Older Americans Act: Title III
Nutrition Services Program
Kirsten J. Colello
Specialist in Health and Aging Policy
June 17, 2011
Congressional Research Service
7-5700
www.crs.gov
RS21202
CRS Report for Congress
P
repared for Members and Committees of Congress

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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 $817.8
million in FY2011, accounting for 42% of the Act’s total funding ($1.932 billion). In FY2009, the
most recent year for which data are available, almost 242 million meals were served to just under
2.6 million people; 62% were served to frail older people living at home, and 38% were served in
congregate settings. The number of home-delivered meals (commonly referred to as “meals on
wheels”) served has outpaced congregate meals, growing by almost 47% from FY1990 to
FY2009; the number of congregate meals served declined by 35%. 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.
This report describes the nutrition services program authorized under Title III of the Older
Americans Act, including the program’s legislative history, purpose, and FY2011 funding levels.
It also provides information on service delivery requirements and program data regarding the
number of meals served and program participation. The report briefly discusses former and more
recent efforts to evaluate these programs. Finally, the report identifies selected issues for federal
policymakers, including measuring unmet need for nutrition services, the effects of the economic
downturn, additional funding flexibility, and increased cost-sharing.

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Older Americans Act: Title III Nutrition Services Program

Contents
Purpose....................................................................................................................................... 1
Nutrition Services Program ......................................................................................................... 1
Congregate Nutrition Services............................................................................................... 2
Home-Delivered Nutrition Services....................................................................................... 2
Nutrition Services Incentive Program .................................................................................... 3
Funding ...................................................................................................................................... 3
Service Delivery Requirements ................................................................................................... 7
Meals Served .............................................................................................................................. 7
Program Participation.................................................................................................................. 8
Program Evaluation .................................................................................................................... 8
Issues for Congress ..................................................................................................................... 9
Unmet Need........................................................................................................................ 10
Economic Downturn ........................................................................................................... 10
Funding Flexibility.............................................................................................................. 11
Client Cost-Sharing............................................................................................................. 11

Figures
Figure 1. Proportion of Senior Nutrition Participants and Meals Served for Congregate
and Home-Delivered Nutrition Programs, FY2009 ................................................................... 3

Tables
Table 1. OAA Nutrition Services Program Funding, FY1990-FY2011 ......................................... 4
Table 2. OAA Nutrition Services, Number of Meals Served, FY1990-FY2009 ............................ 6

Contacts
Author Contact Information ...................................................................................................... 12

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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 $817.8 million, over 42%, of the Act’s total FY2011 funding of $1.932
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 extended the Act’s authorization of appropriations
through FY2011.2
This report describes the nutrition services program authorized under Title III of the Older
Americans Act. Other federal and state programs, such as the Supplemental Nutrition Assistance
Program (SNAP, formerly the Food Stamp Program) and the Seniors Farmers’ Market Nutrition
Program, may provide similar nutrition services to older adults who meet certain income and
other requirements. These programs, administered by the U.S. Department of Agriculture
(USDA), are not the focus of this report.
Purpose
The Older Americans Act Amendments of 2006, P.L. 109-365, added a new purpose statement for
the nutrition services program emphasizing both its nutritional and socialization aspects, as well
as 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 Program, (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.

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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Older Americans Act: Title III Nutrition Services Program

Congregate Nutrition Services
Congregate nutrition services provide meals and related nutrition services to older individuals at 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.
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 FY2009, the most recent year for which data are available, almost 4 in 10 meals (38%) were
served in congregate settings. These meals were served to two-thirds (66%) of all OAA nutrition
program participants. A total of 92.5 million congregate meals were served to just under 1.69
million meal participants3 (see Figure 1).
Home-Delivered Nutrition Services
Home-delivered nutrition services (commonly referred to as “meals on wheels”) 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 FY2009, approximately 6 in 10 meals (62%) were home-delivered. These meals were
delivered to just over one-third (34%) of all OAA nutrition program participants. A total of 149.2
million home-delivered meals were provided to about 880,000 meal participants6 (see Figure 1).

3 Data from Administration on Aging, “State Program Report 2009,” 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 2009,” AGing Integrated Database at
http://www.agidnet.org/.
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Older Americans Act: Title III Nutrition Services Program

Figure 1. Proportion of Senior Nutrition Participants and Meals Served for
Congregate and Home-Delivered Nutrition Programs, FY2009
Senior Nutrition Participants
Meals Served
Hom e
Home
de live re d
de livere d
34%
62%
Congregate
Congregate
66%
38%

Source: CRS analysis of data from Administration on Aging, “State Program Report 2009,” AGing Integrated
Database at http://www.agidnet.org/.
Notes: Congregate meal participants represent a larger proportion of all meal participants but a smaller
proportion of total meals served. On the other hand, home-delivered meal participants are relatively fewer but
likely to receive more meals, Many home-delivered meals participants receive more than one meal delivered
during a week. Congregate meal settings are designed to serve many participants but may serve meals less
frequently. In addition, congregate meal participants may partake in meals on a less than frequent basis,
compared to home-delivered meals participants.
Nutrition Services Incentive Program
The Nutrition Services Incentive 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
USDA for the congregate and home-delivered nutrition programs. Originally established by the
OAA in 1974 as the Nutrition Program for the Elderly and administered by 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 U.S. territories. State agencies, in turn,
award nutrition services funds to the 629 Area Agencies on Aging (AAAs) that administer the

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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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 and U.S.
territories according to a formula based on each entity’s relative share of the population aged 60
and over; however, the law stipulates that no entity is to receive less than it received in FY2006.
P.L. 109-365 gradually eliminated a guaranteed growth provision 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,
U.S. territories, and tribes during the prior year. As previously mentioned, entities 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 entities choose to receive their share of funds in cash,
rather than commodities.11 There is no matching requirement for NSIP funds.
In FY2011, of the total $817.8 million appropriated for the program, $439.9 million was for
congregate nutrition (54%), $217.2 million for home-delivered nutrition (27%), and $160.7
million for nutrition services incentive grants (20%) (Table 1).12 Funding for nutrition services
represents 60% of FY2011 funding for Title III ($1.360 billion), 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-FY2011
(2010 constant dollars, in millions)
Congregate
Home-Delivered
Fiscal year
meals
meals
NSIP Total
1990 $587.2
$131.8
$239.5
$958.5
1995 $537.8
$134.7
$214.7
$887.1
2000 $474.1
$186.2
$177.3
$837.6
2005 $432.5
$204.1
$165.9
$802.6
2006 $416.6
$196.7
$159.8
$773.1
2007 $419.7
$198.1
$155.5
$773.4

10 This guaranteed growth provision ensured that all states would receive a share of any appropriations increase over
the FY2006 level. Congress phased out the guaranteed growth provision, reducing the share of any increase in
appropriations from 20% to 0 by 5 percentage points annually beginning in FY2008. For FY2011, the formula will not
include the guaranteed growth provision. For further information, see CRS Report RS22549, Older Americans Act:
Funding Formulas, by Kirsten J. Colello.
11 In FY2010, nine states chose to receive a portion of their share of the nutrition services incentive funds in
commodities: Connecticut, Delaware, Idaho, Iowa, Kansas, Massachusetts, Montana, Nevada, and Oklahoma. The
FY2010 value for these commodities was $3.4 million, see http://www.obpa.usda.gov/30fns2012notes.pdf, pp. 30g-70.
12 Sums may not total to 100% due to rounding. For further information on OAA funding, see CRS Report RL33880,
Funding for the Older Americans Act and Other Administration on Aging Programs, by Angela Napili and Kirsten J.
Colello. For information on state funding allocations, see http://www.aoa.gov/AoARoot/AoA_Programs/OAA/
Aging_Network/State_Allocations/.
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Congregate
Home-Delivered
Fiscal year
meals
meals
NSIP Total
2008 $416.07
$196.4
$155.4
$767.9
2009a $441.6
$218.1
$163.7
$823.3
2010
$440.7
$217.6
$161.0
$819.4
2011 $439.9
$217.2
$160.7
$817.8
Source: CRS analysis based on AOA/HHS and USDA amounts from appropriations legislation adjusted by the
CPI-U, at http://www.bls.gov/cpi/#tables.
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. These funds were available for obligation through September 30, 2010.
States and territories received separate allotments for congregate nutrition and home-delivered nutrition
programs based on the state’s population age 60 and older relative to the total U.S. population age 60 and
older. These funds could not be transferred among Title III services. 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 ($817.8 million for FY2011 compared to
$958.5 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 2010 dollars, the total appropriation for congregate meals, home-delivered meals, and
NSIP fell from $958.5 million in 1990 to $817.8 million in 2010, a decline of $140.7 million, or
17%. The amount appropriated for congregate meals fell from $587.2 million to $439.9 million, a
decline of $147.3 million, or 25%. The amount appropriated for NSIP fell from $239.5 million to
$160.7 million, a decline of $78.8 million, or 49%. Only the amount appropriated for home-
delivered meals increased in real terms from 1990 to 2010, rising from $131.8 million to $217.2
million, an increase of $85.4 million, or 65%.
Overall, this reduction in purchasing power has affected the number of meals served, which
declined by 2.5 million meals (or 1%) from FY1990 to FY2009, 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.
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Table 2. OAA Nutrition Services, Number of Meals Served, FY1990-FY2009
(in millions)
Home-delivered
Fiscal
Congregate
Home-delivered
Total
meals as a percent
year
meals
meals
meals
of total 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%
2009 92.5
149.2 241.7
62%
Source: Data from Administration on Aging, “State Program Report 2009,” 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.
In recent years, state transfer of funds has resulted in a decrease of funds available for congregate
nutrition services. In FY2009, states transferred $76.1 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 17.8% in funds that were originally allotted to states
for the congregate program. Funds available for home-delivered meals increased by 13.4% as a
result of funding transfers. Funds for the supportive services program also increased by 13.4%.13
State initiatives to respond to the demand for home-based services by frail homebound older
persons are an important factor in their decisions to transfer funds. According to GAO, state and
local officials reportedly moved funds out of congregate meals because of a greater need for
home-delivered meals and support services.14 In FY2008, 34 states transferred funds from
congregate meals to home-delivered meals and 32 states transferred funds from congregate meals
to support services.15
OAA funding is not the only source of funding that state agencies use to provide nutrition
services to older individuals. States rely on other funding sources, such as funding from other

13 Data from Administration on Aging, “2009 U.S. Profile of OAA Programs,” obtained through personal
communication from the Administration on Aging, May 19, 2011.
14 U.S. Government Accountability Office, Older Americans Act: More Should Be Done to Measure the Extent of
Unmet Need for Services, GAO-11-237, February 2011, p. 24.
15 Ibid., p. 24.
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federal programs (e.g., Social Services Block Grant, Medicaid home- and community-based
services), state and local governments, private sources, and clients. GAO found that OAA funds
comprised an estimated 42% of local AAA’s Title III program budgets for FY2009.16 However,
many agencies reported reductions in funding from FY2009 to FY2010 due to the economic
downturn. According to GAO’s survey, approximately 68% of local AAAs reported that the
second-largest source of funding, state funds, decreased in FY2010.17
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.18 The Act, however, did not authorize Title III providers to
actually provide a daily vitamin to meals participants.
Meals Served
In FY2009, almost 242 million meals were provided to older adults (see Table 2). In FY1990,
home-delivered meals represented 42% of total meals served, but by FY2009, the share had
climbed to 62% of total meals. From 1990 to 2009, the number of home-delivered meals served
grew by 47%, while the number of congregate meals served actually declined by 35%. As

16 Ibid., p. 25. Title III funding includes funding for other home- and community-based supportive services, including
the nutrition services programs.
17 Ibid., p. 29.
18 Section 318 of P.L. 109-365.
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discussed earlier, a 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 FY2009, the U.S. average expenditure for congregate meals was $6.96,
ranging from $1.68 in Puerto Rico to $17.36 in Alaska. The average expenditure for home-
delivered meals was $5.30, ranging from $1.93 in Puerto Rico to $13.85 in Alaska.19
Program Participation
A 2009 National Survey of OAA participants shows that in 2009, 57% of congregate nutrition
survey respondents were age 75 and older; 48% lived alone; 13% had annual income of $10,000
or less; and 57% 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 87% saying that they see friends more often due to meals.20
This 2009 survey found that 70% of home-delivered respondents were age 75 and older; 56%
lived alone; 25% had annual income of $10,000 or less; and 59% 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. Four
out of ten recipients (40%) reported needing assistance with one or more activities of daily living
(ADLs, such as bathing, dressing, eating, and using the toilet); 15% of these recipients needed
assistance with three or more ADLs. In addition, 85% reported needing assistance with one or
more instrumental activities of daily living (IADLs, such as shopping, telephoning, housework,
and getting around inside the home).21
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

19 Data from Administration on Aging, “State Program Report 2009,” AGing Integrated Database at
http://www.agidnet.org/.
20 Data from Administration on Aging, “National Survey of OAA Participants, 2009,” AGing Integrated Database at
http://www.agidnet.org/.
21 Ibid.
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variety of sources, including state, local, and private funds as well as participant contributions
toward the cost of meals.22
The 2006 reauthorization legislation stipulated that the Institute of Medicine (IOM) conduct an
evidence-based study of the program.23 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.24 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.
Issues for Congress
As the nation prepares for a growing older population and potential increase in demand for health
and social services that can promote the well-being of older persons to assist them in living
independently in the community, ensuring access to home- and community-based long-term
services and supports will likely be an issue for federal policymakers. The OAA Amendments of
2006 (P.L. 109-365) authorized appropriations for OAA-funded activities, including the Title III
Nutrition programs through FY2011. The 112th Congress may choose to reauthorize the Act. In
doing so, federal policymakers may consider amending or deleting existing authorities under the
Act or establishing new authorities, including those under the nutrition services program. In
addition, Congress will likely consider annual appropriations for these activities. The following
sections discuss several issues for congressional consideration, such as measuring unmet need for
nutrition services, the effects of the economic downturn, additional funding flexibility, and
increased cost-sharing. These issues were among those discussed by GAO in its February 11,
2011, report, Older Americans Act: More Should Be Done to Measure the Extent of Unmet Need
for Services (GAO-11-23711).

22 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.
23 § 317 of P.L. 109-365, the Older Americans Act Amendments of 2006.
24 The evaluation is being conducted by Mathematica Policy, Inc. AOA anticipates submitting a Paperwork Reduction
Act data collection request to OMB in early 2012. This clearance process is expected to take between six months and
one year. Data collection will be began as soon as OMB clearance is received. Personal communication from the
Administration on Aging, June 2011. For additional information on the evaluation see, http://www.aoa.gov/AoARoot/
Program_Results/docs/Program_Eval/III_C_Assessment/Evaluation_Status_Report_11_09.html.
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Unmet Need
According to a national analysis by GAO, meals services provided in 2008 served some, but not
most, low-income older adults who are likely in need of such services.25 State agency officials
identified several reasons why an older adult may need but not receive meals services, including
(1) greater demand for home-delivered meals than available funds can provide, (2) lack of
knowledge or awareness among eligible older adults that meals services exist, and (3) lack of
appeal with the meals served or the time of day meals are provided in congregate settings.26
Overall, GAO found that the lack of federal guidance and data make it difficult for states to
estimate the full extent of need and unmet need for OAA Title III services, including nutrition
services. The OAA requires that AOA design and implement uniform data collection procedures
for states to assess receipt of services, as well as need and unmet need for Title III services.27
Although AOA does provide uniform procedures for states to measure receipt of services, the
agency does not provide standardized definitions or measurement for states to use in measuring
need or unmet need for services. As a result, states use a variety of approaches that are often
limited in their ability to fully estimate need and unmet need among older adults. These
approaches include maintaining waitlists, obtaining information and data from service providers,
and surveying current recipients. GAO recommends that HHS partner with governmental
agencies that provide services to older Americans and convene researchers and agency officials to
develop consistent definitions of need and unmet needs for uniform data collection purposes.28
Economic Downturn
The economic downturn and recovery has affected many Americans, including older adults.
While GAO found that FY2010 funding decreased for many agencies, requests for services have
increased since the beginning of the economic downturn. According to a report by the National
Association of States United for Aging and Disabilities (NASUAD)—formerly the National
Association of State Units on Aging (NASUA)—85% of states that responded to the survey saw
an increase in demand for home-delivered meals, while almost half of states reported an increase
in demand for congregate meals in FY2009.29
State and local agencies have responded to the downturn in various ways, such as creating
waitlists, securing additional funds, collaborating with other agencies, utilizing ARRA funds, and
reducing services. In some cases, limited funding has meant “less services to all rather than full
service to only some.”30 According to NASUAD’s state agencies survey, states reportedly are
reviewing current methods for providing home-delivered food with some states anticipating

25 U.S. Government Accountability Office, Older Americans Act: More Should Be Done to Measure the Extent of
Unmet Need for Services, GAO-11-237, February 2011, p. 15.
26 Ibid., pp. 17-18.
27 42 U.S.C. § 3012.
28 U.S. Government Accountability Office, Older Americans Act: More Should Be Done to Measure the Extent of
Unmet Need for Services, GAO-11-237, February 2011, p. 35.
29 National Association of States United for Aging and Disabilities, The Economic Crisis and Its Impact on State Aging
Programs: Results of All-State Survey, November 2009.
30 U.S. Government Accountability Office, Older Americans Act: More Should Be Done to Measure the Extent of
Unmet Need for Services, GAO-11-237, February 2011, p. 30.
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Older Americans Act: Title III Nutrition Services Program

cutting back on the frequency of meal delivery, among other things.31 Moreover, an estimated
18% of agencies surveyed by GAO reported reducing nutrition services in FY2010. Just over
one-fifth of agencies (21%) reportedly anticipate additional cuts to the nutrition services program
in FY2011. Congress may consider whether appropriations for Title III nutrition services
programs are sufficient to meet this increased demand and potential for continued funding
constraints at the state and local levels.
Funding Flexibility
Most states and a number of AAAs use the statutory flexibilities under current law to transfer
funding among Title III programs. According to GAO, some states recommended consolidating
funding for nutrition services programs into one single funding stream. However, other state
officials did not see the need to alter the current process for transferring Title III funds. Congress
may consider whether additional flexibilities are necessary, possibly consolidating Title III
funding streams or increasing the proportion of funds available for states and AAAs to transfer,
affording those entities who choose to transfer funds greater ability in doing so. Conversely,
Congress may be concerned that funding transfers provide states and AAAs the ability to
reallocate funding to services at a level different than otherwise appropriated. As a result,
Congress may seek to further specify or limit funding flexibility. Congress may also decide that
funding flexibilities under current law are sufficient for states and AAAs current needs and
choose to maintain the status quo.
Client Cost-Sharing
Clients can, and some do, contribute to the cost of their meals. GAO found that almost all local
AAAs permit voluntary contributions for Title III services, including the nutrition services
program.32 For FY2009, voluntary contributions comprised 4% of AAA budgets. Some AAAs
indicated to GAO that voluntary contributions make up a significant portion of their nutrition
services program budget.33 Although the OAA authorizes states to implement cost-sharing as a
requirement for some Title III services, the Act does not permit cost-sharing as a requirement for
participation in congregate and home-delivered meals programs, except on a voluntary basis.
According to GAO, additional cost-sharing arrangements could provide additional funding for
Title III programs.34 GAO recommends that the HHS Secretary study the implementation of cost-
sharing for OAA services with respect to “the real and perceived burdens to implementing cost
sharing for OAA services,” which could include recommending legislative changes to the Act.35


31 National Association of States United for Aging and Disabilities, The Economic Crisis and Its Impact on State Aging
Programs: Results of All-State Survey, November 2009.
32 U.S. Government Accountability Office, Older Americans Act: More Should Be Done to Measure the Extent of
Unmet Need for Services, GAO-11-237, February 2011, p. 27.
33 Ibid., p. 27.
34 Ibid., p. 28.
35 Ibid., p. 35.
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Older Americans Act: Title III Nutrition Services Program

Author Contact Information

Kirsten J. Colello

Specialist in Health and Aging Policy
kcolello@crs.loc.gov, 7-7839



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