Nutrition

IV. TITLE III PROGRAM ADMINISTRATION AND SERVICE DELIVERY

B. NUTRITION AND SUPPORTIVE SERVICES

Nutrition projects have primary responsibility for providing services under the ENP; many of these services are actually provided at individual congregate sites. However, AAAs also contribute extensively to the provision of nutrition and supportive services to older people, through their role in planning and coordinating services within their prescribed service areas, as well as sometimes through the direct provision of services. Our examination of the types of nutrition and supportive services offered under the program supported in whole or in part by Title III funding draws on information from each of these three levels of the program hierarchy. Subsection B.1 provides an overview of the types of services offered by these agencies. Subsection B.2 examines in more detail the characteristics of meal service and other services available through congregate meal sites. Subsection B.3 discusses characteristics of home-delivered meal services, on the basis of nutrition project data.

1. Overview of Nutrition and Supportive Services Provided by the Title III Aging Network

a. AAAs

The top part of Table IV.6 shows the percentage of AAAs that make various nutrition and social supportive services available to elderly persons in their planning and service areas. AAAs either provide these services directly, or more commonly, provide them through grants to or contracts with service providers, or both, using Title III funds. All AAAs offer Title III congregate and home-delivered meals in their service areas. Most are using Title III funds to make available a range of other nonmeal nutrition-related and support services. Two-thirds or more of the AAAs offer information and referral, nutrition education, transportation between home and meal site, outreach, and homemaker services. Fewer than half reported using Title III funds to provide home health aide or adult day care services.

TABLE IV.6

TITLE III SERVICES OFFERED BY AREA AGENCIES ON AGING^a

(Percentages)

Type of Service	AAAs
Services Offered
Personal Care	63
Home Health Aid Services	43
Adult Day Care/Adult Day Health	41
Outreach	88
Recreation and Social Activities	54
Homemaker Services	80
Nutrition Counseling	65
Nutrition Education	92
Information and Referrals	95
Congregate Meal Services	100
Home-Delivered Meal Services	100
Case Management	62
Transportation to Meal Sites	88
Other Transportation b	52
Other Services	64
Main Services Offeredc
Personal Care	8
Home Health	4
Adult Day Care/Adult Day Health	3
Outreach	5
Recreation Facilities and Activities	2
Homemaker Chore Services	12
Nutrition Counseling	1
Nutrition Education	2
Information and Referrals	14
Congregate Meal Services	88
Home-Delivered Meal Services	89
Case Management	9
Transportation to Meal Sites	49
Other Transportationb	*
Other Services	7
Unweighted Sample Size	401

Source: Elderly Nutrition Program Evaluation, AAA survey, weighted tabulations.

^a Services that AAAs either provide directly or provide grants or contracts for, supported in whole or in part by Title III funds.

^b Includes assisted transportation and other transportation.

^c Percentage of sites indicating that service is one of the top three in terms of resources spent providing it.

* = Less than 0.5 percent.

The bottom part of Table IV.6 shows the three main services provided by AAAs and supported by Title III funds in terms of total resources spent. For nearly 90 percent of the AAAs, congregate and home-delivered meals are among the top three services they provide using Title III funds. Transporting participants between their homes and meal sites is frequently the third most important service category and appeared in the "top three" list for nearly half of AAAs. No other service came close to being mentioned as often.

Past research (Hudson 1983) has suggested that the importance of the Title III program--and Title III-C, in particular--to many AAAs extends beyond the direct funding received. According to this study, Title III provides an overall service framework allowing AAAs to plan and provide a broader range of services. To examine this issue, we asked AAA respondents a series of questions about the role of Title III in their operations and capacity to facilitate other supportive services for elderly people. Virtually all said Title III-C was important for them in "ways that go beyond direct meal service" (Table IV.7). More specifically, substantial majorities responded positively to questions about the importance of Title III-C in such matters as providing stability in funding to cover personnel costs (71 percent), bringing in volunteers (92 percent), raising funds (71 percent), creating linkages and bargaining power with other agencies in the community (62 percent), and improving community relations (97 percent). The survey respondents felt that the Title III-C program facilitates a more comprehensive, communitywide approach through beneficial "spillover" effects that extend beyond the direct effects of the supportive services authorized under Title III-B.

TABLE IV.23

AAA ASSESSMENT AND MONITORING OF NUTRITION PROJECTS

(Percentages, Unless Stated Otherwise)

	AAA Assessment and Monitoring of Nutrition Projects
Assessment/Monitoring Method	All AAAs a	AAAs that Monitor or Assess
Assess or Monitor	99	--
Site Visits
Conduct On-Site Assessments	99	100
Average Number of Times Per Year Conduct On-Site Assessments	11.1	11.2
If Had Choice, Would Conduct On-Site Assessments:
More frequently	39	39
About the same	59	60
Less frequently	1	1
Not asked	1	--
Written Narrative Performance Reports
Review Narrative Written Performance Reports	84	85
Average Number of Times Per Year Require Reports Submitted for Review	5.6	6.7
If Had Choice, Would Request Narrative Reports:
More frequently	19	23
About the same	62	74
Less frequently	3	3
Not asked	16	--
Written Statistical Performance Reports
Review Statistical Reports	92	93
Average Number of Times Per Year Require Reports Submitted for Review	16.7	18.2
If Had Choice, Would Request Statistical Reports:
More frequently	5	6
About the same	84	91
Less frequently	3	3
Not asked	8	--
Written Fiscal Reports
Review Fiscal Reports	96	97
Average Number of Times Per Year Require Fiscal Reports Submitted for Review	9.2	9.6
If Had Choice, Would Require Fiscal Reports:
More frequently	6	6
About the same	88	92
Less frequently	2	2
Not asked	4	--
Unweighted Sample Size	341	337

Source: Elderly Nutrition Program Evaluation, AAA survey, weighted tabulations.

^a AAAs that are the only nutrition project in the planning and service area are excluded.

b. Nutrition Projects

Respondents to the nutrition project survey were asked to indicate what services they provided that were supported either fully or partially by Title III funding. Projects were also asked whether the services were available to congregate participants only, home-delivered participants only, or both. Providing ENP meals clearly constitutes the main activity for most nutrition projects, yet, many use Title III funds to provide other services in addition to meals.

The most common service provided by nutrition projects is congregate meals (Table IV.8, third column). Ninety-five percent of projects offer congregate meals; most (81 percent) also provide home-delivered meals. Although the OAA requires each nutrition project to provide nutrition education on at least a semiannual basis, only 87 percent of the projects report that they provide nutrition education. More than half provide nutrition screening to congregate and/or home-delivered participants. Nutrition counseling is also available at about half of projects, while nutritional assessment is provided by a little more than a third.

TABLE IV.8

TITLE III SERVICES OFFERED BY NUTRITION PROJECTS^a

(Percentages)

	Services to Congregate Meal Participantsb	Services to Home-Delivered Meal Participantsc	All Projects
Congregate Meals	100	--	95
Home-Delivered Meals	--	100	81
Nutrition Education	88	81	87
Nutrition Screening	54	54	55
Nutrition Assessment	31	35	36
Nutrition Counseling	49	43	50
Transportation to and from Meal Site	68	--	68d
Other Transportatione	57	58	54
Recreation and Social Activities	69	--	69d
Other Counseling	53	50	51
Information and Referral	85	84	84
Coordination with Other Health and Medical Service Agencies	40	35	39
Personal Care Service	4	5	4
Homemaker Services	12	14	12
Home Health Aid Services	5	6	5
Adult Day Care/Adult Day Health Services	4	5	4
Case Management	4	4	4
Outreach	9	11	9
Other Services	12	12	12
Unweighted Sample Size	229	208	242

Source: Elderly Nutrition Program Evaluation, Nutrition Project survey, weighted tabulations.

^a Services available through the nutrition project that are funded in whole or in part by Title III funds.

^b Projects providing congregate services.

^c Projects providing home-delivered services.

^d Calculated only for those projects with congregate programs, since only projects providing congregate services were asked the question.

^e Includes all assisted or nonassisted transportation services other than transportation between meal sites and participants’ homes.

The most commonly provided other services include information and referral, transportation to and from meal sites, and recreation services. More than 80 percent of projects provide information and referral services to Title III participants. About 70 percent provide transportation to and from meal sites, as well as recreation services. Fewer than 15 percent provide more intensive home- and community-based long-term care services, such as personal care, home health aide, or homemaker services, with Title III funds.

On the basis of past research (Balsam and Rogers 1988), it is useful to assess the degree to which nutrition providers supply innovative services, in addition to simple five-day-a-week meal service. Innovations and enhancements in service by Title III nutrition projects are displayed in Table IV.9. These innovations and enhancements may include offering different types of meals, such as meals modified for dietary or religious reasons; offering meals on the weekends or for supper; establishing food pantry programs, luncheon clubs, or consortiums for volume food purchasing; and accepting food stamps. Modified meals and other special meals (for example, meals provided on holidays) are the most common service enhancements reported by nutrition projects (about 75 percent). Accepting food stamps in lieu of cash was mentioned by about 60 percent of Title III nutrition projects. About one-third provide home-delivered meals on the weekend. Virtually every project (99 percent) has instituted at least one of these service innovations. The typical (median) project has five of these service enhancements.

TABLE IV.9

SERVICE ENHANCEMENTS BY NUTRITION PROJECTS

(Percentages)

	Title III Nutrition Projects
Service Enhancements
Modified or therapeutic meals that vary from regular menu (low fat, low cholesterol, or low salt meals)	73
Other special meals (for example, holiday meals)	73
Food stamps accepted in lieu of cash	62
Once a week delivery of frozen or ready-to-eat prepared meals	37
Regular nursing home visits to nutrition sites	35
Weekend home-delivered meals	35
Ethnic meals (for example, Mexican, Indian)	26
Nutritional supplement program (Ensure, Sustacal, Mix-a-Meal, Nutritreat)	24
Food pantry program (grocery distribution to very needy)	24
Contracts with diners or restaurants to provide meals	17
Religious meals (for example, Kosher, Halal)	16
Supper option for home-delivered meals	15
Luncheon clubs (small groups meeting weekly in a home or apartment building)	14
Vegetarian meals	13
Supper option for congregate meals	13
Weekend congregate meals	11
Meals for homeless elderly (soup kitchen and so forth)	10
Distribution of Service Enhancements
None	1
1 to 2	14
3 to 5	46
6 to 8	25
9 or more	13
Mean	5.2
Median	5.0
Unweighted Sample Size	242

Source: Elderly Nutrition Program Evaluation, Nutrition Project survey, weighted tabulations.

c. Congregate Meal Sites

All congregate meal sites offer congregate meals (Table IV.10). A little more than half (54 percent) also operate a home-delivered meals program from their location. Eighty-percent or more of congregate sites provide nutrition education, recreation and social activities, and information and referral services. Nearly three-quarters of the congregate sites provide transportation between the site and participants’ home, or provide other transportation services (such as assisted transportation). Fewer than one-third of meal sites are providing nutrition screening or assessment services. [ The percentages of nutrition projects reporting some services available might be higher than the corresponding percentages for meal sites. These differences may occur because not all congregate meal sites managed by a project provide the same set of services available. Furthermore, some services may be available only to home-delivered meal participants. In addition, the questions asked of nutrition project survey respondents and meal site survey respondents were slightly different. Nutrition project respondents were asked which services supported by Title III Older Americans Act (OAA) funds were available through the project. Meal site respondents were asked about activities and services that might be available at the meal site. These distinctions were made because meal sites are often co-located at senior and community centers with other service providers. ] No more than 20 percent of the sites are providing the more intensive home- or community-based long-term care services, such as case management, personal care, and homemaker services.

TABLE IV.10

SERVICE AVAILABILITY AT CONGREGATE MEAL SITES

(Percentages)

Service Offered	Title III Congregate Meal Sites
Congregate Meals	100
Home-Delivered Meals	54
Transportation to and from Meal Sites	71
Other Transportationa	69
Nutrition Education	89
Nutrition Screening	25
Nutrition Assessment	16
Nutrition Counseling	29
Recreation and Social Activities	83
Information and Referral	86
Non-Nutritional Counselingb	46
Personal Care Service	13
Homemaker Chore Service	15
Home Health Aid Service	10
Adult Day Care/Adult Day Health Service	9
Case Management	17
Legal Assistance	14
Outreach	20
Other Services	12
Unweighted Sample Size	158

Source:Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Includes all assisted and nonassisted transportation services other than transportation between meal sites and participants’ homes.

^b Non-nutritional counseling may cover personal or mental health, financial, legal, housing, health, or other issues.

2. Service Characteristics and Patterns at Congregate Meal Sites

a. Congregate Meals

Meal Service Schedule. With few exceptions, congregate meal sites serve lunch five days per week, Monday through Friday (Table IV.11). Just 4 percent of congregate sites serve meals on weekends, and fewer than 10 percent provide meals other than lunch (for example, breakfast or supper). Some sites accommodate participants’ needs for meals on holidays (12 percent provide holiday meals). Second helpings are available at 85 percent of the meal sites, but fewer than 20 percent of sites always offer seconds, and fewer than 18 percent offer seconds on all menu items. Thirty-five percent of congregate meal sites reported that they sometimes provide participants with meals to take and eat later at home (usually full meals).

TABLE IV.11

CHARACTERISTICS OF CONGREGATE MEAL SERVICES

(Percentages)

	Title III Congregate Meal Sites
Number of Days Serve Meals Per Week
One	*
Two	3
Three	4
Four	2
Five	86
Six	2
Seven	2
Mean	4.9
Median	5.0
Days Site Is Open for Lunch
Monday	98
Tuesday	97
Wednesday	93
Thursday	93
Friday	95
Saturday	4
Sunday	3
Meals Served at Site
Breakfast	4
Lunch	100
Supper	1
Serve Meals on Weekends	4
Provide Holiday Meals	12
Serve Special Religious or Ethnic Food	26
Type of Special Meals Served
African American	12
Asian	7
Halal/Muslim	*
Kosher	2
Latino	12
Native American	6
Other	13
Serve Modified Mealsa	49
Most Frequently Used Meal Preparation Method
Nutrition project staff in central kitchen	37
Nutrition project staff at congregate site	25
Vendor or caterer	38
If Prepared Off Site, How Meals Delivered to Meal Siteb
Hot	95
In bulk, cold	15
In bulk, frozen	15
Preplated, hot	11
Preplated, cold	*
Preplated, frozen	1
Most Frequently Used Type of Meal Service
Buffet style (participants serve themselves at central serving area and carry plates to dining tables)	1
Cafeteria style (participants’ plates filled by workers at central serving area; participants carry plates or trays to dining tables)	62
Family style (participants serve themselves from serving dishes on dining table)	*
Restaurant style (participants seated at dining tables; preportioned servings brought to them)	37
Other	*
Seconds Are Available
Always	18
Sometimes	67
Never	15
Seconds Are Available
All menu items	15
Just some menu items	70
No seconds available	15
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Information on modified meals pertains to survey questions about modified meals (low salt, low sugar, low fat, or controlled calorie meals) and therapeutic meals (meals for people with conditions such as obesity, heart disease, diabetes, or hypertension). If respondents indicated providing either modified or therapeutic meals, the site is considered to provide modified meals.

^b Calculated only for those sites receiving meals prepared off site (affiliated central kitchens, caterers, or vendors). Percentages sum to greater than 100 percent because multiple responses were allowed.

* = Less than 0.5 percent.

Meal Preparation Methods. The majority of congregate sites serve meals prepared by the nutrition service provider--either by staff at a nutrition-project-affiliated central kitchen (37 percent) or by provider staff at the congregate meal site (25 percent; see Table IV.11). Thirty-eight percent of the congregate sites serve program meals prepared by an outside vendor or contractor (a private for-profit organization such as the Marriott or ARA food services, a school cafeteria or food service, or some other vendor, such as a hospital or other nonprofit organization). When meals are prepared off site--either by a project central kitchen or an outside contractor--they typically are delivered to the meal site at serving temperature. Ninety-five percent of congregate sites that receive meals from external sources receive meals in bulk containers at serving temperature; the food is then portioned and served. Small percentages of sites that receive meals prepared by external sources have them delivered in bulk, cold (15 percent); delivered in bulk, frozen (15 percent); and delivered preplated, hot (11 percent of all sites).

Special Diets. Nearly half of Title III congregate meal sites (49 percent) currently serve modified or therapeutic meals to participants with special health-related needs (Table IV.11). These meals include low salt, low fat, low sugar, controlled calorie, and so forth. A smaller proportion of sites attempt to consider religious and ethnic customs in the meal services. Twenty-six percent of congregate sites reported providing meals that take into account participants’ special ethnic, religious, or cultural preferences.

Meal Service Arrangements. Several alternative serving methods are available to meal sites. The most prevalent arrangements congregate sites use to serve participants meals, however, are cafeteria-styleand restaurant-style arrangements. Sixty-two percent of congregate sites use cafeteria-style meal service arrangements, in which participants’ plates are filled by staff in a central serving area, and participants carry their plates to tables. Restaurant-style service, in which participants are seated at tables and preportioned plates are brought to them, is in use at 37 percent of congregate meal sites. Most sites (96 percent) post menus describing the content of upcoming meals at the meal site. Fifty-eight percent of sites reported that the menus correspond to what is actually served most of the time; 41 percent reported that menus correspond all of the time.

b. Other Nutrition-Related Services

Information about how services other than meals are made available to participants at congregate sites was also obtained during the site interviews. These services are described next.

Nutrition Education. Next to meals, nutrition education, which the OAA requires projects to offer, is one of the most widely available nutrition services offered to participants. Eighty-nine percent of Title III congregate meal sites reported offering nutrition education (Table IV.12). [ Nutrition education entails teaching participants about nutrition, diet, food purchasing, food preparation, and related subjects.] The typical (median) congregate site makes nutrition education available to participants nearly once per month. At nearly one-third of the sites, nutrition education is provided more than once per month. Most sites providing nutrition education use more than one method to provide this service. Lectures and printed materials are the most commonly used approaches for providing nutrition education: 81 percent of all congregate sites (or 91 percent of sites providing nutrition education) provide printed materials to participants; 69 percent of all congregate sites (77 percent of sites providing nutrition education) convey nutrition information through lectures. Visual displays, group discussions, and personal discussions are also widely used. Few sites use methods such as workshops, cooking classes, or trips to supermarkets.

TABLE IV.12

NUTRITION EDUCATION OFFERED BY CONGREGATE SITES

(Percentages)

	Title III Congregate Sites
Offer Nutrition Education	89
Times Per Year Offered
Never	11
1 to 6	18
7 to 12	41
More than 12	30
Mean
Median
Methods Useda
Lectures	69
Printed materials	81
Visual displays	56
Personal discussions	38
Group discussions	50
Workshops	13
Cooking classes/sessions	10
Trips to stores/markets	14
Other	25
Credentials or Training of Staff Providing Nutrition Educationa
Registered dietitian	55
Certified dietary manager	12
Graduate of four-year nutrition program, not registered, certified, or licensed	11
Home economist	25
Dietetic technician	13
Public health nurse	26
Other	23
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Exceeds 100 percent because sites may use more than one method or person to provide nutrition education.

Registered dietitians (RDs) provide nutrition education services to Title III participants at the majority--55 percent--of all Title III congregate meal sites (or at 62 percent of sites providing nutrition education). Several other types of staff without RD degrees are also used, most commonly public health nurses and home economists.

Nutrition Screening. Nutrition screening services, defined as identifying those at high risk for nutritional problems through use of a standard form or interview, are offered by just 25 percent of Title III congregate sites (Table IV.13). Twelve percent of all congregate meals sites (or about half of the projects that conduct nutrition screening) use RDs to provide this service. Public health nurses are used next most frequently to perform nutrition screening. One-quarter of meal sites conducting nutritional screening, or seven percent of all congregate sites, use a public health nurse to screen participants’ nutritional health.

Nutrition Assessment. Nutrition assessment, defined as one-on-one evaluation of a participant’s nutritional status using physical measurements, 24-hour dietary recalls, medical history, or lab tests, is much less common at the sites, with only 16 percent of sites reporting offering this service (Table IV.14). As with the other nutrition-related services, RDs most frequently perform nutrition assessments. Public health nurses are the second most common type of provider.

Nutrition Counseling. Nearly 30 percent of ENP sites offer nutrition counseling (Table IV.15). This counseling was defined as one-on-one dietary guidance about adequate intake of vitamins, minerals, proteins, and energy and/or counseling on how to control chronic diseases with dietary implications, such as diabetes mellitus or obesity. RDs are most often the individuals who provide this counseling (at nearly three-quarters of meal sites providing the service, or 21 percent of sites overall). Public health nurses and dietetic technicians are also used about equally as the next most common professionals providing nutrition counseling.

TABLE IV.13

NUTRITION SCREENING OFFERED BY CONGREGATE SITES

(Percentages)

	Title III Congregate Sites
Offer Nutrition Screening	25
Times Per Year Offered
Never	75
1	9
2 to 6	2
7 to 12	9
More than 12	3
By special appointment	2
Credentials or Training of Staff Performing Nutrition Screeninga
Registered dietitian	12
Certified dietary manager	1
Graduate of four-year nutrition program, not registered, certified, or licensed	1
Home economist	3
Dietetic technician	1
Public health nurse	7
Other	6
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Exceeds the percentage of sites offering nutrition screening because more than one type of staff person provides service at some sites.

TABLE IV.14

NUTRITION ASSESSMENT OFFERED BY CONGREGATE SITES

(Percentages)

	Title III Congregate Sites
Offer Nutrition Assessment	16
Times Per Year Offered
Never	84
1	2
2 to 6	5
7 to 12	4
More than 12	1
By special appointment	4
Credentials or Training of Staff Performing Nutrition Assessmenta
Registered dietitian	11
Certified dietary manager	*
Graduate of four-year nutrition program, not registered, certified, or licensed	*
Home economist	1
Dietetic technician	1
Public health nurse	5
Other	4
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

* = Less than 0.5 percent.

^a Exceeds the percentage of sites offering nutrition assessment because more than one type of staff person provides service at some sites.

TABLE IV.15

NUTRITIONAL COUNSELING OFFERED BY CONGREGATE SITES

(Percentages)

	Title III Congregate Sites
Offer Nutritional Counseling	29
Times Per Year Offered
Never	71
1	3
2 to 6	5
7 to 12	9
More than 12	7
By special appointment	6
Credentials or Training of Staff Providing Nutritional Counselinga
Registered dietitian	21
Certified dietary manager	2
Graduate of four-year nutrition program, not registered, certified, or licensed	3
Home economist	4
Dietetic technician	8
Public health nurse	9
Other	7
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Exceeds the percentage of sites offering nutrition counseling because more than one type of staff person provides service at some sites.

c. Other Supportive Services

Many other non-nutrition supportive services are available to ENP participants through meal sites. These services include transportation, information and referral, homemaker, and other personal care services. This section describes the availability of each of these services.

Transportation. Seventy-one percent of Title III congregate sites offer participants transportation to and from the meal site (Table IV.16). Nearly three-quarters of the sites providing transportation to and from the meal site (or 51 percent of all congregate sites) offer it five days a week. Transportation is most often provided by paid site staff (55 percent of sites providing transportation, or 39 percent of sites overall, use site staff to provide transportation). Other community-based agencies are the next most common source of transportation to and from the meal site.

Transportation to locations other than the meal site is offered by 69 percent of Title III congregate meal sites. This transportation helps ENP participants maintain many of their other daily activities, such as shopping for groceries, going for health care, picking up prescription drugs, going to the bank, and completing other errands. Most often, transportation assistance includes other types of assistance, such as helping participants carry packages. Other types of assistance, such as help in selecting items or discussing participants’ needs or problems with them, were less commonly provided. At nearly three-quarters of the sites providing other transportation (or about 50 percent of all congregate sites), this service is available to participants at least two times per week.

Information and Referral Services. Information about other services and/or referrals to other agencies is offered at 86 percent of congregate meal sites (Table IV.16). Information and referral requests most commonly relate to legal services or consumer protection (70 percent), health care financing (67 percent), social security (65 percent), food stamps and USDA commodity programs (65 percent), and homemaker or personal care services (61 percent). Through information and referral, the ENP thus acts as a link to an array of other types of services.

TABLE IV.16

AVAILABILITY OF OTHER SUPPORTIVE SERVICES AT CONGREGATE SITES

(Percentages)

Service	Title III Congregate Sites
Transportation to and from Meal Site
Sites Where Available	71
Times Available Per Month
Never	29
Less than 6	*
6 to 10	3
11 to 20	17
More than 20	51
Transportation Service Providerb
Paid staff	39
Volunteers	8
Other paid personnel	5
Other donated staff	4
Other agency	23
Other Transportationa
Sites Where Available	69
Times Available Per Month
Never	31
Less than 6	13
6 to 10	6
11 to 20	19
More than 20	30
Occasions for Which Service Availableb
Personal health care	61
Grocery shopping	63
Banking	50
Pay bills	49
Pick up medicines	55
Attend advisory council meetings	30
Attend church	11
Other	14
Information and Referral Services
Sites Where Available	86
Methods Used to Provide Informationb
Participant request	63
Staff announcements at meals or other gatherings	53
Written materials, such as flyers or newsletters	76
Speakers from outside the meal program	57
Other	9
Types of Services/Benefits for Which Information Availableb
Food stamps	65
USDA commodities	64
Social security	65
Health care financing (Medicare, insurance)	67
Housing	57
Legal services, consumer protection	70
Public assistance or welfare	57
Health care	54
Personal care or homemaker services	61
Visiting or other nursing staff	57
Case management	48
Other	10
Staff Referral Activities
Make appointment for participant or notify other agency to expect him/herb	48
Usually	27
Sometimes	21
Accompany participant to other agency	24
Usually	7
Sometimes	17
Provide or arrange transportation to other agency	48
Usually	21
Sometimes	27
Follow up on referral to see that participant was served by other agency	50
Usually	34
Sometimes	16
Non-Nutritional Counseling
Sites Where Available	46
Times Available Per Month
Never	54
Less than 6	19
6 to 10	4
11 to 20	13
More than 20	9
Types of Counseling Availableb
Personal or mental health	35
Financial	35
Legal	37
Housing	32
Health	40
Other	7
Health and Medical Services
Sites Where Available	48
Services Offeredb
Podiatry screening	19
Physical therapy	13
Speech therapy	10
Dental services	17
Blood tests	27
Urine tests	7
Recreational and Social Activities
Sites Where Available	83
Times Available Per Month
Never	17
Less than 6	7
6 to 10	10
11 to 20	43
More than 20	24
Activities Available at Meal Siteb
Arts/crafts	64
Music/dancing	51
Games/cards/bingo	80
Movies	31
Television	43
Exercise classes	57
Educational classes	46
Trips	49
Other	18
Other Services
Sites Where Availableb	33
Services Available
Personal care services	13
Homemaker services	15
Home health aide services	10
Adult day care/adult day health services	9
Case management	17
Legal assistance	14
Outreach	20
Other	12
Unweighted Sample Size	158

Source: Elderly Nutrition Program Evaluation, Meal Site survey, weighted tabulations.

^a Other transportation consists of all assisted and unassisted transportation other than transportation between meal sites and participants’ homes.

^b Exceeds the percentages of sites where service is available because multiple responses were allowed.

* = Less than 0.5 percent.

Sites most frequently provide information and referral via written materials (76 percent) and direct contact with individuals (63 percent). Site respondents indicated that they often assist in making the appointment (48 percent), arranging transportation to and from the other agency (48 percent), and following up to see that the participant was served satisfactorily (50 percent). Site staff do not usually accompany participants to agencies; only 24 percent of all congregate sites have staff accompany a referred participant to the other agency.

Non-Nutritional Counseling. Fewer than one-half (46 percent) of all sites offer non-nutritional counseling (Table IV.16). This service covers a variety of issues important to participants, most frequently health (40 percent), legal (37 percent), and mental health (35 percent) issues. Other issues include housing and finances.

Health and Medical Services. Because the ENP was designed to assist in maintaining elderly people’s health by improving nutritional intake, it makes sense for sites to offer other types of health-related services under the program. About one-half offer some type of health-related screening, therapy, or testing, such as blood testing, podiatry screening, and dental services. Tests for blood sugar level, cholesterol, and blood pressure are also commonly available. A few sites offer other types of medical services, such as vision tests, HIV tests, tuberculosis tests, or mammograms.

Recreation and Social Activities. Recreation and social activities are available at 83 percent of Title III congregate sites (Table IV.16). Eighty percent of the sites providing recreation (or 67 percent of all congregate sites) offer these activities at least twice per week; nearly one-third (or 24 percent of all sites), offer these activities five times per week. Recreation and social activities take many forms. Games, cards, or bingo are available almost everywhere (80 percent of all sites); arts and crafts are available at nearly two-thirds of all congregate sites. Other activities available at the meal site include exercise classes or music and dancing, field trips, and educational classes. Many sites also show movies; many have a television available.

Other Types of Non-Nutritional Services. One-third of Title III congregate sites make at least one other type of non-nutritional service available to ENP participants. These services range from homemaker services to case management, legal assistance, and outreach. Case management is available at 17 percent of congregate sites; assistance with chores is the next most common service offered (15 percent).

3. Characteristics of Home-Delivered Meal Services

Home-delivered meals are largely arranged for or provided at the nutrition project level, making the nutrition project the appropriate unit of analysis. Most Title III nutrition projects (81 percent) arrange or provide home-delivered meals to elderly people in their service areas. In the remainder of this section, we describe characteristics of Title III home-delivered meal services, using data from the sample of nutrition projects that either arrange for or directly provide home-delivered meals.

Meal Service Schedule. In most nutrition projects with home-delivered programs--86 percent--meals are delivered five days a week (Table IV.17). In general, only one meal is provided per delivery (89 percent). Between two and three percent of programs provide more than five meals in a single delivery. Most home-delivered programs provide lunch (93 percent).

Meal Preparation Methods. Home-delivered meals are most frequently prepared at congregate meal sites (43 percent), where they are packaged and then distributed. However, 39 percent of nutrition projects with home-delivered meal programs contract for these meals with outside vendors or caterers, and 17 percent prepare home-delivered meals at a project-affiliated central kitchen. The most common type of meal is delivered hot (88 percent of programs). Some projects deliver meals in other forms, including frozen, to be reheated (23 percent); cold, to be eaten cold (17 percent); and cold, to be reheated (12 percent). Special Meals. Fourteen percent of the Title III nutrition projects with home-delivered meal programs routinely serve meals targeted at specific ethnic or religious groups. Sixty-four percent report serving modified or therapeutic meals to meet participants’ special health needs (Table IV.17).

TABLE IV.17

CHARACTERISTICS OF HOME-DELIVERED MEAL SERVICES OFFERED BY NUTRITION PROJECTS

(Percentages)

	Title III Projects Offering Home-Delivered Meals
Meals Served
Breakfast	2
Lunch	93
Dinner	12
Number of Times Per Week Meals Are Served/Delivered
1	6
2	*
3	*
4	4
5	86
>5	4
Usual Number of Meals Per Delivery
1	89
2	5
3-5	4
6-10	2
>10	*
How Meals Are Delivered
Hot	88
Cold, to be eaten cold	17
Cold, to be reheated	12
Frozen, to be reheated	23
Other	16
Serve Special Religious or Ethnic Food	14
Type of Special Meals Served
African American	*
Asian	*
Halal/Muslim	*
Kosher	3
Latino	2
Native American	*
Other	9
Serve Modified Mealsa	63
Average Percentage of Meals that Are Modified, for Those Serving Modified Mealsa	62
Basis for Determining Who Receives Modified Meala
Participant request	44
Physician request	63
Recommendation from nutrition project professional staff	36
Other	25
Meal Preparer
Nutrition project staff in central kitchen	17
Nutrition project staff at congregate site	43
For-profit contractor	39
Nonprofit contractor	16
Other	4
Unweighted Sample Size	207

Source: Elderly Nutrition Program Evaluation, Nutrition Project survey, weighted tabulations.

^a Information on modified meals pertains to survey questions about modified meals (low salt, low sugar, low fat, or controlled calorie meals) and therapeutic meals (meals for people with conditions such as obesity, heart disease, diabetes, or hypertension). If respondents indicated providing either modified or therapeutic meals, the project is considered to provide modified meals.

* = Less than 0.5 percent.

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