Updated January 23, 2019
Older Americans Act: Nutrition Services Program
Introduction
to meals in congregate settings; and volunteers who provide
The Nutrition Services Program, authorized under Title III
services during the meal hours. In FY2016, a total of 79.2
of the Older Americans Act (OAA), provides grants to
million congregate meals were served to nearly 1.6 million
states and U.S. territories to support nutrition services
meal participants.
programs for seniors. As stipulated in the law, the purposes
of the program are to (1) reduce hunger and food insecurity,
Home-Delivered Nutrition Services
(2) promote the socialization of older individuals, and (3)
Home-delivered nutrition services (commonly referred to as
promote the health and well-being of older individuals by
“meals on wheels”) provide meals and related nutrition
assisting them to access nutrition and other disease
services to older individuals, with priority given to
prevention and health promotion services to delay the onset
homebound older individuals. According to AOA, “home-
of adverse health conditions resulting from poor nutrition or
delivered meals are often the first in-home service that an
sedentary behavior. According to the U.S. Department of
older adult receives, and the program is a primary access
Agriculture (USDA), 7.9% of U.S. households with an
point for other home and community-based services.”
elderly member were food insecure in 2017, which means
Home-delivered meals can be an important service for
they lacked the ability to purchase or otherwise acquire
many family caregivers in assisting them with their
enough to eat. Households in which elderly lived alone
caregiving responsibilities as well as helping maintain their
reported a higher rate of food insecurity, at 8.6%. As the
own health and personal well-being. Individuals aged 60 or
largest OAA program, the Title III Nutrition Services
older and their spouses (regardless of age) may participate
Program received $907 million in FY2019, accounting for
in the home-delivered nutrition program. Services may be
44% of the act’s total funding ($2.1 billion). The Older
available to individuals under age 60 with disabilities if
Americans Act Reauthorization Act of 2016 (P.L. 114-144)
they reside at home with the older individual. In FY2016, a
extended authorized appropriations through FY2019.
total of 145.2 million home-delivered meals were provided
to over 867,000 meal participants.
Administration
The Administration on Aging (AOA) in the Administration
Nutrition Services Incentive Program (NSIP)
for Community Living (ACL) within the Department of
NSIP provides funds to states, U.S. territories, and Indian
Health and Human Services (HHS) administers the
tribal organizations to purchase food or to cover the costs of
Nutrition Services Program, which includes
food commodities provided by the USDA for the
the Congregate Nutrition Services Program,
congregate and home-delivered nutrition programs. NSIP
the Home-Delivered Nutrition Services Program, and
was originally established by the OAA in 1974 as the
Nutrition Services Incentive Program.
Nutrition Program for the Elderly and administered by
USDA. In 2003, Congress transferred the administration of
States that implement these programs must target nutrition
NSIP from USDA to AOA. However, states and other
services to older persons with the greatest social and
entities may continue to receive all or part of their NSIP
economic need, with particular attention to people with
grants in the form of USDA commodities. Obligations for
low-incomes, including low-income minorities, people with
commodity procurement for NSIP are funded under an
limited English proficiency, people residing in rural areas,
agreement between USDA and HHS.
and those at risk for institutionalization. Means tests for
program participation are prohibited, but older persons are
Funding
encouraged to contribute to the costs of nutrition services.
The AOA awards separate grants to states and U.S.
Older individuals may not be denied services for failure to
territories for the congregate nutrition services program and
contribute.
home-delivered nutrition services program. State Units on
Aging (SUAs) administer the program at the state level, and
Congregate Nutrition Services
in turn, award those funds to over 600 Area Agencies on
Congregate nutrition services provide meals and related
Aging (AAAs), which oversee the program in their
nutrition services to older individuals in a variety of group
respective planning and service areas. The AOA also
settings, such as senior centers, community centers,
awards a separate grant to states, U.S. territories, and tribal
schools, and adult day care centers. The program also
organizations for NSIP.
provides seniors with opportunities for social engagement
and volunteering. Individuals aged 60 or older and their
Grants for congregate and home-delivered nutrition services
spouses (regardless of age) may participate in the
are awarded to states and U.S. territories based on a
congregate nutrition program. The following groups may
statutory formula that takes into account each entity’s
also receive meals: persons under age 60 with disabilities
relative share of the population aged 60 and over. States are
who reside in housing facilities occupied primarily by the
required to provide a matching share of 15% in order to
elderly, where congregate meals are served; persons with
receive these funds. NSIP grants are awarded to states and
disabilities who reside with, and accompany, older persons
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Older Americans Act: Nutrition Services Program
other entities based on each entity’s share of total meals
(ADLs, such as bathing, dressing, eating, and using the
served by the nutrition services program (both congregate
toilet); 14% of these recipients needed assistance with three
and home-delivered meals) in all states, U.S. territories, and
or more ADLs. In addition, 84% reported needing
tribes during the prior year. There is no matching
assistance with one or more instrumental activities of daily
requirement for NSIP grant awards. In FY2019, of the $907
living (IADLs, such as shopping, housework, and getting
million appropriated for the Nutrition Services Program,
around inside the home).
$495 million is for congregate nutrition (55%), $251
million for home-delivered nutrition (28%), and $160
Program Evaluation
million for NSIP (18%).
ACL conducted a three-part evaluation of the Nutrition
Services Program: a process study, cost study, and outcome
Service Delivery
evaluation. Results from these studies were compared to the
Nutrition services providers are required to offer at least
last national evaluation of the nutrition program completed
one meal per day, five or more days per week (except in
in 1995, where applicable. The process study collected data
rural areas, where provision can be less frequent). The
from SUAs, AAAs, and local service providers (LSPs) to
meals must comply with the Dietary Guidelines for
assess program administration and service delivery. It found
Americans published by the Secretary of HHS and the
that more LSPs offer home-delivered meals compared to
Secretary of Agriculture. Providers must serve meals that
1995, while somewhat fewer LSPs offer congregate meals
meet certain dietary requirements based on the number of
(95% to 93%). However, more congregate meals programs
meals served by the project each day. Providers that serve
offer breakfast and dinner (in addition to lunch, which all
one meal per day must provide to each participant a
sites offer) and weekend meals. Programs also offer more
minimum of one-third of the daily recommended dietary
options for “modified” meals, which are lower in fat,
reference intakes (DRIs) established by the Food and
sodium, or calories. More LSPs report waiting lists for
Nutrition Board of the National Academy of Sciences.
home-delivered meals, but waiting lists have fewer people,
Providers that serve two meals per day must provide a
on average, than in 1995.
minimum of two-thirds of the DRIs, and those that serve
three meals per day must provide 100% of the DRIs.
The meal cost study estimated the average costs of meals
Providers must comply with state or local laws regarding
provided and examined cost variation. The report found
safe and sanitary handling of food, equipment, and supplies
that, on average, home-delivered meals cost more to
used to store, prepare, and deliver meals, and providers
provide than congregate meals ($11.06 vs. $10.69),
must carry out meal programs using the expertise of
including costs of both purchased and donated resources.
dietitians and meal participants.
This finding was consistent with the 1995 evaluation.
However, costs vary by program size, geographic region,
Nutrition service providers may offer nutrition-related
and urban, suburban, and rural or frontier areas.
services, such as nutrition education and screening,
Researchers found that average meal costs outpaced
nutrition assessment, and counseling, as appropriate.
inflation, which they attributed to food costs increasing at a
Providers are encouraged to make arrangements with
faster rate than inflation between 1995 and 2015.
schools and other facilities serving meals to children to
promote intergenerational meals programs. Where feasible,
The outcome evaluation assessed program effectiveness
states must ensure that nutrition programs encourage the
(e.g., nutrient adequacy, health outcomes). Findings show
use of locally grown foods in meals programs and identify
that most participants had household incomes below 100%
potential partnerships and contracts with local producers
of the federal poverty level. Compared to congregate meal
and providers of locally grown foods.
participants, a larger proportion of home-delivered meal
participants reported being in fair or poor health, being
Program Participation
underweight, having difficulty eating due to dental issues,
A national survey of OAA participants shows that in 2017,
and taking multiple medications. Overall, the study found a
48% of congregate nutrition survey respondents were aged
positive effect on diet quality and prevalence of adequate
75 and older; 47% lived alone; 11% had annual income of
nutrition intake and that the majority of participants had
$10,000 or less; and 51% reported that the congregate
positive impressions of these programs. With respect to
meals program provided one-half or more of their daily
health outcomes, 75% of participants had at least one
food intake. Furthermore, many congregate nutrition
chronic condition. Home-delivered meal participants were
participants reported these meals have fostered greater
more likely to experience a health event (e.g., primary care
socialization, with 83% saying that they saw friends more
visit, hospital admission, emergency room visit, home
often due to meals. The same survey found that 62% of
health episode) compared to congregate meal participants.
home-delivered respondents were aged 75 and older; 58%
Compared to nonparticipant comparison groups, congregate
lived alone; 23% had annual income of $10,000 or less; and
meal participants were less likely to experience certain
57% said that the home-delivered meals program provided
health events and home-delivered meal participants were
at least one-half of their daily food intake. According to the
more likely to experience such events, likely underscoring
survey, home-delivered meals participants tend to be
the vulnerability of these participants.
particularly frail and at risk for institutionalization, in part
due to the requirement that participants be homebound.
Kirsten J. Colello, Specialist in Health and Aging Policy
Almost 4 out of 10 recipients (39%) reported needing
IF10633
assistance with one or more activities of daily living
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Older Americans Act: Nutrition Services Program
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