CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM STANDARDS TRAINING- OAA AND OPI

1. CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM STANDARDS TRAINING- OAA AND OPI Presented by: Judy Bowen, OAA Program Analyst 3 DHS/SPD State Unit on Aging 676 Church Street NE Salem, Oregon 97301 (503) 373-1842 judy.bowen@state.or.us

2. OAA Nutrition • The goal of this Netlink training is to provide Administration on Aging data for older adults and an overview of the Older Americans Act Standards and Guidelines for both the Congregate and Home-Delivered Meal Programs. The learning objectives for this session are: • Increase understanding of the OAA Nutrition Program. • Apply this knowledge to your individual OAA meal operation sites.

3. Number of Older Americans 3

4. Poverty Rates Racial/ethnic 7% White 22.7% African American 12.0% Asian American 19.4% Hispanic Americans Gender 6.6% men 11.5% women Living arrangements 5.6% living with families 16.9% living alone Location, higher than average 12.7% principal cities 11.0% rural 11.7% South Highest poverty rates 40.5% Hispanic women, living alone 37.5% Black women, living alone 4 Administration on Aging. A Profile of Older Americans: 2008.

5. Out-of-Pocket Health Care Expenditures 5

6. Inter-related Factors Affecting the Nutritional Well-Being of Older Adults 6

7. AGE-RELATED CONDITIONS / DISEASES (Hearing Loss; Macular Degeneration; Destructive Joint Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health) CHRONIC DISEASES (Heart Disease; Hypertension; Diabetes; Osteoporosis; Some Cancers: colon and breast; Arthritis; COPD; Renal Disease) ACUTE CONDITIONS (Dehydration; Pressure Ulcers; Infections; Pneumonia; Influenza; Fractures; Tooth Abscesses; Gum Disease) Impacts of Food & Nutrition on Health POOR DIETS • Without Adequate Healthy, Safe Food & Nutrition Services: • (Deafness; Blindness; Reduced Smell &Taste; Chewing & Swallowing Problems; Joint Destruction--Costly Replacements; Confusion, Forgetfulness, Memory Loss; Uncontrolled High Blood Pressure--Heart Attack, Stroke; Uncontrolled Diabetes--Amputations, Blindness, Nerve Disorders, Dialysis; Osteoporosis--Weakened Bones, Decreased Mobility and Falls; Decreased Immune Response--Flu, Colds, Upper Respiratory Infections, HIV/AIDS; Decreased Organ Function & Organ Failure; Wasting--“Dwindles” or “Failure to Thrive”; Involuntary Weight Loss:  Body Mass Index,  Muscle Mass; Excessive Weight Gain--Obesity; •  Serum Albumin--Protein Malnutrition; Pressure Ulcers) Slower Recovery Low Stamina Longer Hospital Stays SleepDisturbance Hospital Re-Admissions Depression & Anxiety PoorAppetite Premature Institutionalization Increased Morbidity & Mortality 7 Reduced Quality of Life - Lessened Independence - Increased Healthcare Costs

8. Nutrition Related Chronic Health Conditions 8

9. IMPACT OF MALNUTRITION ON FUNCTIONALITY Malnutrition UnderweightObesity Limits Muscle Strength Reduces Stamina Prevents Physical Activity Decreases ability to: Perform ADLs & IADLs: Eat, Walk, Grocery Shop, Prepare Meals Grip Items & Lift Heavy Objects Increases Dependency Increases Need for Caregiver Assistance Increases Risk for Falls & Fractures Threatens Independence  Reduces Quality of Life Increases Healthcare Costs 9

10. Diseases Affected by Diet & Future NH Use Valiyeva E, et al. Lifestyle-Related Risk Factors & Risk of Future Nursing Home Admission. Archives of Internal Medicine. 2006; 166:985-90.

11. Persons 70+ with Obesity Related Conditions 18% Diabetes 50% Hypertension 65% Osteoarthritis Villareal, et al. Obesity in older adults: technical review and position statement of the Am. Soc. For Nutrition and NAASO, the Obesity Society. Am J Clin Nutr. 2005 11

12. Food Security Access by all members of a household to be food sufficient for a healthy life, including at a minimum, the ready availability of nutritionally adequate and safe foods and the assured ability to acquire acceptable food in socially acceptable ways. Economic Research Service, USDA 12

13. Prevalence of Food Insecurity in the USHousehold Food Security in the United States, 2007, ERS, USDA http://www.ers.usda.gov/Briefing/FoodSecurity/stats_graphs.htm#food_secure

14. Older Americans Act Programs & Services Established 1965Nutrition Program established 1972 No income requirementsForbids means-testing Means-testing: determination of eligibility for services based on a specific level of income For persons 60+, targetingservices to persons in greatest economic & social need, with particular attention to low income minorities & individuals residing in rural areas & limited English speaking 14

15. OAA Nutrition Program Purpose: Section 330 Reduce hunger & food insecurity Promotesocialization of older individuals Promote the health & well-being of older individuals 15

16. Objectives of the OAA Nutrition Programs • Provide healthy, appealing meals • Promote health and prevent disease • Reduce malnutrition risk and improve nutrition • Reduce social isolation • Link older adults to community-based services • Provide an opportunity for community development, such as volunteering

17. NUTRITION PROGRAMS SERVICE DESCRIPTIONS CONGREGATE NUTRITION SERVICES (Title III, Subpart C1) • Helps to prevent health deterioration and social isolation • Meals provide a minimum of 33 1/3% of the current daily RDA’s • Promotes health and independence • Provides a positive motivation for self care

18. NUTRITION PROGRAMS SERVICE DESCRIPTIONS (cont’d) HOME-DELIVERED MEALS (Title III, Subpart C2) • Critical to maintaining independence and remain in their homes • Provide a minimum of 33 1/3% of the current daily recommended RDA’s • Programs can provide nutritional support added care and support to high-risk individuals.

19. Nutrition & Health Adequate nutrition is essential for Health Functionality Independence Quality of life 19

20. OAA MEALS ELIGIBILITY • Congregate meals will be available to persons: Please refer to Nutrition Standards (page 3)

21. OAA Meals Eligibility • To be eligible for home-delivered meals a person must: • Please refer to Nutrition Standards ( Page 3)

22. Congregate Nutrition Service Standards • Nutrition providers shall provide at least one hot meal or other appropriate meal at least once a day, five or more days/week. • In rural areas the nutrition provider must provide a written request to the SUA for approval of a lesser frequency or meal service. • Must make every effort to obtain required NAPIS data. Clients who decline may not be denied service. • Nutrition screening tool located in Oregon Access and is done at the time of intake and updated annually. Make appropriate referrals. • Congregate meal participants should be advised to keep an emergency food shelf at home; in case of emergencies.

23. Congregate Nutrition Standards – (cont’d) • Nutrition providers shall make available nutrition education to meal site participants at a minimum of quarterly. • Develop a strategy to allow participants to make a confidential donation • Site Location and physical interior( see page 6 of the Nutrition Standards). • Site Management includes- staffing, safe and appetizing meals, meeting clients interests and needs, referral to community services, volunteer opportunities, and accurate reporting. • Compliance with federal, state and local code and regulations • Projects must develop an operating policy manual • Staff should be instructed in: portion control, Food Safety, safety policies and procedures, and the process for reporting concerns

24. Congregate nutrition standards (cont’d) • Confidentiality • Meets ADA requirements • Meets compliance with the Food Protection Program • Compliance with State of Oregon Public Health Code

25. Home-Delivered Meal Standards • Meals may be hot, cold, frozen, dried, or canned with a satisfactory storage life • In rural areas a waiver request must seek approval for less than 5 meals per week • Client assessments are needed • OAA Screening Survey (Oregon Access) should be completed and NAPIS information updated annually • Clients declining NAPIS data may not be denied service • Initial assessment and reassessments (see Page 9 & 10 in the Nutrition Standards)

26. Home-Delivered Meal Standards (cont’d) • All nutrition providers will have a plan to insure clients will receive meals during emergencies, weather-related condition and disasters • It is acceptable to provide a combination of meals • Providers will develop a strategy for confidential contributions • Home-delivery staff and volunteers should be trained in food safety • Providers will develop and update annually operating procedure manuals • Meal temperature procedure shall be developed

27. Nutrition Education • Definition : Promotes better health through education • Each nutrition project shall provide education. Can you give me some examples? • Goals; Education Content ; and Nutrition Resources (see pages 11-13 of the Nutrition Standards) • Nutrition Counseling

28. Menus and Menu Planning • Each meal must meet the 2005 Dietary Guidelines and must contain at least 1/3 of the current RDA’s. • New dietary Reference Intakes (DRI’s) provide values for men and women aged 51-70 and over 70 years. • Special needs of the elderly must be considered in menu planning. • A menu pattern is best used as a tool. • Dietician or Nutritionist will certify that each meal will meet one-third of the Recommended Dietary Allowances.

29. Healthy DietDietary Guidelines for Americans, 2005 Food Components Fruit, vegetables Whole grains Low fat dairy Low fat meat, poultry, fish Lower fat, added sugar & salt Low income households must spend more time and money to consume palatable, nutritious meals* *http://www.ers.usda.gov/AmberWaves /November08/Features/AffordHealthyDiet.htm

30. Menu Planning – (cont’d) • A food identified and counted in one food group category cannot be counted as a food in another food group category. • AAA’s are encouraged to evaluate meals for meeting nutritional requirements using computer-assisted nutrient analysis and Registered Dieticians to ensure nutrient adequacy of meals. • Resources: http://nutritionandaging.fiu.edu/creative_solutions/meal_patterns.asp

31. Food Service, Sanitation and Safety • Requirements for Central Kitchens and Congregate Meal Sites: • Compliance with codes, regulations and licensor requirements • Inspection Reports should be kept on file and posted • Temperature checks should be taken with a food thermometer daily three times- leaving site, arrival off site and at serving time- Hot foods at or above 140 degrees and cold food at or below 41 degrees F • Control access to the kitchen to those who work in it • Foods must be prepared, served and transported with the least possible manual contact. Sanitize utensils to prevent cross contamination • Procedures for sanitizing should be written and posted

32. Sanitation/Safety Requirements for Home-Delivered meals • Shall be individually plated, packaged and prepared • Delivered directly to the participant with food safety guidelines • Hot foods must be maintained at or above 140 degrees F and cold food items maintained at or below 41 degrees F • AAA shall develop procedure for taking and documenting meal temperature of the last meal served on each route

33. Meal Packaging Supplies and Carriers- (cont’d) • Meal packaging supplies and carriers: • Must be used to ensure hot foods and cold foods are separate • Cleaned and sanitized daily • Refrigerated foods requiring refrigeration will be pre-chilled and kept at or below 40 degrees F throughout transport • Hot foods requiring heated storage will be held at or above 140degrees F throughout transport

34. Nutrition Services Incentive Program (NSIP) formerly USDA meals • Changed in 2003 to the NSIP program • Eligibility: • Must be served by a providers under the AAA • Meals served to eligible persons, as defined by the OAA • Title XIX or private reimbursement are not eligible • AAA must document meals served to qualify for reimbursement • Must operate in compliance with all federal requirements • Reimbursements shall be disbursed as requested monthly by the AAA

35. Meal Donations • Voluntary contributions shall be allowed and shall not deny services to those who do not contribute. Protect privacy and inform that there is no obligation to contribute and is purely voluntary. • A clearly visible and easy-to-read sign may be posted for suggested donations and cost for those under 60 • Volunteers should be encouraged to donate towards the cost of their meal • Develop a strategy that allows home delivered meal participants to voluntarily contribute • Drivers receiving contributions should be instructed to bring all donations back to the meal site and given to the appropriate person.

36. Use of Program Income and Administrative and Program Requirements • See Pages 25 & 26 of the Nutrition Standards

37. Nutrition Advisory Council • Each AAA shall establish a nutrition advisory council • The council shall advise on all matters relating to the delivery of nutrition and support services within the program area • Suggested Council roles and Responsibilities ( page 27 & 28)

38. NAPIS Reporting • Please see Pages 28, 29 and 30 of the OAA Nutrition Standards

39. Resources www.aoa.gov www.aoa.gov/about/results/index.aspx http://www.data.aoa.gov http://agingstats.gov/agingstatsdotnet/main_site/default.aspx www.usda.gov www.fns.usda.gov/fns/ www.ers.usda.gov/briefing/foodsecurity/ www.mowaa.org/ 39

40. OAA Nutrition Standards Training Thank You…