June 2021 | 1

Social Care Services Evidence Summary: Meal and Nutrition Services

This evidence summary includes a broad range of research/resources on meal and nutrition services and is primarily focused on 

health care impact. It is not intended to be an exhaustive compilation of research/resources on this topic. The information 

presented in this summary can inform the value proposition of partnering with a community-based organization (CBO) or a network 

of CBOs to offer these services and supports as part of a strategy to address social determinants of health (SDOH).

Meal and nutrition services support individuals in achieving food security and to meet their nutritional needs. Services may include,

but are not limited to, congregate meals, home delivered meals, and medically tailored meals (MTM). These services may be linked 

with additional nutritional support such as connection to a licensed nutritionist or other nutrition education. Food security affects an

individual’s physical and mental health and, as a result, can influence their health care utilization. Meal and nutrition services may 

also provide the added benefit of socialization through gathering at congregate meals sites and through delivery staff/volunteers as 

part of home delivered meals. 

Studies have demonstrated that congregate meals services support older adults to remain in their homes and communities longer by 

avoiding hospitalizations and nursing facility stays (Gualtieri et al. 2018). Meal delivery services have been demonstrated to increase 

participants’ physical health and mental health. Specifically, both non-tailored home-delivered meals and MTM have been proven to 

increase participants’ access to healthy food, reduce malnutrition, and lower depression (O’Leary et al. 2019; Walton et al. 2019;

Berkowitz et al. 2017). In alignment with increased health benefits, meal and nutrition programs have been shown to decrease 

health care utilization through a reduction in hospital and skilled nursing admissions and less overall medical spending (Berkowitz et 

al. 2019). 

For specific, further detailed information on this evidence, please review the resources listed below.
June 2021 | 2

Meal and Nutrition Services Research and Evidence

Study Population Studied Objective of Study Type of Analysis Findings / Results

Berkowitz et 

al. (2017) 

44 adults with 

diabetes, 

hemoglobin 

A1c>8.0%, and food 

insecurity (defined as 

at least one positive 

item on the two-item 

“Hunger Vital Sign”)

To test whether a 

MTM delivery program 

improved dietary 

quality in individuals 

with type 2 diabetes 

and food insecurity.

Randomized crossover clinical trailParticipants who received the home 

delivered meals had a mean Healthy 

Eating Index (HEI) of 71.3 while the 

control group had a mean score of 

39.9 following the 12-week 

intervention. Participants 

experienced improvements in almost 

all sub-categories of the HEI (higher 

score [range 0–100; clinically

significant difference 5] represents 

better dietary quality), with 

increased consumption of 

vegetables, fruits, and whole grains 

and decreased consumption of solid 

fats, alcohol, and added sugar. 

Participants also reported lower food 

insecurity, less hypoglycemia, and 

fewer days where mental health 

interfered with quality of life.

Berkowitz et 

al. (2018)

Included individuals 

aged 21 and older, 

dually eligible for 

Medicare and 

Medicaid services 

enrollment in 

Commonwealth Care 

Alliance health plan; 

133 participants 

received MTM, 624 

To determine whether 

home delivery of 

either MTM or nontailored food reduces 

the use of selected 

health care services 

and medical spending 

in a sample of adults 

dually eligible for 

Statistical analysis 

following the 

development of 

matched cohorts 

Compared with matched

nonparticipants, participants had 

fewer emergency department visits 

in both the MTM program and the 

non-tailored food

program. Participants in the MTM

program also had fewer inpatient 

admissions and lower medical 

spending. Participation in the nontailored food program was not 
June 2021 | 3

Study Population Studied Objective of Study Type of Analysis Findings / Results

participants received 

non-tailored food, 

and 1,002 were 

included as matched 

controls.

Medicare and 

Medicaid. 

associated with fewer inpatient

admissions but was associated with 

lower medical spending.

Berkowitz et 

al. (2019)

Individuals 18 years 

or older who 

received MTM were 

matched with 

individuals or similar 

demographics who 

did not receive MTM 

within the 

Massachusetts All 

Payer Claims 

Database.

To determine whether 

participation in a MTM 

intervention is 

associated with fewer 

subsequent 

hospitalizations. 

Retrospective cohort 

study using near/far 

matching 

instrumental variable 

analysis

Participation in a MTM program 

appears to be associated with fewer 

hospital and skilled nursing 

admissions and less overall medical 

spending.

Gualtieri et 

al. (2018)

8,646 randomly 

selected participants 

of the Older 

Americans Act (OAA) 

Nutrition Services 

Program (NSP) 

participants from 

randomly selected 

sites 

To determine the 

impact of the OAA NSP 

meals and nutrition 

services on overall 

wellness and wellbeing 

by comparing 

outcomes for NSP 

participants and 

nonparticipants. 

Outcomes include 

health and health care 

utilization.

Outcomes evaluation 

using statistical 

analysis including 

both descriptive and 

multivariate analysis 

methods

Congregate meal participants were 

able to remain in their homes and 

communities more than 

nonparticipants. Congregate meal 

participants were 2.3 percentage 

points less likely to be admitted into 

a nursing care facility, and lower 

income congregate meal participants 

experienced nursing home 

admissions at a rate 8.5 percentage 

points lower than nonparticipants. 

Additionally, congregate meal 

participants who lived alone were 

less likely than nonparticipants to 
June 2021 | 4

Study Population Studied Objective of Study Type of Analysis Findings / Results

have a hospital admission or an 

emergency department visit that led 

to a hospital admission. 

Mabli et al.

(2018)

OAA NSP participants 

and a matched 

population eligible 

for but not receiving 

NSP supports 

To evaluate the effect 

of the OAA NSP on 

participants’ health 

outcomes, health care 

utilization, and 

healthcare costs by 

comparing congregate 

and home-delivered 

meals participants to 

similar 

nonparticipants. 

The study uses 

analysis and matching 

methods with the use 

of Medicare claims 

data and 

comprehensive 

surveys of congregate 

and home delivered 

meal participants and 

a matched 

comparison group of 

program-eligible 

nonparticipants. 

When compared to nonparticipants, 

congregate meal participants were 

less likely to be admitted into a 

nursing care facility. For lowerincome congregate meal 

participants, the rate of nursing 

home admissions was lower than the 

rate for nonparticipants. Congregate 

meal participants who lived alone 

were less likely than nonparticipants 

to have a hospital admission or have 

an emergency department visit that 

led to a hospital admission.

Home delivered meal participants 

experienced more varied results with 

home delivered meal participants 

experiencing a higher percentage of 

emergency department visits leading 

to a hospital admission. Similarly, the 

home delivered meal participants 

were more likely to experience a 

home health episode than 

nonparticipants. Study authors note 

that home delivered meal 

participants tend to be older, have 

less income, and were more likely to 
June 2021 | 5

Study Population Studied Objective of Study Type of Analysis Findings / Results

be in poor health and that the 

inability to randomly assign 

participants may have led to 

differences in underlying 

characteristics of participants and 

nonparticipants, rather than the 

program itself. 

Mabli et al.

(2017)

OAA NSP participants 

and a matched 

population eligible 

for but not receiving 

NSP supports

To assess program 

effectiveness, as 

measured by the 

program’s effects on a 

variety of important 

outcomes, including 

diet quality, 

socialization 

opportunities, health 

outcomes, and helping 

older adults avoid 

institutionalization.

The outcome 

evaluation uses 

information obtained 

from comprehensive 

surveys and 24-hour 

dietary recalls 

collected from 

samples of program 

participants and a 

matched comparison 

group of programeligible 

nonparticipants. 

Congregate meal participants 

experienced lower rates of food 

insecurity compared to 

nonparticipants. Home delivered 

meal participants experienced no 

difference in food insecurity rates 

compared to nonparticipants, with 

those receiving fewer than 5 meals 

per week experiencing greater food 

insecurity thank nonparticipants. 

Congregate meal participants had 

more positive socialization outcomes 

compared to nonparticipants. For 

home delivered meal participants 

there were no significant differences 

between participants and 

nonparticipants. Lastly, congregate 

meals and home delivered meals had 

a positive effect on diet quality in 

comparison to nonparticipants. 

O’Leary et al.

(2019)

19 older adults living 

in the United 

Kingdom 

To evaluate the 

effectiveness of a 3-

week, daily meal

Data analysis Following participation in the meal 

service, participants experienced 

increased score on the Mini 
June 2021 | 6

Study Population Studied Objective of Study Type of Analysis Findings / Results

provision service by a 

non-profit provider on 

the physical and 

psychological 

wellbeing of an older 

adult population. 

Nutritional Assessment (MNA), 

which assesses risk of malnutrition, 

and rated themselves as significantly 

less depressed.

Thomas & 

Mor (2013)

Individuals receiving 

home delivered 

meals in each state, 

adjusted for the 

state population 

aged 65 and older

To estimate the 

savings that states 

could realize on 

Medicaid spending by 

increasing the number 

of clients receiving 

home delivered meals. 

Statistical analysis was 

used to develop a 

model to project 

nursing home 

utilization. The results 

were then used to 

approximate 

anticipated savings to 

state Medicaid 

programs by avoiding 

or delaying nursing 

home utilization. 

The results from the model 

generated as part of the study were 

that a 1 percent increase in the 

proportion of adults ages 65 and 

older who received home delivered 

meals in a state was associated with 

a decrease in the state’s low-care 

nursing home population of .2 

percent. 

Thomas et al.

(2015)

626 seniors on 

waiting lists at 8 

Meals on Wheels

(MOW) programs 

across the United 

States

To evaluate the extent 

to which the home

delivered meals 

program, and the type 

of delivery model, 

reduces homebound 

older adults' feelings 

of loneliness.

Three-arm 

randomized control 

study

Participants receiving meals had 

lower adjusted loneliness scores at 

follow-up compared with the control 

group. Individuals who received 

daily-delivered meals were more 

likely to self-report that home

delivered meals improved their 

loneliness than the group receiving 

once-weekly delivered meals.

Thomas et al.

(2016)

371 older adults on 7 

MOW programs’ 

waiting lists

To evaluate whether 

home delivered meals, 

and the frequency of 

Randomized parallel 

three-arm study

The study indicates that daily 

delivered meals may reduce the risk 

of falls. At follow-up, 28.6% of the 
June 2021 | 7

Study Population Studied Objective of Study Type of Analysis Findings / Results

delivery, reduces selfreported falls among 

homebound older 

adults.

control group that received no meals 

while on the waitlist experienced a 

fall, compared to 27.4% of 

participants who received once 

weekly delivered meals and 23.7% of 

participants receiving daily delivered 

meals. 

Walton et al.

(2019)

Older adults (>65), 

studies varied in 

sample size, from 16-

2691 study 

participants

To determine whether 

nutritional intake is 

improved in 

community-living older 

adults when receiving 

meal services 

compared to when 

meals services are not 

received.

Systematic literature 

review of 13 original 

studies that was 

conducted up to 

January 2019. 

Home delivered meals have a 

beneficial effect on dietary intake of 

energy, protein and/or certain 

micronutrient in older adults.
June 2021 | 8

Additional Resources

Resource Author Description of Content Target Audience

Gualtieri et al. (2018) This review focuses on the effects of MOW on the physical and 

emotional well-being of older adults, and the wide variety of 

procedural and operational issues that various MOW programs 

around the county experience. Findings from the literature 

highlight the positive outcomes these programs have on their 

clients.

Policy makers and funders of 

meal programs

The National Resource Center 

on Nutrition and Aging

(NRCNA)

The NRCNA’s purpose is to build the capacity of senior nutrition 

programs funded by the Older Americans Act (OAA) to provide 

high quality, person-centered services, and to assist ACL and 

stakeholders to identify current and emerging issues and 

opportunities to enhance program sustainability and resiliency. 

The intent of the OAA senior nutrition program is to: reduce 

food insecurity, hunger and malnutrition; enhance 

socialization; and promote health and well-being.

The Administration for 

Community Living and the 

senior nutrition program 

network

Meals on Wheels America –

More Than Just a Meal

The More Than Just a Meal site includes a compendium of 

research supporting the positive outcomes associated with the 

Meals on Wheels program. The research includes 

demographics of seniors receiving Meals on Wheels services, 

health and wellness improvement of seniors through mealdelivery service enhanced with technology-supported 

monitoring, and the impact of home-delivered meal services on 

overall health and well-being and associated use of high-cost 

healthcare services. 

Policy makers and funders of 

meal programs

Meals on Wheels America –

Partnerships between 

Community-based 

Organizations (CBOs) and 

Healthcare

This report follows the partnership between community-based 

senior nutrition programs and a large healthcare company and 

explores how CBOs can work effectively with health plans to 

scale their services through outcomes-based financing, such as 

Pay for Success (PFS). 

CBOs and healthcare 

organizations exploring or 

pursing partnerships
June 2021 | 9