The Bringing Food Home During COVID-19 webinar exposes the challenges MTM providers face in responding to a new epidemic and discusses opportunities to boost political and economic support.
Medically tailored meal (MTM) providers were suddenly in high alert when the coronavirus pandemic began unfolding in the United States due to the high-risk nature of their clients. As the disease spread and more stay at home orders were issued, individual care plans continued to be disrupted, and food unemployment and food insecurity rates rose. All of a sudden, there was a much greater need for MTM interventions since they already had the infrastructure and expertise needed to deliver meals to high risk populations. However, as food providers who deliver medical interventions, MTM organizations have existed in an informal space between our food and health care systems for years, lacking the supporting infrastructure and funding of either. Now, as critical responders in this crisis who are straining themselves to meet demand, MTM providers are asking policymakers to formally recognize their significance by including them in policy decisions, providing more support for nonprofit food providers in the federal and state response packages, and integrating these services into the health care system by making medically tailored meals a reimbursable service.
On April 9, the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School and the Food is Medicine Coalition (FIMC) organized a webinar, Bringing Food Home During COVID-19: Medically Tailored Meal Nonprofits Respond to a New Epidemic where MTM providers shared their experiences with having to shift operations, navigate supply challenges, and respond to this surge in demand during the COVID-19 crisis.
MTM interventions provide home-delivered, individually tailored meals to individuals with serious illness or disability who cannot shop or cook for themselves. Individuals are generally referred to MTM services providers by health care personnel and the intervention includes nutrition assessments conducted by Registered Dietitian Nutritionists and access to ongoing nutrition support.
Source: Bringing Food Home During COVID-19 webinar. This slide provides an example of a typical client profile for a Community Servings client.
Typically, recipients of these interventions are extremely sick. Many of these organizations were founded in the 1980’s and 1990’s during the HIV/AIDS epidemic to provide meals to individuals living with HIV/AIDS. Many MTM clients today suffer from multiple comorbidities. Sixty-five percent of the individuals served by FIMC in 2019 were living with comorbidities and 10% were living with a mental health diagnosis in addition to their chronic disease. Research has shown that these interventions can decrease inpatient admissions and health care utilization which is critical to protecting precious the health care resources that communities need most. The presenters summarized the connection between MTM services and COVID-19:
Medically Tailored Meals & COVID:
The typical MTM clients are most at risk for suffering very serious complications from COVID-19
MTM have been shown to reduce inpatient hospital admissions and emergency department visits- exactly what we want for this population right now
Reliable and safe home delivery of nutrition services has become more critical than ever before
To respond to COVID-19, MTM organizations have completely changed their model of operations almost overnight, significantly increasing costs
MTM organizations are seeing unprecedented demand for services from all directions
Panelists on the webinar discussed how medically tailored meal providers are being asked to serve new populations. Cathryn Couch, CEO of Ceres Community Project in California relayed experiences with health care partners reaching out to ask Ceres Community Project if they could provide meals for individuals who have been diagnosed with COVID-19 or are being asked to quarantine at home. Additionally, some other California MTM agencies have been asked to take on Medicare in-home supportive services clients who have lost caregiver supports while community health centers have reached out to try to provide MTM services for individuals who are at increased risk and cannot frequent food pantries.
“We are not included in the emergency food system, yet our communities are specifically looking to medically tailored meal providers to be part of the response. There has been a shift that has happened, that is happening, in terms of the recognition that are clients will not have their needs met by the normal food and nutrition security solutions that exist in our communities.”
Alissa Wassung, Director of Policy and Planning for God’s Love We Deliver in New York City, described the challenges brought on by the disruption of home health aide services, mentioning that “home health aides may not be able to visit as much, or as often, or even at all anymore. It leaves this population open to extreme food insecurity and a lot fear.” Moveable Feast in Maryland seemed to be experiencing many of the same challenges. Sara Zisow-McClean, Director of Programs of Moveable Feast, shared that aside from a surge in their normal clientele, the organization has expanded their services to provide meals to individuals who have recently been moved from shelters to other forms of temporary housing such as hotel and has started helping out other food providers in the area to boost food delivery for seniors.
As normal pathways for care and resources continue to be disrupted, more and more people are looking to MTM providers to step in and assist. MTM providers are always willing and interested to step to the plate and help, however, Cathryn Couch, CEO of Ceres Community Project in California, has noticed that there seems to be a disconnect between need, the services employed to meet the need, and the funding structures that support those programs. “We are not included in the emergency food system, yet our communities are specifically looking to MTM providers to be part of the response,” she said, adding that, “there has been a shift that has happened, that is happening, in terms of the recognition that are clients will not have their needs met by the normal food and nutrition security solutions that exist in our communities.” Lastly, she stressed the need for support for MTM organizations, pointing out that “there are no structures in place like there are for the councils of aging, Meals on Wheels programs, or even the food banks to access federal and state funding in the same ways.”
Representatives from FIMC member organizations shared the lessons they are collectively learning throughout their response efforts:
Lessons Learned: Toward a More Resilient Health Care & Food Safety Net System
COVID has exposed the fragility and weaknesses of our society’s nutrition safety net; MTM are a critical service and must be a priority
There is a desperate need for more coordination of public and private efforts to meet nutrition needs, especially in times of crisis
MTM providers need to partner with organizations across the spectrum of food and nutrition services in order to meet the full range of need
Integration with health care (existing partnerships) supports and facilitates the delivery of services to those who need the most
The more we learn about COVID-19 and who is most at risk, the more we know that food and nutrition interventions in health care are the key to a more equitable system in the future
Given the current evidence surrounding these interventions and the experience these organizations have nourishing vulnerable residents during a crisis, it is no surprise that demand has been increasing throughout the coronavirus pandemic. MTM providers continue to alter operations and innovate systems to meet this need, but these organizations are operating at full capacity and draining their resources in the process. As David Waters, CEO of Community Servings in Boston said, “many of the normal systems have broken down. It is up to food providers like FIMC members to design new systems to make this all happen almost overnight. The connections to emergency preparedness or public health or health care are frayed because everyone is doing the best they can but everyone has their head down trying to power through this. We rely on collaboration.” Cathryn Couch echoed that MTM providers have been doing this work for years, yet acknowledged a long road ahead.
“There is significant work we need to do to place ourselves in that food safety net and to build those relationships, policy solutions, and funding sources that allow us to be more readily part of the policy solutions in this kind moment… We’re not embedded in a way that would allow us to scale up quickly and to have the funding to do so.”
The panelists underlined the value of applying both a systems-level and policy perspective in efforts to understand where we must go and how we can change. Alissa Wassung from God’s Love We Deliver emphasized the need for enhanced coordination and the importance of creating ever more integrated systems. She highlighted that “The experience of COVID has demonstrated how much our country has relied on nonprofits to do public health on a daily basis.” While focusing on policy, Alissa also stressed that there should be a focus on how we bolster and support the social services safety net so it continues to be vibrant for future crises. “Because of the siloes that exist in the food system and the health care system, there has been a lot of difficultly mobilizing the food system on mass and connecting it to the emergency response from the medical field. Each of the separate feeding systems addresses a different population that is much more vulnerable in this setting.” Lastly, she drew our attention back to the fact that MTM agencies and the interventions often get left out of the planning calculus in emergencies because they are not part of a specific funding stream.
In closing, the FIMC members presented paths forward which would strengthen the recognition and support for these services in response to the coronavirus crisis and reinforce a vision for a more equitable, nutrition-oriented health care system moving forward:
Take Action! Future Directions
Government and policymakers must plan for the future, and MTM provider organizations and clients must have a seat at the table
The federal government and states are taking action in response to COVID (for example, the recently passes CARES Act). These responses must support nonprofits in order to enable a nimble, rapid response in the event of a crisis like COVID
MTMs should be a reimbursable health care services, especially within Medicare and Medicaid
Demonstrations in CA, MA, NY, and NC
Additional health care partnerships mean that meals reach thousands of individuals each year