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From the Director
By Catherine R. May, Executive Director
This month’s From the Director comes directly from the website of the National Policy and Resource Center on Nutrition and Aging, from an article by Nancy Wellman, Lester Rosenweig and Jean Lloyd, previously printed in the Journal of The American Dietary Association.
This year marks the 30th anniversary of the Older Americans Act Nutrition program, the largest and most visible federally funded community-based nutrition program for older persons. It began in 1968 as a 3-year demonstration project and was officially established in 1972, when Congress enacted the national Nutrition Program for the Elderly as Title VII in the Older Americans Act (OAA). The program provides congregate and home-delivered meals, nutrition screening, education and counseling. While frequently called Meals-on-Wheels, that term accurately refers only to the home-delivered meals.
This Nutrition Program, administered in the Berkshires by Elder Services, is available to those age 60 and over. However, it is targeted to those in greatest economic and social need, with particular attention to low-income minorities, as well as rural individuals. To receive home-delivered meals, an individual must be assessed to be homebound or otherwise isolated. Because OAA services are not means-tested, it is a primary source of support for many older adults who would not receive services under other income-based programs.
The Nutrition Program is administered by the US Department of Health and Human Services, Administration on Aging (AoA) through an Aging Network that includes 57 State Units on Aging, 655 Area Agencies on Aging (including Elder Services of Berkshire County), thousands of local providers under Title III, and 233 Tribes and tribal Organizations, representing American Indian and Alaskan Natives, and 2 organizations serving native Hawaiians.
Historically, almost half the OAA annual budget has supported the Nutrition Program. In 1975, the appropriation was about $125 million, or 49% of total OAA funds. Of the 48.5 million meals served in 1975, home-delivered meals (HDMs) were limited to approximately 10% of the total. In 2002, the appropriation is $592.2 million, or 44% of the $1.3 billion budget. Today, about 250 million congregate and HDMs are served to approximately 2.6 million older adults annually. Home-delivered meals have grown to about 54% of all meals served, and at least 41% of programs have waiting lists for them.
Nutrition Program an integral part of home and community-based care systems
With the aging of the US population, federal, state, tribal, and local public and private agencies are increasing health and related services in the community to promote successful aging (ie, maintain cognitive and physical functioning, prevent or delay chronic disease and disease related disabilities, and maintain active social engagement with life). For the past 30 years, the OAA Nutrition Program has been an integral component of a comprehensive and coordinated system of home and
community-based care (HCBC) (e.g., transportation, health screenings, wellness and fitness programs, in home services) that did not exist before the OAA was enacted. Previously, only limited social and nutrition services were available through federal programs.
Today, the nutrition program is closely linked to HCBC systems through cross-referrals and the coordination of service delivery by the Aging Network. Since older adults are being discharged earlier from hospitals and nursing homes, many require a plan of care that includes HDMs and other nutrition services (eg, nutrition screening, assessment, education, counseling, and care planning). Many states are enrolling Medicaid beneficiaries in HMOs, using Medicaid HCBC waivers, and
creating state-funded programs to provide necessary HCBC medical, social, and supportive service, including home-delivered meals and nutrition education and counseling services.
The original purposes of the nutrition program were never limited to simply providing a meal, but were always envisioned as providing "more than a meal" and are as applicable today as when the original legislation was passed. Those purposes are: decreasing malnutrition, preventing physical and mental deterioration, promoting health, reducing social isolation, linking older adults to social and rehabilitative services, and providing low-cost, nutritionally sound meals.
At congregate sites, the nutrition program is a foundation service that provides access and linkages to other community based services. It is the primary source of food and nutrients for many program participants and it presents opportunities for active social engagement and meaningful volunteer roles. Home-delivered meals are among the most critical and necessary in-home services provided to vulnerable older adults. Such services may be even more critical for the homebound, who are usually older, poorer, more likely to be women, are significantly functionally impaired and usually have several chronic illnesses or disabling conditions that may be managed by nutrition interventions.