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Farmers Market Senior Delivery Program: Project Description, Implementation, and Results Prepared for the Multnomah Health Department By Kyle Curtis November 2011


ACKNOWLEDGEMENTS: The following people were instrumental in allowing the farmers market senior delivery pilot project to occur: Sonia Manhas and Rachael Banks, Multnomah County Health Department; Jessie Mandle, Multnomah County Aging and Disability Services; Donna Trilli, Belmont Loaves and Fishes; Rowan Steele and the Montavilla Farmers Market Board and staff; Audry Marshall, the senior volunteer extraordinaire; Darvel Lloyd, volunteer with Elders in Action; Barry Bahmanyar, Impact Northwest; and Kathryn Yeomans, who specializes in cooking demos with farm-fresh food items and contributes blogs and cooking tips at the Farmers Feast blog.

Kyle Curtis

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Introduction: Background and Purpose of Project Community health planners and policy makers are actively recognizing the need to improve access and availability of healthy food to low-income people. Far too often, the types of food available in low-income communities are limited to mini-marts, fast food, and chain restaurants as these areas lack full service grocery stores. The typical offerings provided by these businesses consist of processed foods that are high in fats, calories, and sodium. Ironically, the detrimental negative health impacts of a diet consisting primarily of the “cheap” food that is most available in low-income areas— including early adult on-set diabetes and obesity— end up being quite costly as these diet-related negative health outcomes continue to overburden an overtaxed community health programs.i Certainly, it is essential that the availability— and affordability— of healthy, nutritious food needs to be increasingly available in low-income areas to positively impact behavior patterns as well as diet-related health. Providing access to healthy food for low-income seniors is a unique community health concern. As the number of Americans who use food stamps— now referred to Supplemental Nutritional Assistance Program (SNAP)— reaches a record highii, seniors on SNAP are continually the demographic with one of the lowest rates of SNAP reimbursement with less than one-third of eligible seniors participating in the SNAP program.iii While there is nothing concrete to explain why this trend stubbornly exists, studies suggest that issues of pride prevent seniors from using their SNAP assistance more often. After having worked for decades and being able to independently provide for themselves, seniors bristle at the thought of receiving federal assistance or, as has also been commonly found in various studies, are unwilling to take assistance away from “those who may need it more.” According to FNS’s Office of Research and Analysis, seniors may not participate in SNAP because of the perceived low monthly benefit or because of fears of giving personal information to people that they don’t know.iv While there may currently be an entire generation who are accustomed to using SNAP and don’t think twice about relying on such federal food assistance, seniors are resistant to using SNAP despite the economic circumstances brought about by the current recession. Farmers markets are viewed as a potential option to address the lack of available healthy foods in the “food deserts” that are often found in low-income areas.v However, there are a number of barriers that impact the effectiveness of farmers markets to impact the purchasing and eating behavior of low income residents,vi including cultural, socio-economic, and physical barriers. Most farmers markets in a metropolitan area can often be found in the central business district or in closein wealthy neighborhoods, which serve as an anchor to provide the fiscal support necessary for sustainable market operation.vii As these areas provide a base of customer support that continually come to the market with cash in hand, a learned behavior by both purchasers and vendors has developed that result in a socio-economic barrier that exclude low-income shoppers from farmers markets. Twenty years ago, farmers markets were a destination for low-income shoppers to come and purchase bulk volume of low-cost farm-direct foods, which they were able to purchase from the farmer with paper food stamps. The switch of food stamps from paper to an electronic benefit Kyle Curtis

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transfer (EBT) system in the mid-90s resulted in farmers markets no longer being an access point for low-income shoppers. As farmers markets are typically found in outdoor areas such as parks or parking lots, the infrastructure capacity of farmers markets to accept food stamps has decreased dramatically over the past two decades. As a result, while there currently are a record number of SNAP users in the United States, the aggregate amount of SNAP dollars reimbursed at farmers markets is less than it was in 1990.viii Indeed, low-income shoppers have developed their own learned behavior as well. No longer able to use their SNAP EBT cards at farmers markets, low-income consumers instead turned to where the EBT infrastructure existed, which all too often meant the urban markets that sold high-processed, unhealthy foods. While the USDA is actively taking steps to ensure that all farmers markets around the country have at least one EBT machine for food stamp users, a generation of learned behavior won’t suddenly change. There is a perception of lowincome shoppers that the food available for purchase at farmers markets, while of high quality is certainly out of their price range. There is an element of truth to that. Farmers and vendors typically no longer bring a high quantity of cheap produce, but instead have been “trained” by market dynamics to bring the premium products that are expected to be purchased by the cashwielding customer at a premium price.ix A natural outcome of this socio-economic exclusiveness is the inadvertent creation of cultural barriers that exclude non-white ethnicities and minority communities. Indeed, one food policy sociologist has described farmers markets as “cultural white spaces,”x describing how a farmers market set up in east Oakland to serve the census tract with the highest percentage of African-American residents ended up serving as a destination market for white residents of surrounding areas. This should not necessarily be considered a surprise, as while there are certainly white families struggling in poverty, a higher percentage of non-white families live below the poverty level. As whites may be more accustomed to having cash available to shop at farmers markets, they would undoubtedly be more comfortable with the farmers market experience. And, as a result, the white families on SNAP would feel more comfortable taking advantage of the ability to use SNAP benefits at farmers markets than non-white families who may not be comfortable shopping at farmers markets, regardless of whether they were to use cash or SNAP EBT benefits. The final barrier posed to farmers markets successfully providing healthy food in lowincome areas are physical barriers. It may not seem like a huge barrier, but the lack of an automobile can certainly prevent low-income individuals or families from shopping at a farmers market, unless it was within a short walking distance. In areas with a lower-than-average percentage of households owning cars, the need to rely on a bus—or even cross busy streets—may be enough of a barrier to prevent low-income shoppers from going to a farmers market. Considering the other socioeconomic and cultural barriers, if a low-income shopper on a tight budget had to choose between riding the bus to the farmers market where they are perceived to purchase less food from their food dollar as opposed to a bus ride to a low-price supermarket, the latter option will most likely be chosen.

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As has been demonstrated, there is a strong community health benefit in increasing the access and availability of healthy foods to low-income areas, as well as barriers that prevent farmers markets from effectively addressing these issues. To effectively address and overcome these barriers, collaborative efforts are going to need to be created to innovatively find solutions. This report details the outcome of one such effort, a two-month pilot project created in collaboration between the Multnomah County Aging and Disability Services, the Montavilla Farmers Market, and the Belmont Loaves and Fishes Center. Its design was to provide the delivery of custom-ordered bags of farm-direct fresh produce that seniors were able to purchase at half-cost. Project Proposal In the off-season between the 2010 and 2011 market seasons, the Montavilla Farmers Market (MFM) was strongly interested in increasing its outreach efforts to seniors within the Montavilla neighborhood. The executive board of the MFM reached out to the County’s Aging and Disability Services (ADS) for assistance in providing direct mail support informing Montavilla seniors that Senior Farm Direct Nutrition vouchers could be redeemed at the MFM. The Board was informed by ADS that such assistance could easily be provided, and there were also some available funds from the federal Communities Putting Prevention to Work program to increase outreach efforts connecting seniors with healthy food from farmers markets. One project initially proposed by ADS was funding to provide a shuttle bus that would collect interested seniors from housing facilities in the Montavilla neighborhood and bring them to the market. A similar project had been funded by ADS in a prior farmers market season that delivered seniors to the Moreland market in Sellwood. However, a number of concerns were raised with this proposed project. As opposed to the Wednesday afternoon market date of the Moreland market, the MFM operated on Sunday, with hours that directly conflicted with regular church-goers’ hours. It would be unfortunate to provide a shuttle service on the day and time when seniors were instead going to church. Anecdotal evidence had also indicated that the Moreland senior bus shuttle was not very successful, as some weeks would see a nearly empty bus arrive at the market site. A charismatic member of the main senior housing was most responsible for generating interest by seniors to ride the shuttle to the Moreland farmers market. On the weeks that he did not participate, participation in the senior shuttle bus was dramatically reduced. ADS admitted that this had occurred. Other concerns were raised about the practicality of having a shuttle bring seniors to the MFM site. The MFM is located on a gravel lot at the 7600 block of Southeast Stark, just east of Mount Tabor. There are limitations to mobility caused by the gravel parking lot of the MFM’s location. During the hot peak market months, the site is dusty. When it rained during the fall months, the site was covered with puddles. These factors made it very hard to get around for those with limited availability, including not just seniors with canes and wheelchairs but mothers pushing young children in strollers as well. There was a concern that the MFM would expend time and energy for an outreach effort to bring seniors to the market, when if they had one negative experience they might not return, resulting in this expenditure of time and money to be wasted. Kyle Curtis

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In response to these concerns, Jessie Mandle, an ADS staffer, asked about the possibility of creating a program that purchased food on behalf of seniors and then delivered the food to them. The MFM board responded favorably to this suggestion, as it had previously considered similar projects internally, but recognized the need from an external partner to make it happen. Pilot Program To explore the feasibility of a program that addressed the inability of many seniors to shop at farmers markets, the Montavilla Farmers Market (MFM) partnered with Multnomah County’s Aging and Disabilities Division, food policy expert Kyle Curtis, and the Loaves and Fishes Belmont Senior Center to launch the Senior Food Delivery Program Pilot. The goals of this pilot were to:    

Improve senior’s access to local, affordable, healthy food; Explore the feasibility of a long-term Senior Food Delivery Program; Provide outreach to seniors using the Supplemental Nutrition Assistance Program (SNAP— food stamps) to let them know that these dollars can be spent at the farmers market; and, Encourage eligible seniors to sign up for SNAP.

Handling the Logistics Although the decision was made during the winter prior to the MFM’s 2011 season to pursue a delivery program that connected farm-direct food from seniors, a number of logistical barriers needed to be addressed before such a successful program could be implemented. These barriers included the availability of volunteers to assist with purchasing, delivery, the ability of seniors to use SNAP to make purchases of bags of food to be delivered, and—if same-day delivery to senior participants—then overnight storage of food purchased needed to be addressed. In planning discussions with Jessie Mandle of County ADS and members of the MFM’s board, these issues were addressed and potential solutions explored. Not sure of how many seniors would participate in this program, the need for volunteers to assist with purchasing the weekly food orders. Besides assisting with food purchases, volunteers could also help provide same-day delivery of market purchases, which would make the overnight storage of purchased food unnecessary. However, relying on volunteers to deliver food to senior houses would require conducting a background check. While initial contact with Hands On Greater Portland found that they would be willing to help recruit volunteers for this project, they rely on the organizations that they recruit volunteers for to conduct background checks. Due to lack of funding, this option was not considered. Instead, Jessie Mandle reached out to Elders in Action and Metropolitan Family Services to secure volunteers. This outreach led to the recruitment of Darvel Lloyd who was a weekly presence at the MFM, helping with the purchase of items requested by seniors. The concerns about lacking resources to provide same-day delivery to seniors’ homes led to the consideration of dropping off the bags of purchased goods at a centralized site, such as a congregant meal site. The Belmont Loaves and Fishes center was identified as the most ideal site to both register senior participants as well as delivering the bags of food after purchased at the MFM Kyle Curtis

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on Sundays. There was a concern about whether the Belmont Loaves and Fishes would be available to store food over night, as the MFM operates on Sundays and the Center was closed as a congregant meal site over the weekend. However, the Center still provided food deliveries over the weekend and Donna Trilli—the Center’s manager—allowed use of the Center’s refrigerated storage for the market bags to be dropped off on Sunday and stored overnight, to be distributed on Monday. While due diligence was being undertaken by the MFM, County ADS, and Loaves and Fishes as they explored collaborative ways to make this project work, the official beginning of the delivery program was pushed back until September to best figure out how to incorporate SNAP purchases into the program. While the idea of running participants’ SNAP cards on the MFM’s EBT reader to pre-order a bag seemed to make perfectly good sense, the MFM’s executive board was concerned that the use of SNAP in this manner violated the waiver from FNS—the USDA’s Food and Nutritious Services program—that allowed the use of the EBT machine for SNAP users to purchase on-site MFM tokens to purchase food at the Market. Checking with the regional FNS office found that the use of the EBT machine to run SNAP to pre-order market bags did, indeed, violate federal law. The use of SNAP benefits is prohibited if the provision of food does not immediately occur. (Some waivers had been developed for SNAP users to purchase CSA shares.) Even an intervention by Partners for a Hunger Free Oregon to allow SNAP users to pre-purchase bags of food was met with the same response: that it violated federal law. Ultimately, the MFM’s board used left over funds from their 2010 Everybody Eats program to front the money for senior produce bags of SNAP users, and their payment would then be collected with the EBT machine when bags were distributed on Monday. Two final key pieces of information that helped allow this program to occur. The MFM designated its Everybody Eats fund to support this delivery program. The Everybody Eats program had begun the prior season with the Market challenging its customers to make donations, with the MFM matching dollar-to-dollar up to a certain amount, and the final amount provided to clients of St. Vincent de Paul’s to make purchases at the Market’s Thanksgiving stock-up market. Not all the funds were claimed, so the Market began the 2011 season with some carry-over and continued to raise funds throughout the 2011 season. This financial support allowed the Market to cover half the costs of the bags purchased by senior participants, who were able to purchase a small $5 bag for $2.50 or a larger $10 bag for five dollars. Finally, when all of the pertinent details had been lined up and taken care of, and the pilot project was set to begin the second week of September to last through the end of the Market season in October, the Multnomah County Health Department agreed to provide funding to cover the administration and implementation of this project. Such financial support was invaluable. Program Implementation and Results The following is an analysis of the data collected over the two-month, eight-week long pilot program. Kyle Curtis

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Table 1 shows weekly participation in the program.

This table indicates that after the first few weeks of introducing the program idea to seniors at the Belmont Loaves and Fishes Center, it quickly got embraced and was regulalry used by participants on a weekly basis. Indeed, after having four partcipants in the program’s third week, it averaged twice that amount for the last four weeks of the program. The aggregate number over the full pilot was 52 participants over the eight weeks. This was not 52 unique particpants, but includes individuals who repeateded their participation in the program. (This information was not tracked during the pilot.)

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Table 2 shows the number of the different bags purchased by the senior particpants on a week-byweek basis: Table 2: Small bags v. Large bags purchased by Senior Participants on Weekly Basis

Mirroring the results tracked in the first table, the sole purchase of smaller $2.50 bags by seniors in the first few weeks of the program suggest the desire by participants to become more familiar and comfortable with this program. By week four, however, more participants purchased the larger five dollar bags than the smaller bags, a trend that would remain constant for the remainder of the pilot.

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Table 3 indicates the total dollar amount on a weekly basis. Although the amount of the $19 of food purchased in the first week nearly doubled to $37 in the second week, that amount dipped below $30 in the third week. However, the amount of food purchased by the seniors did not drop below $48 from that point on. Table 3: Total Weekly Amount Purchased

For clarification purposes, the “total amount” includes the MFM matching the amount purchased by the seniors. In Week One, for example, three $2.50 bags were purchased, and with the MFM’s match that $7.50 became $15. The outstanding $4 was from a Senior Farm Direct market voucher provided by a participant—which was not matched by the Market. A total of $40 in senior market vouchers were redeemend through this program, which compensated for the fact that not a single SNAP purchase was made during the life of the program. Factoring the redemption of market vouchers with the total combined amount of seniors matched by the MFM, a total of $413 worth of market produce was purchased during the eight-week pilot project. Suggestions and Conclusion As mentioned previously, despite all of the wrangling over the ability for acceptance of SNAP to be used by low-income seniors, not a single purchase was made with a SNAP EBT card. Wondering if not enough SNAP-related outreach was being conducted towards seniors who rely on these benefits, a presentation by Judith Auslander from Partners for a Hunger Free Oregon—who specialize in SNAP outreach for seniors—coincided with a cooking demonstration provided by Kathryn Yeomans from the Farmers Feast, who demonstrated a minestrone soup that could be made with some of the popular items having been purchased by the seniors throughout the pilot project. If this project is going to continue or be expanded, the participation of seniors on SNAP needs to be increased, to ensure that these federal benefits are used to purchase healthful, farmdirect food from local farmers and vendors. Kyle Curtis

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The number of participants never reached an amount that caused a problem regarding the amount of storage space in the kitchen of the Belmont Loaves and Fishes Center. When asked if her kitchen would be able to handle the bags of fifteen participants, Donna Trilli replied: “I can manage.” When asked if the bags of twenty participants could be fit into the refrigerator, she replied: “Now that might be a problem.” Availablity of spacious cold storage would be necessary for this program to successfully expand. Other suggestions to consider if this program is continued would be the impact it has on eating habits and other learned behavior. For example, an attitudinal survey conducted at both the beginning and end of a season-long market delivery program to see how participation in this program could impact perspectives on the affordability of the farm-direct food available at farmers markets, eating behaviors such as a possible increase in the servings of fresh food and vegetables, and similar indicators to measure the net positive impact this program would have on both individual and community health. Conclusion There is potential in this program to connect healthful food to seniors, improve viability of local farmers markets,, educate seniors on healthy eating practices, and also to sign up more SNAPeligible seniors. The model undertaken could help provide food to the urban areas of Portland and Multnomah County that have limited funds and access to healthful food. The reliance on collaborative efforts is a testimony to the desire by so many people to effectively create positive healthful change in this community. Finally, I would like to complete this report with a few quotes by those who have been invovled with the planning and implementation of this project: Donna Trilli, the manager of the Belmont Loaves and Fishes Center, provided the following comment on this senior delivery program: “Participating in this partnership with Montavilla Farmer’s Market has opened two doors for my seniors. The Board and County have allowed seniors to purchase fresh produce using SNAP, cash and/or tokens and have matched their dollars to give them double the amount of produce. The local farmers participating in the market gave these seniors additional discounts or produce for their bags. This allowed my clients to learn how to prepare vegetables that they had never eaten before and gave them additional foods.” Donna also described how the delivery of the foods purchased helps overcome a common transportation barrier that seniors often share: “Our participating seniors enjoyed the delivery of the product to my center. Transportation, or the ability to access public transportation, can be daunting on weekends. Market volunteers offered their time to shop and Darvel Lloyd, Impact NW volunteer and local activist, offered his time to deliver product weekly to my center. Seniors came and picked up their orders on Monday or Tuesday, during their regularly scheduled rides. This program had such a positive impact for my clients. It gave them fresh, local, healthy food, taught them how to prepare new foods, and most importantly, allowed them easier access to these foods Kyle Curtis

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than what they might usually experience. Thank you very much and I hope this program continues next year.” Jessie Mandle, who as a staffer for Multnomah County Aging and Disability Services, provided the offering perspective on the program: “I think the program went well, especially given that it got a fairly late start and there were more than a few challenges to overcome. But I think some of the strengths were the relationships that were established between the market and the senior center, as well the relationships [Kyle] developed with the senior center clients! As for some of the takeaways, I think this project reminded me of the importance of organizational support for any pilot project to expand. Also, I think this project highlighted some of the unique challenges in reaching older adults. The incentive and the ease helped- but I think there are additional barriers that kept more older adults from signing up and are worth exploring because senior hunger/ chronic conditions are on the rise!” Rowan Steele, from the MFM’s board, said the following about this project: “From the Montavilla Farmers Market’s standpoint, what makes this program special is that it addresses a host of issues associated with out mission: providing access to high quality, local, healthy food; creating additional opportunities for our vendors; and education on the value of consuming local produce and supporting local farmers. I’m extremely proud of the connections this program was able to create, and the partnership that was established in order to successfully launch this program. I look forward to the opportunity to continue the program in upcoming seasons, and to further the market’s goal of providing resources to our diverse community.” i

Food Choices and Diet Costs: an Economic Analysis,” Drewnowski, A. and N. Darmon. Presented as part of the symposium “Modifying the Food Environment: Energy Density, Food Costs, and Portion Size,” given at the 2004 Experimental Biology meeting on April 19, 2004, Washington, D.C. ii http://www.fns.usda.gov/pd/29SNAPcurrPP.htm Accessed November 11, 2011 iii Real Choices, Real Food,” Briggs, S., Fisher, A., Lott, M., Miller, S. and N. Tessman. Community Food Security Coalition and Farmers Market Coalition. June 2010. iv Ibid. v “A farmers’ market in a food desert: Evaluating impacts on the price and availability of healthy food.” Larsen, K. and J. Gilliland. Health & Place, Vol. 15, Issue 4. December 2009, pp. 1158-1162 vi “Barriers to Using Urban Farmers’ Market: An Investigation of Food Stamp Clients’ Perception.” Grace, C., Grace, T., Becker, N. and J. Lyden. Kaiser Foundation. October 2005. vii “Montavilla Farmers Market: An Analysis of Customer Trends, Shopping Behavior, and Organizational Development After Three Years,” K. Curtis. December 2010. Accessed from http://issuu.com/kylecurtis/docs/market_survey_report_final_final on November 9, 2011. viii “Real Choices, Real Food,” Briggs, S., Fisher, A., Lott, M., Miller, S. and N. Tessman. Community Food Security Coalition and Farmers Market Coalition. June 2010. ix “Buying Local Has Its Price,” Korn, P. The Portland Tribune. September 23, 2010. Retrieved from http://www.portlandtribune.com/news/print_story.php?story_id=128519001086787200 on November 9, 2011. x “Whiteness and Farmers Markets: Performances, Perpetuations… Contestations?” Alkon, A. H. and C. G. McCullen. Antipode, Sep. 2011, Vol. 43, Issue 4, pp. 937-959.

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Final Report: Farmers Market Senior Delivery program  

A report prepared for the Multnomah County Health Department on the planning, logistics, implementation, and results of a program I helped d...

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