Food insecurity affects 41 million Americans and is especially prevalent among children and the elderly. Addressing food insecurity should be a priority for hospitals because hunger has enormous impacts on community health. Studies have consistently demonstrated that household food insecurity is associated with chronic disease, developmental delays in children, and poorer physical and mental health.

Food insecurity can also impact a hospital’s bottom line. Hunger can exacerbate medical conditions and drive up hospitals’ patient care costs.

Hospitals can play a vital role in connecting patients to resources that address a household’s food needs to support patient health and wellbeing. There are various points of intervention, both clinical and nonclinical, that can shape a hospital’s approach. And most communities have existing resources that a hospital can leverage so alleviating hunger is not solely the responsibility of a single facility.

Food insecurity screening

One of the most important first steps a hospital can take to assist food-insecure individuals is to identify hunger as a need. Many hospitals, like Providence Medical Group in Oregon, have implemented a “screen and intervene” strategy that includes screening for food insecurity (for example, by using the Hunger Vital Sign two-question food insecurity screening tool), identifying food insecurity in patients’ electronic medical records, and connecting food-insecure individuals and families to food resources.

Programs and resources

The following programs and services are available in most communities. Hospitals should be aware of these programs as they will likely be the first place to start when referring food-insecure patients to resources.

• Supplemental Nutrition Assistance Program (SNAP): SNAP (also known as food stamps) provides low-income families with benefits (on a card similar to an ATM debit card) to be used on food.
• Temporary Assistance for Needy Families (TANF): TANF provides low- and very-low-income families with cash assistance to help meet basic needs.
• Women, Infants, and Children (WIC): WIC provides low-income pregnant and postpartum women, infants, and children up to age five with services, including vouchers that can be redeemed for healthy foods at most major grocers, nutrition education, breastfeeding support, and referrals to other services.
• Summer, afterschool, and weekend meal and supplemental food “backpack” programs give low-income children access to nutritious foods when school is not in session. Programs are funded by the U.S. Department of Agriculture (USDA) and administered by local organizations, including hospitals. Find your nearest site on the USDA website and check out this USDA toolkit on how to sponsor a site.
• Soup kitchens and congregate meals: Congregate meals are meals served in community settings such as senior centers, churches, or senior housing communities. Soup kitchens and congregate meals are free or donation-based. The USDA provides tips and resources on how to start a congregate meal site.
• Home-delivered meals: There are numerous services that offer home-delivered meals to vulnerable populations, such as Meals on Wheels, which delivers meals to food-insecure seniors. In Philadelphia, organizations partner with catering or dining services to prepare meals delivered by volunteers. Community Servings and Project Angel Heart are nonprofit food and nutrition programs that deliver medically tailored meals to individuals and families living with critical and chronic illness in Massachusetts, Rhode Island, and Colorado. Many food delivery efforts focus on seniors since this population often faces mobility issues.  
• Food banks and pantries: Food banks partner with local nonprofit organizations to distribute food to families, seniors, and other individuals in need. Feeding America provides helpful information on how hospitals can develop partnerships with food banks or support the work of food pantries.

Best practices for hospital participation in food insecurity interventions

As more and more research emerges on the links between food insecurity and patient health, new interventions are being implemented and evaluated to address food insecurity in clinical and nonclinical settings. Consider these recommendations and best practices when developing a new intervention or seeking to improve existing programs:

Develop an accessible and reliable database of social resources

This is a basic and critical first step to connecting patients with resources. Hospitals should keep an up-to-date internal database and develop a mechanism (pamphlets, info sheets, or a website) for clinicians to share this information with patients.

Project Bread, a Massachusetts-based anti-hunger organization, developed a Hospital Handbook for clinicians and staff. This resource provides up-to-date, brief information in an accessible format. Eat San Francisco’s web-based database of healthy food resources for the San Francisco area is another great example of a community resource.  

Implement an active referral system

Active referrals have been demonstrated to be far more effective than simply providing patients with a list of resources or a hotline. Instead of requiring patients to follow up on their own, hospitals should obtain authorization from patients to allow outside organizations (such as community resource navigators or pantries) to follow up with patients directly.

Kaiser Permanente Colorado integrated a referral form into patients’ electronic medical record, which patients sign to authorize Hunger Free Colorado, an anti-hunger nonprofit, to contact them directly. This change increased the percentage of referred patients who received resources from 5 to 78 percent.

Provide patients with supportive services, such as patient navigators

Patient navigators are employed by hospitals and work with patients onsite to provide supportive services, such as help applying for benefits (SNAP, TANF, WIC, etc.), helping patients locate food banks or even accompanying them to pantries, navigating transportation barriers, and offering other support. Patient navigators can also assist patients in meeting other needs, such as housing, medical insurance, or Medicaid assistance.

For example, Memorial Hermann Memorial City Medical Center’s emergency department provides patients with navigators or “promotores de salud,” bilingual, state-certified community health workers trained in peer-to-peer counseling.

Navigators, who are trained to provide support in a linguistically and culturally appropriate manner, screen patients for food insecurity and assist them in securing resources. In a 2013 study, the use of navigators was shown reduce the use of the emergency room by patients seeking non-emergency care at Memorial Hermann.

Reduce or remove language and cultural barriers

Interventions should consider the unique barriers patients may face due to different cultural preferences, religious beliefs, or language barriers. For example, accessing programs and services like SNAP or WIC can be difficult for patients who do not speak English or are not familiar with social services. Barriers can be minimized by translating materials, providing interpreters, training staff in cultural competency, and designing culturally-appropriate interventions.

Boston Medical Center (BMC) issues food-insecure patients a food prescription, which is captured in their electronic medical record and forwarded to the Preventative Food Pantry. At the pantry, staff compile each patient a bundle of medically and culturally appropriate foods, including fresh produce and meat. The BMC pantry serves approximately 7,000 patients every month.

Address social determinants of health that are interconnected with food insecurity, such as housing and transportation

Health Leads, a Boston-based nonprofit, is helping hospitals implement interventions that connect patients to community-based resources such as food, transportation, and housing. Health Leads works across the country by placing undergraduate volunteers in hospitals to connect patients with social needs to local resources.

2-1-1 is a free, confidential referral and information service that connects people to a specialist who will help them find local health and human services. The 2-1-1 dialing code is available to over 250 million Americans (83 percent of the U.S. population), covering all or part of 49 states. Hospitals can work with their local 2-1-1 organization, such as San Diego 2-1-1, to support their efforts and utilize their referral service.

Unite Us developed software for hospitals to track and coordinate care across all social determinants of health. Unite Us provides technology solutions and technical support to provide a centralized system to record social needs and referrals in electronic medical records and connect patients to service providers, community resources, and employment opportunities.

Recommendations and examples of hospital food insecurity interventions

While food insecurity screening is increasingly becoming a standard part of patient care, a number of hospitals have launched interventions that provide patients with immediate emergency food resources or work to connect them with longer-terms resources for alleviating food insecurity. Below is a list of recommended practices and examples of hospitals implementing these interventions for their patients.

Learn more

• Addressing Food Insecurity: A Toolkit for Pediatricians by the American Academy of Pediatricians and Food Research and Action Center provides hospital staff with information on screening, examples of interventions, and helpful tips and materials for training on food insecurity.
• The Health Research & Educational Trust published Social determinants of health series: Food insecurity and the role of hospitals which provides information that can help hospital staff make a strong case for food insecurity interventions to hospital leadership.
• Exploratory Evaluation of Food Insecurity Programs Initiated by Health Care Organizations provides detailed case studies and evaluation data on food insecurity interventions in hospital settings. Its recommendations provide helpful guidance on implementation strategies.
• The Nutrition and Obesity Research and Evaluation Network developed a toolkit, Food Insecurity Screening Algorithm for Adults with Diabetes, that provides information and guidance on food insecurity screening. In addition to the toolkit, the website provides current research on food insecurity interventions.  
• The American Association of Retired Persons published an issue brief on addressing food insecurity in primary care settings. The brief includes several case studies on model programs screening patients for food insecurity.