CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM STANDARDS TRAINING- OAA AND OPI

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CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM
STANDARDS TRAINING- OAA AND OPI

• Presented by
• Judy Bowen, OAA Program Analyst 3
• DHS/SPD State Unit on Aging
• 676 Church Street NE
• Salem, Oregon 97301
• [phone]
• judy.bowen_at_state.or.us

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OAA Nutrition

• The goal of this Netlink training is to provide
  Administration on Aging data for older adults and
  an overview of the Older Americans Act Standards
  and Guidelines for both the Congregate and
  Home-Delivered Meal Programs.
• The learning objectives for this session are
• Increase understanding of the OAA Nutrition
  Program.
• Apply this knowledge to your individual OAA meal
  operation sites.

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Number of Older Americans
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Poverty Rates

• Racial/ethnic
• 7 White
• 22.7 African American
• 12.0 Asian American
• 19.4 Hispanic Americans
• Gender
• 6.6 men
• 11.5 women
• Living arrangements
• 5.6 living with families
• 16.9 living alone

• Location, higher than average
• 12.7 principal cities
• 11.0 rural
• 11.7 South
• Highest poverty rates
• 40.5 Hispanic women, living alone
• 37.5 Black women, living alone

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Administration on Aging. A Profile of Older
Americans 2008.
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Out-of-Pocket Health Care Expenditures
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Inter-related Factors Affecting the Nutritional
Well-Being of Older Adults
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Impacts of Food Nutrition on Health
POOR DIETS
Without Adequate Healthy, Safe Food Nutrition
Services (Deafness Blindness Reduced Smell
Taste Chewing Swallowing Problems Joint
Destruction--Costly Replacements Confusion,
Forgetfulness, Memory Loss Uncontrolled High
Blood Pressure--Heart Attack, Stroke
Uncontrolled Diabetes--Amputations, Blindness,
Nerve Disorders, Dialysis Osteoporosis--Weakened
Bones, Decreased Mobility and Falls Decreased
Immune Response--Flu, Colds, Upper Respiratory
Infections, HIV/AIDS Decreased Organ Function
Organ Failure Wasting--Dwindles or Failure to
Thrive Involuntary Weight Loss ? Body Mass
Index, ? Muscle Mass Excessive Weight
Gain--Obesity ? Serum Albumin--Protein
Malnutrition Pressure Ulcers)
Slower Recovery
Low Stamina
Longer Hospital Stays
Sleep Disturbance
Hospital Re-Admissions
Depression Anxiety
Poor Appetite
Premature Institutionalization
Increased Morbidity Mortality
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Reduced Quality of Life - Lessened
Independence - Increased Healthcare Costs
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Nutrition Related Chronic Health Conditions
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IMPACT OF MALNUTRITION ON FUNCTIONALITY
Malnutrition Underweight Obesity
Limits Muscle Strength Reduces Stamina Prevents
Physical Activity
Decreases ability to Perform ADLs IADLs Eat,
Walk, Grocery Shop, Prepare Meals Grip Items
Lift Heavy Objects
Increases Dependency Increases Need for
Caregiver Assistance Increases Risk for Falls
Fractures
? Threatens Independence ? Reduces Quality of
Life ? Increases Healthcare Costs
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Diseases Affected by Diet Future NH Use
Valiyeva E, et al. Lifestyle-Related Risk Factors
Risk of Future Nursing Home Admission.
Archives of Internal Medicine. 2006 166985-90.
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Persons 70 with Obesity Related Conditions

• 18 Diabetes
• 50 Hypertension
• 65 Osteoarthritis

Villareal, et al. Obesity in older adults
technical review and position statement of the
Am. Soc. For Nutrition and NAASO, the Obesity
Society. Am J Clin Nutr. 2005
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Food Security

• Access by all members of a household to be food
  sufficient for a healthy life, including at a
  minimum, the ready availability of nutritionally
  adequate and safe foods and the assured ability
  to acquire acceptable food in socially acceptable
  ways.
• Economic Research Service, USDA

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Prevalence of Food Insecurity in the USHousehold
Food Security in the United States, 2007, ERS,
USDA
http//www.ers.usda.gov/Briefing/FoodSecurity/stat
s_graphs.htmfood_secure
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Older Americans Act Programs Services

• Established 1965Nutrition Program established
  1972
• No income requirementsForbids means-testing
• Means-testing determination of eligibility for
  services based on a specific level of income
• For persons 60, targeting services to persons in
  greatest economic social need, with particular
  attention to low income minorities individuals
  residing in rural areas limited English speaking

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OAA Nutrition Program Purpose Section 330

• Reduce hunger food insecurity
• Promote socialization of older individuals
• Promote the health well-being of older
  individuals

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Objectives of the OAA Nutrition Programs

• Provide healthy, appealing meals
• 
  
• Promote health and prevent disease
• Reduce malnutrition risk and improve nutrition
• Reduce social isolation
• Link older adults to community-based services
• Provide an opportunity for community development,
  such as volunteering

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NUTRITION PROGRAMS SERVICE DESCRIPTIONS

• CONGREGATE NUTRITION SERVICES (Title III, Subpart
  C1)
• Helps to prevent health deterioration and social
  isolation
• Meals provide a minimum of 33 1/3 of the current
  daily
• RDAs
• Promotes health and independence
• Provides a positive motivation for self care
• 
  

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NUTRITION PROGRAMS SERVICE DESCRIPTIONS (contd)

• HOME-DELIVERED MEALS (Title III, Subpart C2)
• Critical to maintaining independence and remain
  in their homes
• Provide a minimum of 33 1/3 of the current daily
  recommended RDAs
• Programs can provide nutritional support added
  care and support to high-risk individuals.

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Nutrition Health

• Adequate nutrition is essential for
• Health
• Functionality
• Independence
• Quality of life

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OAA MEALS ELIGIBILITY

• Congregate meals will be available to persons
• Please refer to Nutrition Standards (page 3)

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OAA Meals Eligibility

• To be eligible for home-delivered meals a person
  must
• Please refer to Nutrition Standards ( Page 3)

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Congregate Nutrition Service Standards

• Nutrition providers shall provide at least one
  hot meal or other appropriate meal at least once
  a day, five or more days/week.
• In rural areas the nutrition provider must
  provide a written request to the SUA for approval
  of a lesser frequency or meal service.
• Must make every effort to obtain required NAPIS
  data. Clients who decline may not be denied
  service.
• Nutrition screening tool located in Oregon Access
  and is done at the time of intake and updated
  annually. Make appropriate referrals.
• Congregate meal participants should be advised to
  keep an emergency food shelf at home in case of
  emergencies.

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Congregate Nutrition Standards (contd)

• Nutrition providers shall make available
  nutrition education to meal site participants at
  a minimum of quarterly.
• Develop a strategy to allow participants to make
  a confidential donation
• Site Location and physical interior( see page 6
  of the Nutrition Standards).
• Site Management includes- staffing, safe and
  appetizing meals, meeting clients interests and
  needs, referral to community services, volunteer
  opportunities, and accurate reporting.
• Compliance with federal, state and local code and
  regulations
• Projects must develop an operating policy manual
• Staff should be instructed in portion control,
  Food Safety, safety policies and procedures, and
  the process for reporting concerns

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Congregate nutrition standards (contd)

• Confidentiality
• Meets ADA requirements
• Meets compliance with the Food Protection Program
• Compliance with State of Oregon Public Health
  Code

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Home-Delivered Meal Standards

• Meals may be hot, cold, frozen, dried, or canned
  with a satisfactory storage life
• In rural areas a waiver request must seek
  approval for less than 5 meals per week
• Client assessments are needed
• OAA Screening Survey (Oregon Access) should be
  completed and NAPIS information updated annually
• Clients declining NAPIS data may not be denied
  service
• Initial assessment and reassessments (see Page
  9 10 in the Nutrition Standards)

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Home-Delivered Meal Standards (contd)

• All nutrition providers will have a plan to
  insure clients will receive meals during
  emergencies, weather-related condition and
  disasters
• It is acceptable to provide a combination of
  meals
• Providers will develop a strategy for
  confidential contributions
• Home-delivery staff and volunteers should be
  trained in food safety
• Providers will develop and update annually
  operating procedure manuals
• Meal temperature procedure shall be developed

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Nutrition Education

• Definition Promotes better health through
  education
• Each nutrition project shall provide education.
  Can you give me some examples?
• Goals Education Content and Nutrition
  Resources (see pages 11-13 of the Nutrition
  Standards)
• Nutrition Counseling

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Menus and Menu Planning

• Each meal must meet the 2005 Dietary Guidelines
  and must contain at least 1/3 of the current
  RDAs.
• New dietary Reference Intakes (DRIs) provide
  values for men and women aged 51-70 and over 70
  years.
• Special needs of the elderly must be considered
  in menu planning.
• A menu pattern is best used as a tool.
• Dietician or Nutritionist will certify that each
  meal will meet one-third of the Recommended
  Dietary Allowances.

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Healthy DietDietary Guidelines for Americans,
2005

• Food Components
• Fruit, vegetables
• Whole grains
• Low fat dairy
• Low fat meat, poultry, fish
• Lower fat, added sugar salt
• Low income households must spend more time and
  money to consume palatable, nutritious meals

http//www.ers.usda.gov/AmberWaves /November08/Fe
atures/AffordHealthyDiet.htm
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Menu Planning (contd)

• A food identified and counted in one food group
  category cannot be counted as a food in another
  food group category.
• AAAs are encouraged to evaluate meals for
  meeting nutritional requirements using
  computer-assisted nutrient analysis and
  Registered Dieticians to ensure nutrient adequacy
  of meals.
• Resources http//nutritionandaging.fiu.edu/creat
  ive_solutions/meal_patterns.asp

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Food Service, Sanitation and Safety

• Requirements for Central Kitchens and Congregate
  Meal Sites
• Compliance with codes, regulations and licensor
  requirements
• Inspection Reports should be kept on file and
  posted
• Temperature checks should be taken with a food
  thermometer daily three times- leaving site,
  arrival off site and at serving time- Hot foods
  at or above 140 degrees and cold food at or below
  41 degrees F
• Control access to the kitchen to those who work
  in it
• Foods must be prepared, served and transported
  with the least possible manual contact. Sanitize
  utensils to prevent cross contamination
• Procedures for sanitizing should be written and
  posted

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Sanitation/Safety Requirements for Home-Delivered
meals

• Shall be individually plated, packaged and
  prepared
• Delivered directly to the participant with food
  safety guidelines
• Hot foods must be maintained at or above 140
  degrees F and cold food items maintained at or
  below 41 degrees F
• AAA shall develop procedure for taking and
  documenting meal temperature of the last meal
  served on each route

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Meal Packaging Supplies and Carriers- (contd)

• Meal packaging supplies and carriers
• Must be used to ensure hot foods and cold foods
  are separate
• Cleaned and sanitized daily
• Refrigerated foods requiring refrigeration will
  be pre-chilled and kept at or
• below 40 degrees F throughout transport
• Hot foods requiring heated storage will be held
  at or above 140degrees F throughout transport

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Nutrition Services Incentive Program (NSIP)
formerly USDA meals

• Changed in 2003 to the NSIP program
• Eligibility
• Must be served by a providers under the AAA
• Meals served to eligible persons, as defined by
  the OAA
• Title XIX or private reimbursement are not
  eligible
• AAA must document meals served to qualify for
  reimbursement
• Must operate in compliance with all federal
  requirements
• Reimbursements shall be disbursed as requested
  monthly by the AAA

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Meal Donations

• Voluntary contributions shall be allowed and
  shall not deny services to those who do not
  contribute. Protect privacy and inform that
  there is no obligation to contribute and is
  purely voluntary.
• A clearly visible and easy-to-read sign may be
  posted for suggested donations and cost for those
  under 60
• Volunteers should be encouraged to donate towards
  the cost of their meal
• Develop a strategy that allows home delivered
  meal participants to voluntarily contribute
• Drivers receiving contributions should be
  instructed to bring all donations back to the
  meal site and given to the appropriate person.

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Use of Program Income and Administrative and
Program Requirements

• See Pages 25 26 of the Nutrition Standards

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Nutrition Advisory Council

• Each AAA shall establish a nutrition advisory
  council
• The council shall advise on all matters relating
  to the delivery of nutrition and support services
  within the program area
• Suggested Council roles and Responsibilities (
  page 27 28)

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NAPIS Reporting

• Please see Pages 28, 29 and 30 of the OAA
  Nutrition Standards

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Resources

• www.aoa.gov
• www.aoa.gov/about/results/index.aspx
• http//www.data.aoa.gov
• http//agingstats.gov/agingstatsdotnet/main_site/d
  efault.aspx
• www.usda.gov
• www.fns.usda.gov/fns/
• www.ers.usda.gov/briefing/foodsecurity/
• www.mowaa.org/

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OAA Nutrition Standards Training
Thank You