the questions. 

Confidentiality 

The interview is confidential. Your name will not be on the interview transcript. A code number 

will be used to protect your identity. The interview transcript and recording will be stored in 

password protected electronic file folders. A key linking your name to the transcript will be kept 

separate from the data in a password protected electronic file folder. The electronic key file will 

be stored on a password protected computer with additional security. The key will be destroyed 

at the end of the study, no later than August 31, 2022. The de-identified interview transcript will 
be kept indefinitely on a Center on Aging Google Drive folder. The audio recording of the 

interview will be destroyed no later than August 31, 2022. The data will only be accessible to 

researchers at the University of Maine. Your name or other identifying information will not be 

reported in any publications. 

Voluntary

Participation is voluntary. If you choose to take part in this study, you may stop at any time. You 

may skip any questions you do not wish to answer. You will still receive the $50 gift card even if 

you choose not to answer all the questions.

Contact Information

If you have any questions about this study, please contact David Wihry, Project Manager at the 

UMaine Center on Aging at 207-262-7928. If you have any questions about your rights as a 

research participant, please contact the Office of Research Compliance, University of Maine, 

207-581-2657 (or e-mail umric@maine.edu).
Appendix D – Phone Script

Hello, this is Jennifer Jain and I am a Graduate Research Assistant at the University of Maine. 

We have previously talked to do the surveys as part of the study you’re involved in related to the 

Ibis tablet. You had given us your phone number as part of that study. I’m following up on a 

letter Senscio Systems had sent you about taking part in an interview.

I am calling because we’re conducting follow-up research to learn about how satisfied 

participants were with the Ibis research project and ways that supports for older adults with 

chronic conditions could be improved in the future. 

I’d appreciate it if you would be willing to let me interview you. The interview would be over 

the phone. The interview should take 45 minutes and would be recorded. 

If you would be interested in participating in this interview, we can set up a time now or you can 

let me know when a good time would be to schedule it.

If interested, researcher will set up date and time and will provide participant with researcher 

contact information:

• I have scheduled you for an interview on (date and time). If you have any questions, I can 

be reached at (phone number). Thank you for your help.

If participant is not interested, investigator will end the call.

• Thank you for your time.

This project was supported, in part by grant number 901NNU0015, from the Administration for 

Community Living, U.S. 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.
Appendix D
This project was supported, in part by grant number 901NNU0015, from the Administration for Community 

Living, U.S. 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.

Funding

Funding: Administration for Community Living via Eastern Agency on Aging (lead org)

Funding #: NSN928 (GL Project # 5407980 and PARS submission #2019630)

Title: Older Adult Nutrition Innovation Pilot (Meals on Wheels Survey)

Summary

Rationale

Eastern Area Agency on Aging, in partnership with St. Joseph Healthcare, Senscio Systems, 

and the University of Maine are testing an innovative, technology-driven nutrition enhancement 

and self-management program for older adults with multiple chronic diseases. The goal of this 

three-year project is to improve the nutritional and health status of rural adults 60 and older with 

multiple chronic conditions immediately following hospital discharge. 

Anticipated outcomes include: 1) Improved nutritional status; 2) Improved health and healthrelated quality of life; 3) Improved ability to age in place; and 4) High levels of satisfaction with 

services. Additional outcomes at the program level include increased revenue and use of 

technology in program delivery and decreased food waste. At the systems-level, it is anticipated 

that this project will result in a sustainable partnership and decreased healthcare costs.

In year three of the project, the focus has shifted to evaluating the program process to 

understand the extent to which outcomes were achieved by identifying factors that aided or 

hindered the implementation of the project. The current IRB focuses on a survey of Meals on 

Wheels participants to identify preferences for use of technology to support health and wellbeing 

and barriers to technology use. 
Significance

The majority of adults 65 and older (80%) have at least one chronic disease. Medicare reports 

that 68% of beneficiaries have two or more chronic conditions and about a third of those 

individuals have four or more chronic conditions.1 Ranking among the top chronic diseases are 

chronic obstructive pulmonary disease (COPD) and heart failure, which each impact 

approximately one in 10 older adults, and diabetes, which affects over one in four older adults.2 

Chronic conditions result in increased emergency department visits, inpatient hospital stays, 

outpatient visits, and prescriptions. For inpatient stays, 3% of people with no chronic conditions 

will have at least one inpatient stay in a year, compared with 6% of individuals with 1-2 chronic 

conditions, and 24% with five or more chronic conditions.3 It is argued that a quarter of hospital 

readmissions can potentially be prevented using interventions “that span the continuum of care, 

prioritize efforts to prepare patients more effectively for discharge, and provide better ability for 

patients, caregivers, and health care professionals to support patients and improve outcomes 

during the period after hospitalization.”4 

In addition to chronic disease, food insecurity is a growing national concern with as many as 

one in ten older adults either at-risk for food insecurity or facing hunger. In Maine, there are 

similar proportions of at-risk individuals currently facing hunger with an additional 16% 

experiencing a threat of hunger.5 Chronic diseases and functional limitations are more prevalent 

in food insecure older adults.6 A variety of health conditions are linked to food insecurity in older 

adults including asthma, diabetes, CHF, osteoporosis, and hypertension.7 Furthermore, a 

powerful link exists between the cost of managing chronic disease and the financial and 

nutritional status of older adults.8 Low-income patients are routinely readmitted to hospitals 

because they had to choose between buying food and purchasing medication. This “treat or eat” 

dilemma effects as many as one in three chronically ill older adults, yet most self-management 

interventions do not include nutritional supports.9 

An additional challenge is the cost of maintaining a nutritionally sound diet that is aligned with 

the clinical guidelines necessary to properly manage chronic disease. For clients with chronic 

disease, managing special diets across co-occurring conditions can be complicated and costly. 

Medically tailored meals (MTMs) are currently available to older adult clients through the 

Eastern Area Agency on Aging (EAAA) Meals on Wheels (MOW) program. However, clients 

must self-identify and self-select their meals, leaving room for error in the process, especially 

when that individual has more than one chronic condition. Without the support of a dietician and 

the billing structure to cover costs, it is impossible for EAAA to offer customized MTMs. 

The Rural Imperative: Eastern Maine’s low-income older adults are at considerable risk of food 

insecurity and accompanying health issues making it a critical location for offering nutritional 

and health innovations. EAAA’s four, largely rural service counties have a significant poor older 

adult population: nearly 49,000 residents are over 65, with poverty rates ranging from 8.1% to 

11.4%.10 A recent study notes 43% of Maine’s older adults are low-income, a risk factor for food 

insecurity and poor health.11 12 Some 16% of Maine households are food insecure. This rate of 

food insecurity places Maine in the top 10 states facing food insecurity.13 Innovations in rural 
areas are needed that are accessible to older adults and are efficiently delivered by host 

agencies.

The proposed study will better help practitioners to understand healthcare technology 

preferences and barriers to technology use among the Meals on Wheels population. This 

information may assist in the design of services to those who could potentially benefit from 

interventions that utilize technology to support health and wellbeing.

Methods 

The proposed study will involve the distribution of paper survey packets to 881 individuals 

enrolled in the Meals on Wheels program administered by the Eastern Area Agency on Aging in 

their four county service area of Penobscot, Piscataquis, Washington, and Hancock counties. 

Drivers for the Meals on Wheels program will distribute survey packets to prospective study 

participants during regular meal deliveries. The study is being conducted in spring/summer of 

2022. Packets will contain an introductory letter, informed consent form, paper survey (Appendix 

A), gift card form and prepaid return envelope. Upon submission of the survey, participants will 

be prompted to return their survey and gift card form to the UMaine Center on Aging using their 

prepaid envelope. An option will be provided for individuals to take part in the survey by phone. 

Participants submitting the survey will be eligible to be entered into a drawing for one of three 

$50 Hannaford Gift Cards. The survey will be confidential. Individuals must be 18 or older to 

participate. 

References

1. National Council on Aging. (2016). Chronic disease self-management facts. 

Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-thefacts/chronic-disease-facts/ 

2. National Council on Aging. (2017). Ten Common chronic conditions for adults 

65+. Retrieved from https://www.ncoa.org/wp-content/uploads/10-CommonChronic-Conditions-Older-Adults ncoa.png 

3. Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the 

United States. Retrieved from 

https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf 

4. Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., 

Metlay, J. P., . . . Schnipper, J. L. (2016). Preventability and causes of readmissions 

in a national cohort of general medicine patients. JAMA Internal Medicine, 176(4), 

484 
5. Ziliak, J. P., & Gunderson, P. (2017). The state of senior hunger in 

America 2015: An annual report. Retrieved from 

https://www.feedingamerica.org/sites/default/files/research/senior-hungerresearch/state-of senior-hunger-supplement-2015.pdf 

6. Ziliak, J. P., & Gundersen, C. (2017). The health consequences of senior 

hunger in the United States: Evidence from 1999-2014 NHANES. Retrieved 

from: 

https://www.feedingamerica.org/sites/default/files/research/se

nior-hunger research/senior- health-consequences-2014.pdf 

7. Food Research and Action Center. (2017). Hunger & health: The impact of 

poverty, food insecurity, and poor nutrition on health and well-being. Retrieved 

from http://frac.org/wp content/uploads/hunger-health-impact-poverty-foodinsecurity-health-well-being.pdf 

8. Jih, J., Stijacic-Cenzer, I., Seligman, H. K., Boscardin, W. J., Nguyen, T. T., & 

Ritchie, C. S. (2018). Chronic disease burden predicts food insecurity among 

older adults. Public Health Nutrition, 21(9), 1737-1742. 

doi:10.1017/S1368980017004062 

9. Berkowitz, S. A., MD, Seligman, Hilary K., MD, MAS, & Choudhry, Niteesh 

K., MD, PhD. (2014). Treat or eat: Food insecurity, cost-related medication 

underuse, and unmet needs. American Journal of Medicine, 27(4), 303-

310.e3. doi:10.1016/j.amjmed.2014.01.002 

10. United States Census Bureau. (2017). 2013-2017 American Community 

Survey 5-year estimates: Demographic and housing estimates; Penobscot, 

Piscataquis, Washington, and Hancock, Maine, Counties. 

11. Kaiser Family Foundation. (2018). How many seniors are living in poverty? National and 

state estimates under the official and supplemental poverty measures in 2016. 

Retrieved from http://files.kff.org/attachment/Data-Note-How-Many-Seniors-AreLiving-in-Poverty-National-and State-Estimates-Under-the-Official-andSupplemental-Poverty-Measures-in-2016 

12. United States Census Bureau. (2017). 2013-2017 American Community 

Survey 5-year estimates: Selected economic characteristics; Penobscot, 

Piscataquis, Washington, and Hancock, Maine, Counties 

13. United States Department of Agriculture. (2017). Household food security in the 

United States in 2016. Retrieved from https://www.ers.usda.gov/publications/pubdetails/?pubid=84972 
Personnel 

Lenard Kaye, DSW, PhD is a project Co-PI. Dr. Kaye is Professor of Social Work at the 

University of Maine School of Social Work and Director of the University of Maine Center on 

Aging. Dr. Kaye has been the principal investigator of numerous assessments of innovative 

community services for older adults, including projects funded by the AARP Andrus Foundation, 

Families USA, Brookdale Foundation, Maine Health Access Foundation, Pew Foundation, 

Bingham Program, John Harford Foundation, and U.S. Administration on Aging. He has been 

the principal investigator of the MeHAF-funded Maine Partners for Elder Protection (MePEP), 

the principal investigator of the Health Services Initiative of the Eastern Maine Transportation 

Collaborative Community Needs Assessment Project and has been the co-principal investigator 

for the Maine Primary Partners in Caregiving Project funded through the U.S. Administration on 

Aging. He has 30+ years of experience with human subjects research. Dr. Kaye will have 

oversight of the survey recruitment and response processes and will be regularly updated by the 

project team on the progress of data collection and analysis.

Jennifer Crittenden, MSW, PhD is a Co-PI and will contribute to study oversight including data 

collection, data analysis, and reporting. Dr. Crittenden is an assistant professor in the UMaine 

School of Social Work and the Associate Director at the University of Maine Center on Aging. 

Dr. Crittenden has over 17 years of experience in professional and community education, 

program evaluation and program planning. This time frame includes human subjects activities 

from interviewing to focus group and survey data collection. Dr. Crittenden has been involved in 

implementing and evaluating a wide range of research, training, and community service 

initiatives including serving as the Program Manager for Encore Leadership Corps, an 

innovative volunteer leadership program for Mainers 50+ and served as Project Manager for the 

National Institutes of Health-funded Balancing Act Clinical Trial, a research study testing a falls 

prevention program among older adults with visual impairments. She has 17 years’ experience 

with human subjects research. Dr. Crittenden will have oversight of the survey recruitment and 

response processes and will be regularly updated by the project team on the progress of data 

collection and analysis.

David Wihry, MPA is a Senior Project Manager at the Center on Aging. David will be 

coordinating survey distribution and will be analyzing data and generating reports. David has ten 

years of human subjects research experience and has coordinated or contributed to a number 

of grant-funded research projects focused on aging issues including the NIH-funded Balancing 

Act Study, ACL-funded Nutrition Innovations project. 

Jennifer Jain is Graduate Research Assistant with the UMaine Center on Aging. Jennifer has 

three years of experience with human subject research. She has worked on Aging farmers 

(2018-20); technology and learning (2020-21) and grant funded projects for the Center on 

Aging. Jennifer will be assisting with data entry, analysis, and reporting. Jennifer will also 

complete phone surveys with participants. 
Participant Recruitment

Study participants consist of 881 individuals who receive Meals on Wheels services through the 

Eastern Area Agency on Aging. Individuals are living in Eastern Area Agency on Aging’s four 

county service area of Penobscot, Piscataquis, Washington, and Hancock counties. The 

population of potential study participants is primarily individuals 65+ (88%) with the remainder of 

individuals being under 65.

To recruit study participants, Eastern Area Agency on Aging, the organization administering 

Meals on Wheels and partner on the Nutrition Innovations grant, has agreed to distribute survey 

packets to participants during regular meals on Wheels deliveries. When dropping off food, 

drivers will hand each individual a study packet and inform them that it contains information 

about a research study of Meals on Wheels participants being done by the University of Maine 

Center on Aging and Eastern Area Agency on Aging. Included in the packet will be five items: 1) 

recruitment letter and instructions (Appendix C), 2) informed consent form (Appendix B), 3) 

Survey, 4) gift card registration form (Appendix D), and 5) a prepaid return envelope. The 

anticipated response rate is 25% based on the Center on Aging’s experience with other mailed 

surveys. 

Informed Consent

An informed consent form will be enclosed in the packet that is provided to prospective study 

participants. The informed consent form will indicate to participants that submitting the survey 

implies consent to participate. 

Confidentiality 

The survey will be confidential. Because the gift card registration form will be mailed in the same 

pre-paid envelope, the survey will not be anonymous. This decision to only utilize a single 

envelope was made for two reasons: 1) the added cost of an extra 881 pre-paid envelopes and 

postage and 2) the increase in complexity of instructions and procedures for participants who 

would need to handle mailings of multiple envelopes. Given the low-risk nature of the survey, it 

is believed that anonymity isn’t crucial for the integrity of the data or protection of participants. 

Prepaid return envelopes will be received at the UMaine Center on Aging. On receipt of the 

envelopes, they will be opened and surveys and gift card forms will be separated. Both forms 

will be stored in a locked file cabinet at the Center on Aging. Paper survey data will be entered 

into a SPSS file stored on a password protected Center on Aging Google Drive account. Gift 

card registration form data will be entered into an Excel spreadsheet and stored in a password 
protected Center on Aging Google Drive account. In the case of phone surveys, paper surveys 

and gift card forms will be completed by the interviewer and stored as outlined above. Both 

paper and electronic survey data will be stored indefinitely. Gift card registration data will be 

destroyed upon completion of the gift card drawing in July 2022.

Risks to participants

The only risks to participants are their time and inconvenience.

Benefits

There are no direct benefits to study participants. The overall benefit of the study will be to 

identify potential services and supports that will be beneficial and accessible to the study 

participant population to support their health and wellbeing.

Compensation

Individuals who submit the survey (or submit it via the phone) along with the completed gift card 

registration form will be entered into a drawing for one of three $50 Hannaford gift cards. 

Participants do not have to answer all questions to be eligible to enter the gift card drawing. 
Appendix A - Survey

This survey asks about the value of a potential technology device to you. When answering the 

following questions, please think of an electronic device (computer, tablet, or smartphone) that 

could be used in your home to support your health and wellness.

1. What is the one feature of an electronic device that would be most valuable to you? (Check 

one option)

● Web-based video trainings for caregivers

● Support groups for caregivers that I can join from my device

● Video visits with my doctor

● Live group exercise classes that I can join from my device

● Coaching on how to stay healthy and control chronic conditions

● Classes and events through Eastern Area Agency on Aging that I can join from my 

device

● Tracking my blood pressure, oxygen, heart rate, or other information that can identify 

health problems early

2. What is the one feature of an electronic device that would be least valuable to you? (Check 

one option)

● Web-based video trainings for caregivers

● Support groups for caregivers that I can join from my device

● Video visits with my doctor

● Live group exercise classes that I can join from my device

● Coaching on how to stay healthy and control chronic conditions

● Classes and events through Eastern Area Agency on Aging that I can join from my 

device

● Tracking my blood pressure, oxygen, heart rate, or other information that can identify 

health problems early

3. Which of the following features would be valuable to you in your Meals on Wheels program? 

(Check all that apply)

● Being able to pick the meals I get

● Having meal choices that meet my medical needs (such as low sugar, high protein, etc.)

● A way to use technology to tell staff my about my meal preferences

● Other (write in): 

_______________________________________________________________

Please rate your agreement with the following statements (check your response). 
4. I’ve had good experiences with doing doctor visits over a computer/smartphone/tablet

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree 

● Not applicable – I’ve never had a doctor visit over a computer/smartphone/tablet

5. I am comfortable using computers, smart phones, or tablets

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree

6. I’m interested in using a computer, smart phone, or tablet to help me manage my health

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree

7. I have the money to afford a computer/smartphone/tablet

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree

8. I am concerned about privacy or scams when using the internet

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree
9. I have difficulty using computers, smartphones, or tablets due to vision problems

● Strongly Disagree 

● Disagree 

● Neutral 

● Agree 

● Strongly Agree

10. I have someone who could help me if I have problems using a computer, smartphone, or 

tablet

● Yes

● No

● Not Sure

11. I have a fast internet connection available to me

● Yes

● No

● Not Sure

Please answer these questions about yourself

12. What electronic devices do you currently use? (check all that apply)

● Desktop computer

● Laptop computer

● Smartphone (Phone that can get on the internet, send e-mail, etc.)

● Tablet (such as an iPad or a Kindle)

● Apple Watch or another smartwatch that can monitor health

● Smart home device such as an Echo Dot or a Google Home/Google Nest

● Other (please write in) _______________________________________

● None, I don’t have any electronic devices

13. What is your gender? (check one)

● Male 

● Female 

● Another gender (please specify): ____________________

14. What is your age? (fill in) _____years

15. What is the zip code of the community you live in (fill in) ______________
16. What is your living arrangement? (check one)

● I live alone

● I live with another person (spouse, significant other, adult child, etc.)

17. Do you have any of the following medical conditions (check all that apply)

● Hypertension 

● Chronic kidney disease

● High cholesterol 

● Heart failure

● Arthritis 

● Depression

● Ischemic/coronary heart disease 

● Alzheimer’s disease or dementia

● Diabetes 

● Chronic Obstructive Pulmonary Disease (COPD)

● Prefer not to answer

Other (please write-in): ____________________________________________

18. How would you rate your health? (check one)

● Very poor 

● Poor 

● Neither Poor or Good 

● Good 

● Very Good 

19. How would you rate your ability to concentrate? (check one)

● Very poor 

● Poor 

● Neither Poor or Good 

● Good 

● Very Good 

20. Please use this space below to share any other thoughts you have about technology:
Appendix B - Informed Consent

You are invited to participate in a research project being conducted by Dr. Lenard Kaye, 

Director of the UMaine Center on Aging and Dr. Jennifer Crittenden, Associate Director of the 

UMaine Center on Aging. The study is being done in partnership with the Eastern Area Agency 

on Aging. The purpose of the research is to 1) learn about your views on technology that might 

help support your health and wellbeing and 2) learn about your comfort with technology. You 

must be receiving Meals on Wheels to participate. 

What Will You Be Asked to Do?

If you decide to participate, you will be asked to take a confidential survey. The survey can be 

done on paper or over the phone. It should take you about 10 minutes to participate. If you are 

doing a paper survey, please put the survey in the prepaid return envelope and put it in the mail

when you are ready to submit it. 

Risks: 

Except for your time and inconvenience, there are no risks to you from participating in this 

study.

Benefits

While this study will have no direct benefit to you, this research may help inform how Area 

Agencies on Aging support the health and wellbeing of people they serve by using survey 

information to identify new or improved services that can potentially be provided in the home 

through technology or Meals on Wheels. 

Compensation

You may enter a drawing to win one of three $50 Hannaford Gift cards using the enclosed gift 

card drawing form and returning it with your survey (or providing information over the phone if 

you are completed the survey that way). You don’t have to answer every question on the survey 

to be eligible to enter the drawing. The gift card drawing will be held in July of 2022 and you will 

be notified if you win a gift card. The chance of winning is approximately 1%. 

Confidentiality

This survey is confidential. Please do not write your name on the survey. Survey data (phone or 

paper) will be kept on a password-protected computer (electronic files) and locked file cabinet 

(paper files) at the Center on Aging indefinitely. Because information for the drawing will be 

returned with your survey responses, we will know your identity if you submit a gift card form. 

However, gift card drawing information will be stored separately from your survey data in a 

locked file cabinet and will be destroyed after the drawing is completed in July 2022. Although 

researchers will know who entered the drawing, the gift card form will be separated from the 

survey responses as soon as the researchers receive them. 
Voluntary

Participation is voluntary. If you choose to take part in this study, you may stop at any time. 

Choosing not to take part will not impact your ability to continue receiving Meals on Wheels. You 

may skip any questions you do not wish to answer. Submission of the survey implies consent to 

participate.

Contact Information

If you have any questions about this study, please contact Project Manager David Wihry at 

david.wihry@maine.edu or 207-262-7928. If you have any questions about your rights as a 

research participant, please contact the Office of Research Compliance, University of Maine, 

207-581-2657 (or e-mail umric@maine.edu).

 
Appendix C - Introductory Letter

Dear Meals on Wheels participant,

Eastern Area Agency on Aging is partnering with the UMaine Center on Aging on a research

study looking at how Meals on Wheels participants value technology that can be used to 

support their health and wellbeing. The study also looks at Meals on Wheels participants’ 

comfort with using technology. The study is being led by Dr. Lenard Kaye, Director and Dr. 

Jennifer Crittenden, Associate Director, at the Center on Aging.

We invite you to take the survey that is included in this packet. It takes about 10 minutes to 

participate. The survey asks about what technology may be valuable to you and whether you 

have any challenges using technology. The survey also asks questions about you such as your 

age and health. The survey is confidential. You must be 18+ to participate. 

If you choose to participate, you will be eligible for a drawing to win one of three $50 Hannaford 

gift cards.

Instructions

If you want to participate in the research study, please:

1. Read the enclosed “informed consent” form which explains more about the study.

2. Fill out the enclosed survey.

3. Fill out the gift card drawing form (if you are interested in taking part in the gift card 

drawing)

4. Put your survey and gift card drawing form (if you want to participate in the drawing) in 

the postage-paid return envelope, seal the envelope, and put it in the mail.

If you would like to submit the survey over the phone with a member of the study staff, please 

call 207-262-7928. A member of the staff will call you within 72 hours to conduct the survey over 

the phone. 

Thank you for your time. We hope you consider participating. If you have questions about this 

study, please contact the Project Manager, David Wihry at david.wihry@maine.edu or 207-262-

7928.

Sincerely,

Tabatha Caso, Chief Program Officer

Eastern Area Agency on Aging

Lenard Kaye, DSW/PhD, Director

UMaine Center on Aging

Jennifer Crittenden, PhD, Associate Director

UMaine Center on Aging
Appendix D - Gift Card Form

Please complete this form and return it with your survey to enter for a chance to win a $50 

Hannaford gift card. 

Prize Entry Form** 

Name: 

Mailing Address: 

Phone: 

E-mail: 

**Please note: The information you give us above will be stored separately from your survey. 

This information will be stored in a secure office at the Center on Aging. Only research project 

staff will have access to this information and will use it only for the purposes of drawing and 

contacting gift card recipients. Gift card entry forms will be deleted upon completion of the 

drawing in July 2022.