In 2002, the U.S. Surgeon General declared improved nutrition for individuals with intellectual or developmental disabilities to be a national priority and the 2020 Healthy People, the United States health improvement plan, distinguished Americans with disabilities as a health disparities population. Despite this, there is a massive need for more comprehensive nutrition care for individuals with intellectual and developmental disabilities in the United States, who experience significantly poorer health than the general public. This group makes up more than 3% of the population; almost 10 million individuals. Since the closure of most large asylum-type institutions, individuals who cannot be cared for by family are typically housed in group homes and supportive living facilities. Supportive living usually refers to individuals who can live independently but need some kind of assistance, while group homes are typically family homes in residential neighborhoods that house 3-8 individuals, cared for by 24-hour staff. Caregivers in these homes are usually referred to as Direct Support Professionals, or DSP’s. Group homes are intended to be of the person’s choosing and have as few restraints as possible, but have been shown to be sadly deficient in quality nutrition care.
Research has shown that individuals with disabilities living in group homes commonly suffer from deficiencies and, consequently, bad health due to their diet. Nutrition in disability group homes is typically high in fat and low in fruits and vegetables, dairy, and whole grains. It is inadequate for health and has been shown to directly contribute to a myriad of digestive and health problems, including deficiencies and chronic conditions. There are solutions, however, supported by research, with noticeably improved outcomes. One intervention that was tested included healthy menu plans high in fruits and vegetables, lean protein, and whole grains, and low in processed foods. This method was used in several group homes for a period of 2-4 months with noticeable improvement in the residents’ diets. This approach also allowed homes to systematically address dietary needs and preferences without added nutrition knowledge required by the staff. Where these types of menu-plan interventions fail, however, is the execution by the caregivers of the scheduled meal. In the research study, there was a great deal of oversight into the execution of the menu. In reality, however, overworked and underpaid DSP’s rarely have the skills or time to prepare the assigned meals.
Unlike nursing homes for the elderly, where price and services vie for customers in a competitive market, most disability group homes have waiting lists, as demand far exceeds supply. Families are typically obliged to accept whatever home is nearby and has space for their loved one. Also unlike nursing homes, the majority of group homes do not have formalized nutrition services in place. Instead, meal planning, grocery shopping and food preparation is left mostly or entirely up to staff who often do not have any nutrition knowledge or cooking skills. In fact, studies have shown that these caregivers have less nutrition knowledge on average than the general population, and this shows in the health outcomes of residents. While DSP’s are paid more than most entry-level positions, the rate is far from adequate when compared to the quality of care needed and the wage paid to similarly skilled employees such as certified nursing assistants. DSP’s have extremely high turnover rates, so it falls on the shoulders of a skeleton crew of entry-level workers to provide meals for residents. Furthermore, research has shown that caregivers in group homes have significantly less nutritional knowledge than even the general population. This study concluded that DSP knowledge is insufficient to maintain a healthy diet for the people with intellectual disabilities in their care. Even among dietitians, however, knowledge of the specific needs of people with developmental disabilities is insufficient.
So we have a large population who is suffering from poor health outcomes linked to diet, proven successful nutrition interventions, and caregivers who lack the skills to execute the intervention. There are certainly large-scale changes that could be made to address these issues. Legislators could implement stricter requirements and more oversight around food in disability homes. Organizations could provide nutrition and food preparation training to DSP’s, and increase their wages to reduce turnover. But these changes are costly, and will take time. That is what prompted me to imagine a top-to-bottom service that addressed every component of disability nutrition in group home settings in a way that was accessible to anyone. At Whole Nutrition Services, we not only provide menu plans that are customized to the unique needs of residents, but we also deliver meal kits with pre-portioned and prepped ingredients and easy recipes that make healthy dinners foolproof. While our nutrition services are currently only available in Oregon, we envision a future where they can be delivered nationwide, and nutrient deficiencies in disability group homes are a thing of the past. In keeping with our passion for equity, we are also on the path to becoming licensed to accept SNAP, so cost will not be an issue for any group home, no matter how small.
If you would like to know more about how Whole Nutrition Services is improving nutrition in disability group homes, you can email us at info@wholenutritionservices.com
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