Americans Act 2000 Nutrition Requirements
SUBPART 1--CONGREGATE NUTRITION SERVICES
Assistant Secretary shall carry out a program for making grants
to States under State plans approved under section 307 for the establishment
and operation of nutrition projects...
which, 5 or more days a week (except in a rural area where such
frequency is not feasible (as defined by the Assistant Secretary
by regulation) and a lesser frequency is approved by the State agency),
provide at least one hot or other appropriate meal per day and any
additional meals which the recipient of a grant or contract under
this subpart may elect to provide;
(2) which shall be provided in congregate settings, including adult
day care facilities and multigenerational meal sites; and
(3) which may include nutrition education services and other appropriate
nutrition services for older individuals.
SUA Congregate Nutrition Services Standards / Guidelines
at least one hot or other appropriate meal in a congregate setting
at least once a day, five or more days per week.
necessary (in case of illness, injury, etc.) make home delivered
meals available to congregate meal participants.
a minimum of 98% of all meals to eligible participants and their
procedures for responding to emergency situations for all congregate
sites and provide ongoing training on emergency procedures to
all site managers and other site staff.
nutrition education available to mealsite particpants at a minimum
of once each quarter.
education subjects shall be based on the needs of the participants.
Nutrition information and visual educational materials shall be
available to the participants on a continuing basis.
congregate nutrition site shall be open for at least three hours
per mealtime unless a waiver is received from the Area Agency
congregate nutrition site shall be neat, clean and have adequate
lighting, ventilation, and temperature control.
the maximum extent possible, sites are open at least five days
a week in recognition of the greater impact on the nutritional
status of participants.
sites are open at least one hour before and after the meal to
permit all participants to eat a leisurely meal, enjoy social
contact, and take advantage of other services at the site.
the maximum extent possible there is space available for supportive,
educational and/or recreational services and activities.
the Congregate Nutrition Program
has been a steady decline in both the number of congregate participants
and meals served (2). It is important that service providers identify
means by which their congregate meal services can be expanded and
improved. Ask the Experts Topics: Addressing
the Image of Older Americans Congregate Nutrition Programs,
Participation at Older Americans Act Title III Funded Congregate
Meal Sites, and Restaurant-based
Congregate Nutrition Sites and Restaurant Voucher Programs
offer guidance and suggestions, some of which are included below.
should have policies and procedures in place to help nutrition providers
enhance their programs. The following are some examples to consider:
flexibility, provide food choices and culturally proficient services.
programs at different times during the day, such as breakfast
a variety of activities, transportation to sites, and linkages
to other nutrition and social services.
outreach activities and improve marketing.
a restaurant as an alternative site to provide ethnic meals or
vouchers for individuals to redeem at participating restaurants,
cafeterias (hospital or school lunchroom), grocery stores, food
National Policy and Resource Center on Nutrition and Aging conducted
a survey of nutrition providers, the Nutrition
2030 Grassroots Survey. Providing outreach and improved
marketing were the top-ranked items in the congregate section.
DELIVERED NUTRITION SERVICES
with congregate meals, home-delivered meals (HDM) (sometimes called
meals on wheels) help increase the nutrient intake of older adults
at nutrition risk. HDM participants tend to have more health problems
than congregate participants. The HDM service is associated with
decreased hospital stays and allows participants to remain in their
homes. The OAA allows much flexibility in the type of HDMs provided
to older adults. Such meals may be delivered hot, cold, frozen,
dried, canned or as supplemental foods. In addition, breakfast,
lunch or dinner, or a combination of 2 or 3 meals, may be provided
5 days per week, but can also be provided on weekends.
manager often plays an integral role in the cross-referral and coordination
of service delivery of home and community-based care services (HCBC).
Since older adults are being discharged earlier from hospitals and
nursing homes, many require a care plan that includes HDMs and other
nutrition services, ie, nutrition screening, assessment, education,
and counseling. Many states enroll Medicaid beneficiaries in Health
Maintenance Organizations, use Medicaid HCBC waivers, and create
state-funded programs to provide necessary HCBC medical, social,
and supportive services including HDMs and nutrition education and
counseling services (4).
contrast to congregate meals, the number of HDMs has been steadily
increasing each year. In FY 1988 there were 94.7 million HDMs served
compared to 130 million in FY 1998, a 27.2% increase (1). The demand
for HDMs will continue to increase due to health care cost containment
and rapid hospital discharge. States need to evaluate funding sources
to maximize the availability of HDMs as well as expand and enhance
their nutrition services in response to the diverse and burgeoning
number of older Americans.
Americans Act 2000 Nutrition Requirements
2--HOME DELIVERED NUTRITION SERVICES
Assistant Secretary shall carry out a program for making grants
to states under State plans approved under section 307 for the establishment
and operation of nutrition projects for older individuals which,
5 or more days a week (except in a rural area where such frequency
is not feasible (as defined by the Assistant Secretary by regulation)
and a lesser frequency is approved by the State agency), provide
at least one home delivered hot, cold, frozen, dried, canned, or
supplemental foods (with a satisfactory storage life) meal per day
and any additional meals which the recipient of a grant or contract
under this subpart may elect to provide.
SUA Home Delivered Nutrition Services Standards / Guidelines
a nutritious home delivered meal at least once a day, 5 days a
week. Meals may be hot, cold, frozen, dried, or canned foods with
a satisfactory storage life.
the consent of the older person, or his/her representative, bring
to the attention of appropriate officials for follow up conditions
or circumstances which place the older person or the household
in imminent danger.
arrangement for the availability of meals to older persons in
weather related emergencies.
Home Delivered Meals may be hot, cold, frozen, dried or canned
with a satisfactory storage life, and must conform to procurement
Home Delivered Meals service may include the delivery of more
than 1 meal for each day's consumption provided that proper storage
and heating facilities are available in the recipient's home.
2030 Grassroots Survey found that increasing and maintaining
volunteers and performing needs assessments were the top-ranked
issues in the HDM section. The difficult challenge of deciding who
has priority as a potential meal recipient when resources are limited
is indicated by the emphasis on needs assessment as the second ranked
item. There were differences by funding source for increasing and
maintaining volunteers with privately-funded respondents giving
that a higher ranking than did public or public/private, indicating
that volunteers play even more important roles in privately-funded
is common to provide a combination of two or three meals including
breakfast, lunch and/or dinner, to participants receiving HDMs.
Multiple meal packages are typically delivered with the noon meal.
Breakfast, a popular meal with older adults, contributes to their
health and well being by increasing intakes of critical nutrient
dense food groups associated with positive health outcomes: cereals
and grains, complex carbohydrates, fruits, fiber, milk, and milk
products (5). Written eligibility requirements can help determine
a participant's need to receive one or more meals. A best practice
is to conduct periodic reassessments to determine the continued
need for HDMs and the number of meals per day. Congregate nutrition
programs may also serve breakfast and/or dinner in addition to or
instead of lunch. Such services reflect the needs of a particular
community or group and may only be provided on a limited basis during
the week or month (e.g., 1 day per week or month).
homebound participants have functional impairments that make it
difficult for them to shop and prepare meals. A number of nutrition
programs offer weekend meals to frail, homebound participants receiving
home-delivered meals. Weekend meals help contribute to a nutritionally
adequate diet for these individuals and provides respite for family
and friends. Written eligibility requirements, as noted above, would
assist in determining a participant's need to receive weekend meals.
Congregate nutrition programs may also serve meals on weekends at
specific sites, again reflecting the needs of a particular community
meals are often used in areas where daily delivery is limited, for
weekend meal services, or to enable home delivered meal programs
to offer more menu choices. The participant's kitchen (having appropriate
appliances to store and reheat meals) and functional ability (can
handle and/or heat meals) must be carefully considered when providing
frozen meals. Frozen meals may also be used at congregate sites
in rural areas where participation is small and other food service
options are not feasible. Such meals would be heated and served
at the site.
/ Emergency Meals
meals are generally shelf-stable ready to eat food products. Meal
packages are generally provided to participants determined to need
such food products if the program is unable to deliver meals due
to weather or other problems. A best practice is to instruct participants
on when and how they should use their emergency meal packages or
to provide written suggestions for preparing their own emergency
food stores. Program emergency preparedness is covered in Chapter
SUA Emergency Meal Standards / Guidelines
Nutrition Projects must offer all home delivered meals clients,
at the time of assessment, a shelf stable emergency meal package,
available for use during inclement weather or other emergency situations,
when the Project is unable to deliver meals.
case manager may identify current clients who may require an emergency
meals participants should be advised to keep an emergency foods
shelf at home in case of inclement weather.
emergency meal package for home delivered meals participants shall
be delivered to clients by November 1 of each year.
package should consist of two to three days of shelf stable foods
and shall be replenished by the Nutrition Project.
is recommended that the emergency meal package contain one-third
RDA; the package should, as much as possible, match the regular
no added salt policy is waived for these meals, however, low sodium
items are encouraged.
requiring unsweetened foods must be provided with appropriate
SERVICES INCENTIVE PROGRAM AND COMMODITIES
Services Incentive Program is the new name for the U.S.
Department of Agriculture (USDA) cash allotment or commodity
program. The OAA authorizes the USDA to provide state agencies with
either a cash allotment or commodities to encourage the effective
and efficient delivery of meals funded through Titles III and VI
of the OAA. States have latitude regarding whether they offer one
or both of these options to nutrition projects. Although very few
area agencies or nutrition projects use the additional option to
use commodities, this is part of the program. Most SUAs do not use
the commodity option and only a cash allotment is available. About
98.5% of the USDA funding is distributed as cash; 11 states use
commodities. Examples of commodities are frozen or chilled beef
or poultry, cheese, pasta, rice, canned or frozen vegetables, flour,
vegetable oil, and butter.
projects equipped to handle commodities may find them more cost
effective than cash in lieu of commodities. Furthermore, additional
commodities are available for state or area agencies on aging that
take at least 20% of their program benefits as commodities.
need written policies and procedures for use of cash and commodities,
as well as reporting the number of meals served. Accepting USDA
assistance is a necessary component of maintaining solvency of the
Americans Act 2000 Nutrition Requirements
311 NUTRITION SERVICES INCENTIVE PROGRAM
The purpose of this section is to provide incentives to encourage
and reward effective performance by States and tribal organizations
in the efficient delivery of nutritious meals to older individuals.
(b)(1) The Secretary of Agriculture shall allot and provide in the
form of cash or commodities or a combination thereof (at the discretion
of the State) to each State agency with a plan approved under this
title for a fiscal year, and to each grantee with an application
approved under the title VI for such fiscal year, an amount bearing
the same ration to the total amount appropriated for such fiscal
year under subsection (e) as the number of meals served in the State
under such plan approved for the preceding fiscal year (or the number
of meals served by the title VI grantee, under such application
approved for the preceding fiscal year), bears to the total number
of such meals served in all States by all title VI grantees under
all such plans and applications approved for such preceding fiscal
(2) For purposes of paragraph (1), in the case of a grantee that
has an application approved under title VI for a fiscal year but
that did not receive assistance under this section for the preceding
fiscal year, the number of meals served by the title VI grantee
for the preceding fiscal year shall be deemed to equal the number
of meals that the Assistant Secretary estimates will be served by
the title VI grantee in the fiscal year for which the application
(c)(1) Agriculture commodities and products purchased by the Secretary
of Agriculture under section 32 of the Act of August 24, 1935 (7
U.S.C. 612c), shall be donated to a recipient of a grant or contract
to be used for providing nutrition services in accordance with the
provisions of this title.
(2) The Commodities Credit Corporation shall dispose of food commodities
under section 416 of the Agricultural Act of 1949 (7 U.S.C.1431)
by donating them to a recipient of a grant or contract to be used
for providing nutrition services in accordance with the provisions
of this title.
(3) Dairy products purchased by the Secretary of Agriculture under
section 709 of the Food and Agriculture Act of 1965 (7 U.S.C. 1446a091)
shall be used to meet the requirements of programs providing nutrition
services in accordance with the provisions of this title.
(d)(1) In any case in which a State elects to receive cash payments,
the Secretary of Agriculture shall make cash payments to such State
in an amount equivalent in value to the donated foods which the
State otherwise would have received if such State had retained its
(2) When such payments are made, the State agency shall promptly
and equitably disburse any cash it receives in lieu of commodities
to recipients of grants or contracts. Such disbursements shall only
be used by such recipients of grants or contracts to purchase United
States agricultural commodities and other foods for their nutritional
(3) Nothing in this subsection shall be construed to authorize the
Secretary of Agriculture to require any State to elect to receive
cash payments under this subsection.
(4) Among the commodities delivered under subsection (c), the Secretary
of Agriculture shall give special emphasis to high protein foods.
The Secretary of Agriculture, in consultation with the Assistant
Secretary, is authorized to prescribe the terms and conditions respecting
the donating of commodities under this subsection.'
(e) There are authorized to be appropriated to carry out this section
(other than subsection (c)(1)) such sums as may be necessary for
fiscal year 2001 and such sums as may be necessary for each of the
4 succeeding fiscal years.'
(f) In each fiscal year, the Secretary of Agriculture and the Secretary
of Health and Human Services shall jointly disseminate to State
agencies, area agencies on aging, and providers of nutrition services
assisted under this title, information concerning-
(1) the existence of any Federal commodity processing program in
which such State agencies, area agencies on aging, and providers
may be eligible to participate; and
(2) the procedures to be followed to participate in the program.
SUA Nutrition Services Incentive Program Standards / Guidelines
Because these SUA policies were collected prior to the 2000 reauthorization
of the OAA, authorizing Nutrition Services Incentive Program (NSIP)
SUAs are revising policies to accommodate NSIP changes.
providers shall accept and use all commodities, including bonus
commodities, made available by the state agency and funded by
projects shall store commodities as prescribed in the "Donated
Food Standard Agreement".
nutrition project shall accept only the quantity and type of food
stated on the invoice. If the quantity is less than shown on the
invoice, the nutrition project shall note this on the invoice,
and request the deliverer to initial.
projects shall report any irregularities in the commodity shipping
invoices to Food Assistance.
agencies shall promptly and equitably disburse all USDA cash in
lieu of commodities payments to nutrition providers that are funded
with OAA funds.
distribution of such funds to the nutrition service provider(s)
shall be in proportion to the number of meals served by each provider.
agencies shall ensure that payments received by nutrition providers
are used solely for the purchase of United States agriculture
commodities and other foods produced in the United States; or
Meals furnished under contractual arrangements with food service
management companies, caterers, restaurants, or institutions,
provided that each meal contains United States produced commodities
or foods at least equal in value to the per-meal cash payment
which the nutrition service providers have received.
nutrition provider shall ensure that adequate inventory records
are maintained on commodities received. The inventory must show
commodities received, used and on-hand.
provider shall receive, handle, store and utilize USDA commodities
made available for Title III-C, in accordance with State Policy
and Procedure for Distribution and Control of Commodity Foods.
The provider agrees to comply with these regulations around the
proper use, storage, loss or damage of commodities and recording/accounting
procedures involved. The provider will be responsible to the Nutrition
Project and the State Distributing Agency in the outlined areas
provider recognizes the following responsibilities to be its own:
provider will make use of available USDA commodity foods made
available by the Nutrition Project. The provider shall submit
monthly credit vouchers for commodity foods received. The provider
must use a minimum of $0.13 per meal for commodities for the month.
confer with the Nutrition Program manager and nutritionist in
the ordering of commodities in accordance with an accepted utilization
rate and to work with the nutritionist in designing menus to incorporate
the available commodities.
provider shall properly store and mark for easy identification
all commodity foods.
sign for receipt of shipment of commodities and notify the Nutrition
Project of such in writing.
commodities to be credited will be the total value of the commodities
received. Credit will be made on the month that the commodities
of nutrition projects may also participate in the USDA Commodity
Supplemental Food Program (CSFP). This program works to improve
the health of low-income pregnant and breastfeeding women, infants,
children up to age six, and people at least 60 years of age, by
supplementing their diets with nutritious USDA commodity foods.
It provides food and administrative funds to States to supplement
the diets of these groups.
and Resources concerning OAA Meal Services are available on the
Centerís website at:
Aging Services Network Programs and Organizations
Administration on Aging. 1998 State Performance Reports. Available
Accessed September 7, 2001.
Policy Research, Inc. Serving Elders at Risk, the Older Americans
Act Nutrition Programs: National Evaluation of the Elderly Nutrition
Program 1993-1995, Volume I: Title III Evaluation Findings. Washington,
DC: US Department of Health and Human Services; 1996.
NS, Smith J, Alfonso M, Lloyd J. (1999) Report: The Nutrition 2030
Grassroots Survey. Florida International University, Miami, FL.
DO, Faneelli-Kuczmarski M. Position
of the American Dietetic Association: Nutrition, aging, and the
continuum of care. J Am Diet Assoc. 2000;100; 580-595.
DO, Gollub E, Stacey SS, Wellman NS (1998) Final Report: The Morning
Meals on Wheels Program Pilot Program: The Benefits to Elderly Nutrition
Program Participants and Nutrition Projects. Florida International
University, Miami, FL.