ORLANDO EMA HIV/AIDS RYAN WHITE PART A PROGRAM FOOD BANK/HOME-DELIVERED MEALS SERVICE STANDARDS OF CARE
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1 ORLANDO EMA HIV/AIDS RYAN WHITE PART A PROGRAM FOOD BANK/HOME-DELIVERED MEALS SERVICE STANDARDS OF CARE Definition: The provision of actual food or meals. It does not include finances to purchase food or meals. The provision of essential household supplies such as hygiene items or household-cleaning supplies should be included in this item. Includes vouchers to purchase food. Eligibility for Food Bank Services Consumers accessing Food Services must meet the eligibility standards as defined in the System Wide Standards of Care.. Consumer will need to complete the Emergency Food Assistance (TEFAP) Certification of Eligibility to Take Food Home form, if applicable. 9/15/2009 Page 1 of 10
2 Standard #1 All Food Bank/Home Delivered Meals providers shall comply with the following regulations. 1.1 Policy in place that reflects guidelines 1.1 Agency complies with local, state, and federal food safety, sanitization, and safety regulations. Documentation of monitoring by various regulatory agencies on file 1.2 All agencies shall comply with the USDA Department of Agriculture food handling guidelines. 1.3 Any agencies supplying food baskets that include TEFAP food must sign and maintain a TEFAP contract in order to be able to purchase government surplus food for use in food baskets. 1.4 Home Delivered Meals shall be prepared with adherence to the Food and Drug 1.2 USDA guidelines on file and copies of monitoring by regulatory agencies 1.3 Signed contract on file 1.4 Food and Drug Administration s Food Preparation Standards on file Documentation of monitoring by various regulatory agencies on file 9/15/2009 Page 2 of 10
3 Administration s food preparation standards for people living with HIV/AIDS. Standard #2 All Food Bank/Home Delivered Meals program staff should be able to safely handle food as required by state/local regulation. 2.1 Agency shall comply with procedures for purchasing, receiving, sorting, issuing, preparing, and service of safe food and beverage products. 2.1 Procedures and certifications on file 2.2 All staff members preparing meals shall have current and valid food handling permits. 2.3 All new program staff members in the kitchen and food bank shall attend educational seminars regarding food safety within three months of hire and annually thereafter. 2.2 Permits on file at provider agency 2.3 Education certificates on file at provider agency for each staff member 9/15/2009 Page 3 of 10
4 Scope of Service Standard #3 All Food Bank/Home Delivered Meal providers shall comply with the following scope of services. Guidelines Indicators Data Source 3.1 Food access contains food meeting the Bag recommendation in Appendix A 3.1 Food bags must contain a single food bank/home delivered meal access (3-day supply of food) meeting the nutritional recommendations stated in Appendix A,: Comply with the food guide and pyramid (See attached APPENDIX A) Provide extra protein to assist in maintaining lean body mass. (See attached APPENDIX A) Limit concentrated sweets and fats, which can suppress the immune system. (See attached APPENDIX A) 3.2 Home Delivered Meal must meet the guidelines as set forth in Appendix B. 3.2 Documentation and receipt of compliance with Appendix B Standard #4 All Food Bank/Home Delivered Meal providers shall hire a food liaison. 9/15/2009 Page 4 of 10
5 4.1 Formal and informal memorandum of agreement on file 4.1 All Food Liaisons shall identify and network with other food providers outside of the Ryan White System. 4.2 Food Liaisons shall educate consumers on how to access food services other than Ryan White System. 4.3 Food Liaisons shall create and distribute a resource directory of food service providers in the four county areas that is updated at least bi-annually. 4.4 Food Liaisons shall document all services performed including the time spent as a face-to-face encounter or services provided on behalf of a consumer. 4.2 Documentation of education in consumer file as well as payer of last resort documentation 4.3 Current Resource Directory available 4.4 Documentation in consumer file i.e. progress note, POR form, receipt of food resource directory, etc. Inspection Standard #5 Food bags shall comply with the following food safety guidelines. 5.1 No food bag shall contain cans that are 5.1 Bag and pantry inspections 9/15/2009 Page 5 of 10
6 dented, swollen, showing rust, or missing a label in accordance with FDA Regulations. 5.2 All milk and cheese products shall have the word pasteurized on the label. 5.3 Fresh food such as bread shall be free of any mold. 5.4 Fruits and vegetables shall be free from insects and mold. 5.5 All packaged products should be labeled properly, and within the expiration period as stated on the product in accordance with FDA Regulations. 5.6 Frozen foods are to be packaged, kept completely frozen and stored in a proper freezer at 0 degrees Fahrenheit or below. 5.2 Pantry inspection 5.3 Pantry inspection 5.4 Pantry inspection 5.5 Pantry inspection 5.6 Pantry inspection 9/15/2009 Page 6 of 10
7 Appendix A NUTRITIONAL NEEDS The nutritional needs of a PLWH/A are higher than that of a non-infected individual. Individual nutrient recommendations for a PLWH/A are based on the stage of illness along with any opportunistic infections. The main goal of nutritional support is the prevention of wasting syndrome, but at the same time it is to also ensure that the individual is receiving adequate nutrients needed to promote a healthy immune system. Studies have shown that a diet high in protein is helpful in maintaining muscle structure; a higher than normal intake of anti-oxidants aids in immune function; and limiting saturated fat and simple sugars reduces the risk of heart disease and may prevent the side effects caused by some conditions such as diabetes and lipodystrophy. The average protein and calorie needs of a PLWH/A based on the American Dietetic Association and fat, saturated fat, cholesterol and sodium recommendations based on the American Heart Association are as follows: Health Status Calories Protein Needs HIV+ Asymptomatic kcal per kg Ideal Body Weight gram per kg Ideal Body Weight Symptomatic AIDS Symptomatic AIDS with infection kcal per kg kcal per kg Ideal Body Weight Ideal Body Weight gram per kg gram per kg Ideal Body Weight Ideal Body Weight 9/15/2009 Page 7 of 10
8 The USDA Food Guide Pyramid that has been adapted to meet the needs set forth by the American Dietetic Association recommends the following food intake to meet the nutrient for a PLWHA: 2-3 servings of dairy products 1 serving = 1 cup milk, 1 cup yogurt, ½ cup cottage cheese, 1½ -2 oz. Cheese, 1 can Ensure/Boost 3-5 servings of meat, poultry, fish, pork, beans, eggs, and nuts (1 ounce = 7 grams protein) 1 serving = 3-4 oz. meat (4 oz is about the size of a deck of cards), ½ cup beans, 1 egg or 2 egg whites, 2 tablespoons of peanut butter or 1/3 cup of peanuts 3-5 servings of vegetables 1 serving = ½ cup juice, ½ cup raw or cooked vegetables, 1 cup leafy vegetables 2-4 servings of fruit 1 serving = ½ cup juice, ½ cup canned fruit, 1 medium fresh fruit, ¼ cantaloupe 6-11 servings of bread, cereal, rice, and pasta 1 serving = 1 slice bread, ¾ cup cereal, ½ bun or English muffin, ½ cup pasta or rice, 1-6 flour or corn tortilla, 1 packet of instant oatmeal Less than 3 servings of fat and simple sugars 1 serving = ½ candy bar, ½ can soda, 1 teaspoon frying oil or mayonnaise, 1 ounce chips, cookies, cake Where available, high fiber products should be provided. Fiber helps to control blood sugar and reduce cholesterol in patients with metabolic issues, and the Food and Nutrition Board and Institute of Medicine have adequate intakes of fiber set at 25 grams a day for adult women and 38 grams for adult men. High fiber products would include whole grain breads, whole-wheat pasta, brown rice, high fiber cereals (check label: a serving should contain >5 grams of fiber), fruits, and vegetables. Ryan White Providers supplying the PLWHA community with food baskets are required to meet the needs of their consumers by providing the best nutritional foods available. 9/15/2009 Page 8 of 10
9 Due to the current method of food provision and access (i.e.: Second Harvest Food Bank, Donations), food baskets will fluctuate in the food items contained and in its nutrient content. It will be the responsibility of the provider to assure that one food basket will provide as close to as possible the following: A 3-day supply of food, meeting the nutritional needs stated above totaling: 7200 Calories 300 grams protein <240 grams fat <75 grams saturated fat <900 grams cholesterol <9000 mg sodium As an example, a basket that meets these requirements would contain a minimum of the following: Milk: 1 box powdered (6 servings) Protein: 2 cans tuna (6 servings), 1 can chili or beef stew (2 servings), 9 ounces frozen meat (3 servings) Vegetables: 3 cans vegetables (6 servings), 2 cans of vegetable soup (4 servings), 1 jar spaghetti sauce (4 servings) Fruits: 1 can fruit (2 servings), 2 apples (2 servings), 1 carton of orange juice (8 servings) Starch: 1 box cereal (12 servings), 1 box rice (8 servings), 1 box pasta (8 servings), 2 boxes macaroni and cheese (8 servings) All foods that fall within the snack category, such as cake, candy, chips or cookies, will be considered extra foods and will not account for any portion of the calorie/nutrient requirements set forth in these standards. Should the provider receive donated oral supplements such as Boost/Ensure considered a dairy/milk item in the food basket., it may be provided without a prescription and will be 9/15/2009 Page 9 of 10
10 Appendix B GUIDELINES FOR HOME DELIVERED MEALS A. Eligibility Criteria Ryan White funds are to be used in the provision of home delivered meals as a last resort. Therefore, the eligibility guidelines used in the approval of Project AIDS Care (PAC) home delivered meals will be followed for those who will utilize Ryan White funds for home delivered meals. In addition to PAC guidelines, the following will apply: A signed prescription by a licensed physician, nurse practitioner, or registered dietitian verifying the consumer s inability to prepare meals. Ryan White home delivered meals will be provided for no more than 4 months per calendar year, but may be reevaluated as evidence by individual care plan. B. The nutrient content of menus is to be evaluated by a registered dietitian (as defined by the Medical Nutrition Therapy Standards of Care). Each meal will be required to meet 1/3 the RDA for nutrients and basic vitamins and minerals. Meals can be evaluated by using software programs such as Food Processor, Nutritionist V, Comp Nutrition, or by using the dietary exchange method (available from the American Diabetic Association). Meals with excess saturated fat and sugar are not considered acceptable for HIV+ individuals. C. Meals are to be delivered to the consumer s home at a temperature of 40 degrees or below. Items that have reached a temperature above 40 degrees must be consumed or refrigerated within 2 hours to avoid food borne illness and bacterial contamination. D. Food should be handed directly to the consumer or caregiver and should not be left at the door if he/she is not home. 9/15/2009 Page 10 of 10
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