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Where chronic disease and hunger intersect, Minnesotans are innovating

Courtesy of Lutheran Social Service of Minnesota
Lutheran Social Service volunteer Trisha Linell (left) delivered a meal to Delores and Ken Malm.

This article is part of a yearlong occasional series on late-in-life health care — when chronic illness or a constellation of medical problems can cause a cascade of new needs, complications and worries. 

Across Minnesota, thousands of people wait each day for nutritious meals and food-shelf goods to be delivered by car, van, pickup truck – even by snowmobile in remote settings.

Many of those Minnesotans need home or close-to-home food service because they are chronically ill, too sick to shop for groceries – and, sometimes, even too frail to cook for themselves.

And now, that intersection of disease and hunger is turning Minnesota’s food assistance efforts in new directions, particularly in rural areas where the distances between homes and grocery stores can be vast.

“The place where we have been taking aim and focusing our work is where food insecurity overlaps with some of the chronic diseases,” said Rob Zeaske, CEO of Second Harvest Heartland, a food charity serving 59 counties in central Minnesota and Western Wisconsin.

Where hunger meets disease

Among Minnesotans in that region who had been using food banks, 31 percent lived with diabetes in 2014, according to a survey by Second Harvest’s national partner, Feeding America. By comparison, 7 percent of Minnesota adults have been diagnosed with the disease.

Hypertension, another diet-related disease, also was disproportionately high among those seeking food assistance. Further, inadequate diet is a major risk factor in stroke, chronic kidney disease, heart ailments and a long list of other diseases.

The common maxim that good nutrition is basic to good health holds true and is highly relevant for people who already have such diseases, said Pamela Van Zyl York, a nutrition expert who coordinates the program for healthy aging at the Minnesota Department of Health.

Proper nutrition plays into the quality and length of life with a given disease. It is a factor in fending off complications. And it provides the energy the body needs to stay active and fight disease.

Good nutrition also can help prevent the piling of one disease on top of another. Those with diabetes, for example, are at high risk for heart disease, and a proper diet can help reduce that risk.

“If you have one or two or three chronic diseases, you still are at risk for some of the others,” York said. “If you are not getting good nutrition, you put yourself at risk for diseases across the board.”

'Radical change'

Inspired by the body of evidence that good nutrition also is good medicine, food delivery organizations are serving their clients with ever greater medical precision. Food shelves that once dispensed whatever canned goods hit their donation boxes now are finding the means to provide balanced and special diets, and also to distribute fresh produce, milk and quality protein.

Rob Zeaske

“For us, that’s included a radical change in our supply chain,” said Zeaske at Second Harvest Heartland.

“We are approaching this with the idea that food is absolutely medicine for people,” he said. “And when we have neighbors who can’t get healthy food – because they can’t afford it, or for whatever reason – we have a challenge.”

Hunger amid plenty

Ironically, many of those needing food service live in rural areas, close to the Minnesota farms that send an abundance of food across the state and nation – indeed, across the world.

Grocery stores are long gone in small towns where many Minnesotans still live, and the communities struggle to hold onto a last gas-station/convenience store where at least local residents can pick up fresh milk and a few other groceries, said Monica Douglas, a senior director in nutrition services at the Moorhead office of Lutheran Social Service of Minnesota.

The drive to grocery stores in regional centers is just too physically daunting or too expensive for thousands of rural residents, especially those who are battling diabetes, high blood pressure, cancer and other chronic diseases — those whose nutritional needs are the most complicated and the most urgent.

Lutheran Social Service distributes meals to some 20,000 Minnesota seniors living in 39 counties in the state’s western and central regions.

Douglas estimates that one fourth of those getting the meals are chronically ill. Lutheran Social Service works with discharge planners from local hospitals to determine where a low-sodium meal is needed, or food fit for a diabetic diet. Some diners request food that is pureed or softened in some other way. Recently, some have requested gluten-free food.

Closer to home

Thirty-six years ago, when Douglas joined the Lutheran Social Service program, three-fourths of the meals were served at congregate dining centers. But today, as the rural population ages and becomes more prone to chronic illness, the balance has tilted the other way and just over half the meals are delivered to homes.  

“Our seniors are aging in place,” Douglas said.

Second Harvest Heartland also has seen a profound shift toward filling needs closer and closer to home rather than at a common location such as a food shelf, Zeaske said.

“Increasingly, we understand with seniors and also with other people who might not have transportation to a central location, we’ve got to figure out how to efficiently get food to them,” he said.

One innovation is mobile food pantries where the traditional food-shelf offerings travel on wheels to neighborhood locations. Another has been to make seasonal produce drops at multiple locations rather than one central site.

The meal must go through

Volunteers for Lutheran Social Service drive the food, usually in their own vehicles along rural roads that can be snow-packed and icy this time of year.

Some deliveries run more than 70 miles round trip, Douglas said. At one site near Lake of the Woods on Minnesota’s border with Canada, heavy snow clogged roads last year, so a volunteer made the delivery on a snowmobile.

“The need for volunteers in those areas is just crucial,” Douglas said.

The volunteers come from churches, local businesses, schools, police stations and senior citizens groups. Collectively, they form a stubborn last stand between their vulnerable neighbors and the hunger that can come with isolation.

“When you get into the rural areas, everybody knows everybody, and they take care of a good neighbor,” Douglas said. “That’s why we are so successful.”

Without the volunteers, Douglas said, the food service would have to be cut by at least a third.

While many of the seniors pay a suggested donation of $4 to $7 for their delivered meals, most of the funding comes from federal programs allocated through state agencies, she said. And budgets have been squeezed in recent years. LSS had to close about 10 percent of its sites a year ago, Douglas said.    

“It was a very sad time,” she said.

Millions of meals

Under government programs statewide, providers delivered 1 million meals to seniors’ homes last year and served another 1.7 million at congregate dining sites, said Jean Wood, executive director of the Minnesota Board on Aging, which administers federally funded senior nutrition programs. That service is supplemented by other meal programs run by churches, non-profits and many other non-governmental organizations.

Typically, people use the home delivery service for about two months during transitional times, Wood said. They count on it after a health crisis, for example, or after discharge from a hospital. Medical care coordinators and hospitals often contact the providers to request food services for patients who need them.

As patients recover, “they find something that serves them better,” and transition off the home delivery program, Wood said. Some dining sites have been closed, she said, because they were serving too few people to operate efficiently. And some sites fall short on volunteers to make deliveries.

Other options available to those who need help include home delivery of multiple frozen meals. In cases where someone needs highly specialized meals, yet another option is to award a sum of money that can be used to hire a relative or a neighbor to do the cooking.

Channeling nutrition through health care

Now, organizations that help feed the chronically ill are seeking more direct partnerships with hospitals and clinics.

After all, that’s where many of their clients show up. Several studies have shown that inadequate nutrition goes hand in hand with the chronic conditions that require medical treatment. One study conducted in 2013 for Feeding America and the National Foundation to End Senior Hunger found that seniors lacking reliable adequate nutrition are:

  • 53 percent more likely to report a heart attack
  • 52 percent more likely to develop asthma
  • 40 percent more likely to report an experience of congestive heart failure.

The findings were based on data from the National Health and Nutrition Examination Survey and food security research for the U.S. Department of Agriculture.

In other words, the hospitals and their satellite clinics work precisely at that target intersection where hunger and health come together.

Closing the hunger gap

Hunger in rural Minnesota?

Hunger is an often hidden problem that is affecting seniors, working families and children in rural as well as metro areas. Greater Minnesota makes up half of the population missing meals. Families who live in rural regions face a number of challenges making it difficult to put nutritious food on their tables: transportation obstacles, remote social service agencies and tight employment.

Source: Feeding America Map the Meal Gap 2012

Despite ambitious relief efforts, Minnesota still suffers a hunger gap of some 100 million meals a year, and the gap could be closed by 25 percent if the medical and hunger relief sectors worked together, according to analysis by the Boston Consulting Group for Hunger-Free Minnesota, a coalition that has been working to quantify the nature and extent of hunger in the state. The coalition includes community and food-relief organizations as well as large food processing companies such as Cargill, General Mills and Hormel Foods.

A pioneering effort in that direction took shape four years ago when Hennepin County Medical Center opened what it called a therapeutic food pharmacy, a food shelf in the hospital. The innovation has proved so successful that it has expanded into seven areas of the downtown hospital site and three satellite clinics. In addition to bags full of vegetables, fruit, dried milk and other wholesome foods, patrons get nutrition counseling.

Second Harvest Heartland is a primary supplier to the HCMC food shelf, and Zeaske said variations on that groundbreaking model are in the works. In one project, for example, another hospital is helping to develop a screening tool for food insecurity. Patients found to need assistance will be referred to Second Harvest, which is to triage them to available support programs.

By engaging with food providers, hospitals give their patients a bonus in that the patients can have a “one-stop sort of experience,” said York at the state health department. “They come to a site they are familiar with, and they only have to manage the transportation once,” she said.

Hospitals also can gain more effective and efficient use of dietitians and other nutrition professionals on their staffs. Moving in that direction, some clinics have begun staging farmers markets in their parking lots so that patients can get nutritious produce along with health care. 

In general, though, York said, such change hasn’t been widely implemented.

“We haven’t found the system to make it work,” she said.

A dose of courage too

Yet another key benefit comes through engaging hospitals and clinics in the drive to ensure nutritious diets: Those respected institutions remove some of the stigma associated with a need for food assistance.

Much like a bottle of pills, a bag of food becomes something the doctor ordered.

“One of the biggest things that we hear from our neighbors is when they have fallen into challenging times how difficult it is and how much courage it takes to go in and either seek help from a local food shelf or pantry or to seek help from a nutrition program,” Zeaske said.

“We are very wired as Americans to believe that we’ve got to make it on our own,” he said. “We have to let them know that we as a community are there to support them during difficult times.”

MinnPost's late-in-life series is funded through a regrant by Allina Health from the Robina Foundation and is conducted with media partners Ampers and Twin Cities Public Television (tpt), whose documentaries are focusing on Minnesotans enrolled in a multiyear Allina study.

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