This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

A new program is sending healthy meals home with patients discharged from Traverse City's Munson Medical Center – and connecting them to healthier lifestyles in the long term.

Dr. Jean Kerver created the program and an accompanying research study in 2019 after discussions with Munson's clinical dietitians. Kerver trains medical students at the Michigan State University College of Human Medicine’s Traverse City Campus at Munson, and her role also involves responding to community needs. The program is a collaboration between Munson’s food service department, the Northwest Food Coalition, and the Northwest Michigan Community Action Agency (NMCAA) Meals on Wheels program.

"We weren’t just implementing a food program. Instead, we are trying to really evaluate a group of intensive food deliveries to decrease hospital readmissions and increase patient satisfaction," Kerver says. "Nutritional care coordination is one of our big strengths but we were really also trying to find ways the hospital could help patients more seamlessly interact with community services that are available."
Dr. Jean Kerver.
The food program reflects Munson’s overall commitment to serving healthy foods to patients as well as staff and visitors in its retail food services.

"Our dietitian team is helping people heal through food," says Mary Shanahan, Munson’s director of nutrition. "The dietitians see patients to not only get them set up [with healthy foods] here in the hospital, which can be difficult when they are not feeling well, but then getting them set up at home to be successful."

Before leaving the hospital, patients enrolled in the program choose their meals from a menu that supports their individual health needs. At discharge, they receive meals as well as a generous package of non-perishable and fresh foods, provided by the hospital. After patients' first few days home, the NMCAA Meals On Wheels program collaborates with Munson so that patients receive healthy meals for a total of 10 days. 
A Meals on Wheels volunteer chats with client Mary.
"They go home with three days’ worth of fresh foods, breakfast, lunch, and dinner — a lot of food," Kerver says. "We also send all patients enrolled in the program a mailed packet of resources available in the community. We build up this sort of community structure that could support patients after they leave the hospital and also provide information."

While nutritional consultants do provide education to patients while they are in the hospital and, in some cases, after discharge, going home with healthy foods provides a concrete example of what meals and snacks should look like.

"We’re also referring them to services out in the community like outpatient continued dietitian referrals and working with their physician at their offices," Shanahan says. "We are definitely working on a continuum of care to try to keep our readmission rates down."

In a post-program patient survey, one patient’s spouse said, "God bless you people for doing this … They said he has to cut out sugar now and change how he eats and I didn't know what to make him today … Now I have all this food!"

Kerver recalls the "effusive" feedback from another patient's wife. 

"She said, ‘Bless you, bless you! I had no idea what to feed him when he got out,'" Kerver says.

Kerver notes that 100% of people responding to a post-program phone survey said they would recommend the program to others.

"So many studies over time have documented the impact of [people receiving meals from] Meals on Wheels on reducing hospital readmission rates," says Lisa Robitshek, manager of Meals on Wheels of NMCAA. "This particular program with Munson is unique. We’ve been very interested in doing something like this for years. Other Meals on Wheels programs are doing programs like this across the country, collaborating with hospitals to reduce readmission rates. The core is very similar."
 
Healthy food, helpful company

Meals on Wheels' deliveries through the program provide patients not just with good nutrition, but also good company. Meals on Wheels volunteer drivers stop to chat with patients, and provide a valuable wellness check, following COVID-19 safety guidelines. In addition, this introduction to the Meals on Wheels program can evolve into eligible patients signing up for ongoing Meals on Wheels services. Patients living outside of the NMCAA Meals on Wheels program receive their meals from another similar organization, Mom’s Meals.
Meals on Wheels volunteers Annie and Linda chat with client Quint at a safe distance.
"Nutrition is so vital to the clients’ health. Food is medicine, of course. But many clients say that the interaction with the driver is as important or more important than the food," Robitshek says. "Some people don’t have any family, any friends, or their family is far away. Meals On Wheels volunteers are the only people that they see for that day or for days at a time. We’ve become like family to them."

As state and federal dollars only fund 30% of the NMCAA Meals on Wheels program’s budget, opportunities to partner or contract with other entities, like Munson, are always welcome.

"This program stretches the dollars we have further," Robitshek says. "We were already receiving referrals from Munson before this grant. But we had to pay for all those clients with our existing pot of money."

Pantry partnerships

In addition to sending meals home and introducing patients to Meals on Wheels, the program connects discharged patients to local food pantries. To ensure that discharged patients have additional access to fresh local foods, the meals program provided funding to the Northwest Food Coalition Farm2Neighbor program. Those funds allow the program to purchase fresh fruits and vegetables from local farms, as well as freezers to store frozen fresh foods, which have more nutritional value than boxed and canned items. The Northwest Food Coalition distributes to pantries and meal sites throughout Antrim, Benzie, Grand Traverse, Kalkaska, and Leelanau counties.

"We provide a packet of resources to each enrolled patient with information about how they can connect to the programs offered by the food coalition," Kerver says.

Robitshek hopes that Munson’s home-delivered meals program — and Meals on Wheels involvement — will not only continue but expand in the future.

"We’re hoping the study will document its efficacy and that the hospital will want to pay us in their interest to not have clients readmit," she says. "We are hoping Munson will see the value and want to continue partnering with us."

Kerver is hoping for the same. 

"Our program has been well-received overall, with excellent participation through the final component, which is the 45-day post-discharge survey via phone," she says. "This strengthens our belief that a dietary intervention can improve patient satisfaction and perhaps improve loneliness outcomes."

After all, even when a hospital promotes healthy eating’s role in the healing process, eating habits that are developed over a lifetime are hard to change in the short course of a hospital stay.

"When you have someone who has been eating fried food and no vegetables for years, and now they are in for bypass surgery, you cannot turn their attitude around overnight.  It’s a challenge … to make healthy foods a normal way of living in order to prevent all of these horrible disease processes," Shanahan says. "It’s important because a lot of people have conditions that would have been prevented if only they had been eating well."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Jean Kerver photos by John Russell. All other photos courtesy of NMCAA.