LEARNING OUTCOME: Understand the importance of integrating client input and home-delivered meal quality issues with medical nutrition therapy to improve the nutritional care for home-bound elders.

A Continuous Quality Improvement (CQI) process monitoring nutrition care for homebound elders should include client input, home-delivered meal quality, caterer involvement, and medical nutrition services. Our home health agency became a meals provider to improve our frail multi-ethnic elder's nutritional needs. Our CQI process monitors meal quality, client consumption and solicits feedback for improvement. Using three caterers allows provision of hot (HM) or frozen (FM), Kosher, Anglo and Hispanic meals. A Spanish or English questionnaire was mailed to all 205 clients. More FM(n=37, 55%) responded than did the more frail HM recipients (n-30, 44%) suggesting functional level differences. More English (n=48) than Spanish speakers (n=19) responded, indicating revaluation of cultural attitudes about written surveys. Most (83.5%) reported at least 75% meal consumption, however, improvement was needed. FM clients reported vegetables being tough, prompting investigation of potential oral and dental problems and cooking adjustments. Only 50% of HM clients reported meals arriving at proper temperatures, a food safety risk addressed with caterers. Client names allowed linking of meal consumption with medical nutrition services. Four individuals reported 75-100% meal consumption yet were losing weight requiring clinical assessment. A CQI program reviewing client satisfaction, medical nutrition services and caterer performance can improve nutritional care for home-bound elders.