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A typical home-delivered dinner: almond chicken pasta with broccoli and vanilla pudding.

Vancouver’s Legacy Salmon Creek Medical Center food and nutrition team provides delivery service for at-risk patients

The hospital’s innovative meal delivery tackles post-stay malnutrition for patients.

For some patients at Legacy Salmon Creek Medical Center near Vancouver, Wash., three squares a day don’t stop once the discharge orders are signed.

Patients at risk for malnutrition—either because of a poor diet, chronic illness or the condition that brought them to the hospital in the first place—are eligible for a month of home-delivered ready-to-eat meals.

Discharged patients enrolled in the Creekside Meal Delivery Program receive free twice-a-week deliveries that ensure they have three nutritious meals a day for a month. A collaboration between the hospital dietitians and Executive Chef Brian Seto, the idea is to support better nutrition and healing.

The meals, which riff on the hospital’s rotation of inpatient menus, include items like chef salad, baked fish with rice and asparagus, turkey meatloaf with mashed potatoes, pork carnitas with black beans and corn, breakfast souffles and chicken casserole. Meals meant to be eaten shortly after delivery skew toward fresh ingredients; those slotted for a day or two later lean more toward frozen items that only need to be reheated. Milk and juice are included with breakfast, and dessert rounds out lunch and dinner.


Chicken salad, fruit, a roll and chocolate pudding are on the lunch menu.

Seto says it costs about $4 to produce each meal, and hospital volunteers provide transportation. Dietitians provide nutrition education, and assess the patient at the end of the month.

“We offer balanced meals, but our primary focus is on making sure patients get enough protein and calories,” says Gerry Howick, a food service manager at the medical center. Howick has been the principal champion for the program, which is supported by grants from the Legacy Health Foundation, a supermarket chain foundation and other community organizations.

The meal delivery service arose from the dietary staff’s effort to determine how many of Legacy Salmon Creek’s patients were malnourished. Howick says the average across the U.S. is 20% to 50%. “If you’re malnourished, it can take weeks or months to recover,” Howick says. “Our patients might stay an average of three or four days, so we can’t address that in such a short time.”

The dietitians considered all the potential barriers to eating well after a hospital stay: potential mobility issues, a weakened state, little energy to shop for or prepare food, sometimes poor appetite or lack of transportation to shop. With an initial grant, they collaborated with Seto to create the program, work out the logistics and test the menu to make sure items would freeze and reheat well.

“We hadn’t had experience cooking meals to go, so there was a lot of trial on different types of packaging and the menu,” Howick says. During a three-month pilot phase, the kitchen staff prepared meals, packed them, stored them for a few days, rethermalized them and evaluated the results. “The meals were clinically tailored to support malnutrition, but we also wanted to make sure they were palatable,” she says.


Legacy Salmon Creek Medical Center sends malnourished patients home with more than just physician’s instructions.

Enrolling patients in the Creekside program is a process. When patients are admitted, a dietitian assesses them for malnutrition, or at risk for malnutrition, such as patients being treated for cancer. Those who fall into that category are automatically prescreened for meal delivery. “We look at the patients who fit the eligibility criteria, then do a deeper dive into their charts,” Howick says.

With four possible menu tracks, not every malnourished patient is a good candidate, Seto notes. Those with food allergies or very restrictive diets aren’t likely to qualify; patients who are open to a variety of foods are a better match. Patients can preview the menus to make sure they are on board. “We have made some adjustments, such as when someone can’t eat beef or pork,” he says.

Otherwise, he says, “it’s totally what they would be eating if they were still in the hospital,” so patients have had a preview of what they’ll be receiving at home.

In the past year, more than 50 Legacy Salmon Creek patients have signed up for the delivery service. Both Howick and Seto would like to see the program expand; Howick says they are supporting sister hospital Legacy Good Samaritan Medical Center in Portland, Ore., as it launches meal delivery.

“I’m really hoping that someday we can help our patients no matter what diet they’re on post-discharge, so if you have a broken jaw and can eat only soft foods, we can provide it,” Seto adds. “It’s huge that they can focus on recuperation without the stress of having to think about meals.”

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