Food insecurity, experienced by 5.5 million older adults (7.7%) in the United States, is associated with poor health and health outcomes, and accounts for an estimated $130 billion annually in healthcare expenses. Persons with Alzheimer’s disease and Alzheimer’s disease-related dementias (ADRD) who reside in the community are at increased risk of experiencing food insecurity. Home-delivered meals are designed to promote food security, socialization, and independence among homebound older adults. Evidence, much of which our team has generated, continues to suggest that home-delivered meals affect the health and healthcare utilization of homebound, food insecure older adults, including those with ADRD. Given the strong link between food insecurity and health, healthcare entities (e.g., payers, integrated care organizations, providers) are increasingly interested in addressing food insecurity through home-delivered meals to older patients. While meals have traditionally been provided daily to clients’ homes by a volunteer or paid driver who visits with the client and reports any concerns about the client to the meal provider, less frequent deliveries of frozen meals have emerged in recent years as a lower-cost alternative. In this model, participants are provided one to two weeks’ worth of meals in one bulk delivery via postal courier (referred to as drop-shipped meals). The extent to which different meal delivery methods result in differences in healthcare utilization among persons with ADRD is unknown. As a result, healthcare entities are left with little guidance as to what mode of delivery is most effective in promoting community independence, particularly among a vulnerable and growing population with ADRD experiencing food insecurity. Our multidisciplinary team proposes to conduct a pragmatic randomized controlled trial comparing the outcomes between these two common approaches for delivering meals to food insecure individuals with ADRD, with an anticipated sample size of 2300 participants across six Meals on Wheels programs. During the pilot year of the R61, we will test and validate procedures to recruit individuals with ADRD and evaluate their outcomes. During the four-year R33, we will 1) evaluate the effectiveness of receiving daily home-delivered meals and accompanying wellness check vs. frozen, drop-shipped meals on the time to nursing home placement (primary outcome) as well as days in community and hospital transfers (secondary outcomes); and 2) characterize differences in the context, processes, and mechanisms contributing to the outcomes observed between the two modes of meal delivery among persons with ADRD. This research will be the first to prospectively evaluate the comparative effectiveness of the two predominant meal delivery options, in partnership with community stakeholders, on the ability to age in place among persons with ADRD. The knowledge generated from this research will help healthcare entities, senior nutrition prog...