October 2024 Issue
Homelessness & Nutrition
By Sophia Condic, MS, RDN
Today’s Dietitian
Vol. 26 No. 8 P. 26
Confronting Nutritional Challenges in Food Insecure Populations
Though many of us have a place to call home, approximately 650,000 people in the United States experienced homelessness in January 2023.1 Those who do not have a home face many hardships and are often unsure what will happen next, including not knowing when their next meal may be.
Past research has shown that food insecurity (FI) has strong links to homelessness, with one 2021 study suggesting that homelessness and FI look different across subgroups, locations, and circumstances and that it is often differentiated by psychosocial coping resources such as mental health or social ties.2 While efforts have been made to reduce FI for homeless individuals and families, there are still barriers preventing this population from meeting their nutrition needs.
Charitable food organizations, such as food banks, pantries, and other independent food distribution services, have been specifically created to combat FI. The first food pantry was opened in 1967 by John van Hengel in Phoenix, ushering in nationwide growth in such organizations.3 Feeding America, which is one of the largest charitable food organizations in the country, states that its network has around 200 food banks and 60,000 food pantries as of 2019.4,5
Despite the modern-day prevalence of these organizations, approximately 12.8% of US households, or 17 million people, reported experiencing FI in 2022.6 Although not everyone faced with FI is unhoused in the United States, those without homes have additional nutrition-related challenges.
The Limitations of Charitable Food Organizations
Charitable food organizations intend to reduce FI throughout the country; however, there are some limitations regarding availability that may prevent homeless individuals from accessing nutritious food.
One of the most significant barriers impacting these organizations is a lack of funds. Although personal donations are a great starting point, more funds are required to meet the needs of an organization.
To address this issue, the USDA created The Emergency Food Assistance Program (TEFAP).7 TEFAP provides funds to organizations that then distribute nutritious food to low-income individuals and families at no cost.7 In 2023, TEFAP obtained $550 million for the program.8 Additionally, $60 million was given to TEFAP Reach and Resiliency Grants to service underprivileged communities across the country.8 The money from TEFAP is then distributed to each state.7 The amount of money given is determined by how many people are at or below the poverty level and how many are unemployed for that state.7
Funds from TEFAP can be used to meet the needs of a charitable food organization. For instance, Madelyne Wright, assistant director of nutrition services who manages TEFAP funds at Oakland Livingston Human Service Agency, states that with TEFAP, “We are able to spend a lot more of the budget on food.” However, with increasing rates of inflation, more individuals may be unemployed, homeless, or at or below the poverty level, and they will need to obtain additional food from charitable food organizations. To combat this, there will need to be more funds from TEFAP or personal donations.
Along with managing funds, another limitation for charitable food organizations is finding usable storage at the facility. As the need for emergency food assistance grows, so does the need for storage. Although the USDA states that TEFAP can assist in providing funds to “support the storage and distribution of USDA foods,” there can be some challenges to finding more space.7 Because not all foods can be stored the same way and food must be stored far from walls and at least 6 inches off the floor, this can limit how food is stored at a charitable food organization.9
In addition to implementing first-in-first-out methodology, charitable food organizations can create a plan to remove expired foods as soon as possible. Additionally, if the funding is available through TEFAP or by applying for local, state, or nationwide grants, a charitable food organization can expand operations by increasing usable building space or using vehicles to quickly move food to homebound/homeless individuals and families.10
I Have Food … Now What?
Despite the limitations, charitable food organizations have provided food for many individuals and families during even the most challenging times. Yet those who are homeless are also confronted with additional challenges once they receive food. With no home, there is little to no place to store food, meal preparation accessories, and appliances. Because of this, canned goods, food stored in large containers, or foods that are heavy are some examples of what may not be appropriate to give to individuals or families experiencing homelessness. Despite these barriers, there are still some ways these organizations can provide invaluable support.
Developing Meal Programs at Charitable Organizations
One possible solution to the lack of meal preparation accessories and appliances is to offer shelf-stable prepared meals instead of individual unprepared food ingredients to those who are homeless. Some of the food that has been donated to a charitable food organization can be used to create hot and cold meals by staff and volunteers. Along with offering a meal to someone who is homeless, these organizations would see a reduction in food waste along with a productive turnover rate for items donated to the facility. Additionally, if RDs are on staff, they can help create meals that focus on quality nutrition components and even accommodate those with allergies or specialized diets.
Even though implementing a meal-focused program would help those who are going through homelessness, it would require financial assistance. The Child and Adult Care Food Program offers funding for payments, food, and training for emergency food programs that target homelessness among the youth. There are other financial assistance programs and grants available through the USDA or other national organizations that may reduce some of the financial barriers to developing a homelessness-focused meal program at a charitable food organization.12
Meal Preparation Tools
Small kitchen appliances, such as microwaves, toasters, and blenders, and large kitchen appliances, such as refrigerators and ovens with stovetops, play a central part in meal preparation. Those who are homeless may have no way of accessing these tools, and even if appliances were procured, they may not have the electricity to use them.
Small kitchen equipment, such as can openers and hand mixers, along with basic kitchen utensils such as bowls, whisks, and spatulas, are needed to make many meals. Yet, unhoused individuals may not have such items. Because of this, the Gateway Region YMCA recommends that items requiring can openers or special equipment should not be donated to charitable food organizations.13
Metcalfe and colleagues echoed these concerns in their peer-reviewed research.15 When it came to understanding the significance of kitchen equipment, the researchers discovered that families with lower incomes often face challenges with resources and equipment.15 Kitchen equipment and appliances are not commonly donated to homeless individuals and families; however, these items could temporarily be available through programs and classes offered at a charitable food organization.
Although those experiencing homelessness may not be able to easily access kitchen equipment, cooking classes and programs offered specifically for this community at charitable food organizations can focus on low-cost meals that require little to no equipment, such as mashed chickpea salad sandwiches and homemade vegetarian chilis using canned beans and tomatoes with pop-can lids that don’t require can openers. Furthermore, these classes can give homeless individuals and families the opportunity to learn about basic meal preparation skills. A program in Denver that was specifically designed for those without homes encouraged participants to learn these skills and even helped participants secure job placement once they completed the program.16
Taking the Next Steps
Stable housing directly targets several barriers to reducing FI, including making access to appliances, meal preparation tools, and food storage more feasible. According to The Harvard Gazette, one of the biggest contributing factors to homelessness throughout the country is lack of affordable housing.17 Along with getting assistance from charitable food organizations, those experiencing homelessness can get support from national and local programs and organizations that provide stable housing.
Affordable Housing Access
The US Department of Housing and Urban Development currently has six active programs for those in need.18 For example, the Emergency Solutions Grants Program supports those who need stable housing after a crisis.19 Another program, the Housing Opportunities for Persons with AIDS program, helps those living with HIV/AIDS who are experiencing homelessness or at risk of being homeless.20 All the programs under the US Department of Housing and Urban Development can offer housing support to those experiencing homelessness. There are also state-level programs that can accomplish the same goal.
Housing programs at the state-level can target the housing needs in individual communities. In addition, state-level housing programs can connect homeless individuals and families to other local assistance programs. As one example, the Michigan Department of Health and Human Services provides grants to local providers to assist individuals and families experiencing homelessness with the goal of moving into stable housing as quickly as possible and providing the support needed to achieve permanent housing stability.21 The Michigan Department of Health and Human Services also works with federal and other state programs to promote housing stability.21
Along with Michigan, the New Hampshire Department of Health and Human Services offers a direct assistance line, NH 2-1-1 to connect residents to state-level housing services.22 They also have information available online for those who want to use their services to contact their city or town welfare office.22 Fortunately, there are many more states throughout the country that can help homeless individuals and families find stable housing through similar methods.
Those who are recently housed have a place to store food, small kitchen equipment, and other items needed for cooking and eating. Yet even with ample storage and equipment, there can be ongoing challenges accessing nutritious food.
Many recently housed individuals and families may still struggle with FI and will need to find charitable food organizations in their area. Along with locating these resources, someone who has been recently housed after experiencing homelessness may need to find new grocery stores or markets close to their home. Unfortunately, these places may not be within walking distance, and they may not accept benefits from food assistance programs, such as Electronic Benefit Transfer cards or food stamps.23 Although these challenges can impact FI, RDs can be a vital part of the picture for improving health and food access for those who are unhoused.
How RDs Can Make an Impact
Dietitians can be an important part of helping to reduce FI and improve healthful food choices and access for those in need. Whether at the level of individual care or within state or federal food assistance systems, RDs have valuable support to contribute and may even provide MNT outpatient services. For instance, Ferrer and colleagues conducted a study to examine how a primary health care office and food bank could work together to help low-income participants control their type 2 diabetes. In this study, a food bank RD was able to provide nutrition education on topics such as carb counting and reading produce labels during food deliveries.24
While working with the Greater Boston Food Bank, Adriene Worthington, RDN, LDN, states that she “revised our online recipe database Click N Cook; wrote nutrition specifications for products we purchased; wrote and implemented a warehouse-specific food safety course; modified the food recall procedure; and created, analyzed, and forecasted a cycle menu for seven self-run Kids Café sites.”11
Although setting SMART goals with someone who is experiencing homelessness can be uniquely challenging, RDs can help create realistic goals that address multiple facets of FI and food choice. Above are some ways RDs can make a positive impact on this community in need.
There are many individuals and families struggling with FI throughout the country. Those who face homelessness may have other challenges that can impact who they are now and who they can be in the future. Many charitable food organizations have good intentions, yet a few adjustments need to be made to feed more unhoused individuals and families. Furthermore, once someone has stable housing, there may be an initial struggle to locate nutrition resources. RDs can work with these clients and organizations every step of the way to facilitate improved access to healthy foods.
— Sophia Condic, MS, RDN, is a Michigan-based dietitian who’s currently working in a community clinic. She earned a Bachelor of Integrative Studies at Oakland University and completed the Coordinated Program in Dietetics and a Master of Science in Clinical Dietetics at Grand Valley State University. She has previously written for Today’s Dietitian and for the Dietitians in Business and Communications Practice Group through the Academy of Nutrition and Dietetics.
References
1. Fact sheet: 2023 annual homelessness assessment report key findings from the point-in-time counts. US Department of Housing and Urban Development website. https://www.hud.gov/sites/dfiles/PA/documents/Fact_Sheet_Summarized_Findings.pdf. Published December 1, 2023. Accessed April 23, 2024.
2. Fitzpatrick KM, Willis DE. Homeless and hungry: food insecurity in the land of plenty. Food Secur. 2021;13(1):3-12.
3. Crouch L. Food assistance in the United States. Virginia Commonwealth University website. https://socialwelfare.library.vcu.edu/public-welfare/food-assistance-in-the-united-states/. Published August 19, 2020. Accessed June 8, 2024.
4. Feeding America website. https://www.feedingamerica.org/. Accessed June 8, 2024.
5. Waite T. What is the difference between a food bank and food pantry? Feeding America website. https://www.feedingamerica.org/hunger-blog/what-difference-between-food-bank-and-food-pantry. Published February 20, 2019. Accessed June 8, 2024.
6. Key statistics & graphics. US Department of Agriculture website. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/. Updated October 25, 2023. Accessed May 26, 2024.
7. What is the Emergency Food Assistance Program? US Department of Agriculture website. https://www.fns.usda.gov/tefap/tefap-fact-sheet. Updated September 10, 2021. Accessed June 26, 2024.
8. Fact sheet: USDA support for food banks and the Emergency Food System. US Department of Agriculture website. https://www.fns.usda.gov/fact-sheet/usda-support-for-food-banks-emergency-food-system. Updated November 8, 2023. Accessed June 26, 2024.
9. Preventing cross-contamination. ServSafe website. https://www.servsafe.com/downloads/demos/fh/fh-sample-chapter. Accessed June 26, 2024.
10. Facing Hunger Food Bank faces soaring demand & new challenges amid coronavirus pandemic. Facing Hunger Foodbank website. https://facinghunger.org/facing-hunger-food-bank-faces-soaring-demand-new-challenges-amid-coronavirus-pandemic/. Accessed June 28, 2024.
11. Worthington A. Registered dietitians in food banking: beyond MyPlate. Feeding America. https://www.feedingamerica.org/hunger-blog/registered-dietitians-in-food. Published March 9, 2016. Accessed June 28, 2024.
12. CACFP in emergency shelters. US Department of Agriculture website. https://www.fns.usda.gov/cacfp/emergency-shelters. Updated June 13, 2024. Accessed June 30, 2024.
13. 25 of the best items your food bank needs the most. Gateway Region YMCA website. https://gwrymca.org/blog/25-best-items-your-food-bank-needs-most. Accessed July 1, 2024.
14. Morello P. What to donate to a food bank and what to avoid. Feeding America website. https://www.feedingamerica.org/hunger-blog/what-donate-food-bank-and-what-avoid. Published January 14, 2020. Accessed July 1, 2024.
15. Metcalfe JJ, Prescott MP, Schumacher M, Kownacki C, McCaffrey J. Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption. Public Health Nutr. 2022;25(2):437-449.
16. New cooking program offers slice of self-confidence for homeless participants. CBS News website. https://www.cbsnews.com/colorado/news/cooking-program-homeless-emily-griffith-comitis-crisis-center/. Published February 11, 2021. Accessed July 2, 2024.
17. Powell A. Why it’s so hard to end homelessness in America. The Harvard Gazette. January 24, 2024. https://news.harvard.edu/gazette/story/2024/01/why-its-so-hard-to-end-homelessness-in-america/. Accessed July 7, 2024.
18. Homelessness programs. Hud Exchange website. https://www.hudexchange.info/homelessness-assistance/programs/. Accessed July 3, 2024.
19. ESG: Emergency Solutions Grant Program. Hud Exchange website. https://www.hudexchange.info/programs/esg/. Accessed July 3, 2024.
20. Housing opportunities for persons with AIDS. Hud Exchange website. https://www.hudexchange.info/programs/hopwa/. Accessed July 3, 2024.
21. Housing and homeless services. Michigan Department of Health and Human Services website. https://www.michigan.gov/mdhhs/assistance-programs/housing-and-homeless-services. Accessed July 7, 2024.
22. Homeless & housing. New Hampshire Department of Health and Human Services website. https://www.dhhs.nh.gov/programs-services/homeless-services/homeless-housing. Accessed July 7, 2024.
23. SNAP EBT. US Department of Agriculture website. https://www.fns.usda.gov/snap/ebt. Updated June 25, 2024. Accessed July 7, 2024.
24. Ferrer RL, Neira L, De Leon Garcia GL, Cuellar K, Rodriguez J. Primary care and food bank collaboration to address food insecurity: a pilot randomized trial. Nutr Metab Insights. 2019;12:1-5.