Chapter 2 Community-Based Nutrition Services

age. A limited number of individuals who are under age 60 may also receive services if they have disabili- ties or reside with older individuals or in residences at which congregate nutrition services are provided.

Home-Delivered Meals

Home-delivered meals (HDMs; also known as Meals on Wheels) are a valuable asset for increasing the nutrient intake of older adults who are at nutritional risk. Participants typically have more health problems than participants at congregate meal sites. In addition to meals, services include nutrition screening and edu- cation, nutrition assessment, and counseling as needed. These meals are also an essential service for many caregivers, helping them to maintain their own health and well-being (23). According to Brown University, “Many older adults need only a little support to stay in their homes, but when that isn’t available they can end up in an expensive nursing home where they don’t need most of the available services” (24). These programs can decrease length and frequency of hospital stays and help to allow participants to con- tinue to live in their homes. OAA regulations allow the provision of HDMs in a variety of formats. Meals may be delivered hot, cold, frozen, dried, canned, or as sup- plemental foods. Breakfast, lunch, dinner, or a mixture of two or three meals may be provided five or seven days per week. Many programs provide participants with shelf-stable meals to be used when emergency conditions prevent the regular meal delivery (23). Nutrition programs provide more than meals; they also support older adults and their caregivers in the home setting. This may cut spending for long-term ser- vices. Research has found that if the number of those over age 65 receiving home-delivered meals in 2009 increased by 1% in all states, the total yearly savings to Medicaid programs may have exceeded $109 million. Estimated savings would result from lower Medicaid spending on older adults needing less care and/or lower assistance with activities of daily living, thus no longer requiring nursing facility care. Older adults with ade- quate nutrition would be less apt to require a nursing facility (25) (Figure 2.1).

Major findings from various studies include the

following: ●

HDMs were the only significant factor among OAA services that affected state-to-state differ- ences in low-care nursing home population.

● DMs account for the bulk of OAA spending. ●

For every $25 that states spend on HDMs per older adult that is above the yearly national average, the state could reduce their percentage of

21

low-care nursing home residents compared to the national average by 1 percentage point (24,25).

Figure 2.1 Percentage of Persons with Limitations in Activities of Daily Living by Age Group: 2010

10 15 20 25 30 35 40 45 50

5 0

65–74 75–84 85+

Source: Reprinted from Administration on Aging, Adminis- tration for Community Living, US Department of Health and Human Services. A Profile of Older Americans: 2012. Wash- ington, DC: Administration on Aging; 2013:15. www.aoa.acl. gov/Aging_Statistics/ Profile/2012/docs/2012profile.pdf.

Nutrition Services Incentive Program Established by the OAA (Section 311) in 1974 as the USDA Nutrition Program for the Elderly, the program was transferred to AoA in 2003 and renamed the Nutrition Services Incentive Program (NSIP). NSIP grants are allocated to states, territories, and eligible Indian tribal organizations in addition to C1 and C2 and may be used only for food products such as dairy, meat, fruits, vegetables, and grains. They may not be used for meal preparation or to pay for other nutri- tion-related services such as nutrition education or for state or local adminis trative costs. These grants are based on the proportional share of the total number of meals served by all states, territories, and Indian tribal organizations in the prior federal fiscal year (FY) (18,19). NSIP’s goal is to expand the services of the OAA to a greater number of older adults (19).

UNITED STATES DEPARTMENT OF AGRICULTURE PROGRAMS

Child and Adult Care Food Program CACFP is authorized at section 17 of the National School Lunch Act (42 U.S.C. 1766). Program regulations are issued by the USDA under 7 CFR part 226. The USDA’s Food and Nutrition Service (FNS) administers CACFP to

Bathing/showering Dressing Eating Getting in/out of bed/chairs Walking Using toilet