Older Americans Act: Title III
Nutrition Services Program
Kirsten J. Colello
Specialist in Health and Aging Policy
February 1, 2010
Congressional Research Service
7-5700
www.crs.gov
RS21202
CRS Report for Congress
P
repared for Members and Committees of Congress
Older Americans Act: Title III Nutrition Services Program
Summary
The elderly nutrition services program, authorized under Title III of the Older Americans Act,
provides grants to state agencies on aging to support congregate and home-delivered meals for
people aged 60 and older. The program is designed to address problems of food insecurity,
promote socialization, and promote the health and well-being of older persons through nutrition
and nutrition-related services. It is the largest Older Americans Act program, funded at $819.5
million in FY2010, accounting for over one-third (35%) of the Act’s total funding. In FY2008, the
most recent year for which data are available, over 240 million meals were served to about 2.6
million people; 61% were served to frail older people living at home, and 39% were served in
congregate settings. The number of home-delivered meals served has outpaced congregate meals,
growing by almost 44% from FY1990 to FY2008; the number of congregate meals served
declined by 34%. The faster growth in home-delivered meals is partially due to relatively higher
growth in federal funding for home-delivered meals over that time period, as well as state
decisions to focus funds on frail older people living at home. Congress approved the Older
Americans Act Amendments of 2006 (P.L. 109-365) extending the Act’s authorization of
appropriations through FY2011.
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Older Americans Act: Title III Nutrition Services Program
Contents
Purpose....................................................................................................................................... 1
Nutrition Services Program ......................................................................................................... 1
Congregate Nutrition Services............................................................................................... 1
Home-Delivered Nutrition Services....................................................................................... 2
Nutrition Services Incentive Program .................................................................................... 3
Funding ...................................................................................................................................... 3
Service Delivery Requirements ................................................................................................... 6
Meals Served .............................................................................................................................. 6
Program Participation.................................................................................................................. 7
Program Evaluation .................................................................................................................... 7
Figures
Figure 1. Proportion of Senior Nutrition Participants and Meals Served for Congregate
and Home-Delivered Nutrition Programs, FY2008 ................................................................... 3
Tables
Table 1. OAA Nutrition Services Program Funding, FY1990-FY2010 ......................................... 4
Table 2. OAA Nutrition Services, Number of Meals Served, FY1990-FY2008 ............................ 5
Contacts
Author Contact Information ........................................................................................................ 8
Acknowledgments ...................................................................................................................... 8
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Older Americans Act: Title III Nutrition Services Program
he elderly nutrition services program, authorized under Title III of the Older Americans
Act (OAA)1, provides grants to state agencies on aging to support congregate and home-
T delivered meals to people aged 60 and older. The program is the largest component of the
Act, accounting for $819.5 million, or about one-third (35%), of the Act’s total FY2010 funding
of $2.328 billion. The program is designed to address problems of food insecurity, promote
socialization, and promote the health and well-being of older persons through nutrition and
nutrition-related services. It evolved from demonstration projects first funded in 1968. In 1972,
Congress authorized the program as a separate title of the Act and, in 1978, incorporated it into
Title III. In 2006, Congress enacted P.L. 109-365, which reauthorized all programs under the Act
through FY2011.2
Purpose
P.L. 109-365 added a new purpose statement for the nutrition services program emphasizing both
its nutritional and socialization aspects and its importance in promoting the health of older
people. The purposes of the program as stipulated in the law are to (1) reduce hunger and food
insecurity, (2) promote socialization of older individuals, and (3) promote the health and well-
being of older individuals by assisting them to access nutrition and other disease prevention and
health promotion services to delay the onset of adverse health conditions resulting from poor
nutritional health or sedentary behavior.
Nutrition Services Program
The Administration on Aging (AoA) in the Department of Health and Human Services (HHS)
administers the Nutrition Services Program, which includes (1) the Congregate Nutrition Services
Program, (2) the Home-Delivered Nutrition Services Programs, (3) and the Nutrition Services
Incentive Program (NSIP). For the Congregate and Home-Delivered Programs, services must be
targeted at persons with the greatest social and economic need, with particular attention to low-
income older persons, including low-income minority older persons, older persons with limited
English proficiency, older persons residing in rural areas, and those at risk for institutionalization.
Means tests for program participation are prohibited, but older persons are encouraged to
contribute to the costs of nutrition services, including meals. Older individuals may not be denied
services for failure to contribute. The following describes these programs in greater detail.
Congregate Nutrition Services
Congregate nutrition services provide meals and related nutrition services to older individuals in a
variety of sites, such as senior centers, community centers, schools, and adult day care centers.
Congregate nutrition service providers can also offer a variety of nutrition related services at meal
sites, such as nutrition education and screening, nutrition assessment, and counseling as
appropriate. The program also provides seniors with opportunities for social engagement and
volunteer opportunities.
1 42 U.S.C. 3021 et. seq. Regulations are at 45 C.F.R. 1321.1 et. seq.
2 For further information, see CRS Report RL31336, The Older Americans Act: Programs, Funding, and 2006
Reauthorization (P.L. 109-365), by Carol O’Shaughnessy and Angela Napili.
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Individuals aged 60 or older and their spouses of any age may participate in the congregate
nutrition program. The following groups may also receive meals: persons under age 60 with
disabilities who reside in housing facilities occupied primarily by the elderly where congregate
meals are served; persons with disabilities who reside at home with, and accompany, older
persons to meals; and volunteers who provide services during the meal hours.
In FY2008, the most recent year for which data are available, about 4 in 10 congregate meals
(39%) were served to almost two-thirds (65%) of all OAA nutrition program participants (or 94.2
million meals to almost 1.66 million meal participants).3 (See Figure 1.)
Home-Delivered Nutrition Services
Home-delivered nutrition services provide meals and related nutrition services to older
individuals that are homebound. According to AoA, 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.4 Like congregate nutrition service providers, home-
delivered service providers can offer services such as nutrition screening and education, nutrition
assessment, and counseling as appropriate. Home-delivered meals are also an important service
for many family caregivers by assisting family members with their caregiving responsibilities
and, for some, helping them maintain their own health and personal well-being.5
Individuals aged 60 or older and homebound and their spouses of any age may participate in the
home-delivered nutrition program. Services may be available to individuals who are under age 60
with disabilities if they reside at home with the homebound older individual.
In FY2008, 6 in 10 meals (61%) were delivered to over one-third (35%) of all OAA nutrition
program participants (or 146.4 million home-delivered meals to almost 910,000 participants).6
(See Figure 1.)
3 Data from Administration on Aging, “State Program Report 2008,” AGing Integrated Database at
http://www.agidnet.org/.
4 Administration on Aging, “Nutrition Services (Title C),” at http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/
Nutrition_Services/index.aspx.
5 For further information on family caregiving, see CRS Report RL34123, Family Caregiving to the Older Population:
Background, Federal Programs, and Issues for Congress, by Kirsten J. Colello.
6 Data from Administration on Aging, “State Program Report 2008,” AGing Integrated Database at
http://www.agidnet.org/.
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Figure 1. Proportion of Senior Nutrition Participants and Meals Served for
Congregate and Home-Delivered Nutrition Programs, FY2008
Source: CRS analysis of data from Administration on Aging, “State Program Report 2008,” AGing Integrated
Database at http://www.agidnet.org/.
Nutrition Services Incentive Program
The Nutrition Services Incentives Program (NSIP) provides funds to states, territories, and Indian
tribal organizations to purchase food or to cover the costs of food commodities provided by the
U.S. Department of Agriculture (USDA) for the congregate and home-delivered nutrition
programs. Originally established by the OAA in 1974 as the Nutrition Program for the Elderly in
USDA,7 Congress transferred the administration of NSIP from USDA to AoA in 2003.8 However,
states and other entities may still choose to receive all or part of their NSIP allotments in the form
of commodities. Obligations for commodity procurement for NSIP are funded under an
agreement between USDA and HHS.9
Funding
The AoA awards separate allotments of funds for the congregate nutrition services program and
home-delivered nutrition services program to states and territories. State agencies, in turn, award
nutrition services funds to the 629 area agencies on aging that administer the program in their
respective planning and service areas. The AoA also awards a separate allotment to states,
territories, and Indian tribal organizations for NSIP funds.
Funds for congregate and home-delivered nutrition services are allotted to states according to a
formula based on each state’s relative share of the population aged 60 and over; however, the
law stipulates that no state receive less than it received in FY2006. P.L. 109-365 gradually
7 The program was originally established for commodities only. In 1977, states could receive allotments from USDA in
cash or commodities.
8 Division G, Title II, Section 217 of the Consolidated Appropriations Resolution, 2003 (P.L. 108-7).
9 In 2006, pursuant to P.L. 109-365, Congress rescinded states’ option to receive commodities. However, in 2007, this
option was reinstated through P.L. 110-19 (effective April 23, 2007) which authorized the transfer of NSIP funds from
HHS to USDA for the purchase of commodities and related expenses.
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eliminated a guaranteed growth factor in the formula, beginning in FY2008.10 States are required
to provide a matching share of 15% in order to receive funds for congregate and home-delivered
nutrition programs.
NSIP funds are allotted to states and other entities based on each state’s share of total meals
served by the nutrition services program (both congregate and home-delivered meals) in all states
and tribes during the prior year. As previously mentioned, states receive their share of NSIP funds
in cash, but may elect to use some or all of their funds to purchase commodities through the
USDA. Most states choose to receive their share of funds in cash, rather than commodities.11
There is no matching requirement for NSIP funds.
In FY2010, of the total $819.5 million appropriated for the program, $440.8 million was for
congregate nutrition (54%), $217.7 million for home-delivered nutrition (26%), and $161.0
million for nutrition services incentive grants (20%) (Table 1).12 Funding for nutrition services
represents 60% of FY2010 funding for Title III, which also funds a wide array of social services,
family caregiver support activities, and disease prevention and health promotion services for
older individuals.
Table 1. OAA Nutrition Services Program Funding, FY1990-FY2010
(2009 constant dollars, in millions)
Congregate
Home-Delivered
Fiscal year
meals
meals
NSIP Total
1990 $576.9 $129.5 $235.3 $941.7
1995 $530.3 $132.8 $211.7 $874.7
2000 $466.4 $183.2 $174.4 $824.1
2005 $424.3 $200.3 $162.8 $787.4
2006 $408.3 $192.7 $156.6 $757.7
2007 $413.2 $195.0 $153.1 $761.4
2008 $404.0 $190.7 $150.9 $745.6
2009a $434.3 $214.5 $161.0 $809.7
2010
$440.8 $217.7 $161.0 $819.5
Source: CRS analysis based on AoA/HHS and USDA amounts from appropriations legislation adjusted by the
CPI-U.
a. The American Recovery and Reinvestment Act (ARRA, P.L. 111-5) appropriated additional funding for
senior nutrition services. This amount is not included in the FY2009 total. Specifical y, ARRA appropriated
$100 million for senior nutrition services, of which $97 million was provided to states and territories
($65 million for congregate and $32 million for home-delivered meals), and $3 million was made available
to Indian tribal organizations. States and territories received separate allotments for congregate nutrition
and home-delivered nutrition programs based on the states population age 60 and older relative to the
10 For further information, see CRS Report RS22549, Older Americans Act: Funding Formulas, by Kirsten J. Colello.
11 In FY2008, 8 states chose to receive a portion of their share of the nutrition services incentive funds in commodities:
Connecticut, Delaware, Idaho, Kansas, Massachusetts, Montana, Nevada, and Oklahoma. The FY2008 value for these
commodities was $2.7 million.
12 For further information on OAA funding, see CRS Report RL33880, Older Americans Act (OAA) Funding, by
Angela Napili. For information on state funding allocations see http://www.aoa.gov/AoARoot/AoA_Programs/OAA/
Aging_Network/State_Allocations/.
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total U.S. population age 60 and older. For further information, see http://www.aoa.gov/AoAroot/
PRESS_Room/News/2009/03_18_09.aspx.
When adjusted for inflation, the total amount of funding appropriated for OAA Nutrition Services
has decreased substantially over the past two decades ($819.5 million for FY2010 compared to
$941.7 million in FY1990). This decline in relative funding has been experienced by the
congregate meals and NSIP programs, while funding levels for the home-delivered meals
programs have increased over the same time period.
In constant 2009 dollars, the total appropriation for congregate meals, home-delivered meals, and
NSIP fell from $941.7 million in 1990 to $745.6 million in 2008, a decline of $196.1 million or
21%. The amount appropriated for congregate meals fell from $576.9 million to $404 million, a
decline of $172.9 million or 30%. The amount appropriated for NSIP fell from $253.3 million to
$150.9 million, a decline of $84.4 million or 36%. Only the amount appropriated for home-
delivered meals increased in real terms from 1990 to 2008, rising from $129.5 million to $190.7
million, an increase of $61.2 million or 47%.
Overall, this reduction in purchasing power has affected the number of meals served, which
declined by 3.9 million meals (or 2%) from FY1990 to FY2008, the most recent year for which
data are available (see Table 2). The overall decline in meals served is due to a substantial
decrease in the number of congregate meals served, while the number of home-delivered meals
has increased.
Table 2. OAA Nutrition Services, Number of Meals Served, FY1990-FY2008
(in millions)
Home-delivered
meals as a
Home-delivered
Total
percent of total
Fiscal year
Congregate meals
meals
meals
meals
1990
142.4 101.8 244.2 42%
1995
123.4 119.0 242.4 49%
2000
116.0 143.5 259.4 55%
2005
100.5 140.1 240.6 58%
2008
94.2 146.4 240.6 61%
Source: Data from Administration on Aging, “State Program Report 2008,” AGing Integrated Database at
http://www.agidnet.org/.
Fewer congregate meals served over the past two decades can also be attributed to states
transferring allotted funds from the congregate nutrition program to certain OAA Title III
programs. As previously mentioned, states receive separate allotments for congregate and home-
delivered nutrition services, as well as for supportive services. However, they are allowed to
transfer allotted funds among these three programs (up to 40% of funds between congregate and
home-delivered nutrition services allotments with waivers for higher amounts if approved by the
Assistant Secretary for Aging; and up to 30% among supportive services and congregate and
home-delivered nutrition services allotments). States may not transfer NSIP allotted funds among
these programs.
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In recent years, state transfer of funds has resulted in a decrease of funds available for congregate
nutrition services. In FY2008, states transferred $77.8 million out of their congregate nutrition
services allotments to either the home-delivered nutrition or supportive services allotments. These
funding transfers resulted in a decrease of 19.2% in funds that were originally allotted to states
for the congregate program. Funds available for home-delivered meals increased by 19.9% as a
result of funding transfers. Funds for the supportive services program increased by 11.4%.13 State
initiatives to respond to the demand for home-based services by frail homebound older persons is
an important factor in their decisions to transfer funds.
Service Delivery Requirements
Congregate and home-delivered nutrition services providers are required to offer at least one meal
per day, five or more days per week (except in rural areas where less frequency is allowed).
Meals provided must comply with the Dietary Guidelines for Americans published by the
Secretary of HHS and the Secretary of Agriculture. Providers must serve meals that meet certain
dietary requirements based on the number of meals served by the project each day. Providers that
serve one meal per day must provide to each participant a minimum of one-third of the daily
recommended dietary reference intakes (DRIs) established by the Food and Nutrition Board of
the Institute of Medicine (IOM). Providers that serve two meals per day must provide a minimum
of two-thirds of the DRIs, and those that serve three meals per day must provide 100% of the
DRIs. Providers must provide meals that comply with state or local laws regarding safe and
sanitary handling of food, equipment, and supplies that are used to store, prepare and deliver
meals, and must carry out meal programs using the advice of dietitians and meal participants. The
law requires providers to offer nutrition screening and education to participants, and where
appropriate, nutrition assessment and counseling. Providers are encouraged to make arrangements
with schools and other facilities serving meals to children in order to promote intergenerational
meals programs.
P.L. 109-365 noted that while diet is the preferred source of nutrition, evidence suggests that the
use of a single daily multivitamin-mineral supplement may be an effective way to address poor
nutrition among older people. Also, it noted that Title III nutrition service providers should
consider whether congregate and home-delivered participants would benefit from a multivitamin-
mineral supplement that is in compliance with government quality standards and that provides at
least two-thirds of essential vitamins and minerals at 100% of daily value levels as determined by
the Commissioner of Food and Drugs.14
Meals Served
In FY2008, almost 241 million meals were provided to older people (see Table 2). In FY1990,
home-delivered meals represented 42% of total meals served, but by FY2008, the share had
climbed to 61% of total meals. From 1990 to 2008, the number of home-delivered meals served
grew by almost 44%, while the number of congregate meals served actually declined by 34%. A
13 Data from Administration on Aging, “2008 U.S. Profile of OAA Programs,” obtained through personal
communication from the Administration on Aging, November 17, 2009.
14 Section 318 of P.L. 109-365.
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number of reasons account for this, including the trend by states to transfer funds from their
congregate services allotments to home-delivered services; greater growth in federal funding for
home-delivered services relative to the congregate nutrition program funds; state initiatives to
expand home care services for frail older persons; and successful leveraging of non-federal funds
for home-delivered services.
AoA data show that for FY2008, the U.S. average expenditure for congregate meals was $6.75,
ranging from $15.94 in Alaska to $1.55 in Puerto Rico. The average expenditure for home-
delivered meals was $5.14, ranging from $11.72 in Wyoming to $1.46 in Puerto Rico.15
Program Participation
A 2008 National Survey of OAA participants show that in 2008, 60% of congregate nutrition
survey respondents were age 75 and older; 48% lived alone; 16% had annual income of $10,000
or less; and 58% reported that the congregate meals program provided one-half or more of their
daily food intake. Furthermore, many congregate nutrition recipients reported these meals have
fostered greater socialization, with 82% saying that they see friends more often due to meals.16
This 2008 survey found that 71% of home-delivered respondents were age 75 and older; 60%
lived alone; 28% had annual income of $10,000 or less; and 60% said that the home-delivered
meals program provided at least one-half of their daily food intake. According to the survey,
home-delivered meals recipients are particularly frail and are at risk for institutionalization.
Almost 40% of recipients reported needing assistance with one or more activities of daily living
(ADLs, such as bathing, dressing, eating, and using the toilet); 14% of these recipients needed
assistance with three or more ADLs. In addition, 84% reported needing assistance with one or
more instrumental activities of daily living (IADLs, such as shopping, telephoning, housework,
and getting around inside the home).17
Program Evaluation
The last major national evaluation of the nutrition program was completed in 1996. It showed
that, compared to the total elderly population, nutrition program participants were older and more
likely to be poor, to live alone, and to be members of minority groups. Almost half of home-
delivered meal recipients and more than one-third of congregate meal recipients had income
below the federal poverty level, compared to about 15% of the total U.S. population age 60 and
over (at the time of the evaluation). Recipients were also more likely to have health and
functional limitations that place them at nutritional risk. The report found the program plays an
important role in participants’ overall nutrition and that meals consumed by participants are their
primary source of daily nutrients. The evaluation also found that the program leverages a fairly
significant amount of nonfederal dollars: for every federal dollar spent, the program leveraged (at
that time) on average $1.70 for congregate meals, and $3.35 for home-delivered meals from a
15 Data from Administration on Aging, “State Program Report 2008,” AGing Integrated Database at
http://www.agidnet.org/.
16 Data from Administration on Aging, “National Survey of OAA Participants, 2008,” AGing Integrated Database at
http://www.agidnet.org/.
17 Ibid.
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variety of sources, including state, local, and private funds as well as participant contributions
toward the cost of meals.18
The 2006 reauthorization legislation stipulated that the Institute of Medicine (IOM) conduct an
evidence-based study of the program. The study is to include (1) an evaluation of the effect of
nutrition projects on the health and nutrition status of participants, prevention of hunger and food
insecurity, and ability of participants to remain living independently; (2) a cost-benefit analysis of
nutrition projects, including their potential to affect Medicaid costs; and (3) recommendations on
how nutrition projects may be modified to improve outcomes, and the nutritional quality of
meals. To date, AoA has not conducted this study. However, prior to the 2006 reauthorization
AoA had begun the process to conduct a new evaluation of the Title III Nutrition Services
Program. According to AoA, this evaluation will contain (1) an evaluation of program impacts on
participants’ nutrition, health and well-being, socialization, and food insecurity; (2) a cost
analysis that describes the cost per meal by cost categories and method of meal production; and
(3) a process evaluation that examines the implementation of the program at the state and local
levels and includes an assessment of the nutritional quality of the program meals.19 The
participant outcomes component will involve a matched comparison group and similar survey
methods as those used in the National Health and Nutrition Examination Study (NHANES) to
allow for comparison of research results to the previous evaluation, a matched comparison group,
and national estimates from NHANES and other national data.
Author Contact Information
Kirsten J. Colello
Specialist in Health and Aging Policy
kcolello@crs.loc.gov, 7-7839
Acknowledgments
This report updates a report that was previously authored by Carol O’Shaughnessy.
18 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Aging, Serving Elders at Risk:
The Older Americans Act Nutrition Programs, National Evaluation of the Elderly Nutrition Program, 1993-1995, June
1996. Available at http://www.aoa.dhhs.gov/prof/aoaprog/nutrition/program_eval/eval_report.asp, visited Feb. 5, 2007.
19 The evaluation is being conducted by Mathematica Policy, Inc. Data collection is planned for 2010 and 2011 with
results reported in 2012. Personal communication from the Administration on Aging, November 17, 2009.
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