 My name is Mark Oranis and I am the coordinator of the CLSA seminar webinar series and I am the associate scientific director of the Canadian Longitudinal Study on Aging and I'm also an associate professor in the School of Public Health and Health Systems at the University of Waterloo. Today I'm very pleased to introduce our speaker, Christine Shepard. She will be talking about a needs assessment for a congregate dining program at an urban senior center. And just a little bit about Christine before we start, she is a doctoral student in the School of Public Health and Health Systems. She is specializing in aging health and well-being and she has completed graduate training program evaluation. Prior to coming to the University of Waterloo, Christine studied at the University of Toronto where she completed a master's degree in social work with a specialization in gerontology. So Christine, I will leave it for you to take away. However, just as a note to all participants, you have been muted because what happens when we unmute everyone is we get too much feedback and that can prevent people from hearing the presentation properly. So you're muted and if you wish to ask questions, if you look at the bottom left of the Blackboard Collaborate window, you will see we have a chat feature. So just type your questions into the chat feature and after Christine has finished her talk, then I will read out your questions to everyone and Christine will have an opportunity to answer. So without further ado, let's turn the reins over to Christine for her presentation. Thanks Mark. So I have to apologize. Today I have a bit of a cold, but nonetheless I'm very excited to be here today to talk about an evaluation project that I was involved with. We assisted a senior center with planning and developing a congregate dining program. So just a quick overview of what I'll be talking about today. I'll give a brief background on nutritional well-being and older adulthood. I'll talk about what we know about congregate dining programs and older adult centers in general. I'll go over in detail the methods and the findings of our needs assessment and I'll talk to the program models that we developed as a result of our findings. And then finally I'll give everybody a post evaluation update. I'm not going to go into too much detail about nutritional well-being and older adulthood. Dr. Heather Keller gave a really great webinar back in December that explores this topic in a lot of detail. So I'll just kind of cover the gist here. The bottom point is that many older adults have poor food intake and this happens for a variety of reasons. Many of them may have a reduced income and that may impact their ability to be able to afford the nutritious food that they want to eat or want to eat. Many older adults will have difficulty chewing due to ventilation problems. Chronic diseases and medication use may also impact what types of food people are able to eat and even their overall appetite in general. There's a lot of research that supports the idea that older adults who are socially isolated or depressed are at a heightened nutritional risk. And then finally mobility problems including you know physical mobility or transportation challenges may impair someone's ability to get to the grocery store. Physical mobility challenges might impact their you know ability to cook their meals at home. And so all of these things come together and as a result many older adults are at a heightened nutritional risk. Senior centers are community-based facilities that focus on organizing and providing programs and services that are relevant to older adults. And many senior centers offer a variety of programs that might be exercise based, education based, just social clubs in general. But a lot of them will offer some sort of congregate dining program or food-based programs. There are about 15,000 senior centers across the United States and there's a national governing body called the National Institute on Senior Center and just recently they actually implemented an accreditation process that just over 200 centers have gone through at this point. A lot of the programs at senior centers in the United States are going to be government funded. An example of this is the elderly nutrition program where they provide in-home meals as well as congregate dining meals for seniors in the community. And for the elderly nutrition program a lot of their congregate dining programs are offered through senior centers. There has been a bit of research with older adults who attend these congregate dining programs at the senior centers in the United States. Participants have noted that receiving a nutritious meal at their center through the congregate dining program was the most important benefit that they receive from attending their center. And for many of the low-income seniors attending this program the meal provided is probably the only main meal that they eat that day. Older adults have also noted that the congregate dining programs have provided opportunities for them to eat a wider variety of food without being wasteful and they report that they don't worry as much about eating a nutritious meal at home if they've already had one at their center earlier that day. Many older adults have also suggested that the quality of the food that they receive at their meal program is better than what they would make themselves at home. And so as a result many will purchase additional meals so they can take them home as leftovers. In Canada there is no national organization of senior centers but there do exist some provincial governing organizations. An example is the older adults association of Ontario, older adult center association of Ontario. In Ontario in the older adult center association there are about 160 senior centers that serve over 150,000 seniors but we do know that there are more centers across the province that just are not part of this provincial organization. In Ontario at least many of these senior centers are funded through local government or through external granting agencies such as the United Way. And because of the funding structure many of the programs and services that are offered at centers are going to be unique to an individual center and are going to be highly dependent upon the level of funding they have and what their staffing situation looks like. So some centers in Ontario may offer a congregate dining program for their members but each center would have its own unique program structure and we don't really have a mechanism to facilitate that information sharing to tell other centers what that program might look like. So we worked with a relatively new senior center that's located in Toronto, Ontario. At the time the center did not offer a congregate dining program but members of the center were asking staff if they could develop a program that would feature food. And so we conducted a needs assessment to help the center plan and develop a program that would be of interest to their members but also sustainable over the long term. So generally the goal of a needs assessment is to really get at what type of program is going to work best and it's also important when doing this to elicit information from the people who will be delivering the program but also from the people who are going to be using the program or participating in that program. And so this needs assessment was a great tool to determine the extent of interest and demand for our the congregate dining program and identify what resources from the perspective of the staff would be needed to operate this program over the long term. And finally the needs assessment also provides an opportunity to assess what other related services exist in the area to identify how a new program might be meeting an unmet need. So I'm going to give you a bit of information about the center that we worked with so you can understand the context and sort of what it looked like. The center is relatively new it was built in 2009 and it's located in the inner suburbs of Toronto. It offers a variety of programs six days a week. They have exercise classes, language based social clubs, computer classes, they have special events and outings, really a large variety of classes. And anyone who uses the center has to become a member and when they become a member they have to pay an annual membership fee of $35. With the exception of some special outings there are no additional costs for members to participate in any of the programs. So the membership fee covers all of the programs and services that they offer with the exception of some special events might have an additional charge. The center does have an on-site kitchen although it's not very large. It has a dishwasher and a stove and a fridge and lots of covered space and stainless steel counter spaces. Members are allowed to come in and use the microwave and the fridge to store their food but they're not allowed to use the oven without the supervision of staff. There are over 290 older adults who are members of the center that we worked with. The majority of them are female and they range in age from as young as 52 over age 85. When a member registers for the center they are required to provide their name, their gender, their age and contact information but other information related to maybe their education level, their income, their living arrangements, none of that is collected. So really all we know about the base membership is their age and their gender. The center did conduct a survey in 2013 in order to learn more about what their membership looked like and who was attending their center but the response rate was not very high. They only had 24 percent of their membership complete the survey. Nonetheless the survey revealed that almost half of their members have less than a high school education. Two-thirds or three-quarters of them are living alone. Almost 70 percent have an income of less than $23,000 per year. Many of them identified as Latin American or Caribbean and most or half of them stated that English was not their first language. So really the people who attend the center are low income potentially socially isolated, not well educated and there may be some language barriers or challenges when they try to communicate in English. So to do our needs assessment we saw information from a variety of sources. So we conducted focus groups with members who attend the center. We distributed a survey to try to hear from as many members as possible. We conducted a focus group with a staff at the center. We also did a community scan as well as had telephone interviews with program coordinators of other senior centers in the area. So we started off with our member focus groups. We did three of them in total and we offered them on the busiest day of the center to make it easier for people to come to the sessions. We had a total of 31 members come and participate in the focus group and our discussion consisted of sort of three main parts. We first asked people what they typically do for food when they come for the center. What do they have for lunch? Do they bring snacks? That sort of thing. We also asked them if they have any past experience with meal programs and if we were to offer a meal program what would they expect that program to look like. And then we also asked them what they would be willing to pay to participate in this type of program. At the end of the focus group we had a questionnaire where we tried to get at some of their favorite ethnic foods. What type of program would they want? Would they want it to be serving breakfast, lunch or dinner? And if they wanted that kind of program how often did they want it? How much did they want to pay? And were they interested in volunteering with the program? We conducted a member verification or a member check of a month after the original focus groups where we had 13 of the original 31 participants come and join us. We put together a presentation of our main findings and we presented them to the group just to see how accurate we were and if they had any new ideas. To try to hear from more members we put together a center-wide survey. We had the survey available at the front desk for all members who come in every day where they have to register and it was available for a two-week period. We asked participants about their age and gender and they're interested in attending a lunch program and if they were interested we wanted to know how many times a week did they want to attend, which days would work best for them, how much were they willing to pay for a meal, ways they were willing to help with the program if at all and what kind of food they would like to eat. Given some of the literacy challenges and the low education wherever it was possible we tried to use pictures on the survey instead of just words just to make it a little bit easier for people to fill it on their own. So for the food choices as shown on the screen here we had pictures to accompany the types of food we were getting at just to make it a little less stressful and more inviting for people to complete the survey. We conducted a focus group with staff. The staff at the center included the program coordinator, the manager of the center, the volunteer coordinator, and community development workers. There were also two college-level students who were completing their placement at the center who participated in the focus group as well. Our focus group questions started off very broad and we were really just focused on understanding how the staff perceived a need for food-based programs for older adults in general and what they felt other senior centers do to offer that type of programming to older adults. And then we got into more specific questions about what a meal program might look like at their specific center, what challenges and benefits they anticipated or thought they might experience as they offered that program, and in their opinion what was needed in order to sustain the program over the long term. We conducted a community scan in order to determine what other related programs were available in the neighborhood. We were looking for anything from food banks to other congregate dining programs, anything formal or informal that existed. We limited our search to a 15 kilometer radius around the senior center. We did this because the older adult center association of Ontario conducted a survey with all of their centers that found that people typically don't travel more than 15 kilometers to attend their programs and services, so that's why we limited it to 15 kilometer radius. We consulted with key informants from the center who were familiar with the area about what types of services might be available. We did a Google search and we cross-referenced all of our information with online guides and directories for seniors programs, social programs, and food services in Toronto. So an example of a guide that we consulted was Toronto 211. And based on the community scan, we located five other senior centers nearby that offered a congregate dining program, and we were interested in hearing from them to find out what their program looked like. So we approached the program coordinators for a phone interview and we really got out what their program characteristics were, so how often they offered their program, what the budget was, how people registered, how involved their members were. We asked about what types of benefits the coordinators saw from people who participated in the program. And then finally, we asked the coordinators to identify any challenges that they've experienced with respect to delivering the program or sustaining the program long term. What did the members say? So the people who participated in our focus groups were predominantly female. There were only four men who participated, but this is consistent with the overall membership profile of people who attend the center. The participants ranged in age from age 55 to over 80. However, when we asked them to report their age, they did not feel comfortable telling us. They've reported things like 65 plus or I'm very old or I'm over 70. So we weren't actually able to determine their average age of the group. People reported that they were that they enjoyed eating a variety of ethnic foods, Caribbean food, Asian food, Canadian food, European food. They really were not picky eaters, so to speak. And all of the participants who attended the focus group said that they would love to attend a meal program with the overwhelming majority saying that they wanted it to be a lunch-based program. Members stated that they wanted the program to be offered two to three times per week and Wednesday was really their preferred day if they can only do it once. But they did say that Monday, Tuesday, or Thursdays would also work for them as well. We saw an interesting split with how much people were willing or able to pay per meal. About 45 percent were willing to pay four to six dollars per meal, but 42 percent were willing to pay one to three dollars per meal. And so that's a big difference and was a flag for us when we're thinking about what a program might look like because it's a pretty big difference between one dollar per meal and six dollars per meal. 29 of the members, so almost everyone who participated, expressed interest in volunteering with the program. And in fact, people see that they were interested in volunteering across multiple capacities, so they wanted to help with all sorts of aspects of the program, including setup, serving the food, cleaning up the room, the cooking, and or any fundraising that would be done to support the program. In the focus groups, it was revealed by one participant that she was having one heck of a heart sign eating properly. My cupboards are bare, so I eat peanut butter. Another participant also noted that they don't bring lunch and they don't eat lunch, but they would be at the head of the line if it was available. People really expressed a desire to eat healthy, fresh foods, and they suggested that the meals be prepared in the kitchen on site in order to ensure the freshness and the quality of the food. They wanted the dining room, like setting with tablecloths and music to really focus on the social aspects of the program, and they really only wanted the program to be available for members only. They didn't want to bring their family or their children. They wanted it to just be about them coming together to make new friends and have a nice social meal with each other. When we conducted our member verification about a month later, we found that people agreed with the idea of having a meal program that served healthy, tasty food that was offered two to three times a week and was for members only. But there was some areas of disagreement about program cost and how people wanted to volunteer for the program. Several people at the member verification felt that paying only one to three dollars per meal would be insufficient to provide the quality of meals they were hoping for. And one person noted that there's nothing good to eat for one or two dollars. And more than half of the participants indicated that they were unlikely to volunteer with the program on any sort of regular basis. So again, these are really important discrepancies for us because program costs and volunteerism are two really important things for determining how the program is going to function and whether it's accessible for everyone and if the program can sustain itself over the long term. So our center-wide survey was completed by 36 members and again, 14% of them were male. The 35 of the 36 people said they'd like to attend the survey. And you can see here that again, their food preferences are very healthy, very fresh, not very heavy meals. They didn't want pasta or bread or heavy meat. They really wanted soups and salads and fruits and vegetables. They said that they would like to attend the program two days per week on Mondays and Wednesdays. And again, here you see that there's a big split over how much people were really willing to pay. 25% said three dollars was their maximum, 30% said four dollars was their maximum, and 30% said five dollars. Most of the respondents said that they would be willing to help with the program, but they were really only hoping to do so with respect to cleaning up after the program or setting up the dining room before serving the meal. When we had our focus group with the staff, the staff really identified that there was a big need for a lunch program. They noted that a lot of their seniors live alone, have lost a spouse, or children have gone their own way. They don't feel they need to cook as much or eat a nutritious meal anymore. So they do the quick, easy thing, which is not necessarily nutritious. They felt that a lunch program would offer more opportunities for people to socialize together and build friendships. They felt that by providing a nutritious meal, it would really help improve the overall health of the people who participated and would increase more opportunities for people to volunteer at the center, as the staff were finding that people were always looking for ways to give back. The staff did express some concerns about how affordable this type of program would be for them, and if they'd have enough staff to really support the program in the way that it needed to be. Staff also wondered about how they would be able to provide meal options that were going to be suitable for everyone's personal preferences or any dietary restrictions that people might have. One staff member also questioned whether or not the center should be offering a program that had an additional user fee. Right now, all of their programs are offered free for charge once the annual membership fee has been paid. So members don't have to pay any additional fees to participate in any of their programs. But this meal program, the staff recognized would really need to have that additional user fee. And so the staff were unsure about how people would really respond to that, and if the program would be a favorable uptake by the members. With respects to sustainability, the staff said the two biggest things needed for program success are money and people. And one staff member noted that for it to work, you have to have at least 10 people participating because you can make a good meal for $30 for sure. But if there's only five people or four people, it gets harder and harder. The community scan identified five other senior centers within a 15 kilometer radius that offer a meal program. And you can see here that the menu pricing, the frequency of the program, and the days that they're offered all vary across the centers. If you look down here at center number five, which is the closest center to the one we were working with, only 2.4 kilometers away, they offer a meal on a once a month basis. So the one Friday of every month. And you'll also notice here that the meal costs for people who are not members of the center is $10 per meal, which is well outside of the price range that members of our center indicated they were willing to pay. I'd also like to point out that if an individual wants to attend programming at a different center, they are required to pay the annual membership fee. So the members would have to pay additional money in order to attend one of these meal programs. When we spoke to the other coordinators, they noted that the attendance to their lunch program was going to be highest on days when their center offered a lot of other programming. They all attempted to accommodate dietary restrictions when they all offered a vegetarian meal. Primarily the food that funded their program was outsourced from food suppliers. So an example of this might be second harvest, often they get pre-posed to prepare food. However, two centers have an onsite cook that they use to supplement the program. Many centers have external funding for the program, but the annual budgets were not well maintained. The cost of the program ranged from $10,000 a year to $75,000 per year. And so there was a lot of variation there and people didn't really have a clear idea of how their money was being spent. And the centers all stated that members are really involved in the program and they insist on things like selecting the menu items as well as cleaning out back in the program. One of the main challenges that was faced by the centers, especially those who outsource the meals, is that the meals that they bring in are healthy, yes, but tasty, no. The members have complained that the food is dry and that the fruits and vegetables are not fresh. The centers have also had to install additional kitchen equipment in order to keep some of the hot food hot. The centers also noted that it was becoming difficult to keep the program affordable while still trying to manage the rise and cost of food. They don't feel that it's always fair or that their members can afford to have the program price increase just because the cost of food is also rising. And finally, centers that relied on volunteers noted that recruiting and retaining volunteers was a big challenge that they faced, which is not really surprising. I think people are uncommon for senior centers. So based on the feedback that we received from the members and from the staff and from the other program coordinators, we put together three possible models that might work to offer a lunch program at our center. The first model is an outsourced meals model, where you purchase your pre-closed or your prepared foods from an external source and reheat that food or re-cook it on site. These meals could potentially be supplemented by a salad or a dessert, for example, that is prepared on site, which would address some of the challenges that were faced with respect to the quality and the freshness of the food. The staff at each center would be responsible for ordering the food and reheating or cooking the meals in the on-site kitchen. However, the members will be able to assist with things like program setup and cleanup. Two of the five centers that we identified offer a program through a model similar to this, and the challenges they noted again were the rise in cost of food and the food quality. The second program model that we came up with a volunteer-based model, and this is really relying on external volunteers to come in and prepare the meals on site. You would need to find a volunteer that has experience in quantity food production and safe food handling, and many of the centers noted that they provide a volunteer stipend in order to promote consistency and reliability from their volunteer. The center staff, however, are still responsible for the meal planning and completing the weekly grocery shopping. Two centers adopt a model like this, but they've experienced a lot of challenges with respect to finding reliable volunteers and also how expensive it is to do grocery shopping for a meal program serving 30 or 20 or 30 people. The final model, which emerged, was a rotating committee model. This is really a model that hinges on volunteer support from the membership team. Established groups at the senior center might take responsibility for preparing or serving a meal. So, for example, the sewing group might take a meal one week and the Spanish group might take a meal the next week. The staff at the center would assist each group in a planning for the meal and completing the grocery shopping, but each group would be responsible for preparing the meal using the on-site kitchen, completing the room setup, and cleaning up afterwards. Group members may be able to contribute by potentially bringing a dessert from home or bringing a salad from home, something like that. One of the challenges with this model, however, is that you're going to have to provide safe food handling workshops to your members who are participating in the cooking to ensure that food safety is occurring. And you would really need to have a lot of involvement with staff to assist and support the groups. However, this type of model has a lot of potential to really enhance the cooking skills of the membership and promote a lot of teamwork and collaboration in that friendship building, which is one of the main goals of the senior center. So this would be a good model if the membership were engaged to that. So the senior center took the findings from our needs assessment and they applied for a senior community grant. They received $10,000 to pilot the lunch program from October 2014 and it's ending this coming March 2015. They've adopted a volunteer-based program, so they have an external volunteer come in and they cook their meal in their kitchen. But what they're hoping to eventually move towards is a model where they're outsourcing the meals to an internal day program kitchen. So this senior center is associated with another community service agency that offers a day program for dementia patients. And that day program has a kitchen on site and the capacity to cook meals for large groups of people. And so the program staff would like to eventually figure out a mechanism to outsource their meal program food to this internal kitchen, which would address a lot of the food quality issues that other programs have experienced outsourcing from external agencies. The current meal program is offered two days a week on Wednesdays and Fridays. Wednesdays has a higher attendance with 20 to 25 members attending. Friday wasn't actually a day that emerged in the needs assessment as an ideal day. However, what happened was when they went to try to fit the meal program in on Monday, which was the other preferred day, they didn't actually have room in their calendar or their daily timetable to do that. They have to take out a program that's currently offered in order to do the meal program on a day. So they decided to move it to Friday and what they're finding is that people are attending the center more on Fridays and they're getting engaged in other activities or programs that are being offered around the time of the lunch program. So that's a really great way to get more people to come to your center on a day that might be a bit slower. In total, 67 members have accessed the program since October and this number is as of July 1st or January 1st, my apologies, so this might have changed. And the cost per meal has been set at $350. And I think what's most important is that the members of the center feel really excited and valued and proud knowing that they helped secure the funding that is supporting their meal program that they attend. The program is collecting a variety of records so that we can hopefully conduct a future evaluation to figure out how the pilot program works and ways that we can improve the program so that it is more tailored towards the center and the members' interests. They're collecting data related to the number of meals that they're serving and how many are being sold as leftovers. They're tracking things like how many hours the staff are involved in the program, what activities the staff are doing. They're also tracking volunteer hours and are looking at how the members are volunteering specifically to find out how often they're volunteering and what activities they're doing because that was a big area of discrepancy that emerged in our findings. And they're also hoping to be able to track the gender and the age of the program. But we know from experience that they connect all of this back to the CLSA data set. This is something that I thought of over quite a while. And the CLSA does an excellent job collecting information about how often people participate in social activities. And they really capture a wide variety of social activities. They look at family or friendship activities that happen outside of the home, religious activities that people might anticipate in, exercise classes, education or cultural activities, service clubs such as the Lions Club, neighborhood communities, volunteer and charity work and just broad categories of other recreational activities. And I think too a really important thing that the questioner gets at as well is what barriers people face when they're trying to access and participate in these social recreational and group activities. Currently there really hasn't been a lot of research looking at who uses senior centers, what types of programs are available for seniors at these centers. And so I think this was a really great opportunity to start thinking about what types of participation older Canadians are having in their community. And I think the next step then would be to begin thinking about where they're doing a lot of these activities. Many senior centers offer exercise classes, education activities, cultural activities, just volunteer opportunities, other recreational activities. But there are also other places where people may be completed or doing this participation. And so I think what would be very important to do is to figure out where people are going to do these activities and to participate socially in their community. And with that information I think that service providers such as people at senior centers would be able to begin thinking about who is attending their programs and what can they do to make their programs more tailored to the interests and needs of the community. So that's it for me. I just wanted to take a moment though to acknowledge the people who I conducted this project with. These do Bay and Kate Ducek who are also PhD students at the School of Public Health and Health Systems at the University of Waterloo. And we conducted this needs assessment under the supervision of Dr. Anita Myers. So now I'd like to take this opportunity to answer any questions that you might have. Great. Thank you very much Christine for this very excellent and informative presentation. So as I said at the outset before Christine gave her presentation, if you have any questions please use the chat features located at the bottom left hand side of your Blackboard Collaborate screen. Type in your questions and I shall read them. And we have one question here so let's get to it. A great presentation. Did you measure if the seniors had increased membership due to the meal program? That's a great question. So when a member when someone becomes a member of the center they get a membership swipe card that they have to swipe in when they come into the center each day. So one thing that we will be able to track is if more people and more unique members are coming to the center on Fridays for example to participate in the meal program because we'll have historical data for which members and how frequently members attend programs on the center on a given day. And we would be able to see if new members have joined the center but I don't know that we'd be able to attribute that specifically to the meal program. One thing that the members did note in their focus group was that they would be interested in having non-members attend the meal program if they were people who had the potential to become members. So if it was a friend who was just seeing what the senior center was really about and wanted to know what types of programs and services were offered to see if they should become a member they thought that would be okay. So I'm hoping that we'll be able to gather some information about if other people are attending the center more frequently because of this program or if people are now coming on Fridays when they never used to in order to come to the lunch program. I think we'll definitely be able to find that information out at the end of the pilot. Great, thank you. One question for me. Hold on before I ask a question someone else has something. Has your research looked at other barriers for seniors going to senior centers for meals other than mobility, transportation, etc? So most of the seniors who attend the center we worked with walk to the center or use public transit they really they're very hesitant to let us ask them questions about their about their personal life about what barriers they face about what mobility aids they might have about how they get to the center that they didn't even want to want to tell us how old they were. And so this is something that we're trying to work out as we get ready to evaluate how the pilot project functions to figure out in what ways can we ask questions to people about you know their transportation about mobility barriers about other access barriers that they experience and how that impacted their participation in the program. But that's it's been a challenge definitely because we found that people are very hesitant to open up about any sort of personal information that they that that would be relevant to us. Great, thanks. How portable might this program be in terms of applying it to other senior centers be they in Ontario or in other parts of Canada? Well I think I think it would be very portable because I I feel like it outlines a lot of steps that people should consider when they're trying to develop this type of program. So how should they elicit feedback from their member base how should they elicit feedback from their other staff members and I think too what's really interesting is that we were able to connect with other people at centers who offer these types of programs and what we found was that there were a lot of similarities with how their program functioned what it looked like how it was funded how they offered their meals so there was a lot of similarities and in fact one of the program coordinators suggested that she was really interested in trying to find a way to connect with other senior centers who are offering meal programs because she thought that might be one opportunity to increase purchasing power with food suppliers so that they could try to bring some of their costs down so that the program can stay affordable to the people who are attending. I see so a question from the audience what methods do the centers use to promote their meal programs both to those they want to attend the meals and to those who could fund or support the programs? So to my knowledge the centers don't do any external advertising trying to find people to give in-kind donations that might happen more at an individual level. Most of the funding aspect is going to be coming from granting agencies so they have to put together an application and have it be funded. In terms of how they promote their meal internally that comes down a lot to the staff at the center and the staffing levels and how connected they are to the members. The members do get a calendar of all of the monthly activities that have been planned out for the center for the upcoming months so they know when things are and what things are happening. Another center also noted however that one really big benefit of their meal program was that their kitchen kind of became the hub of the center and through having people you know coming together over food they were able to promote other programs at the center and so they found that the participation of the members in different programs that happen you know before and after the meal program increased because people were more aware of the services and programs that were available to them. Great thinking from I guess a broad public health or systems perspective. What are the potential implications? So this is more of a broad question. What are the implications of successful programs as you described for the health of seniors or population health or prevention? I think that these types of programs and senior centers in general have a big opportunity to be really impactful for people. One of the things for example that the staff talked about was how many opportunities they saw in a meal program to add an education component for example or to build on the program to expand it to just focus on nutritional well-being and not just here is a healthy meal for you today and you have an opportunity to socialize. So the staff saw a lot of opportunity for adding components to the program that would reach other aspects of people's health and well-being and I think that just the simple act of providing a meal with a group of people who you know and have friendships with is a really powerful thing. It's not just the nutritional benefit of the meal but it comes with the social interactions and developing new friendships and coming out of your house to engage in these programs and so I think senior centers as a whole have an opportunity to really become the hub of a community where older adults can come and find programs and activities that they think are relevant and interesting to them and we can build other mechanisms into those programs to promote health and well-being. So one example might be providing recipes of the meals that we're serving so that if a participant wants to go home they can maybe make that meal themselves or providing the nutritional information of the meal to help teach them how to read labels so that when they go grocery shopping they can make healthy food choices. Excellent thank you. So are there any further questions for Christine? I don't see any new questions coming through on the chat so maybe oh yeah we have one question that has come through. Why do you think more women than men use the congregate dining program? I think some of that might just be a function of that idea that women are living longer but I know that's a demographic trend that started to shift. I'm not sure why more women use these centers. I'm wondering if maybe more men are getting involved in different types of organizations for example. I know that there are a lot of just men's clubs that are geared towards older men in general and so maybe people feel like senior centers just aren't the spot for them. I'm not sure and I do think that that is something that is going to need to be examined further and I also think what will need to be looked at is how baby boomers want to use senior centers as they start to get older and these services become more interesting and relevant to them. How are we going to adapt the model of senior centers and what programs are available in order to meet these needs? So I think this is definitely something that needs to be explored and why women like these services that men don't and then identify ways that we can start to target or deliver programs that men want to participate in. It could be that just maybe none of these programs are interesting to older gentlemen. So that's definitely one of the ways where we really need to research senior centers and that's why I think something like the CLSA could be very, very useful if we could learn where people are conducting or participating socially in their community. You could start to identify demographic or understand who is using different services so do men prefer going to the YMCA and women's senior centers or are people getting their services in a totally different location and I think when we find out where people are going we can begin identifying what barriers they face to access programs at that location and then we can start tailoring programs that are going to attract all of the demographic that we're hoping to reach. Great thanks. So I guess a last call for any further questions. Is anybody frantically going to put their hand up to ask a question? There's a feature to allow for that but I don't see anybody raising their hand so I think then we are finished with the questions from the audience. So Christine thank you very much. I really enjoyed listening to your presentation and on behalf of all of us at CLSA we really do appreciate that you have taken the time to present this very interesting study to us. I enjoyed it very much. Thank you. Well thank you for having me and I hope that everyone was able to take something away from it. And I especially like how you connected your interests in your research to the CLSA in terms of how the CLSA might be a useful vehicle to advance research in your area so that was very good. Thank you. Great so thanks again to Christine for her presentation and just before everybody logs off a reminder that our next CLSA webinar is going to be on March 13th. It's a Friday from noon to 1 30. It's going to be an overview of CLSA and how CLSA will advance the science of population and health and aging through interdisciplinary research with specific emphasis on describing data access and release. The presenter is going to be Tina Wilson, one of the co-principal investigators and director of the statistical analysis center at McGill and Dr. Yves Chauhanet, the scientific director of CIHR's Institute of Aging will present opening remarks. So we look forward to that in about a month's time and hopefully you'll all be able to join us for this next webinar. Thank you for joining us today and thanks again to Christine. Have a wonderful afternoon everyone.