Older Americans Act: Nutrition Services Program

Older Americans Act: Nutrition Services Program

Updated May 4, 2020
Older Americans Act: Nutrition Services Program
Introduction
who reside in housing facilities occupied primarily by the
The Nutrition Services Program, authorized under Title III
elderly, where congregate meals are served; persons with
of the Older Americans Act (OAA), provides grants to
disabilities who reside with, and accompany, older persons
states and U.S. territories to support nutrition services
to meals in congregate settings; and volunteers who provide
programs for seniors. As stipulated in the law, the purposes
services during the meal hours. In FY2018, a total of 73.6
of the program are to (1) reduce hunger and food insecurity,
million congregate meals were served to nearly 1.5 million
(2) promote the socialization of older individuals, and (3)
meal participants.
promote the health and well-being of older individuals by
assisting them to access nutrition and other disease
Home-Delivered Nutrition Services
prevention and health promotion services to delay the onset
Home-delivered nutrition services (commonly referred to as
of adverse health conditions resulting from poor nutrition or
“meals on wheels”) provide meals and related nutrition
sedentary behavior. According to the U.S. Department of
services to older individuals, with priority given to
Agriculture (USDA), 7.5% of U.S. households with an
homebound older individuals. According to AOA, “home-
elderly member were food insecure in 2018, which means
delivered meals are often the first in-home service that an
they lacked the ability to purchase or otherwise acquire
older adult receives, and the program is a primary access
enough to eat. Households in which elderly lived alone
point for other home and community-based services.”
reported a higher rate of food insecurity, at 8.9%. As the
Home-delivered meals can be an important service for
largest OAA program, the Title III Nutrition Services
many family caregivers in assisting them with their
Program received $937 million in FY2020, accounting for
caregiving responsibilities as well as helping maintain their
45% of the act’s total funding ($2.1 billion). A total of $720
own health and personal well-being. Individuals aged 60 or
million in FY2020 supplemental funding has been provided
older and their spouses (regardless of age) may participate
under P.L. 116-127 ($240 million) and P.L. 116-136 ($480
in the home-delivered nutrition program. Services may be
million) for nutrition programs to respond to the COVID-19
available to individuals under age 60 with disabilities if
pandemic. The Supporting Older Americans Act of 2016
they reside at home with the older individual. In FY2018, a
(P.L. 116-131) extended authorizations of appropriations
total of 147.0 million home-delivered meals were provided
through FY2024.
to over 892,000 meal participants.
Administration
Nutrition Services Incentive Program (NSIP)
The Administration on Aging (AOA) in the Administration
NSIP provides funds to states, U.S. territories, and Indian
for Community Living (ACL) within the Department of
tribal organizations to purchase food or to cover the costs of
Health and Human Services (HHS) administers the
food commodities provided by the USDA for the
Nutrition Services Program, which includes
congregate and home-delivered nutrition programs. NSIP
 the Congregate Nutrition Services Program,
was originally established by the OAA in 1974 as the
 the Home-Delivered Nutrition Services Program, and
Nutrition Program for the Elderly and administered by
 Nutrition Services Incentive Program.
USDA. In 2003, Congress transferred the administration of
NSIP from USDA to AOA. However, states and other
States that implement these programs must target nutrition
entities may continue to receive all or part of their NSIP
services to older persons with the greatest social and
grants in the form of USDA commodities. Obligations for
economic need, with particular attention to people with
commodity procurement for NSIP are funded under an
low-incomes, including low-income minorities, people with
agreement between USDA and HHS.
limited English proficiency, people residing in rural areas,
and those at risk for institutionalization. Means tests for
Funding
program participation are prohibited. Older persons are
The AOA awards separate grants to states and U.S.
encouraged to contribute to the costs of nutrition services,
territories for the congregate nutrition services program and
but may not be denied services for failure to 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
https://crsreports.congress.gov

Older Americans Act: Nutrition Services Program
relative share of the population aged 60 and over. States are
more activities of daily living (ADLs, such as bathing,
required to provide a matching share of 15% in order to
dressing, eating, and using the toilet); 12% of these
receive these funds. NSIP grants are awarded to states and
recipients needed assistance with three or more ADLs. In
other entities based on each entity’s share of total meals
addition, 78% reported needing assistance with one or more
served by the nutrition services program (both congregate
instrumental activities of daily living (IADLs, such as
and home-delivered meals) in all states, U.S. territories, and
shopping, housework, and getting around inside the home).
tribes during the prior year. There is no matching
requirement for NSIP grant awards. For FY2020 program
Program Evaluation
funding, including supplemental funding in response to the
ACL conducted a three-part evaluation of the Nutrition
COVID-19 pandemic, see Table A-1 in CRS Report
Services Program: a process study, cost study, and outcome
R43414, Older Americans Act: Overview and Funding.
evaluation. Results from these studies were compared to the
last national evaluation of the nutrition program completed
Service Delivery
in 1995, where applicable. The process study collected data
Nutrition services providers are required to offer at least
from SUAs, AAAs, and local service providers (LSPs) to
one meal per day, five or more days per week (except in
assess program administration and service delivery. It found
rural areas, where provision can be less frequent). The
that more LSPs offer home-delivered meals compared to
meals must comply with the Dietary Guidelines for
1995, while somewhat fewer LSPs offer congregate meals
Americans published by the Secretary of HHS and the
(95% to 93%). However, more congregate meals programs
Secretary of Agriculture. Providers must serve meals that
offer breakfast and dinner (in addition to lunch, which all
meet certain dietary requirements based on the number of
sites offer) and weekend meals. Programs also offer more
meals served by the project each day. Providers that serve
options for “modified” meals, which are lower in fat,
one meal per day must provide to each participant a
sodium, or calories. More LSPs report waiting lists for
minimum of one-third of the daily recommended dietary
home-delivered meals, but waiting lists have fewer people,
reference intakes (DRIs) established by the Food and
on average, than in 1995.
Nutrition Board of the National Academy of Sciences,
Engineering, and Medicine. Providers that serve two meals
The meal cost study estimated the average costs of meals
per day must provide a minimum of two-thirds of the DRIs,
provided and examined cost variation. The report found
and those that serve three meals per day must provide 100%
that, on average, home-delivered meals cost more to
of the DRIs. Providers must comply with state or local laws
provide than congregate meals ($11.06 vs. $10.69),
regarding safe and sanitary handling of food, equipment,
including costs of both purchased and donated resources.
and supplies used to store, prepare, and deliver meals, and
This finding was consistent with the 1995 evaluation.
providers must carry out meal programs using the expertise
However, costs vary by program size, geographic region,
of dietitians and meal participants.
and urban, suburban, and rural or frontier areas.
Researchers found that average meal costs outpaced
Nutrition service providers may offer nutrition-related
inflation, which they attributed to food costs increasing at a
services, such as nutrition education and screening,
faster rate than inflation between 1995 and 2015.
nutrition assessment, and counseling, as appropriate.
Providers are encouraged to make arrangements with
The outcome evaluation assessed program effectiveness
schools and other facilities serving meals to children to
(e.g., nutrient adequacy, health outcomes). Findings show
promote intergenerational meals programs. Where feasible,
that most participants had household incomes below 100%
states must ensure that nutrition programs encourage the
of the federal poverty level. Compared to congregate meal
use of locally grown foods in meals programs and identify
participants, a larger proportion of home-delivered meal
potential partnerships and contracts with local producers
participants reported being in fair or poor health, being
and providers of locally grown foods.
underweight, having difficulty eating due to dental issues,
and taking multiple medications. Overall, the study found a
Program Participation
positive effect on diet quality and prevalence of adequate
A national survey of OAA participants shows that in 2018,
nutrition intake and that the majority of participants had
53% of congregate nutrition survey respondents were aged
positive impressions of these programs. With respect to
75 and older; 50% lived alone; 11% had annual income of
health outcomes, 75% of participants had at least one
$10,000 or less; and 53% reported that the congregate
chronic condition. Home-delivered meal participants were
meals program provided one-half or more of their daily
more likely to experience a health event (e.g., primary care
food intake. Furthermore, many congregate nutrition
visit, hospital admission, emergency room visit, home
participants reported these meals have fostered greater
health episode) compared to congregate meal participants.
socialization, with 81% saying that they saw friends more
Compared to nonparticipant comparison groups, congregate
often due to meals. The same survey found that 62% of
meal participants were less likely to experience certain
home-delivered respondents were aged 75 and older; 57%
health events and home-delivered meal participants were
lived alone; 19% had annual income of $10,000 or less; and
more likely to experience such events, likely underscoring
62% said that the home-delivered meals program provided
the vulnerability of these participants.
at least one-half of their daily food intake. According to the
survey, home-delivered meals participants tend to be
Kirsten J. Colello, Specialist in Health and Aging Policy
particularly frail and at risk for institutionalization as
IF10633
participants are likely to be homebound. Over one-third of
recipients (36%) reported needing assistance with one or
https://crsreports.congress.gov

Older Americans Act: Nutrition Services Program

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material.

https://crsreports.congress.gov | IF10633 · VERSION 6 · UPDATED