Nutrition

Vol. 1 Chapter II. CHARACTERISTICS OF TITLE III NUTRITION PROGRAM PARTICIPANTS

A (Part 2): CHARACTERISTICS OF PARTICIPANTS

5. Program Participation Experiences

This section examines program participation experiences of Title III congregate and home-delivered meal program participants. It describes how long current participants have been in the program, how participants found out about the program or were referred to the program, their frequency of site attendance/receipt of home-delivered meals, and their experiences and attitudes about voluntary contributions for meals.

How Long Ago Participants Entered Program. Eighty-five percent of congregate participants and 65 percent of home-delivered participants first enrolled in the meal program more than one year earlier (Table II.12). Approximately 10 percent of congregate participants and nearly 20 percent of home-delivered participants enrolled within the preceding six months. As a group, congregate participants have been participating longer than home-delivered participants. Forty-five percent of congregate participants enrolled more than five years earlier, compared with 11 percent of home-delivered participants.

Method of Referral to the Program. Title III congregate and home-delivered meal program participants find out about or are referred to the program in several ways. There are, however, important differences between congregate and home-delivered meal recipients in the ways in which they become program participants. Specifically, most congregate participants hear about the program from family, friends, or neighbors, whereas home-delivered participants hear about the program from hospitals/ community-based organizations and family, friends, or neighbors, in roughly equal proportions. Forty-five percent of home-delivered participants report first hearing about the program through a hospital or community-based agency or organization (Table II.12). Most of the rest--44 percent--heard about the program through family, friends, or neighbors. In contrast, 68 percent of congregate participants heard about the program from this source. Fewer than 15 percent of congregate participants were referred to the program from hospitals or community-based organizations. Again, indicative of the ways in which participants might hear of the program, 22 percent of home-delivered participants were receiving one or

more other home- or community-based long-term care services (for example, transportation, home health, personal care, or homemaker services) prior to their receipt of program meals, compared with 5 percent of congregate participants. Thirteen percent of home-delivered participants were on a waiting list prior to receiving their first home-delivered meal.

TABLE II.12

MEAL PROGRAM PARTICIPANTS' REFERRAL TO THE PROGRAM

(Percentages)

	Title III Congregate Meal Participants	Title III Home-Delivered Meal Participants
How Long Ago Began Participating
Less than 6 months	9	17
6 to 11 months	7	18
1 to 5 years	40	54
6 to 10 years	25	9
More than 10 years ago	20	2
How First Heard About the Program
Family member or friend	68	44
Community-based organization or hospital	12	45
Newspaper, radio, or television	5	2
Posters or announcement in mail	1	1
Announcement in church or club	6	1
Other method	8	7
On Waiting List Before Receiving Meals	2	13
Received Other Long-Term Care Services Before Receiving Mealsa	5	22
Unweighted Sample Size	1,040	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

a The most commonly mentioned home- and community-based long-term care services were home health, personal care, and homemaker services. Congregate participants most commonly mentioned transportation, homemaker, and personal care services.

Attendance/Meal Receipt Patterns. A substantial proportion of the congregate participants who received a program meal on a given day go to the meal site frequently. Nearly 60 percent of congregate meal program participants who attended a meal site on a given day usually participate four or more days per week (Table II.13). Most congregate participants--91 percent--go to one site for meals. Sixty-one percent receive five or more meals per week; 12 percent report taking meals home from the congregate meal site to eat later. The meals taken for consumption at home are usually full meals, but some are snacks or combinations of full meals/snacks. Most participants reported usually spending a significant amount of time at the congregate site when they attend on a given day. Ninety percent reported spending more than one hour at the site, and nearly half spend three or more hours at the site on days they attend. Just under 10 percent of congregate participants reported receiving home-delivered meals regularly at some time during the past (Table II.13). The majority of those receiving home-delivered meals sometime in the past quit receiving them because their health improved.

TABLE II.13

CONGREGATE PARTICIPANTS' PARTICIPATION CHARACTERISTICS

(Percentages)

Participation Characteristic	Percentage of Title III Congregate Meal Participants
Number of Days Usually Attend Meal Site Per Week
Less than 1	2
1 to 3 days	39
4 to 5 days	57
More than 5 days	2
Number of Different Sites Attended
One	91
Two	8
More than two	1
Number of Meals Usually Received Per Week
Less than 1	2
1 to 2	14
3 to 4	23
5 or more	61
Take Other Meals Home from Meal Site to Eat Later	12
Types of Other Meals Taken Home from Meal Site to Eat Later
Full meal	8
Snack	3
Some combination	1
Amount of Time Usually Spent at Meal Site Per Visit
Less than 1 hour	10
1 to 2 hours	43
3 to 4 hours	35
More than 4 hours	12
Received Home-Delivered Meals Regularly in the Past	9
Reasons No Longer Receiving Home-Delivered Meals a
No longer need them	51
No longer eligible	4
Contribution too high	2
Didn’t like the meals	2
Other reasons	43
Unweighted Sample Size	1,040

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III congregate meals on a given day.

a Calculated for only those congregate participants who received home-delivered meals sometime during the past.

TABLE II.14

HOME-DELIVERED PARTICIPANTS' PARTICIPATION CHARACTERISTICS

(Percentages)

Participation Characteristic	Percentage of Title III Home-Delivered Meal Participants
Number of Meals Usually Received Per Week
Less than 1	*
1 to 2	1
3 to 4	3
5 or more	95
Reasons Why Participant Usually Receives Fewer than 5 Meals Per Week a
Cannot get more from the program	32
Could get them, but not at home to receive them	5
Could get them, but have other meal arrangements	35
Could get them, but do not receive them for other reasons	28
Type of Program Meals Usually Received
Lunch only	83
Supper/dinner only	1
Some combination	16
Type of Preparation Methods for Meals Usually Receivedb
Hot meals	94
Cold, ready to eat	14
Cold or frozen, need to be reheated	9
Program Meal Usage
Usually eat entire program meal in one sitting	55
Eat leftovers as another meal or snack	16
Eat leftovers as part of another meal	23
Throw leftover portion away	3
Other	2
Received Congregate Meals Regularly in the Past	19
Reasons No Longer Receiving Congregate Meals c
Too many health problems to get to program	59
No transportation to program	15
Did not need it	5
Did not like other participants	2
Other	22
Unweighted Sample Size	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III home-delivered meals on a given day.

a Calculated only for those home-delivered participants who usually get fewer than five program meals per week.

b Percentages total more than 100 percent because participants can receive different types of meals during the week.

c Calculated only for home-delivered participants who regularly received congregate meals sometime during the past. Percentages may total more than 100 percent because of multiple responses.

* = Less than 0.5 percent.

Two-thirds of those who receive fewer than five meals per week, or 3.3 percent of home-delivered participants overall, do so because of personal preference; one-third of home-delivered participants who receive fewer than five meals per week, or less than 2 percent of home-delivered participants overall, would like to receive more meals from the program but reported that they cannot get them. Home-delivered participants typically receive one meal from the program per day, usually a hot lunch. Eighty-three percent receive a program lunch only, but 16 percent receive two meals daily (lunch and dinner/supper). More than ninety percent of participants receive hot meals. The majority of home-delivered participants--55 percent--usually eat their entire program meal in one sitting, but 45 percent do not usually eat the entire meal in one sitting. Overall, 23 percent of home-delivered participants eat program meal leftovers as part of another meal; 16 percent eat program meal leftovers as an entire other meal. Just three percent report throwing away leftover food from program meals. About 20 percent of current home-delivered participants participated in the congregate meals program regularly at some time during the past (Table II.14). More than two-thirds of the home-delivered meal participants who participated in the congregate program in the past, or 14 percent of current home-delivered participants overall, discontinued participating in the congregate program because of health problems or lack of transportation, which prevented them from getting to the meal site.

There is a moderate amount of fluidity between the two components of the ENP: 9 percent of Title III congregate participants have received home-delivered meals in the past, and 19 percent of Title III home-delivered participants have received congregate meals. Most current home-delivered meal participants, however, have not participated in the congregate meals program in the past. They represent a new pool of participants and have not aged in place at the congregate site.

Voluntary Contributions for Program Meals. Means tests for program participation are prohibited. However, participants are given the opportunity to contribute toward the costs of meals. Ninety-four percent of congregate participants reported typically making a contribution for the program meals they receive (Table II.15). Seventy-three percent of home-delivered participants typically contribute toward the program meal. The median amount contributed by congregate participants who typically make contributions for meals is $1.25, compared with $1.50 for home-delivered participants. Considering all participants (those who contribute and those who do not), the average contribution for congregate participants is $1.18, compared with $1.45 for home-delivered participants.

TABLE II.15

PARTICIPANT REPORTED MEAL CONTRIBUTIONS

	Title III Congregate Meal Participants	Title III Home-Delivered Meal Participants
Percentage Who Make a Contribution	94	73
Dollar Amount Usually Contributed (Only for Those Making a Contribution)
Mean	1.26	1.99
Median	1.25	1.50
Mean Dollar Amount Usually Contributed (Calculated for All Participants)	1.18	1.45
Percentage Who Feel Suggested Meal Contribution Amount Is:a
Too high	4	8
About right	85	85
Too low	11	7
Unweighted Sample Size	1,040	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

^a Question asked only when participants make a contribution and the nutrition program has suggested contribution amount. Eighty-one percent of all congregate participants make a contribution, and the program has suggested the amount. The percentage for home-delivered participants is 52 percent.

Of the Title III congregate and home-delivered meal participants who usually make contributions and attend sites that suggest an amount, the majority--85 percent--felt that the suggested amount was "about right." Home-delivered participants were twice as likely to report the suggested amount as "too high" (eight percent versus four percent).

6. Receipt of Nutrition and Supportive Services

Table II.16 shows receipt of other nutrition and supportive services by Title III meal program participants during the past year. The columns showing receipt of services from all public or private sources exclude help from family, friends, or neighbors. The columns showing receipt of services from all sources include help from family, friends, and neighbors.

If we examine nutrition and supportive services received from all types of public and private sources only, congregate participants are more likely to receive recreation and nutrition education services (Table II.16). Seventy percent of congregate participants participated in recreation activities during the past year, and 68 percent received some formal nutrition education from public or private sources. Slightly more than 40 percent of congregate participants received nutrition screening and/or assessment from public or private sources, and about one-quarter used special transportation to get to and from the meal site. Another quarter used information and referral services from public or private sources. Few congregate participants used core long-term care services such as personal care, homemaker, or home health services.

TABLE II.16

USE OF NUTRITION AND SUPPORTIVE SERVICES BY MEAL PROGRAM PARTICIPANTS DURING THE PAST YEAR

(Percentages)

	Title III Congregate Meal Participants			Title III Home-Delivered Meal Participants
Service Use	Publicly or Privately Funded Organized Programsa	All Sourcesb		Publicly or Privately Funded Organized Programsa	All Sourcesb
Receive Title III Program Meals	100	100		100	100
Use Special Transportation to Get to Meal Site	26	26		NA	NA
Receive Assisted Transportation	16	18		19	28
Receive Nutrition Screening or Assessment	43	43		36	36
Receive Nutrition Education	68	69		34	35
Receive Nutrition Counseling	18	20		12	12
Receive Recreation Services	70	70		NA	NA
Receive Personal Care Services	3	6		29	39
Receive Homemaker Services	9	23		35	66
Receive Home Health Aide Services	2	2		14	16
Receive Adult Day Care Services	2	2		2	2
Use Information and Referral Services	30	31		18	19
Other Services	7	8		6	18
Percentage of Participants Receiving:
1 to 2 services	19	17		44	27
3 to 4 services	46	42		37	43
5 to 6 services	29	33		15	21
More than 6 services	6	8		5	8
Mean	3.9	4.2		3.0	3.7
Median	4.0	4.0		3.0	3.0
Unweighted Sample Size	1,040	1,040		818	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTES: Use of transportation to and from meal site and receipt of recreation services are not applicable to home-delivered participants. Home-delivered participants can receive between 1 and 11 services; congregate participants can receive between 1 and 13 services. Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

^a Participant receives service from public or private source, but source does not include family, friends, or neighbors.

^b Participant receives service from any source, including family, friends, and neighbors.

NA = not applicable.

Less than 40 percent of home-delivered participants received nutrition or supportive services other than a meal from public or private sources. Thirty-six percent received nutrition assessment/screening from a public or private source, 35 percent received homemaker services from public or private sources during the past year, and slightly less than one-third received personal care services from public or private sources. Overall, between 15 and 40 percent of home-delivered participants used long-term care services other than program meals from public or private sources during the past year.

The percentages of Title III participants receiving nutrition and certain supportive services are often higher, especially for home-delivered participants, when services provided by family, friends, and neighbors are included. For example, the percentage of congregate participants receiving assistance with household chores increases from 9 percent to 23 percent when assistance from family, friends, and neighbors is included. For home-delivered participants, the percentage receiving homemaker services increases from 35 percent to 66 percent (Table II.16).

7. Participation in Other Federal, State, and Local Food and Nonfood Assistance Programs

A variety of federal, state, and local food assistance programs are available to help elderly people, particularly low-income ones, meet their food and nutritional needs. The evaluation asked congregate and home-delivered participants about participation in the Food Stamp Program (FSP) and other food and nutrition assistance programs, such as receipt of USDA commodity food packages and participation in food pantries and soup kitchens. The evaluation also asked about receipt of Medicaid benefits, and whether money was being received from Social Security, Social Security Disability Income, Supplemental Security Income (SSI), or public assistance.

Ten percent of congregate participants and about 20 percent of home-delivered participants reported participating in the FSP, a means-tested program that provides benefits in the form of coupons redeemable for eligible food items sold in authorized retail food stores (Table II.17). (Note that in addition to using FSP coupons to purchase food, congregate and home-delivered meal program participants may use food stamp benefits to make their contribution for program meals: seven percent of both congregate and home-delivered participants that participated in the FSP reported using food stamps to make donations for meals received.) Nearly 25 percent of congregate participants and 18 percent of home-delivered participants reported that they received USDA commodity food packages during the past year. Fewer than five percent of both congregate and home-delivered participants reported receiving food from food pantries or soup kitchens. On the basis of previous research, the relatively low use of other food and nutrition programs by congregate and home-delivered meal program participants probably reflects one or more of the following factors: lack of need for the programs, ineligibility for the programs (because income or assets exceed program limits), lack of knowledge about the programs' existence, perception of ineligibility for the program, program access barriers, and personal preferences that may include stigma associated with program participation (Ponza and Wray 1990; and Clark et al. 1993).

Title III meal program participants make use of other federal (nonfood) programs. Approximately 95 percent receive income from Social Security. Seventeen percent of home-delivered meal participants and 11 percent of congregate participants receive SSI. Approximately 15 percent of both congregate and home-delivered participants live in public housing. Sixteen percent of congregate participants and 23 percent of home-delivered partici .pants receive federal or state Medicaid benefits.

TABLE II.17

PARTICIPATION IN OTHER FOOD AND NONFOOD ASSISTANCE PROGRAMS

(Percentages)

Program	Title III Congregate Meal Participants	Title III Home-Delivered Meal Participants
Receive Food Stamps	10	18
Receive USDA Commodities	24	18
Receive Food from Food Pantries	4	3
Receive Other Local Food Assistance	2	2
Receive Medicaid Benefits	16	23
Live in Public Housing	15	16
Receive Supplemental Security Income (SSI)	11	17
Receive General Assistance Income	3	4
Receive Social Security Income	93	95
Receive Social Security Disability Insurance Income	5	8
Unweighted Sample Size	1,040	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

8. Social Interactions and Activities

The participant survey included several questions about the types and frequency of social interactions and activities participants engaged in during the past year. These questions examined social interactions and activities within participants' families, within friendship and neighborhood groups, and within the larger community (for example, clubs, social organizations, religious groups, and the meals program). The first part of this section examines the frequency of specific types of interactions and activities of participants with family, friends, and community organizations. The second part describes the total number of social interactions and activities, which includes contacts with public and private caregivers and the meals program, as well as with family, friends, and the community.

a. Types and Frequency of Selected Social Interactions and Social Activities

Title III congregate participants are socially active. The majority (82 percent) talk on the telephone with family, friends, or neighbors more than twice per week. Sixty-eight percent see relatives, friends, or neighbors at least once per week (Table II.18). Sixty-four percent attend church or religious services once or more per week. Twenty percent of congregate participants are members of clubs or other organizations that meet at least once per month. Eighty-four percent go to congregate meal sites more than twice per week to receive nutritious meals and to socialize.

Home-delivered meal program participants are less active outside of the home than congregate participants. Although 76 percent talk on the telephone with family, friends, or neighbors more than two times a week, just 24 percent attend church or religious services once or more per week, and only 6 percent attend club or other organization meetings at least once per month (Table II.18). The majority of home-delivered meal program participants, however, have contact with family, friends, neighbors, or the meal delivery person. Fifty-six percent see relatives, friends, or neighbors at least once per week. Eighty-eight percent have contact with the meal delivery person four or more times per week. Although contact for most participants is brief, 25 percent report that the meal delivery person spends some time with them to talk and see how they are doing (tabulation not shown).

TABLE II.18

MEAL PROGRAM PARTICIPANTS' SOCIAL INTERACTIONS DURING THE PAST YEAR

(Percentages, Unless Stated Otherwise)

Type of Social Contact	Title III Congregate Meal Participants	Title III Home-Delivered Meal Participants
Times Per Month Talk on the Telephone with Family, Friends, or Neighbors
Never	6	10
1 to 10 times	12	14
11 to 19 times	14	10
More than 19 times	68	66
Median number of times	30.1	30.0
Times Per Month See Relatives, Friends, or Neighbors
Never	15	29
Less than once	9	9
1 to 3 times	9	5
4 to 10 times	34	26
11 to 19 times	15	10
More than 19 times	19	20
Median number of times	8.0	4.2
Times Per Month Attend Church or Religious Services
Never	22	69
Less than once	9	5
1 to 2 times	5	2
3 to 4 times	51	20
More than 4 times	13	4
Median number of times	4.3	0.0
Times Per Month Attend Club Meetings
Never	63	89
Less than once	17	6
1 to 2	6	2
More than 2 times	13	4
Median number of times	0.0	0.0
Times Per Month Attend Congregate Meal Program Site
Never	0	100
Less than once	1	0
1 to 3 times	1	0
4 to 10 times	14	0
11 to 19 times	25	0
More than 19 times	59	0
Median number of times	21.5	0.0
Times Per Month Have Contact with Person Delivering Program Meal to Home
Never	100	0
Less than once	0	0
1 to 3 times	0	0
4 to 10 times	0	7
11 to 19 times	0	5
More than 19 times	0	88
Median number of times	0.0	21.5
Unweighted Sample Size	1,040	818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

If we include social interactions that involve the ENP (either attendance at a meal site or receipt of a home meal delivery), as well as those that involve in-home providers of personal care, homemaker, and nursing care, along with contacts with friends, relatives, and neighbors, the average Title III meal program participant has approximately 100 contacts with other people per month (Table II.19). Home-delivered participants have slightly more monthly social contacts than congregate participants (100 versus 95). Congregate and home-delivered participants have approximately the same number of contacts from the Title III program and from church or clubs (18 versus 20 per month, respectively). Congregate participants have more contacts with family, friends, and neighbors, whereas home-delivered participants have more social contacts through in-home care (for example, with providers of personal care, homemaker, or home health care services).

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