New research shows that seniors who participate in the SNAP program are much less likely to be admitted to nursing homes and hospitals, demonstrating the power of investing in social services to reduce health care costs and improve health outcomes.
The fresh fruit, frozen vegetables and salad Karen Seabolt eats help her “do more of what I need to do to live a better life,” she says. The 66-year-old from Tulsa, Oklahoma, has diabetes and is paralyzed on her right side from a stroke.
As a diabetic, Karen needs to eat the fresh fruits and vegetables her doctors recommend, and the $15 dollars per month she gets from SNAP—the Supplemental Nutrition Assistance Program—help her do that.
“It really comes in handy towards the end of the month. You may run out of money, but you always have your SNAP benefits. They’re for food only, so you’re not tempted to do without medicine to get food,” she told us.
SNAP benefits go far beyond a healthy meal. We now know that they can be a critical link to lower health care costs and better health for millions of seniors like Karen. A new study suggests—for the first time—that accessing SNAP benefits helps keep low-income seniors out of nursing homes and reduces hospital admissions.
The RWJF-supported study was a cross-sector research partnership between Benefits Data Trust, Johns Hopkins University School of Nursing, and the Hilltop Institute at the University of Maryland Baltimore County. It looked at the impact of access to food and energy assistance on health care utilization among 77,678 older adults in Maryland who received both Medicare and Medicaid, and found compelling evidence linking SNAP to reduced health care utilization, health care costs savings and improved health status.
The research found that Maryland seniors on Medicaid who were enrolled in SNAP were 23 percent less likely to enter a nursing home and 14 percent less likely to be hospitalized in the following year. Furthermore, SNAP participation reduced the likelihood of each additional day in the hospital by 10 percent and reduced the likelihood of each additional day in the nursing home by 8 percent. Researchers concluded that 42 percent of the study population were eligible but not enrolled in SNAP, meaning many who could take advantage of this benefit weren’t.
These findings have significant implications for the future of American health care. We have a growing aging population that are increasingly vulnerable to food insecurity. Between 2001 and 2015, the number of food insecure seniors more than doubled. The National Council on Aging reports that in 2014, 10.2 million older Americans—15.8 percent of the senior population—faced the threat of hunger. It’s critical to understand how hunger influences their health, and how we can address this need.
A new study suggests—for the first time—that accessing SNAP benefits helps keep low-income seniors out of nursing homes and reduces hospital admissions.
Food Insecurity Influences Health Outcomes
There is growing evidence around the link between social determinants—the social, economic, and physical factors that contribute to health status, including food insecurity—and health outcomes for seniors. Per a 2014 report from Feeding America and the National Foundation to End Senior Hunger*, food insecure seniors are 52 percent more likely to have asthma, 53 percent more likely to have heart attacks and 43 percent more likely to have congestive heart failure. Yet, nationally only 42 percent of eligible older adults are enrolled in SNAP
For low-income adults, food insecurity has critical implications on health status. Poor nutrition also makes chronic conditions more difficult and expensive to manage. The average participant in the study is 76 years old with at least two chronic conditions—the most common were diabetes and hypertension, which are both food sensitive health conditions.
Another study found that among individuals with diabetes, food insecurity was associated with less control of blood sugar and LDL cholesterol levels as well as higher rates of hospitalization toward the end of the month, when food budgets are more likely to be exhausted. There are limitations to viable clinical interventions for diabetics who simply can not afford food.
Nutrition is not the only factor that may lead to worse health among the study participants. A more insidious harm to health may be the stress of poverty, which can itself be a factor for poor health. Research participants had an average annual income of just $5,864. And as the Feeding America report cites, food insecure seniors are 60 percent more likely to experience depression, which is associated with poor diabetes management and heart disease.
Access to SNAP Protects Limited Health Care Resources
The research demonstrates how important it is for individuals to meet their basic needs to improve their health and live their healthiest lives. Enrolling more seniors into SNAP equates to big savings for states. Of the Benefits Data Trust study participants, 28% of the population experienced a hospitalization and 17% were admitted to a nursing home in any given year. Using the average cost of nursing home admissions and hospitalizations, giving SNAP to non-SNAP participants in this sample was associated with annual nursing home savings of $34 million and inpatient hospital savings of $19 million in the state. Together, these savings added up to $2,120 in health care savings for every low-income senior on SNAP in the year after enrollment.
Integrated Systems Drive Change
Seniors need to access the benefits to which they are entitled to receive to keep them healthy. Nationally, 5.2 million seniors are eligible but do not receive SNAP benefits. Increasing SNAP participation among seniors requires overcoming the barriers to access, including lack of benefit awareness, confusion over eligibility criteria, cumbersome application processes, stigma, limited mobility and access to technology.
To connect them with benefits, it’s essential to integrate health and human services into health care systems. States have a huge opportunity to be drivers for change by making sure that residents access the benefits that can help them stay healthy. In a report released last January, the National Academy of Social Insurance recommended a number of administrative and policy steps to improve Medicaid’s ability to address social determinants of health, including screening tools for managed care and integrative health systems along with improving data sharing between service and health care providers.
Leveraging data sources can serve as an effective cross-sector approach that serves seniors’ entire health needs. For instance, using federal and state verified data can streamline processes to ensure that all low-income seniors on Medicaid are enrolled in SNAP and other benefit programs. In doing so, eligible clients are connected to benefits, services are delivered in the most cost-effective way possible, and health care savings are realized. Benefits Data Trust is actively working with state and federal agencies to help promote systems change that leads to smarter and more efficient government to save Medicaid dollars and improve senior health.
Actions like these require dedicated resources and committed leadership. But it’s increasingly clear that interventions to tackle food insecurity can make a strong impact on health care’s triple aim—better care for individuals, better health for populations, and lower per capita costs.
*Data is from the National Health and Nutrition Examination Survey (NHANES).
About the Authors
Ginger Zielinskie is president and CEO of Benefits Data Trust, a national not-for-profit organization that partners with government agencies, corporations, national organizations and local community partners to decrease barriers and increase access to vital benefits and services.
David Adler is a senior program officer at Robert Wood Johnson Foundation where he oversees programs to make sure that consumers are represented in conversations about cost, quality, and value in health care. Read his full bio.