Nutrition Services

Nutrition Program

Through the Older Americans Act (OAA) Nutrition Program, ACL’s Administration on Aging (AoA) provides grants to states to help support nutrition services for older people throughout the country. These services include the Congregate Nutrition Program and the Home-Delivered Nutrition Program, which provide healthy meals in group settings, such as senior centers and faith-based locations, as well as in the homes of older adults who live alone. Through the Aging Network’s meal providers, the programs provide a range of services including nutrition screening, assessment, education, and counseling. Nutrition services also provide an important link to other supportive in-home and community-based supports such as homemaker and home-health aide services, transportation, physical activity and chronic disease self-management programs, home repair and modification, and falls prevention programs.

Purpose of the OAA Nutrition Program

Nutrition services are authorized under Title III-C of the OAA. Designed to promote the general health and well-being of older individuals, the services are intended to:

• Reduce hunger and food insecurity,
• Promote socialization, and
• Delay the onset of adverse health conditions.

Services are not intended to reach every individual in the community. Programs target adults age 60 and older who are in greatest social and economic need, with particular attention to the following groups.

• Low-income older adults
• Minority older individuals
• Older adults in rural communities
• Older individuals with limited English proficiency
• Older adults at risk of institutional care

About 5,000 providers together serve more than 900,000 meals a day in communities across the country.

Nutrition Programs are funded (in part) by AoA, which administers the OAA. They are also funded by:

• State and local governments,
• Foundations,
• Direct payment for services,
• Fundraising,
• Program participants’ voluntary contributions (time and/or money), and
• Other sources.

Congregate Nutrition Services (OAA Section 331, sometimes called C1)

The Congregate Nutrition Services section of the OAA authorizes meals and related nutrition services in congregate settings, which help to keep older Americans healthy and prevent the need for more costly medical interventions. In addition to serving healthy meals, the program presents opportunities for social engagement, information on healthy aging, and meaningful volunteer roles, all of which contribute to an older individual’s overall health and well-being.

The Congregate Nutrition program serves individuals age 60 and older, and in some cases, their caregivers, spouses, and/or persons with disabilities.

Recent data from the National Survey of OAA Participants illustrates that Congregate Nutrition Programs are effectively targeting their services:

• More than 50% of participants are 75 years or older
• The average age of a participant is 76 years old
• 58% of participants indicated that one congregate meal provides one-half or more of their total food for the day
• 77% of participants say they eat healthier because of a meal program
• 76% of participants believe their health has improved as a result of a lunch program

Home-Delivered Nutrition Services (OAA Section 336, sometimes called C2)

The Home-Delivered Nutrition Services of the OAA authorizes meals and related nutrition services for older individuals who are homebound. Home-delivered meals are often the first in-home service that an older adult receives, and the program is a primary access point for other home- and community-based services.

The program serves frail, homebound, or isolated individuals who are age 60 and over, and in some cases, their caregivers, spouses, and/or persons with disabilities.

Recent data from the National Survey of OAA Participants illustrates how the Home-Delivered Nutrition Programs are effectively targeting services:

• 69% of individuals served by this program are 75 years or older
• The average age of a participant is 79 years old
• More than 60% of participants indicate that a home-delivered meal provides one-half or more of their total food for the day
• 91% of participants say that home-delivered meals help them to stay in their own home
• More than 50% of all participants live alone

This program serves much more than food. It provides a safety check, and sometimes the only opportunity for face-to-face contact or conversation that day.

Nutrition Services Incentive Program (OAA Section 311)

The Nutrition Services Incentive Program of the OAA provides grants to states, territories, and eligible Tribal organizations to support the Congregate and Home-Delivered Nutrition Programs by providing an incentive to serve more meals. Grantees can choose to receive their grant as cash, commodities (food), or a combination of cash and commodities.  Please note that the only NSIP requirements a provider must follow are in the OAA, Section 311.  Previous guidance provided by other federal agencies is no longer required.

Federal Grants for Nutrition Services

AoA issues grants for Congregate Nutrition Services and Home-Delivered Nutrition Services programs to states using a formula (Section 304) defined in the OAA. The formula is largely based on each state’s share of the U.S. population aged 60 and older.

AoA issues grants for the Nutrition Services Incentive Program to states, territories, and Tribal organizations using a formula (Section 311) defined in the OAA. The formula is based on the entity’s percentage of the total number of meals served in the prior federal fiscal year. For more information on the federal funding, see Funding Allocations to States and Tribal Organizations.

Nutrition Quality Standards

The OAA requires that all meals served using OAA funds adhere to the current Dietary Guidelines for Americans, provide a minimum of one-third of the Dietary Reference Intakes, meet state and local food safety and sanitation requirements, and be appealing to older adults.

Because services are state administered, each State Unit on Aging has the responsibility and authority (OAA Section 305) to implement the nutritional standards (OAA Section 339) to best meet the needs of the older adults that they serve. For example, a state may choose to use its funds to provide meals that focus nutrient standards or prevalent statewide chronic disease(s) or predominant health issues affecting older individuals. In practice, some states may require that menus for meals served using OAA funds be developed using nutrient analysis, eating patterns, or a combination.

Benefits of the Nutrition Program: A Research Brief

Older Americans Benefit from the OAA Nutrition Program (PDF, 385KB)

This research brief discusses findings from AoA’s recent National Survey of OAA Participants. It describes program requirements; the at-risk population served; and the link between nutrition, health, and the ability of older adults to remain at home. The brief also discusses participants’ perceptions of the impact of nutrition services on their quality of life.

Did You Know? OAA Nutrition Program Facts

The OAA is a flexible law that allows states to tailor programs to meet the needs of the older adults in their states/communities who are in greatest social and economic need. This Nutrition Program Did You Know? (PDF) presents information that may be surprising to some. In many areas, the OAA gives states the authority to add requirements beyond those in the OAA. That means some practices that might be allowable under the OAA could be handled differently in certain states or local areas. This document does not address state and local variances; rather, it reflects myths and truths from a federal perspective.

Performance and Outcome Information

AoA collects and reports on the performance of all OAA programs through the State Program Reports (SPR) component of ACL’s National Aging Program Information System. SPR serve as a critical measure of each OAA program’s performance. AoA uses the reported information for a variety of purposes, including its Congressional Justification. In practice, states may choose to access the SPR for intrastate or interstate comparisons. For example, a state may want to know if it is serving more or fewer home-delivered nutrition program participants than another state. For this type of data query, visit AGing Integrated Database (AGID). For information on national or state-specific performance outcome information, visit SPR. States, Area Agencies on Aging, or providers seeking to develop measures to assess their own program’s performance are encouraged to visit the Performance Outcome Measurement Project (POMP).

Programmatic Evaluation

ACL conducted a three-part evaluation of its Title III-C OAA Nutrition Services Program.

• Part One: Process Evaluation of OAA Title III-C Nutrition Services Program (PDF, 948KB) provides information to support program planning by analyzing program structure, administration, staffing, coordination, and service delivery. It evaluates the interactions between the many types of organizations that provide congregate meals, home-delivered meals, and collateral services under the OAA Nutrition Programs. This evaluation is complete and a Nutrition Program Process Evaluation webinar and handouts (PDF) are available.
• Part Two: OAA Nutrition Programs Evaluation: Meal Cost Analysis (PDF, 667KB) estimates the costs of program operations, the most important being the cost of the congregate and home-delivered meals provided using Title III. It also examines cost variation within the program by component and program characteristics. View the Process Evaluation and the Meal Cost Analysis webinar and handouts (PDF).
• Part Three: The Client Outcome Study: Part I was released in two parts with Part l describing nutrition services program participants’ demographics, health status, mobility, eating behaviors, diet quality, food security, socialization, and other characteristics, as well as participants’ experiences with  the program and their valuation of meals and supportive services received. See briefing handouts as well as responses to questions posed during the briefing for Part 1. Client Outcome Study: Part II describes participants’ health and health care utilization and examines overall wellness measured using longer-term outcomes related to health and avoidance of institutionalization. Briefing handouts from the webinar for the Part II report are also available.

Additional issue briefs and reports from this evaluation include:

• An issue brief that describes the nutritional quality of congregate and home-delivered meals offered through the NSP and examines their compliance with the 2010 Dietary Guidelines for Americans, which were in effect at the time of the data collection.
• A report that describes NSP participants’ needs, frequency of program use, and participation in other programs and use of services.
• An issue brief that examines the social activities at congregate meal sites and the role of those activities in improving socialization outcomes for participants.

More materials related to the evaluation can be found on the Programs and Evaluations Reports webpage.

National Resource Center on Nutrition and Aging

The National Resource Center on Nutrition and Aging (NRC) is one of many ACL-funded Resource Centers that provide information primarily geared toward professionals, and when possible, for consumers. The NRC’s mission is to disseminate information on how to build the capacity of the Aging Network’s nutrition services and increase the Network’s integration into a home- and community-based service system.