Skip to main content

CareOregon prescribes food for wound healing

April 11, 2017

PORTLAND, Ore. — Being injured or ill is a fact of life on the streets. Even with Medicaid coverage under the Oregon Health Plan and access to the great care providers of safety net clinics, the lack of many basics, including food, makes it difficult to get well.

Autumn Akers, NCMA, QMHA, knows that well. She spent 23 years as a case manager for Central City Concern’s Old Town Clinic. Now she’s a case management navigator for CareOregon. She’s seen a lot of the health barriers for the homeless population that makes up a great deal of patients in the Old Town area, and always a lack of proper nutrition.

“You just see a constant cycle just coming back for the same exact thing,” Akers says. “They can’t take care of themselves and they can’t take care of any wounds or any other illnesses they may have. Eventually, they just keep going back to the emergency room and the emergency room continues to call us: ‘What can you do? We can’t do anything about them.’”

But something can be done. CareOregon’s “Curative Nutrition” program is for patients with food insecurity and severe wounds that are not healing, and who need help maintaining a healing diet. Through its relationship with Coordinated Care Organizations, CareOregon manages care for about 180,000 members of the Oregon Health Plan (Medicaid) a population that is at greater risk for food insecurity.

Take the example of “Buddy,” a CareOregon member and Old Town Clinic patient Akers has known for years. Multiple wounds, stages II or III (stage IV being most severe), that were not healing. Sleeping in cars or in parks, no access to bathing facilities, no regular place to get food. Physical health complicated by mental health issues and a history of drug misuse.

“The wound care clinic at Old Town Clinic was treating those wounds externally,” says Kristian VanDoorn-Logan, food access coordinator for CareOregon. “Then he was sent back out into the streets again, maybe with some antibiotics.”

“And he really couldn’t take those medications on a regular basis,” says Akers. “So he would come in once a day and grab his medications. We were really trying to help him with what we had, and we didn’t have much.”

But they did have a new tool: CareOregon’s Curative Nutrition program.

“What we know about wound care is that healing takes almost twice as many grams of protein a day to help with that healing, as opposed to the protein needed by a healthy individual,” says VanDoorn-Logan. “Curative Nutrition is more tailored approach to a specific condition: wounds that are stalled, or not healing.”

Curative Nutrition is a prescribed dose of protein in the form of whole foods. For eight weeks, patients get three high-protein meals a day. A local vendor, Farm to Fit, prepares the meals to individual needs and from mostly local sources and delivers them. All the patients need to do is microwave the meals, and continue to see their health care providers for wound monitoring.

Buddy’s circumstances on the streets gave him extra challenges. With no place for delivery, storage or food preparation, the clinic tried having him come for his meals. But time frames and remembering regular clinic visits weren’t in the cards for him at that time.

So they tried an alternative.

“I was able to give him high-protein bars and shakes, so he could remain out there, doing whatever he was doing, wherever he was at,” Akers says. “At least he had these with him. They were packed full of protein, and he could actually eat and drink them whenever he wanted to, so he would get that protein that would help heal his wounds.”

For a year, this was where Buddy got his Curative Nutrition meals. And he made progress, both with his injuries and overall well-being. Previously non-verbal, in the year and a half he was on the program, he regained the ability to carry on conversations.

Last year, Buddy qualified for Central City Concern’s Recuperative Care Program, which provides a place for homeless people after discharge from surgery or recovery from wounds. Without housing, 90 percent of them would be back in the hospital.

Buddy was able to switch to the meal delivery, and with Central City’s social services assistance, he found a more permanent place of his own in the housing where Akers now practices for CareOregon.

Like Buddy, 87 percent of the CareOregon members who have been a part of the two-year-old Curative Nutrition program have seen improvements, according to their health care providers.

“We’ve seen people who have had open wounds for years have been able to have them closed while on the CN program,” VanDoorn-Logan says. “Not only are they decreasing utilization—fewer visits to the doctor for the wound—but they have reduced suffering and improved overall health.”

What is “food insecurity”

CareOregon members referred by their doctors for CareOregon’s Curative Nutrition program are screened for food insecurity. The simple, two-question screen gives a pretty good definition of what food insecurity is:

For each statement, please tell me whether the statement was “often true, sometimes true, or never true” for your household:

“Within the past 12 months we worried whether our food would run out before we got money to buy more.”
“Within the past 12 months the food we bought just didn't last, and we didn't have money to get more.”

If the answer for both questions is “often,” that is severe food insecurity.

Of the CareOregon members in the Curative Nutrition program, all had food insecurity, and nearly 90 percent had severe food insecurity.

According to an Oregon Health & Science University study, nearly 75 percent of adults who qualify for the Oregon Health Plan have food insecurity. That’s a higher rate than for other common factors for higher risk of ill health, such as diabetes, depression and heart disease.

 
About CareOregon
CareOregon is a nonprofit community benefits company that’s been involved in health plan services, reforms and innovations since 1994, serving Oregon Health Plan (Medicaid) and Medicare members and their communities. Our mission is cultivating individual well-being and community health through shared learning and innovation. Our vision is healthy communities for all individuals, regardless of income or social circumstances. We focus on the total health of our members, not just traditional health care. In teaming up with members, their families and their communities, we help Oregonians live better lives, prevent illness and respond effectively to health issues.
 

Comments