Key takeaways:
- A Duke study examined whether home-delivered meals could support older adults after a hospital stay.
- Researchers explored how food access and other social needs can shape recovery at home.
- The findings raise questions about whether community meal programs have the resources to meet growing demand.
By Ashley Fredde
A hospital can treat an infection, stabilize blood sugar or care for a wound. But for an older adult heading home after a hospital admission, recovery can be affected by something far more fundamental — food.
New research from Duke University suggests that getting people regular meals after a hospital stay could mean a lower chance of their winding up right back in the hospital.
Older adults who got two weeks of home-delivered meals after leaving the hospital were 69 percent less likely to be readmitted within 14 days than people who were referred for those meals, but who did not receive them, according to a study published in the Journal of Hospital Medicine. And the effects of receiving the meals lasted longer than the two-week delivery period; patients who had had the meals were 54 percent less likely to be readmitted after three weeks at home.
After two weeks, nearly 5 percent of patients who received meals had been readmitted, compared with about 13 percent of those who did not.
The authors said the findings raise questions about what older adults need to recover successfully once they leave the hospital — and whether health systems have the community infrastructure to meet those needs.
Finding food insecurity — but few places to address it
The program wasn’t originally designed as a research experiment. In 2021, the North Carolina General Assembly funded a hospital discharge pilot program for residents 60 and older who were at risk of food insecurity or malnutrition, and who were returning home after hospitalization.
The program was coordinated by the North Carolina Division of Aging and Adult Services in partnership with Meals on Wheels of North Carolina and NCCARE360, the state’s electronic referral network for health and social services. Eligible participants could receive one home-delivered meal each day for two weeks, with meal providers reimbursed $15 per meal.
For Dr. Susan Spratt, an endocrinologist and senior medical director in Duke’s Population Health Management Office, the program offered something Duke had been struggling to find: a way to help patients after identifying they didn’t have reliable access to food.
Before the pilot study, Duke had begun screening patients for health-related social needs and using NCCARE360 to connect them to services. But the hospitals where Spratt worked were not part of North Carolina’s Healthy Opportunities Pilot, a separate Medicaid initiative that paid for some services addressing food, housing, transportation and other nonmedical needs. Healthy Opportunities only served counties in the far northeastern part of North Carolina, western counties and the southeastern area.
“The major problem is that our area of North Carolina did not get the Healthy Opportunities Pilots, so when we were trying to use NCCARE360, it was hard to find community organizations that could meet the demand that we were finding when we screened our patients,” Spratt said.
When the hospital discharge meal program became available through a partnership with Meals on Wheels, Spratt said, “We were so relieved to actually be able to do something about all the food insecurity that we found.”
Duke built the referral process into its existing transitions-of-care workflow. Nurses were already calling patients after they left the hospital to make sure they had what they needed at home — prescriptions, oxygen or insulin. The health system incorporated patients’ social needs into that process, allowing staff to identify older adults and refer them for meals.
“I think that was part of our success, is that we didn’t have a way to connect people to resources, so we were desperately looking for things that would work,” Spratt said. “And we also put it in workflows so that people would remember.”
Spratt said Duke ultimately accounted for 96 percent of the referrals to the statewide pilot program, though she wasn’t certain why uptake was so limited at other hospitals. She said lack of access to NCCARE360 at some facilities may have contributed.
Eventually, Duke researchers realized the program had produced an opportunity to examine what happened to patients after they were referred.
Researchers analyzed 380 qualifying referrals representing 368 patients discharged from Duke hospitals between September 2022 and April 2024. Everyone in the study had been referred to the meal program because they were identified as food insecure or at risk of malnutrition.
But not everyone actually got the meals. Of the 380 referrals, about two-thirds of the people received them. For a smattering of reasons, the remaining people did not. That created a natural comparison group researchers had not initially intended.
What could two weeks of food change?
Spratt says there are straightforward reasons that nutrition affects what happens to someone after hospitalization.
“We don’t want people to be readmitted because their wound didn’t heal because they couldn’t eat enough food to produce protein to heal that wound, or conversely because the food that they’re eating is raising their blood sugars, so their wound didn’t heal,” she said.
The intervention itself was relatively inexpensive. At $15 per meal for 14 days, meal reimbursements amounted to about $210 for someone receiving the full two weeks.
“There are multiple reasons why food is medicine and food works,” she said.
For comparison, a 2024 analysis published by the Centers for Disease Control and Prevention cited federal data estimating the average U.S. hospital readmission cost $15,200 in 2018. The Duke researchers note they did not conduct a cost-effectiveness analysis or calculate savings from hospitalizations that may have been avoided.
Spratt said the comparison illustrates a larger problem in health care — failing to recognize that conditions outside the doctor’s office affect health. And when conditions are recognized, not enough is invested in addressing them.
“Hospital costs and medical costs are just rising. They continue to skyrocket, and we talk about, ‘Oh well, social drivers are part of that,’ but we’re not doing enough to address them,” Spratt said. “And by ‘address them,’ I mean help put in the safety net so that people who are at risk for malnutrition or at risk for poor outcomes, that we actually address one of the root causes, which is food insecurity.”
Was it the food — or the person delivering it?
While the research explored the delivery of food and hospital readmission, authors noted that while they knew that a meal had been delivered, they did not know whether it had been eaten.
Meal delivery involves human contact, and the researchers couldn’t separate the potential nutritional effects from the benefits of social interaction that a person has when someone regularly visits.
“It could be someone coming by and saying, ‘Oh wait, you don’t look so good. Maybe we should call your doctor.’ It could be the company. It could be a friendly face. It could actually be getting someone to sooner medical care,” Spratt said.
“It’s unclear,” she added. “Was it the food, or was it the company, or was it just a second eye on the person to say, ‘How are you doing?’”
That “second eye” is already part of the way many home-delivered meal programs operate. In a 2025 survey by Meals on Wheels America, 96 percent of home-delivered meal programs said they train drivers to keep an eye on clients’ well-being or general health. Nearly all offered at least some opportunities for social connection, including 94 percent who reported conversations with willing clients during meal delivery.
Separate research has found that older adults themselves describe benefits from meal delivery that extend beyond the food. A 2025 study published in JAMA Network Open interviewed 54 older adults in five states, including North Carolina, where they described reliable access to nutritious food, reduced physical burden around preparing meals and social interaction among the ways the service affected their lives.
Neither that study nor the Meals on Wheels survey explains the difference in hospital readmissions observed at Duke. But they illustrate why a knock at the door with a meal could represent more than just calories. Spratt pointed to North Carolina’s Healthy Opportunities Pilot as another example of thinking broadly about what people need outside the health care system.
“HOP was wraparound services,” she said. “You got care management. You got food. You got housing help if you needed it.
“I do think where there’s one social driver, there’s often more,” she added. “And having patients see that friendly face that delivered the meal might have been part of that.”
A referral doesn’t guarantee a meal
More than one in three referrals included in the study never resulted in a documented meal delivery. Researchers were able to identify reasons for some of that gap: Twenty-three patients couldn’t be reached, 10 referrals were missing necessary documentation and 10 patients declined the service.
The study’s authors noted that connecting patients to reliable food delivery required multiple handoffs — from the health system to the statewide referral platform, to Meals on Wheels of North Carolina and ultimately to the local volunteers responsible for delivery.
The problem is not unique to the pilot. Nearly all providers — 98 percent — responding to the 2025 Meals on Wheels of America survey reported at least one challenge to serving all the older adults in their communities who needed meals.
Funding was the most common, cited by nearly three-quarters of the respondents. Other issues included food prices, recruiting and retaining enough volunteers, and gas prices.
More and more often, those pressures are translating into limits on who can receive services. A third of providers reported having a waitlist, representing 36,000 older adults waiting for meals across the organizations surveyed. The average wait was nearly four months.
Nearly all home-delivery providers surveyed said they had taken some action because of funding challenges, including tapping organizational reserves, subsidizing clients who lacked another source of funding or adding older adults to waitlists.
The timing of when one first receives a meal after hospitalization may matter, according to the Duke study. Among meal recipients whose delivery dates were known, the median time from hospital discharge to the first meal was nine days. Those who got their first meal within nine days had significantly lower odds of a 14-day readmission than patients who received no meals.
Growth potential
Health systems and insurers are already becoming part of the funding picture for some meal providers. About half of Meals on Wheels organizations said they had received some funding from a hospital, health system, community health center or insurance company. Some had contracts where they were paid by health care providers for delivering meals.
And there are opportunities for expanding those relationships. Among providers that did not have a health care contract or receive other health-related funding, a third said they wanted to pursue one as part of their growth strategy.
Spratt would like to see that investment grow in North Carolina.
“I really wish that the state, the General Assembly would fund [the pilot] again,” she said. “I would be happy to help other hospitals adopt this.”
Additionally, Spratt said, she’d like to see more insurers support meal delivery; some Medicare Advantage plans already pay for similar services.
The study raises a broader question about where hospital care ends. A patient’s condition may be stable enough that they no longer need a hospital bed, but recovery continues once they get home — where the health system has less control.
“This is a perfect example of when we invest upstream how we can prevent inappropriate utilization,” Spratt said.
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