This case study is from “Food Insecurity and the Role of Hospitals,” which offers strategies and case examples to help hospitals and health systems address food insecurity issues in their communities. For more information and to access the full guide, click here.

Introduction 

Eskenazi Health, Indiana’s largest safety-net hospital, has 11 outpatient health centers across Marion County and a hospital with 315 beds in downtown Indianapolis. Eskenazi Health primarily serves people with no insurance, low-income patients and those insured by Medicaid or Medicare. The health system has recognized the burden of food insecurity and the prevalence of food deserts in the community. Food insecurity levels have increased in Indiana. The USDA reports that in 2013, 14.1 percent of households in Indiana were identified as food insecure, while 6.1 percent were experiencing hunger or very low food security. According to Map the Meal Gap 2016, a report by Feeding America, approximately 15 percent of Indiana households still struggled to purchase or afford food in 2015. Eskenazi Health is working to reduce the effects of food insecurity on all age groups. 

Approach 

Key Partnerships 

Eskenazi Health and Meals on Wheels (MOW) of Central Indiana have been partners for over 40 years. Together, they developed a program that provides recently discharged patients of all ages with 30 days of medically tailored meals for free. The hospital predicts readmission rates will decline through the efforts of this program. MOW delivers more than 500 meals on weekdays to homebound residents across seven routes in the Indianapolis area. The program reaches out to an additional 170 clients by providing two bulk deliveries to local adult day care centers. 

The success of this program stemmed from a partnership between MOW, Eskenazi Health and the Central Indiana Senior Fund, resulting in a nationally recognized Head Start Nutrition Program for Seniors. This program also offers 30 days of medically tailored meals to seniors being discharged in an effort to reduce readmission rates. A patient suffering from irregular eating habits and a suspected heart attack says the Head Start program has been a blessing. Her recent separation from her husband left her without a place to live. Currently living with her nephew, she worried about being a burden. The program’s daily food delivery and a full month’s worth of food helped her eat healthy meals and regain energy. She says, “The food portions were just the right amount, and consistently tasted good.” 

Eskenazi Health works with the local St. Luke’s United Methodist Church, Dow AgroSciences and Gleaners Food Bank to run the Crooked Creek Food Pantry at Eskenazi Health Center Pecar and a food pantry at the Forest Manor Health Center, which are located in disadvantaged areas with food deserts. Within walking distance of most area residents, these food pantries provide foodinsecure patients with additional healthy food options. The pantries are stocked with the help of volunteers from the local, partnering community and faith-based organizations. Dawn Haut, chief physician at the health center, has noticed that many patients deny they are food insecure when screened at the clinic. To help patients feel comfortable, Haut raises questions about food face-to-face and indirectly, suggesting that patients direct anyone they know who has difficulty accessing food to visit the food pantry. By the end of their visit, most patients ask to be reminded of the pantry’s hours of operation. Haut sees this as an opportunity to reduce the stigma associated with food insecurity and hunger. 

Eskenazi Health Center Pecar and Gleaners Food Bank partnered to establish the Senior Shopping Day, a program that gives residents over the age of 55 an extra shopping day at the Gleaners Food Bank each month. Knowing that this population may be at risk due to low, fixed incomes and the inability to purchase enough needed protein, produce and dairy items, Gleaners Food Bank is providing access to additional lowsodium, low-sugar and high-protein foods. With the help of dietitians, the program is promoting a healthy food focus each month—e.g., no salt seasonings—to educate clients about food and nutrition. 

Eskenazi Health’s Initiatives 

The Sidney & Lois Eskenazi Hospital on the Eskenazi Health main campus has a rooftop “Sky Farm” garden accessible to patients and community members at all times. This 5,000-square-foot space has grown into an engaging environment as many people visit to learn how food grows, discover how to prepare fresh produce and gain a greater understanding of why food is important to health. Open 24 hours a day, seven days a week, the Sky Farm garden offers large growing spaces for fruits and vegetables that are used in hospital meals and in menu items at the Ingram Micro Mobility Marketplace and Café Soleil, both at Eskenazi Health. The garden also features a beehive with 500 bees. 

Impact 

Results and Data 

Eskenazi Health hopes to reduce its current 22 percent readmission rate to 8 percent through its partnership with MOW. This initiative reduces readmission rates and provides better care for seniors suffering from chronic illnesses. Additionally, partnerships that support Eskenazi Health’s food pantries not only address needs of the food-insecure population but they also promote community engagement and sustainability. Besides offering more than 3,000 pounds of freshly grown produce, the Sky Farm garden encourages patients and community members to engage with one another through cooking and food demonstration classes. 

Lessons Learned 

To overcome challenges and barriers when implementing similar initiatives, Eskenazi Health encourages other hospitals to: 
•    Recognize the impact food insecurity has on health and health outcomes 
•    Research and identify the best location for food-insecure populations to access food 
•    Secure food pantries in safe and effective storage places to ensure freshness 
•    Integrate financially affordable programs to make food access easier for low-income populations 

Next Steps 

Due to the success of the Head Start Nutrition Program for Seniors, MOW, Eskenazi Health and the Central Indiana Senior Fund collaborated again for the Step Up Frozen Food Program for Seniors. This program gives central Indiana residents the ability to purchase frozen, medically tailored meals that are available for delivery at a convenient time. This is part of Eskenazi Health’s approach to take extra but necessary measures to deliver services that fulfill residents’ basic dayto-day needs. These medically tailored meals are easily reheated and can be supplemented with any other meals. 

Additionally, as an in-kind gift, the health system will work with MOW to deliver 75,000 meals for those in need in 2017. Eskenazi Health will continue to support MOW and other programs to help battle malnutrition and food insecurity for seniors and homebound, disabled residents in the community. 

Contact Information 
Alisha P. Jessup 
Associate Director 
Population Health & Healthy Families Program, Marion, III. 
(317) 880-7552 
alisha.jessup@eskenazihealth.edu

Deanna Reinoso, M.D. 
Pediatrician 
Eskenazi Health Center Pecar 
Assistant Professor of Pediatrics Indiana University   
(317) 517-0988 
dreinoso@iu.edu