The inability to access adequate food explicitly for financial reasons— which is known as “food insecurity”—also appears to be prevalent among people younger than 65 who qualify for Medicare because of a long-term disability. Within that group, Madden’s study finds that four out of 10 doesn’t have enough to eat.
“Obviously, it connects to these very big inequalities that we have as a country and a society that are underlying some of the big differences in people’s social status that then impacts their health,” says Madden, an associate professor in the Department of Pharmacy and Health Systems Sciences, who led the study with her research colleagues from Northeastern University and Harvard Medical School.
The researchers examined data from a 2016 survey conducted by Medicare in which nearly 10,000 people—representing 56 million enrollees nationally—participated. The authors estimated that 9.1 percent of older Americans are going hungry, while 38.3 percent of younger beneficiaries frequently do not have enough to eat.
“It’s a really important group because they’re known to be very vulnerable, clinically, socially, and they’re costly,” says Madden of the younger group. “They’re often in Medicare and Medicaid and they’re often very ill.”
Among the over-65 age group, the study found that the prevalence of food insecurity was higher in the Northeast than in the Midwest. Most at risk among both younger and older beneficiaries are people whose income falls below $15,000 a year, or those who suffer from multiple chronic illnesses, depression, or anxiety.
Efforts are being taken within the healthcare system to address this problem, Madden says.
“There are some limits to what the healthcare system can do, but all the same, there are things that they can do, and are doing,” she says.
Some clinics screen patients for food and housing problems before referring them to social services, such as Meals on Wheels or the Supplemental Nutrition Assistance Program, which provides needy families a monthly stipend for purchasing healthy food. Some health centers will assist patients in navigating available programs to ensure that the connection to services really happens, says Madden. A number of clinics also partner with food suppliers to provide food on-site to patients.
Some hospitals have gotten into the practice of asking patients before discharging them whether they have enough food to eat at home. Those determined not to have adequate food are either sent home with a package of food, or referred to programs such as Meals on Wheels.
The practice stems partly in response to the Hospital Readmissions Reduction Program, a component of the Affordable Care Act that began in 2012, which penalizes hospitals for readmitting patients too soon, according to Madden. But, in effect, it provides an incentive to hospitals to ensure that patients survive their discharge, she says.
The federal government and local communities also offer programs and resources to improve access to healthy food. The Accountable Health Communities Model addresses the social needs of Medicare and Medicaid beneficiaries through screening, referral, and community services.
“The Accountable Health Communities Model is so new that it’s not even really a program; it’s a bunch of demonstration projects that are being evaluated,” says Madden. “But it reflects the Centers for Medicaid and Medicare Services getting into this area and taking more interest in the social determinants of health.”
While the study did not establish causation between food insecurity and poor health, Madden suggested that a correlation does seem to exist between the two outcomes.
“If someone can’t afford to eat properly, that can affect their health. If they’re in poor health, that imposes costs on them and puts physical limitations on them which interferes with their ability to get food,” Madden says.
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