Supplemental Nutrition Assistance Program (SNAP) - Primary funding sources: OAA Title IIIC 1&2;
Since 1984, New York State’s Supplemental Nutrition Assistance Program (SNAP) provides funding primarily for home-delivered meals to frail older persons who are unable to prepare meals for themselves, but it also supports nutrition counseling, nutrition education and congregate meals.
While 2012 is the fortieth anniversary of the federal Older Americans Act (OAA) nutrition program, providing this service in New York State predates its inclusion in the OAA. The purposes of the program are to reduce hunger and food insecurity; to promote socialization of older individuals [avoid social isolation]; and to promote the health and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. (Source: Older Americans Act)
During SFY 2010-11 NYSOFA provided 22.9 million meals to 181,536 older New Yorkers with $175,697,278 in funding from all sources. [10.4 million congregate meals to slightly more than 122,000 participants and 12.5 million home delivered meals to slightly more than 59,000 participants] In addition, during 2010-11 SFY NYSOFA provided 13,800 sessions of nutrition counseling to 9,200 participants with $1.1 million in funding from all sources; 37,900 sessions of nutrition education to 86,400 participants with $2.4 million in funding from all sources.
Benefits of the Nutrition Program:
Based on client-based data collected from all state units on aging and survey methods, the Administration on Aging indicates that participants receiving services through Title III of the Older Americans Act (including meals) are at higher risk of nursing home placement than others in their age group nationally, based on common predictors of nursing home entry. Those who receive homemaker services, home-delivered meals, and case management appear especially vulnerable. National survey results of program participants do show that most participants believe the services help keep them out of nursing homes and in their communities. With the number of older individuals in the United States (and New York State) increasing, the number of people wanting to remain independent in their homes will continue to grow. Analysis done by the Administration on Aging indicates that state units on aging are effectively reaching those most at risk of institutionalization, and that Title III services play an important role in helping older adults remain living independently in the community.
*Nursing Home placement indicators:
- Demographic characteristics: Older individuals and those who are non-Hispanic white. In NYS for the reporting year 2011-12 74 percent of our home delivered meal clients were age 75 plus while 73 percent are non-Hispanic white.
- Socioeconomic status: Individuals with low incomes
- Health status and physical functioning: Those with certain health conditions (such as cognitive impairment, cancer, high blood pressure, diabetes, and a history of strokes and falls) and those who have difficulty performing activities of daily living (ADLs). In NYS for the reporting year 2011-12, 24 percent of our home delivered meal clients had 3 or more ADLs and 56 percent had hypertension while 24 percent had diabetes. Forty-four percent of our home delivered meal clients were at high nutrition risk and 56 percent were frail or disabled.
- Prior health care utilization: Individuals who have spent time in the hospital or in a nursing home. In 2009, about 7 percent of state residents 65 or older had one nursing home stay and 23 percent of state residents 85 or older had one nursing home stay. (Source: Nursing Home Compendium 2010 from CMS) )
- Living arrangements and family structure: Those who live alone including widowed and divorced individuals, do not own their home, and have fewer children than their peers not in nursing homes. In NYS for the reporting year 2011-12 59 percent of our home delivered meals clients lived alone.
- Availability of support: Individuals who lack caregiver support
People who have difficulty performing three or more ADLs are at increased risk of nursing home placement, and Title III participants—especially those receiving home-delivered meals, case management, homemaker services, are much worse off than the national population based on analysis done by the Administration on Aging. In general, Title III participants also have a higher average number of difficulties with ADLs, and more have been diagnosed with health conditions like stroke and diabetes, which also make nursing home entry more likely.
*Source: Administration on Aging identified predictors of nursing home entry using two comprehensive analyses of predictors of nursing home entry (Gaugler et al. 2007; Miller and Weissert 2000).
Cost/benefit of meals:
Using our client data for the 201-12 reporting year and NYS DoH nursing home data, providing home delivered meals and other community-based services avoids nursing home placement and keeps older New Yorkers in their community where they want to be. It reduces nursing home costs to the state by delaying or avoiding all together costly nursing home care. In 20111-12 24 percent (or about 13,250 clients) of our home delivered meal recipients had 3 ADL deficiencies or more, which is a significant nursing home placement indicator. If we prolong the stay of 10 percent of our clients at home by one month, the state would save $12,599,425 in potential Medicaid costs.
Vignettes of meal recipients:
Allegany County:
A 90 yr old totally disabled man and 85 yr old wife and caregiver were referred for meals. They had been managing independently but she was having some health problems and struggling to give care, prepare meals, get groceries and even take the garbage to the dump and additionally they were struggling financially. They were referred by their daughter who lives in California. They live at the end of an unpaved road in the woods and are frequented by bears, which is why getting the garbage to the dump was so important.
He is in a wheelchair and has a colostomy and has 5 ADLs; needing assistance with bathing, dressing, mobility, transferring and toileting and 4 IADLs needing assistance for housework, shopping, laundry, transportation, and preparing meals.
Meals provided much needed caregiver respite and nutritional support. In addition, as a result of the client assessment they were assisted with help with: Homecare through Caregiver respite; Insurance counseling - she was struggling to continue paying for insurance through a former employer which was very expensive and duplicating her Medicare coverage. The counseling and change of insurance freed up $400 per month, and HEAP benefits. A volunteer was found to take the garbage to the dump.
In the view of the local office, without a doubt he would have been placed in a nursing home. With a little support [they] were able to stay in their home for four more years until he passed away.
Broome County:
We have an elderly gentleman, Howard, who lives in the farm house where he grew up. Up until recently he sold eggs from the chickens he maintains. Howard wants to continue living at this home but he has been having dizzy spells and TIA’s. Howard’s caregiver, a grandson of one of his friends, called us a couple of years ago to say he was really afraid for Howard, fearful that he would fall and really hurt himself. The caregiver was doing the best he can but he also operates a business.
We were able to make several changes that allowed Howard, age 84, with 1 ADL and 7 IADLs to stay home. We found an aide who would come and do some housekeeping and Howard began to receive home delivered meals. The caregiver can now concentrate on helping Howard with shopping, medical appointments and the outside chores. We also got him an emergency-PERS- button. This reassured the caregiver that if something happened while he was at his business, Howard would still get the help he needed. A friend from his church was happy to purchase a lift chair for him when a case manager pointed out how helpful this would be.
While we are helping Howard in pretty small ways, it has made a big difference in his ability to stay safe enough to stay home. We are helping his caregiver sustain their effort. The formal and informal supports keep Howard home.
Suffolk County:
Mrs. “D�, age 95 is a frail disabled client who is legally blind. She lives alone and ambulates with a cane. She is 150% below the poverty threshold. The nutritional screening score (NSI) is high at 14. The ADL total number is 3 and her IADL total number is 7. Her health status presents her with Congestive Heart Failure, Digestive Problems, and Hypertension and is a fall risk due to her visual impairment. The daily HDM provides Mrs.“D� with a nutritious meal and is a safety factor for her so she won’t try and cook for herself as she is blind. Several times, before she received HDM the fire department has been called as Mrs. “D� burns food as she attempts to prepare something to eat. At the time her home visit it was evident that Mrs. “D’s� family was not responsive to her needs.
Mr. “F�, age 79 is a handicapped/disabled man who lives alone and ambulates with a cane. He has a high nutritional screening score (NSI) of 13. His ADL total number is 3 and his IADL total number is 7. Mr. “F� is a diabetic with a history of Bladder Cancer, Congestive Heart Failure, Hypertension, Renal Disease, Respiratory Problems and status post a stroke. Mr. “F� goes to dialysis three times per week via SCAT which provides transportation. His son and daughter assist as necessary as they both have jobs and family responsibilities that limit them as primary care giver. The HDM helps Mr. “F� maintain his independence and meets his dietary requirement of a Diabetic diet as he is unable to shop or cook for himself.
Mrs. “M�, age 73 is a homebound client who lives alone. She is disabled and ambulates with a walker or wheelchair as needed. She is 150% below the poverty threshold and is Medicaid pending. She is unable to cook nutritious meals for herself due to the following health issues: Arthritis, Digestive Problems, Heart Disease, Hypertension, COPD and High Cholesterol. She resides in a recliner chair due to COPD. Mrs. “M�’s nutritional screening score (NSI) is high at 14 and has an ADL total number of 4 and an IADL total number of 5. Due to Mrs. “M�’s living situation, limited family involvement and health limitations, meals are indicated.