Written by: Center for Care Innovations

Parking lots morphing into pop-up food pantries. Nutrition education classes moving online. Safety net clinics connecting food programs to medical care. Community-based organizations tackling transportation insecurity—through regional hubs, home delivery, and ride-share services—to ensure food insecure clients received bagged groceries and/or cooked meals.

These are just a handful of the ways community-based organizations met an unprecedented need to feed hungry Angelenos during the height of the COVID-19 crisis in 2020 as food insecurity skyrocketed, a result of both the pandemic and widespread unemployment. Even before the pandemic, an estimated 1 in 5 people in Los Angeles County lived with food insecurity, according to the Los Angeles County Food Bank. But after the COVID-19 outbreak, that percentage increased markedly. Now, an estimated 1 in 4 people in Los Angeles don’t have enough to eat.

Recently, three food security leaders in Los Angeles discussed their strategies to address this challenge in a webinar hosted by Moving Clinics Upstream, a CCI program in partnership with Cedars-Sinai. The speakers shared how their organizations pivoted during the pandemic to fight food insecurity during the coronavirus crisis. Here are highlights from the discussion, including the innovative solutions these groups continue to use to make sure none of their clients miss a meal or go hungry.

Find the video recording of the session and timestamps for all the key takeaways below.

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11:08 — Think Outside the Clinic

For 35 years, APLA Health has worked to achieve health care equity and promote well-being for the LGBT community living with and affected by HIV in Los Angeles. During all this time, its doors were open to distribute food to clients through the Vance North Necessities of Life Program Food Pantries. In 2020, however, the pandemic forced the organization to shift its services so staff could serve clients safely.

“We moved to a model where everything is done in the parking lot,” says Jeff Bailey, director of HIV access and community-based services at APLA Health, which is part of CCI’s Moving Clinics Upstream program. “We set up particular stations, where clients come in, they check in, and then they go to one of two or three stations in order to pick up their groceries. We also have socially distant tables where clients can take their bags and reorganize them, particularly if they’re on foot or they’re taking public transportation. Or perhaps there’s certain items that they would prefer not to have; they can organize them on those tables.”

Even before COVID-19 hit, APLA Health had planned to expand its food program in March. The organization now provides clients with 100 percent of their caloric needs (in the past, the supplemental food program provided a minimum of 50 percent.) The organization, which gained Federally Qualified Health Center status in 2014, went from providing food for around 530,000 meals a year to more than 900,000 meals’ worth of food, says Bailey. The organization’s food pantry program—part of the division Bailey oversees – grew from eight to 14 locations throughout Los Angeles County during the pandemic.

11:40 — Connect Food Services with Transportation

Besides offering food programs and setting them up in accessible locations, community organizations realized that they needed to address transportation insecurity as well so clients could collect the food they needed.

After APLA Health nearly doubled the amount of groceries it was distributing, for example, it began scheduling ride-sharing services through Lyft for patients who lacked access to transit to pick up food at pantry locations. “That has been a welcome addition to our program,” Bailey says. “In November, when we went back to the additional stay at home orders, we saw a particular uptick in clients accessing transportation.”

12:43 — Move SERVICES Online

APLA Health offers weekly nutrition classes in English and Spanish. Before COVID, clients could attend in person. “We had to move to a virtual methodology for offering those nutrition classes and a lot of our clients struggled with technology [and] learning how to use Zoom,” notes Bailey.

APLA then moved over to a platform called RingCentral, which is smartphone-focused and requires high-speed internet. “That was an educational opportunity as well for clients to get connected to technology,” says Bailey. APLA Health also sought out providers who would give smartphones to clients free of charge so they could get connected.

“We just initiated a kitchen-less bag program [for clients] who don’t have access to refrigeration or a stove.” — Jeff Bailey, APLA Health

13:07 — Meet Clients Where They’re At

Many distribute fresh vegetables and proteins and canned or packaged  foods that require cooking, for example, but unhoused clients don’t have the means to cook food. With this in mind, community organizations have adapted to meet such needs.

“We just initiated a kitchen-less bag program because we do have a number of clients that are housed unstably,” says Bailey, “or maybe they are living in an emergency facility where they don’t have access to refrigeration or a stove.”

18:17 — Develop Regional Hubs for Food Distribution

Supplying fresh food to all the organizations that wanted it proved a particular challenge in 2020, according to Pearson King, agency relations & field manager for Food Forward, a food recovery organization that distributes surplus produce to more than 300 organizations. The largest urban gleaning program in Southern California, Food Forward is dedicated to getting this excess bounty into the mouths of people who need it.

Food Forward warehouse

Due to major upheavals and disruptions in the food supply chain in 2020, many farmers were unable to get their food to market, and the government provided incentives to distribute it as consumer food relief. Food Forward, in fact, recovered more fresh food last year than ever before—around 60 million pounds of produce — almost twice as much as in previous years. This unprecedented abundance was also met with unprecedented demand from both existing and new food programs, King says.

Food Forward quickly realized that the organization needed regional hubs to accommodate demand, especially because its main warehouse was located in Bell, eight miles south-east of the city of Los Angeles. “Folks reached out and they came out in droves and we did everything we could to make sure that we were able to connect them to produce, to get to the people that they served,” explains King. “The first thing that we did was we launched regional hubs. We’ve launched three new regional sites: San Gabriel Valley, one down in the South Bay, and one in the South LA area, to make sure that organizations didn’t have to drive all the way up to Bell, to our warehouse, in order to get food.”

19:03 — MakE food pickup convenient

Food Forward also reconfigured its warehouse to make it more convenient to all comers. “To pick up at the warehouse, you’ve really gotta have a massive truck,” adds King. “So we actually expanded our warehouse. We doubled the square footage. We added a second door, a second loading dock, and we completely redesigned that site to serve small and medium-sized agencies. We have our largest agencies—folks coming with tractor trailers or large, full-size, heavy-duty box trucks–pick up at the Pit Stop. On the other side of the building, we have our folks coming in cargo vans and U-hauls and pickup trucks, or even just passenger vehicles, picking up at what we’ve affectionately called The Sprout.”

This kind of adaptation, he says, has allowed the organization to focus internally on its own gaps in service—beyond geographic coverage—to make sure that food is getting to the people who need and want it. 

34:29 — Consider Culture and Cooking

It’s not enough to simply make food available. Some clients need guidance around nutrition and cooking. Others may be most comfortable eating familiar foods. And, of course, food should not only taste and look good; it should be healthful for the recipients, moving the needle from simple food security to nutritional security.

Food Forward van

“You can make the best meal in the world, but if somebody doesn’t know what to do with it or doesn’t want it, it doesn’t really matter that you made a delicious meal,’ says King.  “It doesn’t really matter that you provided somebody with a really high value, really nutritious piece of fruit, if they just don’t want to eat it,” adds King, who says many organizations Food Forward works with consider cultural relevancy and food justice, along with nutrition, for their constituents.

Bailey agrees and explained some ways APLA Health addresses this challenge.  The organization provides recipe suggestions, along with food bags, and offers cooking demos—currently virtual—for clients who might not know how to, say, cook fish, incorporate tofu into their diet, or use a vegetable outside of their cultural comfort zone. “Someone might get something like a Thai squash and people had no idea what to do with it. Even salmon – [clients] didn’t say they didn’t like it; it was mainly because they didn’t know how to cook it,” he explains. “When we introduced tofu, we had to do food demonstrations around tofu so that people understood how to cook it.”

21:03 — Keep COVID Changes For The Long Haul

Panelists noted that many of the creative solutions demanded by COVID-19 are worth continuing when the pandemic wanes.

“So much of what we’ve all been forced to do because of COVID—changes in our programming, shrinking how many people are in a room at a time, changing how many organizations are picking up at a time—these sorts of things were done out of necessity,” notes King. “And necessity is the mother of invention, right? But we’ve got to hang onto a lot of these too, because so many of them are efficient, effective, and they’re safe beyond a pandemic; they’re safe for anybody participating at any time.”

24:12 — Remember That Food is Medicine

Both APLA Health and Project Angel Food, which delivers medically tailored meals to critically ill individuals, began delivering food to people in response to another pandemic: the AIDS crisis of the 1980s and 1990s. As Project Angel Food’s executive director Richard Ayoub explains, these organizations have long equated food as medicine—and an act of comfort, love, and dignity during challenging times.

Project Angel Food

Project Angel Food is one of six community-based organizations that form the California Food is Medicine Coalition, which provides free, nutritious meals to low-income residents with critical or chronic health conditions, such as heart disease, diabetes, and HIV.  “Here we are 32 years later living through another pandemic. So we truly feel we were born for this moment,” says Ayoub. “If there was any time where Project Angel Food couldn’t slow down, shut down, it was this time,” says Ayoub, noting that the organization went from serving 1,500 people a day to serving 2,300 people every day.

“Human connection is really important, but we keep six feet away. We wear a mask, they wear a mask, we smile under the mask.” — Richard Ayoub, Project Angel Food

Project Angel Food previously delivered around 600,000 meals a year, but last year it broke the one million meal mark in December, notes Ayoub. “During the pandemic we’ve learned that we could do more, and we could do it faster than we ever thought we could,” he says. “We never would have thought in one year we could grow by 400,000 meals, but out of necessity, we made it happen.”

38:41 — Diversify Your Funding Sources

Responding to food insecurity—including recent demand—requires funding to sustain programming. All three panelists spoke about diversifying funding streams and finding a balance between public and private sources. Bailey suggested getting creative: seeking clinic pharmaceutical reimbursement funds, for instance, which can be used to support food security programs. Among other suggestions:

Look for ways to partner with like-minded organizations to expand services.

“At Project Angel Food, about 78 percent of our funding is non-government funding,” notes  Ayoub.  “Yes, we get a good chunk from the Ryan White Act –close to a million dollars, which is great. Our budget is about 7 million. A lot of it comes from corporations, individuals, and foundations. Food insecurity has really put a spotlight on us and organizations like us. And we’ve had an influx of clients because of that. We need to sustain these clients we have and continue to grow. So yes, we need to find [other] funding models. And there are two things we’re doing right now. We’ve partnered with five other agencies in California, and we’ve already been doing this pilot program that Medicaid, which is Medi-Cal in California, is funding where we’re providing meals for people with congestive heart failure.”

Gather data to show how cost-effective food programming can be in the long haul.

“We are proving that food is indeed medicine and there’s an ROI [return on investment] to having the right food,” says Ayoub. “It reduces healthcare costs, reduces readmissions to the hospital and reduces hospital stays. So all of that is a big ROI. And then for the person in the family, it improves their quality of life. While that pilot continues to go and we see great results in it, we are doing a budget request to the state of California asking for $9 million for this year for these six agencies to help us, in response to COVID, help more people out.”

Communicate the value of food security in human terms.

Ayoub discussed a recent national bill that’s been introduced into Congress. “It is to get Medicare to do a similar pilot to our Medicaid pilot in California,” he says. “All of this is going to take a lot of advocacy work and who knows how quickly we can get that done” – not to mention attracting funding by communicating the pilot’s value in human terms.”

“From a clinic perspective, funding streams are really all about storytelling and how you find individuals that are interested in telling that ROI,” King explains. “I think now the story of food insecurity is easier to tell to funders, because we all experienced that stochastic event of upheaval, major issues with an entire supply chain,” he notes. “It really created a lot of interest, a lot of buzz, and people got very focused telling that story of food insecurity. It’s a lot easier. It’s changing the narrative of folks who have worked in hunger relief and food justice. The three of us have always talked about food as medicine, and we’ve certainly always told people that hunger doesn’t look like what you think it looks like. Those two pieces are a lot easier to talk about now than they were a year ago.”

26:50 — Manage Expectations During Uncertain Times

Like many non-profit, community-based food organizations, Project Angel Food’s kitchen was run by a mostly volunteer crew prior to the pandemic. But COVID forced Project Angel Food to hit pause on the volunteer front—as many organizations were forced to do. Instead of its typical kitchen shift of 25 volunteers, the organization hired eight out-of-work restaurant chefs to handle kitchen duties during the pandemic. What lesson did the organization learn in this process? “We might want to hire more professional chefs to help the volunteers so we can keep at this pace,” says Ayoub

Ayoub’s motto during the COVID crisis: No one misses a meal.

“We do whatever it takes to get the meals to [clients]. At the very beginning, we delivered three weeks of shelf-stable meals to every single client, just in case an emergency happened, just in case they were quarantined,” he says. “We didn’t know if we were going to be shut down in March. We didn’t know what was going to happen. I went and delivered meals the first week of the initial lockdown,” he recalls. “I went to the Skid Row area, some of those single room occupancy hotels, and first of all, they were shocked we were still there. Secondly, the question almost everyone asked is: ‘You will be back next week, won’t you?’ There was a great deal of fear — very, very similar to the AIDS crisis. My answer was: ‘Yes, we’ll be back next week and we’ll keep coming back.’ And that’s been what we’ve been doing.”

28:05 — Adapt Quickly When One Crisis Spills Into Another

Not only did Project Angel Food return to its Skid Row clients, it tailored its approach to meet their hygiene needs  Remember the great run on toilet paper and personal hygiene supplies?

“There was a moment when we couldn’t get toilet paper,” Ayoub recalls. “So can you imagine if we can’t get toilet paper, how about these people who are sick, can’t shop and cook for themselves, and they shouldn’t be leaving because they’re the most susceptible to the virus, how are they going to get it? So we decided to put hygiene kits together for all of them. We gave them gloves, masks, toilet paper, and hand sanitizer,” he recalls. “COVID forced us to actually take on a bigger role with our clients. And we continued to do delivery. That human connection is really important, but we keep six feet away. We wear a mask, they wear a mask, we smile under the mask.”

50:34 — Offer One-Stop Shopping for Food & Medicine

King notes that time is a precious commodity for safety-net clinic clients.

“One of the things that we’ve seen with collaboration is it allows for a lot of creative problem solving around time,” says King. “Breaking down that barrier, by delivering to people’s homes or co-locating your services so that when people arrive to pick up their bag of produce, they also have an appointment for that day. Referring people or scheduling their follow-up appointments on the same day as your food distribution,” he says. “We have been working with Venice Family Clinic on an onboarding project where folks screen, new patients for food insecurity.”

Timing food pick up services to when a client is already on site just makes sense, says King.

“Start by saying, ‘Well, are you free on Tuesday? Cause every Tuesday we have a food distribution and we’ll set a bag of produce aside for you,’” he says. “’So on your way out after your appointment, grab your produce,’ that [kind of] tacking on–anybody who’s ever tried to get college students to do anything knows that you offer them pizza, right? And they’ll show up. It can be the same thing. It’s very difficult to get people to come to a location that they’re going to have to be at next week…Find ways to offer as many services as you can [while they’re there].”

These kinds of collaborations and stacking of services, King continues, tend to work the best, and they also tend to attract the most funding. “Because you’re able to gather a bunch of data and you can actually prove that a dollar spent on this event is better than a dollar spent on just giving people books about how to cook food,” he says. “This is a better use of those dollars.”

Jeff Bailey agrees. He says APLA Health uses a reverse methodology approach to see how its outreach around food programming can serve to connect client to medical care and other center services.

“Even though it has been challenging because of COVID, we still have been creative in how we engage clients in our parking lots, even setting up office spaces in our parking lots,” he says. “We’re not letting clients in the buildings, so that there’s still an opportunity for them to engage with staff safely, but outside in the fresh air.”

28:57— Nourish The Whole Client

Project Angel Food pivoted to offer services to feed people’s souls during the pandemic as well.

“We realized these people are the most isolated people you can possibly find. And some of them are going through depression,” he explains. “So we started a new program called the telephone angels where we pair some of our volunteers, who are a little lonely, with our clients who are lonely. It’s a buddy system. They have check-in calls every week, and it cheers everyone up,” says Ayoub. “It actually has created some amazing friendships. One of the volunteers told me that she was on the phone for two hours because that’s how long that client needed to talk.

“There’s been a lot of darkness surrounding this horrible virus. But when you look at APLA Health, Food Forward and Project Angel Food, this is where you see the bright light, because the community has come together to help all these organizations flourish,” notes Ayoub. “It’s good to be here with everyone.”



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