16 CHAPTER 2 | Community-Based Nutrition Services


Box 2.3 Postacute Care and Other Settings: Overview of Services Provided in the United States Type of facility


Overview of services provided Adult day care center


Offers supervision, social and recreational activities, lunch, and oversight. Provides respite for individuals who care for a family member at home


Assisted-living community Provides residents with assistance with basic activities of daily living, such as bathing, grooming, and dressing. Services vary based on state licensure regulations. Complex medical services are not provided


Continuing care retirement community


Home- and community- based waiver programs


Home health agencies Hospice


Combines independent living, assisted-living, and skilled nursing options on one campus. If a resident’s care needs increase over time, they move to the next level of care


Assists with the costs of home and community-based services (eg, homemaker services, personal care, and respite care) for those eligible for Medicaid


Includes medical, nursing, social, or therapeutic treatment, along with daily activities, such as meal preparation, bathing, and dressing. Most patients are recovering, disabled, or terminally ill


Provides comfort and support to patients and their families as they approach the last stages of life. Services can be provided in a variety of postacute settings, including at home


Adapted with permission from Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: individualized nutrition approaches for older adults: long-term care, post-acute care, and other settings. J Acad Nutr Diet. 2018;118(4):724-735. doi:10 . 1016 / j . jand . 2018 . 01 . 022


shopping and delivery services, especially since the COVID-19 pandemic. However, seniors may not have access to, interest in, or ability to order online and may not be able to afford delivery services. If older adults live in a household with others, their food preferences may not be a prior- ity for the person shopping.


• Limited mobility—Limited mobility makes it harder for older adults to get to the grocery store and navigate it once they are there. Some grocery stores have motorized wheelchair carts, but they can be intimidating for some. After food supplies have been selected and purchased, they must be brought into the home and stored. This can be challenging for individuals who use a wheelchair or have medical conditions (eg, heart failure) that make walking difficult. • Isolation—Older


adults who live alone can


become isolated, particularly those with limited mobility. If family is not nearby or is not involved, individuals may have very few visitors and not get out much. Sometimes their social network is lim- ited to neighbors, health care practitioners, and aides.


• Need for medical nutrition therapy—Older adults who are community-dwelling often have medical conditions and may benefit from medical nutrition therapy (MNT). They may be trying to comply with a physician-recommended therapeu- tic diet but have not been referred to an RDN for assessment and individualized diet instruction; this may cause frustration and affect achievement of the desired outcomes.


• Food insecurity—Food insecurity is defined as an inadequate amount of food intake attributable to a lack of resources or access. This term also applies to people who may have enough food, but the food they are eating does not meet nutri- tional and dietary standards (eg, lack of fruits and vegetables).6


This may be due to having only con-


venience stores nearby for food purchases, com- pounded by an inability to drive to an area with larger traditional grocery stores. A person may be food insecure but not feel hungry because they are filling up on simple carbohydrates and less healthy fast food. Older adults who experience food inse- curity may have lower serum levels of certain nutrients and a higher risk of being underweight.


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