Community Nutrition Exam #2 (you got this!!!!!!!)
-financial eligibility is determined by income at or below 185% of the poverty guidelines (not entitlement) -lifecycle stage: women who are pregnant, breastfeeding, or postpartum -exhibit nutritional risk factors: medical, dietary, behavioral or environmental
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
-sponsors are various community agencies -in areas where more than half of children are from households less than 185% of poverty guideline -guidelines similar to NSLP (increase fruits, vegetables, whole grains, fat-free and low-fat milk, reduce sodium and saturated fat. provide 1/3 DRI for kcal, protein, calcium, iron, vitamin A< and vitamin C)
Summer Food Service Program for Children
enacted in the 1930's, expanded in the 1960's areas of service: -maternity and infant care -intensive infant care -family planning -health care for children and youth (including children with special health care needs) -dental care for children coordinated through state health agencies (which provide funds to various community agencies)
Title V (of the Social Security Act) Maternal and Child Health Program
-lists of foods available through USDA to a variety of programs -see USDA What's Cookin for recipes featuring commodity foods
USDA Commodity Foods
-provides free fresh fruits and vegetables to students in participating elementary schools during the school day (outside of breakfast and lunch)
USDA Fresh Fruit and Vegetable Program
-SNAP and SNAP-Ed -EFNEP -Adult and Child Day Care Program -Commodity Supplemental Food Program(some states, food packages) -Senior Farmers Market Nutrition Program-- coupons to be exchanged at farmers markets, community supported agriculture
USDA Programs for Adults and Older Adults
-coupons for fresh local fruits and -Increases fruit and vegetable consumption of women by 5%
WIC Farmers' Market Nutrition Program
-reduce incidence of LBW and VLBW babies -reduction in fetal mortality -fewer premature births -savings in Medicaid costs -increased breastfeeding rates and use of healthcare services -increased adequacy of iron intake, reduced incidence of anemia in children -reduced food insecurity -improved performance of children on vocabulary and memory tests
WIC Outcomes
food packages or vouchers -milk, eggs, cheese -cereal (low sugar, iron fortified) -beans/peanut butter/soybeans -juice (Vitamin C, no added sugar) -fruits and vegetables (100% fruit or veggies, fresh, frozen, canned) -canned tuna for breastfeeding moms nutrition screening (anthropometrics, dietary, screen for anemia, medical history) groups and individual nutrition education referrals to social service and health care
WIC benefits
-reduce the number of people who are uninsured -makes the health insurance system work better for all consumers -reorienting health care to focus on preventative and primary care -transform delivery and payment systems to get better value
basic ideas in the affordable care act:
used by HMO to control health care costs. it is a fixed amount of money per patient per unit of time paid in advance to the health care provider
capitation payment
-foods distributed by Feeding America, a network of food banks, have increased -local food pantries report increases as well
community-based emergency food assistance-- filling the gaps
amount paid when go to doctor, insurance picks up rest of payment
copayment
hospitals and other providers bill fee-for-service insurers at higher rates to recover the costs of charity care and to make up for discounts given to HMOs, PPOs, medicare, and medicaid. (higher copayments and deductibles)
cost shifting
some coverage for kids and pregnant women, varies by state
coverage for nutrition services by Medicaid
-didn't cover nutrition services specifically until 2002 -in 2002 medicare began covering limited MNT for diabetes, pre dialysis, post kidney transplant -in 2005 nutrition screening became part of initial preventative exam -2011 intensive behavior therapy for obesity approved by Medicare
coverage for nutrition services by Medicare
the thrifty food plan serves as a food guide for a nutritious diet at a minimal cost, and is used as the basis for SNAP allotments. it is maintained by the USDA many households purchasing foods at the value of the thrifty are not eating adequate diets (lack of education or transportation) many eligible families do not participate
criticisms of the SNAP program
how much paid before insurance starts
deductible
requirements and benefits may vary state to state generally the following are eligible: -low income people -the aged -blind -disabled -children in fostercare
eligibility for medicaid
income level used to define eligibility in certain programs. Based on consumer price index (CPI) now, (as opposed to USDA "thrifty food plan")
federal poverty guideline
limited or uncertain ability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways
food insecurity
access by all people at all times to sufficient food for an active and health life. must be consistent throughout the year (access, utilization, stability)
food security
survey of households food security high food security: households had no problems, or anxiety about, consistently accessing adequate food marginal food security: 1 or 2 reported concerns-- typically households had problems at times, or anxiety about, accessing adequate food, but the quality of food intake is not reduced low food security: households reduced the quality, variety, and desirability of their diets, but little or no indication of reduced food intake very low food security: all times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food
measuring food security
a federally aided, state operated program that provides medical benefits for low-income persons in need of medical care
medicaid
Hospital: in & outpatient, labs and X-rays, physician services; screenings, diagnosis and treatment of children; home health care Medical: health clinic, dental, eyes, prescribed medications, rehab, and preventive services (like nutrition)
medicaid services
A federal program of health insurance for persons 65 years of age and older and certain other eligible categories (end-stage renal disease, some disabilities, and some government employees)
medicare
type of Medicare health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits. cost may be higher or lower depending on coverage chosen
medicare advantage plan (part C)
consumers may purchase this to cover coinsurance and deductibles not covered by Medicare
medigap policy
• Active Duty and retired (Tricare) • Veterans Administration
military insurance
In adults: -Higher rates of obesity (People who don't get enough food tend to overeat when they have access) -Lower intakes of fruits a vegetable, many nutrients (potassium, fiber, Vitamins A and C) In Children: - Poorer health status - Poorer academic performance - Link to obesity less clear
nutritional consequences of food insecurity
fee for service
original medicare
-dept of HHS Office of Woman's Health -dept of HHS, NIH, National Institute on Aging -CDC Workplace Health Promotion -Texas Dept. of State Health Services Farm to Work Program
other government funded adult health promotion programs
covers hospitalization and up to 100 days nursing home or in home care/year
part A
covers medical care (doctors and other health care providers -- usually pay a premium)
part B
covers prescription drugs
part D
involve patients more in decision making working with primary care provider
patient centered medical home (PCMH)
allows members to get medical attention from both in-network (reduced cost) and out-of-network providers (higher cost)
point of service plan (POS)
-children and women -black and hispanic households -older adults and individuals with disabilities -inner city (food deserts) and rural dwellers (often hidden) -residents of some states -homeless
population groups most likely to experience food insecurity
-working poor -small businesses -preexisting medical conditions (addressed by Affordable Care Act) -homeless -some retirees -christian non-insurance programs like Medi-share
population groups most likely to have no insurance
acts as a gatekeeper, this person (typically a doctor) decides if you get another procedure or not
primary care provider (PCP)
indian health service (IHS)
public health service
-malpractice insurance costs -aging population -advances in medicine and technology -increased consumer demand
reasons for escalating healthcare costs:
-avoiding unnecessary tests/surgery -"experimental" procedures may not be covered -out of network providers require consumers to pay more
restricting access to care
benefits are issued by maximum monthly allotments placed on electronic benefit cards (for families with income, the maximum amount is reduced by 30% of income) SNAP cannot be used for: -ready to eat hot foods -vitamins or medicines -pet foods -tobacco or alcohol -cleaning items and non-food items (except garden plants)
what does SNAP provide?
-healthcare expenditures in the US is substantially higher than other industrialized countries -large gap between wages and cost of insurance -concerns about access disparities and resource allocation
why health care reform is needed
group of hospitals or care providers who provide care to patients for a capitation payment
Accountable Care Organization (ACO)
-reduce overweight and obesity -reduce disordered eating in adolescents -increase physical activity (reduce screen time, increase physical education + recess) -food and nutrient intake: reduce kcal from sat fats and added sugars, sodium intake, increase calcium intake -foods in schools and child care: dont sell calorically sweetened beverages, offer fruits + veg whenever food is offered/sold -healthcare: increase physicians who discuss nutrition and P.A., measurement of BMI -reduce food insecurity: increase school breakfast -reduce iron deficiency anemia -reduce blood lead levels -increase access to dental care -reduce hypertension -reduce substance abuse -increase screening and treatment for special healthcare needs (autism, down syndrome, CP, genetic disorders)
Briefly describe the HP2020 nutrition objectives for children and adolescents.
inpatient and outpatient hospital services, phsyicians surgical and medical services, lab and x-ray services, immunizations, perscription drugs, mental health services, vision care, hearing care
CHIP services
-for day care for children, elderly, disabled -reimbursement for meals which meet the standards of the program -two meals plus 1-2 snacks
Child and Adult Care Food Program
Expands health insurance to children who's families earn too much income to qualify for Medicaid but cannot buy private insurance
Children's Health Insurance Program (CHIP)
-administered through the state -as of 2014, legislation targets older adults only (pregnant, breastfeeding, postpartum women and young women now need to participate in WIC - change from text) - monthly food packages of 'commodity foods' are provided
Commodity Supplemental Food Program (USDA)
-began in 1996 -funds community health centers in medically underserved areas (migrant health, Appalachian Health Demonstration project, rural areas) -offers well-child care, nutrition assessment, health education
Community Health Centers
-volunteer with a local program -help develop means of informing people about available programs or provide assistance with applying -monitor/document food insecurity in your community -support local food production -represent nutrition issues at community planning meetings -write legislators, increase public awareness
Describe actions that individuals might take to eliminate food insecurity.
sporadically covered by private insurance programs, especially managed care
Describe coverage for nutrition services by private insurance
-WIC is trying online options (nutrition education modules, videoconferencing for breastfeeding peer counselors) -some states have added reimbursable nutrition counseling to maternal and child health services -more voluntary organizations are interested in providing nutrition information to clients
Describe current efforts to improve community services for mothers and babies.
Reduce infant mortality rate -reduce # of low birth weight infants -reduce preterm births -increase # of mothers who gain the recommended amount of weight during pregnancy -decrease use of tobacco, alcohol, illicit drugs -reduce iron deficiency in women of childbearing age and during pregnancy -increase the proportion of women who receive prenatal care during the first trimester of pregnancy -increase the proportion of women who attend a series of prepared childbirth classes -increase the proportion of women at a healthy weight prior to pregnancy Reduced maternal mortality rate -timely prenatal care -reduce anemia in pregnant women -healthy weight prior to pregnancy and recommended prenatal weight gain -reduce substance abuse in pregnant women -reduce cesarean births Reduce the incidence of birth defects -reduce the incidence of fetal alcohol syndrome -reduce the incidence of spina bifida and other neural tube defects -increased screening and services for children with autism and other developmental delays Increase breastfeeding -increase the proportion of infants that are breastfed ever, at 6 months, at 1 year -increase the proportion of infants that are exclusively breastfed at 3 months and at 6 months -increase lactation support at work -reduce use of formula for breastfed babies during the first 2 days of life -increase births at hospitals which follow recommended breastfeeding practices
Describe current trends and concerns for maternal and infant health, including the Healthy People 2020 objectives related to maternal and infant health.
private insurance (mostly through employers or unions but may be purchased independently)
Describe how health insurance is typically purchased in the US
WHO child growth charts
Describe how infant growth is assessed.
-obesity has gotten worse -little to no progress with: fruit and vegetables, whole grains, sodium -some small increases in physical activity, though physical activity declines with aging
Describe how the BMI and diet and exercise habits of US adults have changed since the 2010 baseline.
-children do poor with vegetables, greens and beans, whole grains, fatty acids, refined grains, sodium, and saturated fats -close to recommendations with whole fruit, total protein foods, dairy -improves with age: total veg, greens and beans, protein, fatty acids -gets worse with age: total fruit, whole grains, dairy, whole fruit, added sugar, sodium
Describe how the intake of US children compares to current guidelines?
-Mini Nutritional Assessment assesses early malnutrition -Activities of Daily Living assess activities related to adequate nutrition status
Describe how to perform nutrition screening and assessment of adults and older adults using standard tools.
International Classification of Diseases. The better health care providers do with using codes to classify patients illnesses according to DRG, the more they get paid. DRG is Diagnosis Related Groups which is the classified diagnoses and determines reimbursement. The reimbursement is paid by the average cost per category in the Prospective Payment System
Describe the ICD system and how it relates to cost containment. Be able to use DRGs and PPS in your explanation.
-provides appropriate balance of nutrients and supports healthy weight -improves cognitive development -protects against food allergies -reduces risk of sudden infant death syndrome -may lower risk of chronic diseases -protects against infections and illnesses for mothers: -contracts the uterus and delays the return of regular ovulation -conserves iron stores -may lead to a lower risk of type 2 diabetes, certain types of breast cancer, and ovarian cancer
Describe the benefits of breastfeeding
-born between 1946 and 1964 -Generally concerned about health and convenience, not aging gracefully (not accepting decline of age) -Make decisions based on personal beliefs, want to be empowered and involved in learning -Looking for value and quality -Like nostalgia
Describe the characteristics of the baby boomers.
- expected to be a large increase in the number of older adults (increase health care prices) - percent of older adult population is becoming somewhat less white (boost cross-cultural skills)
Describe the demographic trends in aging in America and the potential impact on health care services.
-hyperinsulinemia and type 2 diabetes -hypertriglyceridemia -orthopedic problems -social stigmitazation -low self esteem
Describe the health risks associated with obesity in children.
1930's -- government buys excess agricultural commodities and distributes them, Food Stamp program begins 1940's -- national school lunch program begins 1960's and early 1970's -- food stamps, school lunch, and breakfast program expanded, WIC program begins 1980's-- contraction of federal funds 1996 -- 'welfare' becomes TANF 2008 -- food stamps becomes renamed SNAP
Describe the history of government food assistance programs in the US.
-growing independence from parents -eating away from home -concern with physical appearance and body weight -the need for peer acceptance -busy schedules
Describe the main influences on the diets of children and adolescents.
decreased absorption of (GI function decreases): -Vitamin D -Iron -Calcium -Vitamin B12
Describe the primary nutrition -related problems of aging.
overall about 11.8% US households are food insecure at some point during the year
Describe the status of food security in the United States
-schools can use their USDA funds for fresh fruits and vegetables, taking advantage of the quantity discounts that the DoD gets
DoD Fresh Fruit and Vegetable Program
-nutrition education for low income homemakers with young children -implemented by trained nutrition aides from the local community (peer counselors) -administered by the county cooperative extension nutritionist (USDA extension service)
EFNEP (Expanded Food and Nutrition Education Program)
-through extension agencies (federal, state county cooperative extension) -provides nutrition education only -peer education model
EFNEP (Expanded Food and Nutrition Education Program)
-provides commodity foods to state distributing agencies like food banks -foods are distributed through local food pantries and soup kitchen -eligibility differs by state, SNAP participants are often automatically eligible
Emergency Food Assistance Program
Women who fail to gain recommended weight during pregnancy have increased odds of giving birth to lbw baby.
Explain the relationship of maternal weight gain to infant birth weight.
-use standardized practice guidelines or protocols (for comparisons of treatment options) -identify measurable outcomes of intervention -evaluate whether outcomes are improved by nutrition care -cost-effectiveness matters!
Explain what nutrition professionals can do to compete for health care dollars.
-adolescents have increased energy an nutrient demands because they are not done growing -adolescents are encouraged to gain weight at the upper end of the ranges recommended for pregnant women
Explain why adolescents are at greater risk for health problems during pregnancy and how weight gain recommendations are adjusted for pregnant teens.
a traditional type of insurance that includes a billing system in which the provider of care charges for each service rendered. the insurer pays the provider for each service
Fee for service/indemnity
-provides food to state relief agencies and organizations in times of emergency -commodity foods distributed to shelters and mass feeding sites, commodity food packages to persons in need, or SNAP EBT cards
Food Distribution Disaster Assistance
-available to native american families residing in designated areas -monthly packages of commodity foods -participants may choose this or SNAP (many prefer this if no access to grocery store)
Food Distribution Program on Indian Reservations
-Medicare -Medicaid can also help to pay health care costs for low income older adults
Health Insurance for Adults and Older Adults
a prepaid plan that both finances and delivers health care. this type of insurance enrolls patients as members, charge a fixed fee per year, and provide all medical services deemed necessary. enrollees generally must use the plan's providers or face financial penalties
Health Maintenance Organization (HMO)
tax-advantaged health reimbursement. designed to help make healthcare more affordable for workers and their families by providing financial support for health related expenses.
Health Reimbursement Account (HRA) and Health Savings Account (HSA)
-developed in 1991 for communities with high infant mortality rates -specializes in outreach and home visits to get women prenatal care as early as possible
Healthy Start Program
enrollees pay for a portion of their health expenses. it is so people are more conscientious about their health and want to save money
High Deductible Health Plan
-Temporary Assistance for Needy Families (TANF) block grants to states for income assistance -Social Security: income support for those who paid into the system and their spouses, can begin withdrawing at age 62, but full benefits at 65-67 -Social Security Disability Insurance (SSDI): From the social security tax (must have paid into the system -- must be disabled 12 months -Supplemental Security Income (SSI): tax funded, but not from the social security tax; income support for aged, blind, and disabled
Income Support for Adults and Older Adults
-age 15 and under -unwanted pregnancy -many pregnancies close together (depletes nutrient stores) -history of poor pregnancy outcome -poverty -lack of access to healthcare -low education level -inadequate diet (dieting) -anemia early in pregnancy -cigarette smoking -alcohol or drug abuse -chronic disease requiring special diet (diabetes) -underweight or overweight -insufficient or excessive weight gain in pregnancy -carrying twins or triplets
List nutrition-related risk factors during pregnancy (Table 11-5)
• Arthritis: Increase PT, weight loss, omega-3 and rheumatoid arthritis (related to types of fatty acids in cell membranes. Block enzymes that inflammatory drugs block. Eicosanoids) • Osteoporosis: Bone mass building, calcium (spinach, soy, rice, almond), weight bearing activities, Vitamin D (sunlight) • Cancer: healthy weight, exercise, avoid substance use (alchohol), screening. Eat less nitrates and nitrites from processed meats. • Heart Disease: Dash Diet (Half of protein are from legumes, nuts, lean meat, increased dairy*, fruits and vegetables* *increase potassium • Diabetes: healthy weight, exercise, reasonable sugar intake, whole grains • Infections disease: Food safety practices (hand washing, cooking food,) • Overweight and obesity: Exercise (150) myplate, • Dementia: exercise, Mediterranean pattern, omega-3 fatty acids, social stimulation, B vitamins, Folic acid, Vit. E/antioxidants • Food insecurity: Cook and prep at home, access resources that can help, education on where to shop, increase access to grocery stores/farmers markets • Falling: weight bearing exercise, balance exercises (glutes), calcium, vitamin D, balance, railing in the shower, rugs, stairways.
List the health concerns for adults identified in HP2020 and lifestyle factors which help to prevent* these concerns.
underweight: 28-40 lb normal weight: 25-35 lb overweight: 15-25 lb obese: 11-20 lb
List the recommendations for maternal weight gain during pregnancy.
an approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both. prevents unnecessary treatment by requiring enrollees to obtain approval for nonemergency hospital care, denying payment for wasteful treatment, and monitoring severely ill patients to ensure they get cost-effective care. the presumed goal of managed care is improved quality of care with decreased costs.
Managed Care
-meat or meat alternative-- 3 oz cooked -vegetables and fruits (vitamin C and vitamin A) -grain -butter or margarine -low fat milk -dessert
Meal Pattern for OANP
-Medicaid was created in 1965 to provide healthcare for economically disadvantaged -state based, entitlement program -EPSDT (Early Periodic Screening, Diagnosis, and Treatment) is a group of mandatory Medicaid services (specific protocols-- preventative focus, includes nutrition screening)
Medicaid and EPSDT
-eligibility and administration same as NSLP -also based on lists of required foods (whole grain rich, meat alternative, low fat milk, vegetables/fruit)
National School Breakfast Program
-administered federally by food and nutrition service and at the state level by the dept. of education -free lunch for students at or below 130% of the poverty guideline, reduced for students between 130% and 185% -schools that participate get cash subsidies and commodities -in 2004, Child Nutrition and WIC authorization act required schools to have wellness programs in place (guidelines for competitive foods, nutrition ed and physical education)
National School Lunch Program
-targets older adults -cash and commodities to agencies serving nutritious meals to older adults
Nutrition Services Incentive Program (HHS w/ funding from USDA)
-Meals on Wheels America: aims to fill the gaps left by the elderly nutrition program, run by local volunteer agencies -Mobile Markets -The Nutrition Screening Initiative: collaborate efforts of ADA, American Academy of Family Physicians and National Council on Aging; a series of screening and assessment tools (now somewhat outdated -Nestle Mini Nutrition Assessment (screening is more predictive of who has malnutrition)
Private Sector Programs for adults
The Older Americans Nutrition Program (federally funded) -managed by the Administration on Aging -Grants typically made to a state or local "agency on aging" (AoA) -types of service: congregate meals, home-delivered meals, some preventative education/services -for all individuals age 60 and over and their spouses (not dependant on income) (Native American Tribes can set their own age limits) -priority is given to the needy -provides at least 5 meals/week -meals must supply 1/3 of the RDA/AI and meet the dietary guidelines -generally no cost for the meals, but donations often collected
Programs Administered by HHS for Adults and Older Adults
administered by USDA (FNS) -- locally see Welfare or county assistance program entitlement program -eligibility based on income, household size, assets, housing costs, work requirements -generally, SNAP benefit go to those with net income less than the poverty line -many participants receive federal income support (TANF, SSI, Social Security)
SNAP
an optional program which is intend to improve the likelihood that the participants will make healthful choices within a limited budget nd choose active lifestyles consistent with the dietary guidelines states can apply for funding nutrition education for SNAP participants often managed by state cooperative extension agency
SNAP-Ed