Nutrition
Evaluations Report
Chapter II. CHARACTERISTICS OF TITLE III NUTRITION
PROGRAM PARTICIPANTS
C: THE EFFECTIVENESS OF PROGRAM TARGETING
The original intent of the OAA was to enable all older persons
to receive program services, regardless of income, health, residence,
or other factors. Thus, neither the congregate nor home-delivered
meal components use means tests to determine eligibility for receipt
of program services. Over time, however, Congress has recognized
that specific subgroups of elderly people have greater needs than
others for program services. The program continues to operate
without a means test, but subsequent amendments to the OAA have
directed the program to target elderly people with the greatest
"economic or social need," in particular, low-income
elderly and members of racial and ethnic minority groups. A person
with an economic need has an income below the poverty threshold
specified by the DHHS guidelines (see discussion in Section A).
A person with a social need has a need for services that is the
result of noneconomic factors, such as physical or mental disabilities,
language barriers, or cultural or social isolation.
In this section of the report, we assess the extent to which
the two meal program components successfully target program services
to these priority subgroups of elderly people. We do so by comparing
the distribution of Title III elderly priority target groups in
the participant populations with their representation in the contiguous
U.S. population, based on Census data. Target groups considered
are racial and ethnic, low-income, low-income minority, rural,
and disabled elderly. We make the comparisons in two ways. The
first examines program targeting, using the approach that makes
the participant tabulations representative of the characteristics
of persons who are more frequent users of program meal services
(Table II.24). The second examines targeting, using the weight
variable that makes tabulations representative of all participants
(Table II.25). The first approach assesses targeting in terms
of those who use the bulk of program resources. The second approach
assesses targeting in terms of all persons who participate, regardless
of the intensity of service use, and is consistent with program
reporting data maintained by AoA and the previous evaluation.
TABLE II.24
PARTICIPATION OF SELECTED TARGET GROUPS, COMPARED WITH
THAT OF CONTIGUOUS UNITED STATES ELDERLY POPULATION
(Percentage of a Cross-Section of Participants Receiving Title
III Meals on a Given Day)
|
All
Eligible Elderly
|
|
Title
III Congregate Meal
Eligible Elderly
|
|
Title
III Home-Delivered Meal
Eligible Elderly
|
| Elderly Target Group
| Program
Participantsa
| Elderly
Populationb
|
|
Program
Participantsc
| Elderly
Populationd
|
|
Program
Participantse
| Elderly
Populationf
|
| Non-Hispanic Blacks
| 14.96
| 8.21
|
|
11.65
| 7.25
|
|
18.87
| 12.81
|
| Non-Hispanic American Indians, Eskimos,
or Aleuts
| 1.73
| 0.40
|
|
2.22
| 0.36
|
|
1.14
| 0.56
|
| Non-Hispanic Asians or Pacific Islanders
| 0.69
| 1.58
|
|
1.26
| 1.56
|
|
0.01
| 1.68
|
| Hispanics
| 8.40
| 3.90
|
|
11.67
| 3.68
|
|
4.53
| 4.93
|
| All Racial and Ethnic Minorities
| 26.15
| 14.12
|
|
27.24
| 12.88
|
|
24.86
| 20.03
|
| All Low-Income Elderly
| 40.37
| 14.58
|
|
34.03
| 12.54
|
|
47.84
| 24.34
|
| Low-Income Racial and Ethnic Minorities
| 15.49
| 4.10
|
|
14.97
| 3.36
|
|
16.10
| 7.62
|
| Low-Income Nonminorities
| 24.88
| 10.49
|
|
19.06
| 9.18
|
|
31.74
| 16.72
|
| Rural Elderly
| 22.64
| 25.36
|
|
28.42
| 25.54
|
|
15.86
| 24.48
|
Source: Elderly Nutrition Program Evaluation,
participant survey, weighted tabulations; Census of Population
and Housing 1990; U.S. Bureau of the Census 1994.
Note: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on
a given day.
aTitle III congregate and home-delivered participants
60 years of age and older.
bPersons in the contiguous United States 60 years
of age and older.
cTitle III congregate participants 60 years of age
and older.
dPersons in the contiguous United States 60 years
of age and older who do not have a mobility limitation or self-care
limitation.
eTitle III home-delivered meal program participants
60 years of age and older.
fPersons in the contiguous United States 60 years
of age and older who have either a mobility limitation or a
self-care limitation or both.
Regardless of the approach used, the findings show that the
Title III meals program is very successful at targeting services
to priority groups of elderly people, particularly low-income
and minority elderly, when the representation of these groups
in the overall U.S. population is used as the benchmark.
1. Targeting Results Based Principally on Characteristics
of More Frequent Users of Meals Program
Table II.24 shows the distribution of Title III elderly priority
groups in the participant population, using the weighting approach
that reflects the population of participants receiving the bulk
of program resources, and comparing them with the representation
of these groups in the contiguous U.S. population. Both the congregate
and home-delivered meals programs have success in targeting the
priority subgroups of elderly people, when the proportion of these
groups in the overall U.S. population is used as the benchmark.
Except for non-Hispanic Asians and Pacific Islanders and, for
the home-delivered meal program, rural residents, the proportion
of these groups in the participant populations exceeds their representation
in the overall elderly population.
The proportion of racial and ethnic minorities is 27 percent
of the congregate participant population, compared with 13 percent
in the overall elderly population; the percentages for the home-delivered
meal program are 25 and 20 percent, respectively. The proportion
of low-income persons in the congregate program participant population
is nearly three times as large as their proportion in the elderly
population eligible for the program overall (34 percent versus
12.5 percent). Similarly, the proportion of low-income elderly
home-delivered participants is more than twice as large as their
proportion in the home-delivered eligible elderly population overall
(48 percent versus 24 percent). Low-income minorities represent
15 percent of congregate participants, compared with 3 percent
in the overall elderly population. The proportion of low-income
minority elderly home-delivered participants is twice as large
as their proportion in the overall elderly eligible population
(16 percent versus 8 percent). Title III rural congregate participants
exceed their representation in the overall population (28 percent
versus 26 percent), but the proportion of home-delivered participants
that are rural residents is considerably smaller than their representation
in the overall elderly population (16 percent versus 24 percent).
TABLE II.25
PARTICIPATION OF ELDERLY TARGET GROUPS, COMPARED WITH
THAT OF CONTIGUOUS UNITED STATES POPULATION
(Percentage of a Cross-Section of Title III Meal Participants
Who Ever Receive Meals)
|
All
Eligible Elderly
|
|
Title
III Congregate Meal
Eligible Elderly
|
|
Title
III Home-Delivered Meal
Eligible Elderly
|
| Elderly Target Group
| Program
Participantsa
| Elderly
Populationb
|
|
Program
Participantsc
| Elderly
Populationd
|
|
Program
Participantse
| Elderly
Populationf
|
| Non-Hispanic Blacks
| 15.68
| 8.21
|
|
10.69
| 7.25
|
|
18.72
| 12.81
|
| Non-Hispanic American Indians, Eskimos,
or Aleuts
| 1.18
| 0.40
|
|
1.22
| 0.36
|
|
1.16
| 0.56
|
| Non-Hispanic Asians or Pacific Islanders
| 0.38
| 1.58
|
|
0.99
| 1.56
|
|
0.01
| 1.68
|
| Hispanics
| 5.31
| 3.90
|
|
6.70
| 3.68
|
|
4.47
| 4.93
|
| All Racial and Ethnic Minorities
| 22.89
| 14.12
|
|
19.92
| 12.88
|
|
24.69
| 20.03
|
| All Low-Income Elderly
| 41.16
| 14.58
|
|
33.78
| 12.54
|
|
45.79
| 24.34
|
| Low-Income Racial and Ethnic Minorities
| 13.52
| 4.10
|
|
11.05
| 3.36
|
|
15.07
| 7.62
|
| Low-Income Nonminorities
| 27.63
| 10.49
|
|
22.68
| 9.18
|
|
30.74
| 16.72
|
| Rural Elderly
| 25.51
| 25.36
|
|
39.57
| 25.54
|
|
16.97
| 24.48
|
Source: Elderly Nutrition Program Evaluation,
participant survey, weighted tabulations; Census of Population
and Housing 1990; U.S. Bureau of the Census 1994.
Note: Tabulations are weighted to be representative
of all participants receiving Title III meals during a one-year
period.
aTitle III congregate and home-delivered participants
60 years of age and older.
bPersons in the contiguous United States 60 years
of age and older.
cTitle III congregate participants 60 years of age
and older.
dPersons in the contiguous United States 60 years
of age and older who do not have a mobility limitation or self-care
limitation.
eTitle III home-delivered meal program participants
60 years of age and older.
fPersons in the contiguous United States 60 years
of age and older who have either a mobility limitation or a
self-care limitation or both.
2. Targeting Results Based Principally on Characteristics
of All Meal Program Participants
Table II.25 shows the distribution of Title III elderly priority
groups in the participant population, using the weighting approach
that gives equal weight to all participants who ever attended
the program during a one-year period, and comparing them with
their representation in the contiguous U.S. population. Both the
congregate and home-delivered programs differentially target the
program to priority subgroups of elderly people, when the proportion
of these groups in the overall population is used as the benchmark.
When the data are weighted to reflect the overall participant
population who ever attended the program, the estimated percentages
of minorities go down somewhat but still remain higher than their
proportions in the overall population. For example, 20 percent
of congregate participants are members of racial and ethnic minority
groups, compared with 13 percent in the overall elderly congregate
eligible population. Under the second approach, the percentage
of participants that are rural residents increases, particularly
for congregate participants. This increase reflects the fact that
the program, particularly the congregate program, reaches rural
elderly people, but they do not use meal services as frequently
as other groups.
3. Use of Program Services by Selected Priority Subgroups
of Elderly
Tables II.26 and II.27 show the receipt of public and private
nutrition and supportive services by selected subgroups of elderly
Title III congregate and home-delivered meal program participants.
The priority groups examined are minority, low-income, and low-income
minority elderly participants. Relative to all participants, these
priority subgroups of elderly people are more frequent users of
most, but not all, program services. This relationship is stronger
for congregate than for home-delivered participant priority groups.
Minority, low-income, and low-income minority Title III congregate
participants are more likely than congregate participants overall
to use special transportation between home and the meal site,
and to use assisted transportation for shopping or other purposes
(Table II.26). These groups are also more likely than all congregate
participants to receive nutrition counseling. Minority, low-income,
and low-income minority Title III home-delivered meal program
participants are also more likely than participants overall to
use assisted transportation, nutrition counseling services, and
personal care services (Table II.27).
TABLE II.26
USE OF OTHER NUTRITION AND SUPPORTIVE SERVICES BY SELECTED PRIORITY
SUBGROUPS OF CONGREGATE MEAL PARTICIPANTS
(Percentages of a Cross-Section of Participants Receiving Title
III Meals on a Given Day)
| Service
| Minority
| Low-Income
|
|
Low-Income Minority
| All Participants
|
| Use Special Transportation to Get to and
from Meal Site
| 39
| 36
|
|
43
| 26
|
| Receive Assisted Transportation
| 18
| 25
|
|
25
| 16
|
| Receive Nutrition Screening or Assessment
| 38
| 35
|
|
36
| 43
|
| Receive Nutrition Education
| 62
| 64
|
|
61
| 68
|
| Receive Nutrition Counseling
| 18
| 19
|
|
22
| 18
|
| Receive Recreation Services
| 75
| 70
|
|
74
| 70
|
| Receive Personal Care Services
| 4
| 5
|
|
6
| 3
|
| Receive Homemaker Chore Services
| 5
| 12
|
|
9
| 9
|
| Receive Home Health Aide Services
| 3
| 3
|
|
4
| 2
|
| Receive Adult Day Care Services
| 2
| 2
|
|
3
| 2
|
| Use Information and Referral Services
| 28
| 30
|
|
27
| 26
|
| Unweighted Sample Size
| 460
| 654
|
|
252
| 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 meals on a given day. Services
include those offered by formal public or private programs, but
not informal support from friends, neighbors, and so forth.
TABLE II.27
USE OF OTHER NUTRITION AND SUPPORTIVE SERVICES BY SELECTED PRIORITY
SUBGROUPS OF HOME-DELIVERED MEAL PARTICIPANTS
(Percentages of a Cross-Section of Participants Receiving Title
III Meals on a Given Day)
| Service
| Minority
| Low -Income
|
|
Low-Income Minority
| All Participants
|
| Receive Assisted Transportation
| 25
| 20
|
|
27
| 19
|
| Receive Nutrition Screening or Assessment
| 40
| 31
|
|
34
| 36
|
| Receive Nutrition Education
| 29
| 29
|
|
27
| 34
|
| Receive Nutrition Counseling
| 14
| 11
|
|
13
| 12
|
| Receive Personal Care Services
| 39
| 31
|
|
34
| 29
|
| Receive Homemaker Chore Services
| 40
| 30
|
|
31
| 35
|
| Receive Home Health Aide Services
| 17
| 14
|
|
15
| 14
|
| Receive Adult Day Care Services
| 4
| 2
|
|
5
| 2
|
| Use Information and Referral Services
| 10
| 13
|
|
8
| 18
|
| Unweighted Sample Size
| 213
| 338
|
|
135
| 818
|
Source:Elderly Nutrition Program Evaluation, participant survey,
weighted tabulations.
Note:Tabulations are weighted to be representative of a cross-section
of all participants receiving Title III meals during a one-year
period. Services include those offered by formal public or private
programs, but not informal support from friends, neighbors, and
so forth.
| Last Modified: 1/15/2009 11:05:57 AM |
|