Countering Social Isolation to Improve Health Outcomes
The importance of social services and supports for maintaining health—like transportation, housing, access to healthy foods, and other neighborhood factors—is increasingly understood. For vulnerable populations, like older adults, social supports are especially critical. Professor Kali Thomas, a Florida native who grew up in a rural community, had long noticed that many of her neighbors and family members were living in nursing homes when they really didn’t need to be. “They could have been cared for in the community,” she said, “if there were services available, but those didn’t exist.”
Through her work as a graduate student and from research led by Professor Vincent Mor among others, Thomas knew some of the factors associated with the prevalence of low-care residents in nursing homes, including assisted living capacities, state policies, and spending on Medicaid home- and community-based services.
“What hadn’t been looked at,” Thomas said, “was the relative influence of social services, so things like transportation, homemaker services, and home delivered meals.” During her postdoctoral fellowship in the Center for Gerontology and Healthcare Research, Thomas examined ten years of data on older Americans and social service programs spending to see how those were related to the prevalence of low-care residents, adjusting for all the factors previous research had shown to be influences.
That landmark 2013 study found that, of all the programs examined, including Medicaid home- and community-based services, state expenditures on home delivered meals were associated with the greatest reductions in low-care nursing home residents over a decade.
As author of the first study of its kind to demonstrate that increased spending on home delivered meals correlates to reductions in nursing home use, and potentially health care costs, Thomas garnered national attention. “I kept getting calls,” Thomas said, “from states and programs saying ‘What does this mean? You have these model estimates, help me understand what this means for the programs in my state.’”
Thomas’ follow-up study provided a model for states showing how their increased spending on home delivered meals would result in reductions in their low-care nursing home population, which would translate into money saved by Medicaid. “Every state had a road map of what they needed to do based on these models,” Thomas said.
It wasn’t long before Ellie Hollander, the newly-named President and CEO of Meals on Wheels America, called, too.
“She had seen the study,” Thomas said, “and she said ‘I’m looking to increase the evidence base of our program, and you seem like the right person to do it.’” They met and Thomas learned the problems Meals on Wheels programs faced, including increased transportation and food costs, reduced donations and federal funding, and a new competitor in the market: lower-priced, frozen, drop-shipped meals.