Public Health Nutrition Practice Group n The American Dietetic Association Summer 1997

Homeless P Homeless P Homeless People: How can we meet their food needs?

The Dige The Digest

Food security is a basic right of all human beings. From the

beginning, we have known that referring people to a food shelf

would not eliminate hunger, but only temporarily relieve it.

Access to food of high nutritional value, which is also culturally

acceptable, is the most basic step for achieving and maintaining

health.

Factors Which Affect Food

Selection/Adequacy

In our need to provide

food, shelter and other basic

needs of homeless individuals,

we often fail to factor in the

many aspects which strongly

influence an individuals

willingness to accept and eat

offered foods. Cultural food

practices strongly influence

food selection and acceptance.

Even if food is available, if it is

not familiar (in terms of taste

and food preparation method)

it may remain uneaten. Culture, beliefs, assumptions,

customs and values all impact

food choices.

A good example of this is the

following scenario:

Everyone wants to help

somebody less fortunate ...

however the lives and cultures

of volunteers and workers and

those of the recipients are

vastly different --- the middle

class American culture and the

culture of poverty. Not to

mention the fact that the

majority of the volunteers are

often white and many of the

recipients are from minority

groups. Conflicting expectations and attitudes are a

natural result.

The scene at a hot meal

site....

Some might interpret this

scene as being the poor and

homeless who have assembled to eat and who are

being served by the middle

class. They think that the

poor should be grateful to eat

whatever they are served,

right? The poor should

recognize and appreciate the

hospitality of those making

such a big effort to provide

food.

In reality...

People who attend hot

meal sites are aware that they

have no choice. They are

dependent on someone else for

one of lifes basic needs ---

food. Being served a nice meal

doesnt seem like a privlege;

its another part of living from

hand to mouth. Foods thought

to be a nice treat may not be

familiar to people who have

struggled all their lives just to

get some basic food on the

table, or who are from a different ethnic group.

The voice of the hungry

person ...

Voicing a complaint about

the food being served is a cry

for dignity --- another way of

saying I have a choice, I am

not so hungry that I have to

eat what someone else has

decided I should eat. Most

people want a say in what

they will eat and how much

they will eat. When a person

Article by:

Laura McNally Kruse, MPH, RD, FADA

DHHS, HRSA,

Bureau of Primary Health Care Please turn to page 2
 2 The Digest v Summer 1997

periodically or over a long

period is denied adequate and/

or preferred food, irrational

choices often result. A person

with only $10 for food, needing to last 2 weeks, may use

the full amount on a pizza

knowing the money wont last

2 weeks anyway. This may

look like bad planning to

someone with greater resources, while the person at

the end of his food dollars sees

this as taking control and then

waiting for the hunger to

come. At least he used the

money for something he or she

likes instead of less expensive

items that do not satisfy.

Studies of food purchasing and

food waste comparing lowand no-income people with

middle class people have

shown that the lower income

people make much better use

of their food dollars than the

more affluent.

Nutritional Needs of

Homeless Individuals

Better understanding of

some of the cultural practices

which influence food acceptance can help us plan better

strategies for addressing the

nutritional needs of homeless

individuals more successfully.

Public health providers working in settings serving special

population groups (homeless,

HIV, public housing, etc.) often

are required to wear many

different hats during the

course of a single day. This is

especially true when resources

are extremely limited, as is

frequently the case. Simply

doing the job for which we

were trained is no longer

enough or even acceptable in

most settings.

A major public health

concern for homeless people is

whether or not they are getting

enough to eat, and what the

nutritional quality of their diet

is. This is further compounded

by the special nutritional

needs of women, especially

pregnant women, infants and

children. A review of several

recent studies on this issue

indicate that the diets of

homeless individuals overall

are often nutritionally inadequate. Studies on homeless

women and children indicate

all subjects were consuming

less than half the RDA for:

iron, zinc, magnesium and

folacin on a

daily basis. In

addition, the

adults were

consuming less

than 50% of the

RDA for calcium. Similarly homeless males had

diets low in: calcium, zinc, B-6

and energy (overall calories).

At the same time, these diets

were found to be frequently

high in fat, cholesterol and

sodium which can contribute

or compound chronic diseases

such as heart disease, high

blood pressure, diabetes and

obesity. In an attempt to

provide sufficient calories, and

fill a person, foods such as

gravy, butter/margarine and

other high fat foods are added

to foods in feeding programs.

In addition, these foods still

fail to provide the missing

vitamins and minerals. Diets

which are inadequate in essential nutrients such as vitamins

and minerals, put the homeless individual at risk for an

increased incidence of illness

and chronic conditions. Pregnant women, children and

individuals with compromised

health status are especially

vulnerable.

Though homeless people

receive their food from many

sources, including shelters,

drop-in centers, fast food

restaurants and garbage bins;

shelters and drop-in centers

are the primary places where

food choices can be influenced

and nutritional quality controlled.

In order to determine the

individual

nutritional

needs of this

population in a

consistent

manner, a

screening tool

was developed

to provide a quick overview

and a place to begin counseling. If needs for shelter, urgent health care or other needs

have not been met, nutrition

counseling will not be successful. (See camera-ready copy in

this issue).

Meeting Nutritional

Adequacy with Limited

Resources:

Imagine the following

scenarios:

 A 2 month old infant

Homeless Nutrition

continued from page 1

Food Security Requires:

v Knowledge

v Access

v Choices

Please turn to page 3
The Digest v Summer 1997 3

with only enough formula for

2 more bottles and no money

to buy any more ---

 A pregnant woman,

living on the streets, and

having nothing to eat for 3

days ---

 A mother with 3 children who never has enough

food stamps or money to last

through the month ---

 A child who is anemic

and underweight and wont eat

at the only times meals are

available at your shelter ---

Access to food of high

nutritional value is the most

basic step for achieving and

maintaining health. Assessing

the individual situation and

then determining which food

programs might be of most

benefit is the first step. Since

food stamps do not provide

enough money for adequate

food for a month, participating

in other programs means

preserving scarce cash for rent

and other needs or the difference between meeting basic

food needs or not.

Accessing programs such

as WIC and FareShare can

stretch the dollars to ensure

both shelter and food needs

are met. Once access to food

is secure, nutritional value

and special needs can be

addressed more concretely.

Dealing with issues of weight

gain, special dietary issues of

pregnancy, under weight in

children, anemia, diabetes,

hypertension and overweight

then become reasonable.

Now Imagine the Health Care

Provider Has:

 Certified, or made an

immediate referral for the

infant to WIC and the mother

has vouchers for infant formula which can be obtained

immediately.

 Referred the pregnant

woman to a shelter for emergency housing, with a schedule of the meals and a WIC

appointment the next day to

receive special vouchers for

supplemental foods for a

homeless pregnant woman.

 Scheduled a MAC

(Mothers and Children Commodity Foods Program) appointment for the child, provided directions to the mother

for a summer food site for free

weekday lunches for all 3

children all summer, and

provided information to the

mother on how to enroll in

FareShare.

 Provided strategies to

the mother for dealing with

meal and snack times, including non-perishable, child-size

foods and a list of foods high

in iron.

As you can see from these

examples, simply providing the

food or information might not

be enough. Often times, it

takes more exploration of the

individuals concerns or needs

to resolve the problem. Shelters and food sites which are

suitable for children can provide additional issues. Portion

sizes, food preparation and

presentation all play a strong

role in food acceptance.

Homeless Nutrition

continued from page 2

Simply certifying a child

or pregnant woman for WIC is

only the first step. If the

woman is lactose intolerant

and does not drink milk, then

those vouchers will be wasted.

If no resources are available

for storing foods needing

refrigeration, then providing

vouchers for larger amounts of

cheese, milk and eggs might

be a problem and the food is

not used. Bringing about

changes in food availability to

homeless people requires a

variety of approaches, from

behind-the-scenes to very

direct advocacy. Simply talking about food and diet will

not achieve this change.

Eating Well Without A

Refrigerator, the cameraready copy in this issue of the

newsletter as well as the

Nutrition Screening Tool for

Homeless, have been provided to assist you in providing nutrition counseling to this

population.

Looking at this list, these

items seem pretty simplistic.

However, if a little thought is

put into combining foods,

nutritional needs can be met.

Although hot foods often play

an important role in food

satiety and feelings of comfort,

it is not necessary to have a

hot meal to meet needs.

Contributing Authors:

Julianne Seiber, MS, RD, Jerry

Soechting, MS, RD, St. Paul - Ramsey

County Nutrition Program. Both

nutritionists provide services to the

Health Care for the Homeless Project in

Ramsey County.
1. I dont always have the money to buy the food I need. Yes No

2. I eat less than 2 times a day. Yes No

3. I eat meat and other proteins like beef, poultry, peanut butter, dried beans, 

etc. less than once a day. Yes No

4. I eat breads, cereals, rice, pasta, etc. less than 2 times a day. Yes No

5. I eat fruits or vegetables or drink juice less than 2 times a day. Yes No

6. I drink/eat milk products like milk, cheese, yogurt, etc. less than 2 times 

a day. Yes No

7. I do not have any place to cook or to keep my foods cold. Yes No

8. I have 3 or more drinks of beer, liquor or wine almost every day. Yes No

9. I smoke cigarettes, cigars, or chew tobacco everyday. Yes No

10. I often do not feel like eating, food shopping or cooking. Yes No

11. I have tooth or mouth problems that make it hard for me to eat. Yes No

12. I have one or more of the following: (check all that apply)

o Diarrhea o Nausea o Heartburn o Bloating

o Vomiting o No/Poor Appetite o Feel Tired

13. I have been told that I have anemia. Yes No

14. I have to watch what I eat because of a health problem like: (check all that apply)

o Diabetes o High Blood Pressure o Kidney/Liver Problems o HIV

15. I get about $___________ of money a month to spend.

16. I spend about $___________ on housing/shelter every month.

17. I spend about $___________ on food every month.

18. I receive food from the following food programs: (check all that apply)

o Food Stamps o Soup Kitchen

o Food Pantry/Food Bank o WIC

o Fare Share o Summer Food Program

o MAC (Mothers and Children Commodity Food Program)

o Other (s):

For each statement below, circle YES for those that apply and NO for those that do not.

Nutrition Screen for the Homeless

Public Health Nutrition Practice Group

A Dietetic Practice Group of the

American Dietetic Association

©1997

May be reproduced for educational purposes.

Concept by:

Laura McNally Kruse, MPH, RD, FADA

G. Ted Fairchild, MPH, RD
Eating Well Without

a Refrigerator

Eating Well Without

a Refrigerator

No Place To Cook? Try ....

Milk - canned, evaporated, single serve fresh, or

aseptic (Parmelat)

Cheese - hard cheeses which keep well (Cheddar,

Swiss, etc.)

Yogurt/Pudding cups (single-serve, non-refrigerated type)

Cottage cheese (small or single serve size)

Hard-cooked eggs

Tuna/chicken (canned, single

portion)

Sardines, salmon (canned)

Peanuts, peanut butter

Beans, canned (baked beans, pinto, kidney, black, etc.)

Breads, bagels, tortillas, rolls

Cereals - especially single serve packets which

transport easily and are more acceptable to a

child (dry cereals, oatmeal)

Crackers - all types including peanut

butter crackers

Pasta

Fruits and Veggies

Fresh

Canned

100% fruit juice

Dried fruits

Fruit cups (single serve)

Dried Soups ( cup-a-soup,

noodle soups, bean soups)

Graham crackers, plain

cookies

Jell-o cups

Instant breakfast