August 7, 2018
Older Americans Act: Nutrition Services Program
Introduction
disabilities who reside with, and accompany, older persons
The Nutrition Services Program, authorized under Title III
to meals in congregate settings; and volunteers who provide
of the Older Americans Act (OAA), provides grants to
services during the meal hours. In FY2016, a total of 79.2
states and U.S. territories to support nutrition services
million congregate meals were served to nearly 1.6 million
programs for seniors. As stipulated in the law, the purposes
meal participants.
of the program are to (1) reduce hunger and food insecurity,
(2) promote the socialization of older individuals, and (3)
Home-Delivered Nutrition Services
promote the health and well-being of older individuals by
Home-delivered nutrition services (commonly referred to as
assisting them to access nutrition and other disease
“meals on wheels”) provide meals and related nutrition
prevention and health promotion services to delay the onset
services to older individuals, with priority given to
of adverse health conditions resulting from poor nutrition or
homebound older individuals. According to AOA, “home-
sedentary behavior. According to the U.S. Department of
delivered meals are often the first in-home service that an
Agriculture (USDA), 7.8% of U.S. households with an
older adult receives, and the program is a primary access
elderly member were food insecure in 2016, defined as
point for other home and community-based services.”
households reporting low or very low food security.
Home-delivered meals can be an important service for
Households in which elderly lived alone reported a higher
many family caregivers in assisting them with their
rate of food insecurity, at 8.9%. As the largest OAA
caregiving responsibilities as well as helping maintain their
program, the Title III Nutrition Services Program received
own health and personal well-being. Individuals aged 60 or
$897 million in FY2018, accounting for 44% of the act’s
older and their spouses (regardless of age) may participate
total funding ($2.0 billion). The Older Americans Act
in the home-delivered nutrition program. Services may be
Reauthorization Act of 2016 (P.L. 114-144) extended
available to individuals under age 60 with disabilities if
authorized appropriations through FY2019.
they reside at home with the older individual. In FY2016, a
total of 145.2 million home-delivered meals were provided
Administration
to over 867,000 meal participants.
The Administration on Aging (AOA) in the Administration
for Community Living (ACL) within the Department of
Nutrition Services Incentive Program (NSIP)
Health and Human Services (HHS) administers the
NSIP provides funds to states, U.S. territories, and Indian
Nutrition Services Program, which includes
tribal organizations to purchase food or to cover the costs of
 the Congregate Nutrition Services Program,
food commodities provided by the USDA for the
 the Home-Delivered Nutrition Services Program, and
congregate and home-delivered nutrition programs. NSIP
 Nutrition Services Incentive Program.
was originally established by the OAA in 1974 as the
Nutrition Program for the Elderly and administered by
States that implement these programs must target nutrition
USDA. In 2003, Congress transferred the administration of
services to older persons with the greatest social and
NSIP from USDA to AOA. However, states and other
economic need, with particular attention to people with
entities may continue to receive all or part of their NSIP
low-incomes, including low-income minorities, people with
grants in the form of USDA commodities. Obligations for
limited English proficiency, people residing in rural areas,
commodity procurement for NSIP are funded under an
and those at risk for institutionalization. Means tests for
agreement between USDA and HHS.
program participation are prohibited, but older persons are
encouraged to contribute to the costs of nutrition services.
Funding
Older individuals may not be denied services for failure to
The AOA awards separate grants to states and U.S.
contribute.
territories for the congregate nutrition services program and
home-delivered nutrition services program. State Units on
Congregate Nutrition Services
Aging (SUAs) administer the program at the state level, and
Congregate nutrition services provide meals and related
in turn, award those funds to over 600 Area Agencies on
nutrition services to older individuals in a variety of group
Aging (AAAs), which oversee the program in their
settings, such as senior centers, community centers,
respective planning and service areas. The AOA also
schools, and adult day care centers. The program also
awards a separate grant to states, U.S. territories, and tribal
provides seniors with opportunities for social engagement
organizations for NSIP.
and volunteering. Individuals aged 60 or older and their
spouses (regardless of age) may participate in the
Grants for congregate and home-delivered nutrition services
congregate nutrition program. The following groups may
are awarded to states and U.S. territories based on a
also receive meals: persons under age 60 with disabilities
statutory formula that takes into account each entity’s
who reside in housing facilities occupied primarily by the
relative share of the population aged 60 and over. States are
elderly, where congregate meals are served; persons with
required to provide a matching share of 15% in order to
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Older Americans Act: Nutrition Services Program
receive these funds. NSIP grants are awarded to states and
(ADLs, such as bathing, dressing, eating, and using the
other entities based on each entity’s share of total meals
toilet); 14% of these recipients needed assistance with three
served by the nutrition services program (both congregate
or more ADLs. In addition, 84% reported needing
and home-delivered meals) in all states, U.S. territories, and
assistance with one or more instrumental activities of daily
tribes during the prior year. There is no matching
living (IADLs, such as shopping, housework, and getting
requirement for NSIP grant awards. In FY2018, of the $897
around inside the home).
million appropriated for the Nutrition Services Program,
$490 million was for congregate nutrition (55%), $246
Program Evaluation
million for home-delivered nutrition (27%), and $160
ACL is conducting an evaluation of the Nutrition Services
million for NSIP (18%).
Program. The first two phases, a process evaluation and
meal cost analysis, are complete. The third phase, a client
Service Delivery
outcome study, is underway. Mathematica Policy Research
Nutrition services providers are required to offer at least
is conducting the evaluation. Final reports from the first
one meal per day, five or more days per week (except in
two phases were published in 2015. The final report for Part
rural areas, where provision can be less frequent). The
1 of the third phase was published in 2017. Results from
meals must comply with the Dietary Guidelines for
these studies were compared to the last national evaluation
Americans published by the Secretary of HHS and the
of the nutrition program completed in 1995.
Secretary of Agriculture. Providers must serve meals that
meet certain dietary requirements based on the number of
The process study collected data from SUAs, AAAs, and
meals served by the project each day. Providers that serve
local service providers (LSPs) to assess program
one meal per day must provide to each participant a
administration and service delivery. The report found that
minimum of one-third of the daily recommended dietary
the provision of home-delivered meals has expanded since
reference intakes (DRIs) established by the Food and
1995, with more LSPs offering these meals. While the
Nutrition Board of the National Academy of Sciences.
percentage of LSPs offering congregate meals decreased
Providers that serve two meals per day must provide a
slightly (95% to 93%), more congregate meals programs
minimum of two-thirds of the DRIs, and those that serve
are offering breakfast and dinner (in addition to lunch,
three meals per day must provide 100% of the DRIs.
which all sites offer), and weekend meals. In addition,
Providers must comply with state or local laws regarding
programs are offering more options for “modified” meals,
safe and sanitary handling of food, equipment, and supplies
which are lower in fat, sodium, or calories. More LSPs
used to store, prepare, and deliver meals, and providers
report waiting lists for home-delivered meals, but waiting
must carry out meal programs using the expertise of
lists have fewer people, on average, than in 1995.
dietitians and meal participants.
The meal cost study estimated the average costs of meals
Nutrition service providers may offer nutrition-related
provided and examined cost variation. The report found
services, such as nutrition education and screening,
that, on average, home-delivered meals cost more to
nutrition assessment, and counseling, as appropriate.
provide than congregate meals ($11.06 vs. $10.69),
Providers are encouraged to make arrangements with
including costs of both purchased and donated resources.
schools and other facilities serving meals to children to
However, costs vary by program size, geographic region,
promote intergenerational meals programs. Where feasible,
and urban, suburban, and rural or frontier areas. Consistent
states must ensure that nutrition programs encourage the
with the 1995 evaluation, findings show it costs more to
use of locally grown foods in meals programs and identify
produce a home-delivered meal than a congregate meal.
potential partnerships and contracts with local producers
Researchers found that average meal costs outpaced
and providers of locally grown foods.
inflation, which they attributed to food costs increasing at a
faster rate than inflation between 1995 and 2015.
Program Participation
A national survey of OAA participants shows that in 2017,
The client outcome study is assessing program
48% of congregate nutrition survey respondents were aged
effectiveness (e.g., nutrient adequacy, health outcomes).
75 and older; 47% lived alone; 11% had annual income of
Part 1 of the study describes program participants’
$10,000 or less; and 51% reported that the congregate
characteristics and experiences, and the impact on nutrition,
meals program provided one-half or more of their daily
food security, and diet quality. Findings show that most
food intake. Furthermore, many congregate nutrition
participants had household incomes below 100% of the
participants reported these meals have fostered greater
federal poverty level. Compared to congregate meal
socialization, with 83% saying that they saw friends more
participants, a larger proportion of home-delivered meal
often due to meals. The same survey found that 62% of
participants reported being in fair or poor health, being
home-delivered respondents were aged 75 and older; 58%
underweight, having difficulty eating due to dental issues,
lived alone; 23% had annual income of $10,000 or less; and
and taking multiple medications. Overall, the study found a
57% said that the home-delivered meals program provided
positive effect on diet quality and prevalence of adequate
at least one-half of their daily food intake. According to the
nutrition intake and that the majority of participants had
survey, home-delivered meals participants tend to be
positive impressions of these programs.
particularly frail and at risk for institutionalization, in part
due to the requirement that participants be homebound.
Kirsten J. Colello, kcolello@crs.loc.gov, 7-7839
Almost 4 out of 10 recipients (39%) reported needing
IF10633
assistance with one or more activities of daily living
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