Ruby understands the importance of social nutrition and that’s why she never eats alone. What she helped start has ensured countless seniors receive a hot meal and a warm smile every weekday all over Dallas County. She was with VNA when it all began. In order to receive funding for programs from the Older Americans Act, Executive Director of VNA at the time, Elsie Griffith, was informed she was required to have a Licensed Master Social Worker (LMSW), Dietician, and a Masters-level RN employed by the agency. That’s when Ruby Nell Ruth met VNA and her story with VNA began.

The year was 1971 and back then, frozen meals were baked at the local YWCA before nurses picked them up for delivery. Back then, the only Meals on Wheels program was in Texarkana and Miss Ruby set off to learn as much as she could. Returning with her new-found knowledge of the Texarkana program, Miss Ruby got to work planning for the Dallas County Meals on Wheels program. “I spent lots of time soliciting volunteers!” said Ruby who discussed how the complicated logistics of delivering so many meals were apparent even then.

VNA is partnering with UT Southwestern Hospital System and Texas Health Presbyterian Hospital Dallas to provide daily home-delivered meals for high-risk patients recently discharged from the hospital. The goal of the pilot program is to provide nutrition and daily safety checks to reduce hospital re-admission rates, improve health outcomes and help patients age in place. The target population for the pilot program is high health care utilization patients and recently discharged patients with food insecurity due to poverty, lack of a support system, and frailness contributing to their inability to maintain their independence at home.

VNA CEO & President Katherine Krause said, “Providing daily nourishment, social contact and safety checks for vulnerable high-risk patients is critical to strengthening our community and reducing medical costs.”

The collaborative pilot is an innovative model for care coordination integrating Meals on Wheels’ daily nutritious meals, social support, critical safety checks, and clinical support into a continuum of care helping high-risk patients safely remain in their homes. VNA, Texas Health and UT Southwestern are piloting this model in Dallas County to improve health outcomes for vulnerable patients, especially seniors.

UT Southwestern researchers will evaluate program outcomes and report back to funders and the community with published research in 2019.  With the senior population projected to double by the year 2050, this joint program is intended to create a replicable model that will encourage healthcare entities across the country to utilize home- and community-based service providers to address the significant challenges present in the nation’s health care system. 

Funding from the Kosmetsky Family Foundation is supporting the pilot program with UT Southwestern. Texas Health is providing all funding for Meals on Wheels service for their patients.