Developing the Expanded Food Security Screener and Pilot Testing It for Prioritization of Applicants to the Home-Delivered Meal Program

Abstract

Food insecurity is multidimensional and may be an outcome not only of economic need but also of inability to prepare meals and shop for food, especially in older adults. As the prevalence of waiting lists for the Older Americans Act home-delivered meal program is increasing, we expanded the 6-item US Department of Agriculture Household Food Security Survey Module, named it the Expanded Food Security Screener, and used it to develop a 5-level prioritization system to assess need for a meal based on economic access and ability to shop and cook, with or without help. We pilot-tested the tool and its prioritization system on older adults who applied for the program. The tool effectively distributes applicants into 5 different levels of need. The priority levels were generally appropriate (75%), based on follow-up assessment by programs. The tool is useful to set priorities for a waiting list and/or to identify need in the community.

Testing a Prioritization Tool to Identify Older Adults in Need of Home-Delivered Meals and Nutrition-Related Services

“…To address this gap, the University of Maryland in collaboration with the Maryland Department on Aging created the Expanded Food Security Screener (FSS-Exp). 10 The FSS-Exp is a screening tool that homedelivered meal (HDM) programs could use for assessing food insecurity in older adults and for quickly determining who is most in need of prepared meals delivered to their home. 10 The FSS-Exp tool measures the economic, physical, and social access dimensions of food insecurity.…”

“…10 The FSS-Exp is a screening tool that homedelivered meal (HDM) programs could use for assessing food insecurity in older adults and for quickly determining who is most in need of prepared meals delivered to their home. 10 The FSS-Exp tool measures the economic, physical, and social access dimensions of food insecurity. 10 To measure the eco-nomic access dimension, the FSS-Exp uses the validated 6-item HFSSM 11 and to measure the physical and social dimensions, 2 questions assess difficulty with getting groceries into the home and preparing hot meals (with or without help).…”

“…10 The FSS-Exp tool measures the economic, physical, and social access dimensions of food insecurity. 10 To measure the eco-nomic access dimension, the FSS-Exp uses the validated 6-item HFSSM 11 and to measure the physical and social dimensions, 2 questions assess difficulty with getting groceries into the home and preparing hot meals (with or without help). 10 Depending on the applicant's responses, they are assigned a priority level ranging from highest priority to lowest (priority levels A to E).…”

“…10 To measure the eco-nomic access dimension, the FSS-Exp uses the validated 6-item HFSSM 11 and to measure the physical and social dimensions, 2 questions assess difficulty with getting groceries into the home and preparing hot meals (with or without help). 10 Depending on the applicant's responses, they are assigned a priority level ranging from highest priority to lowest (priority levels A to E). 10 The rationale for each priority category is based on financial ability to afford food and physical ability to shop and/or to prepare meals accounting for social support.…”

“…10 Depending on the applicant's responses, they are assigned a priority level ranging from highest priority to lowest (priority levels A to E). 10 The rationale for each priority category is based on financial ability to afford food and physical ability to shop and/or to prepare meals accounting for social support. 10 It is important to recognize that overall, individuals applying for HDMs are not healthy and have chronic conditions that limit their ability to leave home without help.…”