MAKE YOUR MARK ON 

FOOD INSECURITY 
OPENING REMARKS 

2 
WELCOME 

Keri Ann Lipperini, MPA 

Director 

Office of Nutrition and Health 

Promotion Programs (ONHPP) 

Administration on Aging 

Administration for Community Living 

U.S. Department of Health and 

Human Services 

keri.lipperini@acl.hhs.gov
INTRODUCTIONS 

4 
AGE OPTIONS NUTRITION INNOVATIONS PROJECT 

“CLOSING THE LOOP”

Community Initiatives Manager & Project Lead, Age Options 

March 25, 2020 

@NRCNA_engAging 
AGEOPTIONS 

History: 

• Incorporated as a 501(c) (3) non-profit in 1974 and designated by the 

Illinois Department on Aging as the Suburban Cook County Area Agency on 

Aging (AAA) 

• Our service area is suburban Cook County, IL – outside of the City of 

Chicago and is made up of 30 townships; We serve approximately 572,830 

persons living in 130 communities 

• Funding sources include: state, federal, corporate, private foundations and 

individual donations 

Mission: 

• AgeOptions innovates, partners, and advocates to improve systems and 

services in order to strengthen communities so people thrive as they age 

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AGEOPTIONS’ ROLE AS AN 

AREA AGENCY ON AGING (AAA) 

• As the AAA for suburban Cook County, we serve individuals with 

disabilities and those 60+ 

• AgeOptions is one of 13 AAA in Illinois 

• AgeOptions funds local agencies to provide services directly to 

community members including 

o In-home care, adult day services, home delivered meals (HDMs), 

congregate meal sites, benefit access 

o Caregiver resources, adult protective services, fraud prevention, 

Medicare education 

• AgeOptions also provides a number of direct services 

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Map of Illinois’ Area 

Agencies on Aging 

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SETTING THE STAGE & AGENDA 

• AgeOptions was one of five agencies awarded an Administration 

for Community Living (ACL) Nutrition Innovations’ grant in 2018

• Grants are given to projects that demonstrate and enhance the 

quality, effectiveness, and outcomes of nutrition services 

programs provided by the national aging services network 

• Grants are to identify innovative and promising practices that 

can be scaled across the country and to increase use of evidence- informed practices within nutrition programs 

• Presentation will discuss 

• Background to Food Insecurity 

• AgeOptions’ Past Experience

• Thumbnail Sketch of the Project 

• What we are Learning 

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FOOD INSECURITY AS A SOCIAL DETERMINANTS OF HEALTH 

(SDOH) 

The World Health Organization defines Social Determinants of Health as the 

conditions in which people are born, grow, live, work, and age. They are the factors

mostly responsible for health inequities . . . Approximately 80 percent of physicians

maintain that addressing patients’ social needs is as critical as addressing their 

medical needs. There are five major determinant areas: 

• Economic stability (poverty, employment, food security, housing stability); 

• Education (high school graduation, enrollment in higher education, language and literacy); 

• Social and community context (social cohesion, discrimination, incarceration); 

• Health and health care (accessibility and health literacy); and 

• Neighborhood and built environment (food deserts, quality of housing, safety) 

These factors can impact population health outcomes by establishing a negative 

social and physical environment and deepening the inequities that certain 

populations face. 

Retrieved on November 20, 2018 from: http://www.allhealthpolicy.org/sourcebook/social-determinants-of-health/ 

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Retrieved on August 28, 2019 from: https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-of-health 

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ECONOMIC SECURITY AND FINANCIAL HEALTH ENSURE 

WELL-BEING 

• Social Determinants of Health have a

systemic effect

• Think about how financial hardships

impact

• Ability to buy medicine? seek

medical care? Comply with a

treatment plan? Eat healthful foods?

• Literature discusses “spending

trade-offs” – medical care or

housing? Paying utility bills?

Retrieved on August 28, 2019 from: https://endseniorhunger.aarp.org/issue-brief-social-determinants-ofhealth-and-the-aging-population/ 

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50-59

50-59

60-64

60-64
 

DEFINITIONS OF FOOD INSECURITY 

• According to Lee and Frongillo, in their study Nutrition and 

Health Consequences Are Associated with Food Insecurity 

among U.S. Elderly Persons define food insecurity as: 

• “Older people who consume less than the recommended dietary

allowance for eight nutrients of saturated fat, niacin, riboflavin, Vitamins 

B-6 and B-12, magnesium, iron and zinc.”

• The U.S. Department of Agriculture defines food insecurity as 

“the limited or uncertain availability of nutritionally adequate

and safe foods or limited or uncertain ability to acquire 

acceptable foods in socially acceptable ways.”

• “ . . . Those who are food insecure are not necessarily suffering from

hunger.”

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BACKGROUND 

• In 2017, three million households with at least one adult age 65 or older 

were food insecure. Millions more households with seniors face marginal 

food security. https://www.frac.org/hunger-poverty-america/senior-hunger 

• One in eight older adults are food insecure and this can impact 

their health. 

• Food insecurity can increase the likelihood of a whole range of 

illnesses and conditions. 

• There are estimates that up to 50% of older adults may be malnourished, 

and that up to 33% of older adults admitted to the hospital may be 

malnourished. 

• 81% of people on Meals on Wheels say that their health has improved 

https://www.mealsonwheelsamerica.org/docs/default-source/research/hungerinolderadults-execsummaryfeb2017.pdf?sfvrsn=2; 

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FOOD INSECURE OLDER ADULTS ARE . . . 

Source: Meals on Wheels America, 2017. Hunger in Older Adults: Challenges and Opportunities for the Aging Network: 

https://www.mealsonwheelsamerica.org/docs/default-source/research/hungerinolderadults-execsummary-feb2017.pdf?sfvrsn=2; 

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WHAT WE NOTICED . . . . 

• A disconnect exists between health care providers and 

community-based organizations regarding Social 

Determinants of Health including food insecurity 

• When referrals for nutritional services are given, health 

care providers most often do not know the outcome of the 

referral; Did the patient get linked with the service? 

• Studies on closed-loop referral systems to-date have 

focused-on physicians referring to medical specialists, but 

not for community-based services 

• A closed loop is both acknowledging the referral and informing the 

referring entity of the outcome of the referral 

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POLL QUESTION 

• Are you using a web-based resource and referral platform to 

send and receive referrals? 

❑Yes 

❑No 

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Since 1974, AgeOptions has 

esAge tablished Options a national reputation for 

meeting the needs, wants and screens for an array of needs and links the individuals 

expectations of older adults in 

suto food burban Cook Countyas well . We are as other resources, e.g. SNAP, Medicaid recognized as a leader in developing

THUMBNAIL SKETCH OF THE PROJECT 

• In collaboration with our healthcare partners, the project is to

develop, implement and evaluate a closed referral system:

• Using an on-line resource database and referral system, our

healthcare entities refer persons to AgeOptions who are identified

as being food insecure

•

•

and helping to deliver innovative 

coAge mmunityOptions based resources and 

options to the evolving, diverse “closes the loop” and informs the referring entities of

co

the

mmunitie

 re

s we s

sults o

erve.

f the referral; Results are integrated into the 

electronic healthcare record 

• Evaluation/research is examining benefit to participants,

helpfulness to referring entities and potential cost savings

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PROJECT PARTNERS 

▪ Project Coordination - AgeOptions 

▪ Health Care Providers 

• Rush University Health Systems’ Rush Oak Park Hospital

• Oak Street Health – four (4) suburban locations 

• AMITA Health – four (4) suburban locations 

▪ Technology for Closed Loop System – NowPow; Recently expanded to Aunt 

Bertha 

▪ Meal Resources 

• Array of our grantee Home Delivered Meal providers including Mom’s

Meals for special diet needs; Congregate Dining sites; food pantries; 

farmer’s markets.

▪ Education – Mather LifeWays – Telephone Topics 

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LESSONS WE ARE LEARNING 

• Start-up takes longer than projected 

• Survey of partners and their populations – need to reach the 

most at-risk for targeting food insecurity 

• Expand Definition of food insecurity 

• Financial triggers which were derived from questions on USDA 

tools may address food insecurity, but do not mesh well with 

nutritional needs of persons who may benefit from home 

delivered meals 

• Questions do not address ADLs and IADLs – Added a specific 

question relating to HDMs 

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FOOD INSECURITY TRIGGER QUESTIONS 

1. Are you worried that your food will run out before you have

money to buy more?

☐ Yes ☐ No ☐ Declined to Answer

2. In the last 2 months, have you run out of food that you bought,

and didn't have money to get more?

☐ Yes ☐ No ☐ Declined to Answer

3. I am not always physically able to:

☐ Shop ☐ Cook ☐ Feed myself

☐ No difficulty with these ADL/IADLs

☐ Declined to Answer

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INITIAL RESEARCH FINDINGS 

• As of our last survey, 83% of referrals were generated by social 

workers with 16% generated by nurses. 

• 3⁄4 of the referrals were generated by the social workers using a SODH 

screen; Remainder came from the PCP or APN asking for a referral. 

• 66% were from the outpatient setting with 16% from the Emergency 

Department and 16% from the inpatient setting 

• Most of the referrals were generated from a conversation and use of 

the SODH screening tool, with the remainder coming from a patient 

conversation alone. 

• 67% indicated that because of the on-line referral platform, the 

referring agents indicated that they were now more likely to refer. 

• There were close to 50% of the referring agents indicating that they 

actually do not routinely check the outcome of their HCBS referrals 

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SUMMARY OF FINDINGS TO -DATE 

• Attitudes towards NowPow and the Electronic Health Record are 

generally positive 

• The rate at which professional respondents estimate they make food 

insecurity referrals has increased 

• Of concern is that some professionals do not have referral follow-up 

as a part of their practice, so even if the information is available with 

these new tools, if the tools are not used to assure services are 

rendered or to flag cases in which services were never received the 

system will not be improved 

• Buy-in to the “closed loop system” and utilizing it by assuring effective

referrals is needed to improve positive outcomes with elderly with 

nutrition insufficiency 

@NRCNA_engAging 
POLL QUESTION 

Are you collecting food insecurity data via 

your client questionnaires using a food 

insecurity screener? 

❑Yes 

❑No 

@NRCNA_engAging 
INITIATIVES ADDRESSING FOOD INSECURITY 

Research Analyst, Erie County Department of Senior Services 

March 25, 2020 

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NUTRITION & WELLNESS 

Michael Saccomanno 

Community Services Coordinator 

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CONGREGATE-STAY FIT DINING PROGRAM 

• 48 Independent Dining Sites serve throughout Erie County 

• Senior/Community Centers & Senior Housing Facilities 

• FREE Monthly Nutrition Education 

• FREE Nutritional Counseling 

• +3,000 Registered Participants 

• 200,000+ meals served in 2019 

• $3 Confidential contribution 

Balanced, 

Nutritious Lunch 

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CLUB 99 FITNESS CLASS 

LANCASTER SENIOR CENTER 

William Emslie Center 
HEALTHY COOKING DEMONSTRATIONS 

*Teaching simple 

healthy cooking 

techniques that seniors 

can follow and use at 

home. 

*Partnered with EC 

case managers to 

provide SNAP outreach. 

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POLL 

Are you currently using SNAP benefits as a 

way to make a voluntary meal contribution? 

❑

❑

Yes 

No

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SNAP BENEFIT ENROLLMENT 

• National Council on Aging Senior SNAP enrollment initiative 

partner 

• Offering the use of SNAP benefits as a way of contribution at our 

48 Congregate Dining Sites 

• Using 8 community partners including inner city, rural and 

English second language community-based organizations 

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UNIVERSITY 

EXPRESS 

“Lifelong Learning For 

Adults 

in Erie County”

-Two Yearly Sessions: 

Spring & Fall Semesters 

-Currently 14 class 

locations 

-3 Locations offer Lunch 

and Learn series 

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NEW EVENTS AND PROJECTS 

ANNUAL SUMMER PICNIC 

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INNOVATIONS IN NUTRITION PILOT PROGRAM 

• $500k (2) year grant from 

ACL shared by Erie and 

Albany Counties 

• Menu’s analyzed by EC RD’s

• 4 Meals per month 

• 10+ restaurants offered in 

each county 

• Each has different menu 

options 

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ERIE COUNTY SENIOR SERVICES NUTRITION & WELLNESS PROGRAM 

Providing appealing, nutritious meals in a friendly 

atmosphere where seniors can improve the health of 

their body, mind and spirit! 

@NRCNA_engAging 
DISCUSSION QUESTION 

Please share your organization’s 

programs or initiatives for addressing 

food security among the older adults you 

serve. 

Please enter a brief description of these 

efforts into the Chat box on your control 

panel. Let us know! 

@NRCNA_engAging 

CELEBRATE THE SENIOR NUTRITION PROGRAM 

• Help ACL celebrate the Older Americans Act National 

Senior Nutrition Program congregate services. 

• Please continue to send in photos, videos, audio clips, or 

testimonials from seniors about your meal site, program 

activities, or nutrition education to 

healthpromotion@acl.hhs.gov. 

• Please include your contact information and permission to 

use the material. 

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SAVE THE DATE 

Together with ACL, we will host a two-part webinar series on the 

learnings and next steps for the inaugural cohort of six Innovations 

in Nutrition Programs and Services grantees. 

Title: Capstone Webinars Series 

Date: Tuesday April 14th and 21st, 2020 

Time: 2:00pm – 3:30pm ET 

Register: Coming Soon! 

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CONNECT WITH YOUR PEERS VIA NRCNAengage 

NRCNAengage is an online venue for senior nutrition program staff, nutrition 

and aging professionals across the country to connect, share best practices, 

resources, recopies and ideas for action! 

@NRCNA_engAging 

Signing up is easy! 

Visit 

https://nrcna.mn.co/ and 

click ‘Invite’!

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• Title Text

THANK YOU 

– Body Level Five