2011 Home-Delivered Meals Survey Report

RICK SCOTT GOVERNOR CHARLES T.CORLEY SECRETARY 2011 Home-Delivered Meals Survey Report elderaffairs.state.fl.us 1 Bureau of Planning & Evaluation, March 2012

Table of Contents Executive Summary... 3 Key Findings... 3 Consumer Satisfaction... 3 Background... 4 Methodology... 4 Survey... 4 Population and Sample... 4 Procedures... 4 Findings... 5 Meal Delivery... 5 Food Preferences and Consumption... 6 Finances and Food Security... 8 Impact of Service... 9 Dietary Impact... 9 Health, Well-being and Independence... 9 Client Feedback... 10 Client Satisfaction... 10 Demographics... 11 Age, Marital Status, Residence and Educational Level... 11 Gender, Race and Ethnicity... 13 Summary and Recommendations... 13 Appendix A: 2011 Home Delivered Meals Survey... 15 Appendix B: Home Delivered Meals Survey Tabulations... 23 Appendix C: Client Comments... 32 2

Executive Summary Home-delivered meals, commonly known as Meals on Wheels, is a service that delivers nutritious meals to homebound older Floridians. The purpose of this service is to reduce hunger and food insecurity and delay adverse health conditions while promoting the health and wellbeing of older individuals. The primary target population receiving home-delivered meals is individuals age 60 and older who are homebound due to illness, disability, or isolation. In addition, the volunteers or staff members delivering the meals have an important opportunity to provide social contact for the homebound elder. This service offers a needed support for many homebound elders wanting to remain in their own homes. The Planning and Evaluation Bureau of the Florida Department of Elder Affairs (DOEA) conducted a survey of participants receiving home-delivered meals to assess the effectiveness of the service in accomplishing its purpose. A random sample of service participants was contacted by telephone in the fall of 2011. Key Findings 1. About 96% of respondents reported that home-delivered meals: a. Helped them eat healthier foods; b. Helped them achieve or maintain a healthy weight; and c. Improved their health. 2. Nearly 96% of respondents reported they feel better because of the meals they receive. 3. Over 97% of respondents reported the home-delivered meals service helped them to continue to live at home. 4. For three-fourths of the clients, home-delivered meals made up at least one-half of their daily intake, though home-delivered meals are designed to provide clients with one-third of their daily nutritional requirements if they eat the complete meal. In addition, only about 43% received a daily delivery of a hot meal, whereas others received frozen meals. 5. Fewer than half (48.6%) of the respondents reported always having enough money or Supplemental Nutrition Assistance Program (formerly Food Stamps) funds to buy the food they need. 17.6% of clients skipped meals because they had no food and no SNAP funds with which to buy food. Low-income respondents said they were forced to make choices between buying food or other essential services such as buying medication (17.3%) or paying rent or utility bills (18.8%). Consumer Satisfaction Nearly 94% of clients reported that overall, home-delivered meals helped them. More than 95% said they would recommend the service to a friend. The quality of the meals was rated as excellent or very good by 68.7% of consumers with another 24.7% rating them as good. 3

2011 Home-Delivered Meals Survey Report Background Home-delivered meals, commonly known as Meals on Wheels, is a service that delivers nutritious meals to homebound older Floridians. The purpose of this service is to reduce hunger and food insecurity and delay adverse health conditions while promoting the health and wellbeing of older individuals. The primary target population receiving home-delivered meals is individuals age 60 and older who are homebound due to illness, disability, or isolation. In addition, the volunteers or staff members delivering the meals have an important opportunity to provide social contact for the homebound elder. This service offers a needed support for many homebound elders wanting to remain in their own homes. Methodology Survey The survey was developed by the Performance Outcome Measures Project for the U.S. Administration on Aging with questions added by the Department's registered dietician. The survey questions assess the following areas: meal delivery, food preferences and consumption, finances and food security, service impact, client satisfaction, and demographics. Population and Sample A stratified random sample was taken from 20,893 clients participating in six DOEA administered programs that provide home-delivered meals. These programs are as follows: Community Care for the Elderly, Home Care for the Elderly, Local Services Programs, Medicaid Waiver, Older Americans Act Title III C2, and Nursing Home Diversion. The sample response size of 271 provides a.90 confidence level for the results. Procedures The survey was conducted by trained interviewers in the DOEA Computer-Assisted Telephone Interview (CATI) Call Center. The interviewers, who have from one to five years experience in interviewing elders, received detailed instructions on conducting the survey and recording information and responses. Calls were made in the fall of 2011 and were placed between 9:00 a.m. and 5:00 p.m. A total of 271 clients completed the survey, yielding a response rate of 40%. 4

Findings The analysis in this report addresses a subset of all questions that were administered in the survey. Questions with indeterminate results were omitted. Meal Delivery All clients surveyed were currently receiving home-delivered meals. As shown in Exhibit 1 below, over two-thirds (68.1%) of clients had been receiving meals for less than two years. Over one-quarter (25.6%) received meals for two to five years, and about 6% had been receiving services for over five years. Exhibit 1. Number of Months Clients Have Been Receiving Home Delivered Meals. Service approach varied by provider. More than 43% of clients received a daily delivery of a hot meal or a hot meal and a snack, while about 42% received weekly deliveries or shipments of multiple frozen meals. Of those clients who received their meals daily, 11.2% also received a Friday delivery of frozen meals for the weekend. Clients are given a window of time in which they can expect delivery of their meals. When asked Do the home-delivered meals arrive when expected? 92.3% said they always or usually arrive on time. Fewer than 1% reported they seldom received their meals when expected (Exhibit 2). 5

Exhibit 2. of Clients Receiving Their Meals on Time. Food Preferences and Consumption Home-delivered meals are prepared to provide clients with about one-third of their daily nutritional requirements. In order to reach this standard, clients need to consume the entire meal. The survey included questions to determine what food items were consumed and to identify reasons for avoiding or not eating a particular item or meal. Exhibit 3 summarizes client eating habits or preferences for different categories of food. With the exception of beans, nuts, eggs, or tofu, which only 87.4% of clients consumed, all other food was consumed by between 91% and 97% of clients. Exhibit 3. Food Preferences and Consumption. Please tell me if you usually eat each food or group of foods when you eat home delivered meals. Yes Responses Fruit 93.0 Potatoes 95.2 Vegetables 92.3 Milk, cheese, yogurt, soy cheese, soy yogurt 93.4 Beans, nuts, eggs, or tofu 87.4 Meat, turkey, chicken, fish 97.0 Bread, tortillas, pancakes 94.8 Cereal, rice, pasta, noodles 94.8 Dessert 91.4 6

Clients reported that they avoided eating a meal or a portion of a home-delivered meal for the following reasons: because the food was not compatible with a chronic condition diet (5.5%); because of food allergies (2.6%); because of religious beliefs (1.5%); or because of a vegan or vegetarian lifestyle (.7%). Other reasons for not consuming the meal were explored indirectly. Clients were asked how often they were satisfied with food choices, preparation, and delivery. As Exhibit 4 shows, 90% of clients were satisfied with the way the food was cooked and were satisfied that hot foods were kept hot and cold foods were kept cold. However, clients reported lower satisfaction levels with several aspects of food preparation. Only 74.1% were always or usually satisfied with the variety of food provided; 79.1% with the way the food tastes; 84.5% with the way the food smells; and 86.1% with the way the food looks. More details are shown in Exhibit 4 below. Exhibit 4. Client Satisfaction with Food Choices, Preparation, and Delivery. How often are your satisfied... Always or Usually clients answered... Sometimes Rarely or Never Total That the hot foods are hot and cold foods are cold 90.6 8.2 1.2 100.0 With the way the foods are cooked 89.7 8.2 2.1 100.0 With the way the food looks 86.1 10.9 3.0 100.0 With the way the food smells 84.5 11.0 4.5 100.0 With the way the food tastes 79.1 16.4 4.4 100.0 With the variety of foods 74.1 17.0 8.8 100.0 About 93% of clients reported that milk was included with their meal. Clients were asked what they usually do with the milk and were given an opportunity to report a variety of ways they might use or not use it. Exhibit 5 shows that over half (55%) drank all the milk with their home-delivered meal. Clients also might drink some and save some, or save it all for later. Fewer than 5% of clients reported giving the milk to other people, their pet, or throwing it away. 7

Exhibit 5. Milk Consumption. What do you usually do with your milk when it is delivered? (Check all that apply.) You drink all of it with your meal. 55.0 You drink part of it and save the rest for later. 39.8 You save it all for later. 25.7 You drink some and give the rest to other people or to your pet. 3.3 You drink some and throw away the rest. 3.7 You throw all or most of it away. 4.1 Finances and Food Security Nearly all clients (95.3%) receiving home-delivered meals reported annual incomes for all persons in their households at or below $20,000. These figures included income from jobs, Social Security, retirement, public assistance, and all other sources. Exhibit 6 shows that roughly a quarter of all clients fell into each of four income categories, $5,000 or less, $5,001 to $10,000, $10,001 to $15,000, and $15,001 to $20,000 per year. Exhibit 6. Annual Household Income of Home Delivered Meals Clients. 8

Food security is defined as access to enough food for an active, healthy life. At a minimum, food security includes the ready availability of nutritionally sufficient and safe foods, and an assured ability to acquire adequate foods in socially acceptable ways. Several questions assessed the food security of clients receiving home-delivered meals. Fewer than half (48.6%) of the respondents reported always having enough money or funds provided through the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, to buy the food they needed. More than 17% had to choose between buying food or buying medication during the month prior to the survey; 18.8% had to choose between buying food or paying rent or utility bills. On one or more days during the prior month, 17.6% of clients skipped meals because they had no food or SNAP funds to buy food. Impact of Service Dietary Impact Home-delivered meals are prepared to provide clients with about one-third of their daily nutritional requirements. For three-fourths of the clients surveyed, a single home-delivered meal was half or more of their daily intake. Without this nutritional supplement, their health would be severely impaired. Exhibit 7 shows the daily portion of food that is provided by each home-delivered meal. Exhibit 7. Portion of Daily Dietary Intake Provided by Home Delivered Meals. Think about the amount of food you eat from home delivered meals. On the days you eat a meal from home delivered meals, what proportion of all the foods you eat in a day does this meal represent? Would you say... More than one half 63.7 About one half 13.4 Between one third and one half 10.3 Less than one third 12.6 Total 100.0 Health, Well-being, and Independence Several survey questions addressed the success of these services in achieving the purposes of the home-delivered meals service. Responses, in general, were highly positive. About 96% of clients reported the meals helped them to 1) improve their health, 2) eat healthier foods, and 3) achieve or maintain a healthy weight. According to 95.7% of the clients, the service helped them to feel better. When clients were asked if the home-delivered meals service helped them to continue to live at home, 97.3% said yes. These findings are summarized in Exhibit 8 below. 9

Exhibit 8. Impact on Health and Independence. Purpose 1. Improve physical health through nutritional meals Do the services received in the home delivered meals help you to... Yes Responses eat healthier foods 96.6 improve your health 95.7 achieve or maintain a healthy weight 96.6 feel better 95.7 2. Help maintain independence continue to live at home 97.3 Client Feedback Clients were asked In general, would you say that the home-delivered meals service has helped you? Nearly 94% responded yes. Responses varied when asked How has the home-delivered meals service helped you? The predominant response was simply that the service provides them with food they otherwise would not have. Many clients are unable to shop for groceries. Others are unable to stand or perform the tasks required to prepare a meal. The home-delivered meals service provides them with a meal they can readily eat. Below are some typical comments related to their appreciation for the service. All comments can be found in Appendix C. I really like the meals. It is better food than I would otherwise be able to eat. I would not have been able to eat sometimes if it were not for the meals. It's the only meal I have to eat. I'm thankful for what I receive but would like bigger portions. I have problems eating, but the meals I receive I'm able to eat. Without the service, I would not be able to continue living in the house. I am crippled and cannot prepare meals. This service really helps me to have a meal every day. Client Satisfaction The survey included three indicators of client satisfaction. In response to the question Do you like the meals you get from the home-delivered meals program? 97.4% of clients said yes. When asked if they would recommend the home-delivered meals program to a friend, 95.4% said yes. 10

Overall, 93.4% of clients rated the quality of their meals as good, very good, or excellent. The distribution of the responses is depicted in Exhibit 9. Exhibit 9. Client Evaluation of the Quality of Meals. Demographics Age, Marital Status, Residence, and Educational Level Four clients receiving home-delivered meals were over 100 years old. Nearly a third were 85 or older and most (57%) were 75 or older. Exhibit 10 shows the overall distribution of clients by age group. 11

Exhibit 10. Client Age Groups. Most clients surveyed were widowed (54.8%); 21.9% were married. The remainder were divorced, separated, or never married. Over 63% of clients lived alone. About one-quarter lived with a spouse (24.7%) and/or with children (26.8%). Most home-delivered meals clients lived in a city (65%); others resided in the suburbs (21.8%) or rural areas (13.2%). Clients were asked What is your highest education level? Over 43% reported not having a high school diploma. About 30% had a high school diploma, and the remainder had some college or a degree. Exhibit 11. Educational Level What is your highest education level? Less than high school diploma 43.6 High school diploma 30.4 Some college, Including Associate Degree 15.0 Bachelor's degree 6.6 Some post graduate work or advanced degree 4.4 Total 100.0 12

Gender, Race and Ethnicity Most home-delivered meals clients were women (77.4%). As shown in Exhibit 12, more than twice as many clients were White or Caucasian (48%) as were Black or African American (22.1%). Of those reporting their ethnicity, 18.4% were of Spanish, Hispanic, or Latin descent. Exhibit 12. Client Race What is your race? White or Caucasian 48.0 Black or African American 22.1 American Indian or Alaskan Native 0.7 Asian 0.0 Native Hawaiian, Other Pacific Islander 0.0 Other Race 10.3 Refused/Don't Know/No Answer 18.8 Total 100.0 Summary and Recommendations The Planning and Evaluation Bureau of the Florida Department of Elder Affairs conducted a survey of participants receiving home-delivered meals to assess the effectiveness of the service in achieving its purpose. Specific questions related to meal delivery, client food preferences and consumption, client finances and food security, service impact, client satisfaction, and demographics. A random sample of current service participants was called in the fall of 2011. More than half of home-delivered meals clients were age 75 or older, with 31% being 85 or older. Most clients lived alone (63%), or with their spouse (24.7%), and/or children (26.8%). Most clients were women (77.4%), 48% were White or Caucasian, and 18.4% were of Spanish, Hispanic, or Latin descent. More than half of the respondents had been receiving services for over a year. Survey responses indicated that the home-delivered meals service is very successful in achieving its purpose. Over 97% of clients reported that the service helped them to continue to live at home. About 96% of clients said the meals helped them to 1) improve their health, 2) eat healthier foods, and 3) achieve or maintain a healthy weight. Nearly 96% of the clients said services helped them to feel better. Overall, clients were very satisfied with home-delivered meals. About 94% of clients reported that the service was helpful to them. Over 97% of clients reported they liked the meals they get 13

from the home-delivered meals service with nearly 70% of consumers rating the overall quality of the home-delivered meals to be very good to excellent with another 24.7% rating them as good. More than 95% said they would recommend the service to a friend. Most clients (92%) reported that the meals always or usually arrived when expected. Clients were asked which foods they usually eat and which they may avoid. The food provided in each food group is usually consumed by between 87% and 97% of clients. Some clients avoided certain items because of chronic conditions (5.5%) or food allergies (2.6%). While about 90% of clients were satisfied with the way the food is cooked and that it was appropriately hot or cold, fewer clients were satisfied with the way it looks (86.1%), smells (84.5%), and tastes (79.1%). Clients would also like to have a greater variety of food (74.1% were satisfied). Home-delivered meals are designed to provide clients with one-third of their daily nutritional requirements if they eat the complete meal. However, for three-fourths of the clients, the meal was half or more of their daily intake. In addition, only about 43% received a daily delivery of a hot meal, whereas others received multiple or frozen meals weekly or monthly. Low income levels of respondents also forced them to make choices between purchasing essential items or services. Fewer than half (48.6%) of the respondents reported always having enough money or SNAP funding to buy the food they need. More than 17.3% had to choose between buying food or buying medication during the past month; 18.8% had to choose between buying food or paying rent or utility bills. On one or more days during the prior month, 17.6% of clients skipped meals because they had no food and no Food Stamps to buy food. As baby boomers age and the nation shifts from institutional care for older adults to home and community-based care, nutritional services will become a fiscally responsible and respectful method to assist elders to remain in their homes. The meals served to clients need to be palatable to the recipient so that they will be consumed. Greater attention to an elder s food intake will help improve nutritional status, promote successful aging, reduce long term care costs by preventing the development of diseases, and enable elders to stay in their homes. Diet quality and quantity play major roles in preventing, delaying onset, and managing chronic diseases associated with aging. Escalating health care costs are largely related to chronic diseases in which nutrition interventions have proven effective. About 87% of older adults have diabetes, hypertension, dyslipidemia, or a combination of these chronic diseases. These costly conditions, as well as their roles as predisposing factors for nursing home placement, may be ameliorated with appropriate nutrition services. Research shows that the cost of one day in a hospital equals the cost of one year of Older Americans Actfunded home delivered meals. Food assistance programs may contribute to a reduction in these costs by helping people stay in their homes. 14

Appendix A: 2011 Home-Delivered Meals Survey 15

2011 Home Delivered Meals Survey Report Items 1. How long have you been receiving home delivered meals? Would you say... Six months or less,... 1 More than six months, but less than one year,... 2 At least one year but less than two years,... 3 Two to five years, or... 4 More than five years?... 5 REFUSED... 7 DON T KNOW... 8 2. How do you usually receive your meals? [Check all that apply] a. Weekday delivery of a hot meal b. Weekday delivery of a hot meal and snack c. Weekly delivery of multiple or frozen meals d. Friday delivery of frozen meal(s) for the weekend e. Other Specify: Always Usually Sometimes Seldom Never RF DK N/A 3. Do the home delivered meals arrive when expected? 1 2 3 4 5 7 8 9 4. For the next set of questions, I am going to ask about food or groups of foods that you eat from your home delivered meals. Please tell me if you usually eat each food or group of food when you eat the home delivered meals. 4a. Do you usually eat the fruit when it is provided? 16 YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4b. Do you usually eat the potatoes that are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8

4c. Do you usually eat the vegetables that are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4d. Do you usually eat or drink the milk, cheese, yogurt, soy milk, soy cheese, or soy yogurt that are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4e. Do you usually eat the beans, nuts, eggs, or tofu when they are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4f. Do you usually eat the meat, turkey, chicken, or fish that are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4g. Do you usually eat the bread, tortillas, or pancakes that are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 4h. Do you usually eat the cereal, rice, pasta, or noodles when they are provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 17

4i. Do you usually eat the dessert when it is provided? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 5. Do you ever avoid eating a meal or a portion of a meal for any of the following reasons? [Check all that apply.] a. Food allergies b. Food not compatible with chronic conditions diet c. You are a vegan or vegetarian d. Religious beliefs e. Other 6. Think about all the foods that {you receive/s/he receives} from the home delivered meals program. Now tell me, how often {are you/is s/he} satisfied Always Usually Sometimes Seldom Never RF DK N/A that the hot foods are hot and the cold foods are cold? 1 2 3 4 5 7 8 9 with the way the food is cooked? 1 2 3 4 5 7 8 9 with the way the food looks? 1 2 3 4 5 7 8 9 with the way the food smells? 1 2 3 4 5 7 8 9 with the way the food tastes? 1 2 3 4 5 7 8 9 with the variety of foods? 1 2 3 4 5 7 8 9 7. Is milk usually included with your meal? 18 a. Yes b. No 8. What do you usually do with your milk when it is delivered? [Check all that apply] f. You drink all of it with your meal. b. You drink part of it and save the rest for later. c. You save it all for later. d. You drink some and give the rest to other people or to your pet. e. You drink some and throw away the rest. f. Throw most or all of it away. g. Other

9. Thinking about the total combined income from all sources for all persons in your household, including income from jobs, Social Security, retirement income, public assistance, and all other sources was your total household annual income during the last calendar year above or below $20,000? At or below $20,000 ($1,666 per month or less), or... 1 Above $20,000 ($1,667 per month or more)?... 2 Don t know... 8 Refused... 9 10. Which category best describes your total household annual income during the last calendar year? Would you say $5,000 or less ($417 or less per month),... 1 $5,001 $10,000 ($418 $833 per month),... 2 $10,001 $15,000 ($834 to $1,250 per month), or... 3 $15,001 $20,000 ($1,251 to $1,666 per month)? Don t know... 8 Refused... 9 11. Do you always have enough money or Food Stamps to buy the food you need? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 12. During the past month, did you have to choose between buying food and medication? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 13. During the past month, did you have to choose between buying food and paying rent or utility bills? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 14. On one or more days during the past month, did you skip meals because you had no food and or Food Stamps to buy food? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 19

15. Think about the amount of food you eat from home delivered meals. On the days you eat a meal from home delivered meals, what portion of all the foods you eat in a day does this meal represent? Would you say Less than one third... 1 Between one third and one half... 2 About one half... 3 More than one half... 4 OTHER... 91 (Please Specify) REFUSED... 7 DON T KNOW... 8 Please answer the following questions about the home delivered meals program. Do services received in the home delivered meals program help you... Yes No Ref DK 16. continue to live in at home? 1 2 7 8 17. improve your health 1 2 7 8 18. eat healthier foods? 1 2 7 8 19. achieve or maintain a healthy weight? 1 2 7 8 20. feel better? 1 2 7 8 21. In general would you say that the home delivered meals service has helped you? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 22. Do you like the meals you get from the home delivered meals program? YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8 23. Would you recommend the home delivered meals program to a friend? 20 YES... 1 NO... 2 REFUSED... 7 DON T KNOW... 8

24. How would you rate the home delivered meals program overall? Would you say... Excellent... 1 Very good... 2 Good... 3 Fair... 4 Poor... 5 REFUSED... 7 DON T KNOW... 8 25. What is your highest education level? Less than high school diploma... 1 High school diploma... 2 Some college, including associate degree... 3 Bachelor s degree... 4 Some post graduate work or advanced degree... 5 Don t know... 8 Refused... 9 26. In what year were you born? Year Don t kknow... 8 Refused... 9 27. What is your marital status? Now married... 1 Widowed... 2 Divorced... 3 Separated... 4 Never married... 5 Don t know... 8 21

28. We d like to ask about who lives in your household. Do you live (with)... Yes No DK Refused a. Alone... 1 2 8 9 b. Spouse... 1 2 8 9 c. Children... 1 2 8 9 d. Other relatives... 1 2 8 9 e. Domestic partner... 1 2 8 9 f. Non relatives other than domestic partner... 1 2 8 9 29. Where is your home located? Would you say In a city... 1 In a suburban area... 2 In a rural area... 3 Don t know... 8 Refused... 9 30. What is your gender? [Record sex of respondent. Don t ask if obvious.] Male... 1 Female... 2 31. What is your race? Check all that apply. a. American Indian or Alaskan Native... 1 b. Asian... 2 c. Black or African American... 3 d. White/Caucasian... 4 e. Native Hawaiian/Other Pacific Islander... 5 f. Other race... 6 g. Don t know... 8 h. Refused... 9 32. Are you Spanish, Hispanic, or Latino? Yes... 1 No... 2 Don t know... 8 Refused... 9 22

23 Appendix B: Home-Delivered Meals Survey Tabulations

2011 Home Delivered Meals Survey 1. How long have you been receiving home-delivered meals? Would you say... Valid Six months or less. 40 16.5 More than six months, but less than one year. 63 26.0 At least one year but less than two years. 62 25.6 Two to five years. 62 25.6 More than five years. 15 6.2 Total 242 100.0 2. How do you usually receive your meal? (Check all that apply) a. Weekday delivery of a hot meal No 193 72.3 Yes 74 27.7 Total 267 100.0 b. Weekday delivery of a hot meal and snack No 226 84.3 Yes 42 15.7 Total 268 100.0 c. Weekly delivery of multiple or frozen meals No 157 58.4 Yes 112 41.6 Total 269 100.0 d. Friday delivery of frozen meal(s) for the weekend No 239 88.8 Yes 30 11.2 Total 269 100.0 e. Other (Specify): 263 97.0 Biweekly 1.4 Monthly 7 2.6 Total 271 100.0 24

3. Do the home-delivered meals arrive when expected? Always 187 69.3 Usually 62 23.0 Sometimes 19 7.0 Seldom 2.7 Total 270 100.0 4. Please tell me if you usually eat each food or group of foods when you eat home delivered meals. Yes Responses a. Fruit 251 93.0 b. Potatoes 257 95.2 c. Vegetables 250 92.3 d. Milk, cheese, yogurt, soy cheese, soy yogurt 253 93.4 e. Beans, nuts, eggs, or tofu 236 87.4 f. Meat, turkey, chicken, fish 263 97.0 g. Bread, tortillas, pancakes 257 94.8 h. Cereal, rice, pasta, noodles 257 94.8 i. Dessert 257 91.4 Total 270 100.0 5. Do you ever avoid eating a meal or portion of a meal for any of the following reasons? (Check all that apply) a. Food allergies No 264 97.4 Yes 7 2.6 Total 271 100.0 b. Food not compatible with chronic condition diet No 256 94.5 Yes 15 5.5 Total 271 100.0 c. You are a vegan or vegetarian No 269 99.3 Yes 2.7 Total 271 100.0 25

d. Religious beliefs No 267 98.5 Yes 4 1.5 Total 271 100.0 e. Other reason No 256 94.5 Yes 15 5.5 Total 271 100.0 6. How often are your satisfied... Always/ Usually Sometimes Rarely/ Never that the hot foods are hot and cold foods are cold 90.6 8.2 1.2 with the way the foods are cooked 89.7 8.2 2.1 with the way the food looks 86.1 10.9 3 with the way the food smells 84.5 11 4.5 with the way the food tastes 79.1 16.4 4.4 with the variety of foods 74.1 17 8.8 7. Is milk usually included with your meal? Yes 245 93.2 No 18 6.8 Total 263 100.0 8. Milk consumption. What do you usually do with your milk when it is delivered? (Check all that apply.) You drink all of it with your meal. 144 55.0 You drink part of it and save the rest for later. 106 39.8 You save it all for later. 69 25.7 You drink some and give the rest to other people or to your pet. 9 3.3 You drink some and throw away the rest. 10 3.7 You throw all or most of it away. 11 4.1 9. Thinking about the total combined income from all sources for all persons in your household, including income from jobs, social security, retirement income, public assistance, and all other sources was you total household annual income during the last calendar year above or below $20,000? At or below $20,000 ($1,666 per month or less) 162 95.3 Above $20,000 ($1,667 per month or more) 8 4.7 Total 170 100.0 26

10. Which category best describes your total household annual income during that last calendar year? Would you say... $5,000 - or less ( $417 or less per month) 41 28.9 $5,001 - $10,000 ( $418 to $833 per month) 32 22.5 $10,001- $15,000( $834 - $1,250 per month) 38 26.8 $15,001-$20,000 ($1,251- $1,666 per month) 31 21.8 Total 142 100.0 11. Do you always have enough money or Food Stamps (SNAP) to buy the food you need? Yes 126 48.6 No 133 51.4 Total 259 100.0 12. During the past month, did you have to choose between buying food or buying medication? Yes 44 17.3 No 211 82.7 Total 255 100.0 13. During the past month did you have to choose between buying food or paying rent or utility bills? Yes 48 18.8 No 208 81.3 Total 256 100.0 Refused 3 14. On one or more days during the past month, did you skip meals because you had no food and no Food Stamps to buy food? Yes 46 17.6 No 215 82.4 Total 261 100.0 15. Think about the amount of food you eat from home-delivered meals. On the days you eat a meal from home-delivered meals, what proportion of all the foods you eat in a day does this meal represent? Would you say... More than one-half 167 63.7 About one-half 35 13.4 Between one-third and one-half 27 10.3 Less than one-third 33 12.6 Total 262 100 27

16-20. Please answer the following questions about the home delivered meals program. Do the services received at the home delivered meals program help you to... 16. continue to live at home Yes 253 97.3 No 7 2.7 Total 260 100.0 17. improve your health Yes 246 95.7 No 11 4.3 Total 257 100.0 18. eat healthier foods Yes 252 96.6 No 9 3.4 Total 261 100.0 19. achieve or maintain a healthy weight Yes 254 96.6 No 9 3.4 Total 263 100.0 20. feel better Yes 247 95.7 No 11 4.3 Total 258 100.0 21. In general, would you say that the home-delivered meals service has helped you? Yes 247 93.9 No 16 6.1 Total 263 100.0 22. Do you like the meals you get from the home-delivered meals? Yes 258 97.4 No 7 2.6 Total 265 100.0 28

23. Would you recommend the home-delivered meals to a friend? Yes 249 95.4 No 12 4.6 Total 261 100.0 24. How would rate the quality of home-delivered meals overall? Would you say... Excellent 66 24.4 Very Good 120 44.3 Good 67 24.7 Fair 15 5.5 Poor 3 1.1 Total 271 100.0 25. What is your highest education level? Less than high school diploma 99 43.6 High school diploma 69 30.4 Some college, Including Associate Degree 34 15.0 Bachelor's degree 15 6.6 Some post graduate work or advanced degree 10 4.4 Total 227 100.0 26. Client Age Age 85 and over 50 31.1 Age 75 to 84 42 26.1 Age 65 to 74 57 35.4 Age 60 to 64 12 7.5 Total 161 1 27. What is your marital status? Widowed 125 54.8 Now married 50 21.9 Divorced 25 11.0 Separated 14 6.1 Never married 14 6.1 Total 228 100.0 29

28. Do you live (with)... a. Alone Yes 137 63.1 No 80 36.9 Total 217 100.0 b. Spouse Yes 46 24.7 No 140 75.3 Total 186 100.0 c. Children Yes 51 26.8 No 139 73.2 Total 190 100.0 d. Other Relatives Yes 26 14.1 No 158 85.9 Total 184 100.0 e. Domestic Partner Yes 1.6 No 176 99.4 Total 177 100.0 f. Non-Relatives other than domestic partner Yes 4 2.2 No 174 97.8 Total 178 100.0 29. Where is your home located? Would you say... In a city 152 65.0 In a suburban area 51 21.8 In a rural area 31 13.2 Total 234 100.0 30

30. What is your gender? Male 60 22.6 Female 205 77.4 Total 265 100.0 31. What is your race? White or Caucasian 130 48.0 Black or African-American 60 22.1 Other Race 28 10.3 American Indian or Alaskan Native 2 0.7 Asian 0 0.0 Native Hawaiian, Other Pacific Islander 0 0.0 Refused/don't know/no answer 51 18.8 Total 271 100.0 32. Are you Spanish, Hispanic, or Latino? Yes 38 18.5 No 167 81.5 Total 205 100.0 31

32 Appendix C: Client Comments

How has the home-delivered meals service helped you? After having surgery I have not been able to cook, so the meals are easy to prepare. As her caregiver, this program really helps by providing one meal. Don't have to cook; everything is prepared and ready! Don't have to cook. I'm in bed a lot. Don't have to get out and buy food. I always have food to eat. I am able to eat healthy. I am able to have something to eat. I am confined to the house because of a fall. I depend on the program so I don't have to cook. I am crippled and cannot prepare meals, so this program really helps me to have a meal every day. I blend the food from meal in order to be able to eat it. I can count on the meals being there. I can depend on the person that makes the delivery. I can eat healthy. I cannot go out to buy food. I can t leave the house often to get food. I can't cook, and with the meals delivered, I don't have to. I can't cook. It makes things easier for me. I can't go out to buy food. I can't go shopping because of a low income. I can't move around much. I can't prepare food anymore so the meals are easy for her to put in the microwave. My other meals are prepared by (my caregiver). I can't prepare meals so this program helps. I can't prepare meals. This program is very helpful. I cannot cook so the meals I get are all I have to eat. Thank you for the program. I cannot cook. This program provides me with meals. I cannot prepare meals. This program provides meals for me. I cannot walk, so the program really helps me. This is the only way she is able to prepare a meal. I cannot go shopping for anything either. I'm very happy with the program. There's no improvement needed. I rely on this program and appreciate it. I depend on the program for food. I don't drive so it's helpful. I don't feel like cooking. Sometimes I feel bad and just stay in bed. I don't have much financial help. I don't have to cook all the time. I don't have to cook and can save money for other things. I don't have to cook the whole time. I don't have to cook. I don't have to cook. It makes life easier. I don't have to go and buy food. I don't have to go out and buy a meal. I don't have to go out and buy it. I don't have to go out to buy food. I don't have to skip a meal. 33

How has the home-delivered meals service helped you? I don't have to worry about my next meal. I know I'll have at least a meal everyday. I don't have transportation. It makes it easier for me since the meals are prepared and delivered. I don't need to cook and they keep me fed for the week. I don't have to cook or prepare all the meals, so I can take care of other business. I enjoy having meals ready to warm up. I have been able to eat because of this program. My health is not good. I'm on oxygen and have eye problems making it very hard to drive or go anywhere. I need this program. I have problems eating but the meals I'm able to eat the meals I receive. Without the program I would not able to continue living in the house. I have something to eat. I have trouble walking. It is hard to stand up and cook. I like the meals I receive. I am really grateful. I only receive hot meals. I really like the meals. It's better food than I would otherwise be able to eat. I really like the workers who deliver the meals. They make me feel special. I really like the meals I receive. It's better food than I would otherwise be able to eat. I would not have been able to eat sometimes if it were not for the meals. I'm 90 years old and can't do much cooking. I'm blind and limited in what I can do. I'm homebound and can't go out much. I'm not able to cook, so with this program I have something to eat. I'm partially blind and am limited in how I can prepare meals. I'm unable to get out of bed at times. It makes it easier to have meals ready. It brings the food to my home. It brings the meals to my house. It gives me food to eat. It gives me hot meal every day. It gives me something to eat; I cannot afford to buy things to eat so this program helps a lot. It has helped me. It has provided me with meals. I can hardly cook for myself so having the meals to warm up really makes life easier. It helps financially. It helps me by having something to eat and saving me money. It helps me have meals to eat. It helps to have meals easy to prepare. It helps with cooking. It helps with my expenses. It is cheap. It is less work to prepare food. It keeps me going. It makes it easier for me when I don't feel like cooking. It provides me with something to eat. I appreciate everything. It provides me with food to eat. It provides me with food. It provides me with meals so I am able to have something to eat. It provides me with meals. The first program was not satisfactory but the one I am enrolled in now is much better. It provides me with something to eat. It provides me with something to eat. My health is not good so everything helps. 34

How has the home-delivered meals service helped you? It provides meals and really helps. It provides meals for me. It saves me from cooking every day. It saves me money on food. It saves me the cost of a meal. It's a big help to have meals delivered because I'm crippled. It also allows my son to do other things. It's a blessing to have this help. It's difficult to cook since my eyesight isn't very good. It's hard for me to cook. I also have limited finances. It's hard for me to prepare meals. It's made living at home a lot easier. It's one less expense; I have something for other necessities. It's the only meal I have to eat. I'm thankful for what I receive but would like bigger portions. My diet is more balanced. It also helps me since I don't cook. My health is not good and I can't always cook, so the meals are good to have. The quality of the food is not always that good. No cooking. Not having to cook is very helpful. NOTE: The client's speech was unclear but I believe he said he shares his meals with his dog sometimes. Now I eat more often. Receiving the meals reduces my expenses and other bills can to be paid. Since having knee surgery, I haven't been able to move around. This program also helps me save money. The food is brought to me. The food is brought to my house. The food is delivered to me. The inexpensive meals are helpful. The meals already prepared for me. The program has provided me with meals when I am unable to cook for myself. I really liked the vegetable lasagna. The program has provided me with meals. The program helps provide healthy meals that are easy to prepare. They bring food to the house. They bring it to my house. They bring me food to my home. They bring me the food. They bring the food to me. They bring the food to my home They bring the food to my home. They bring the meals to my house. They bring to me. This has provided healthy meals for my mom; she really likes the meals she receives. She has high blood pressure and can't eat a lot of foods, but these meals do provide food that she can eat. This provides me with food because I can't afford to buy it myself. This service gives me meals to eat. I cannot prepare meals since I've been sick for the last two years. (The client also shared that her grandson eats the meals when he doesn't feel well enough to cook. He prepares meals for the both of them.) This service provides a meal that I wouldn't be able to have otherwise. Without the meals, I wouldn't have anything to eat. 35

How has the home-delivered meals service helped you? Helps her because she can't cook. Keeps her from cooking. Can't cook for herself Helps because she's disabled. She has food. It has helped her gain weight. She can't really cook too much on her own. 36