The Elderly Nutrition Program provides grants to State units on aging to subsidize the provision of daily meals to people 60 years of age or older. This evaluation study describes participant characteristics, compares the characteristics of recipients of home-delivered meals to those receiving meals in congregate settings, assesses how well the program reaches disabled and poor elderly, estimates the program's impact on the nutritional intake and social contacts of participants, and examines program costs and other sources of funding. The study showed that participants have higher daily intakes of nutrients and more social contacts per month than a comparable group of nonparticipants. The Elderly Nutrition Program is successful in targeting older people who are poor, live alone, are nutritionally "at risk" because they are overweight or underweight, or are more functionally disabled than their age-group peers. Federal expenditures are highly leveraged with State, local, and private funds.
This study was conducted to inform policymakers about the effectiveness of the Elderly Nutrition Program (ENP), the largest Federal program aimed at meeting the nutrition service needs of the elderly. Four major issues were evaluated: (1) the ENP's effects on participants' nutrition and socialization, (2) who is using the ENP and how effectively the program serves targeted groups most in need of its services, (3) how efficiently and effectively the ENP is administered and delivers services, and (4) the range of ENP funding sources and the allocation of ENP funds among its components.
America will face critical challenges in the coming decades as it attempts to provide long-term care services to the nation's elderly population. As the large group of individuals born after World War II ages, a much higher proportion of Americans will be elderly and will require more health services and long-term care. In this context, it is important to examine whether existing long-term care service programs are producing their intended outcomes and whether their services are directed to those who need them the most.
One very important component of the overall package of home- and community-based services available for elderly people is nutrition services. A critical step toward meeting this need was taken in 1972 with the creation of the Elderly Nutrition Program under Titles III and VI of the Older Americans Act. Through Title III, State Units on Aging and Area Agencies on Aging implement a system of coordinated, community-based services targeted to older individuals. The ENP is administered by the Administration on Aging (AoA) of the U.S. Department of Health and Human Services. The AoA awards funds to State Units on Aging, which in turn distribute the funds to Area Agencies on Aging on the basis of State-determined formulas that reflect the proportion of older people in their areas and other factors. The area agencies provide services directly or award grants to and contract with nutrition projects that provide nutritional and supportive services. In addition, area agencies receive financial support from State and local governments, in-kind contributions, private donations, and voluntary contributions from participants.
Title III of the Older Americans Act authorizes the provision of nutrition and supportive services, such as meals, nutrition education, transportation, personal and homemaker services, and information and referral. Congregate meals and supportive services are provided at nutrition projects' meal sites (e.g., senior centers, religious facilities, schools, public or low-income housing sites, or residential care facilities). Alternatively, home-delivered meals are provided to homebound clients, either by the congregate meal sites and affiliated central kitchens or by nonaffiliated food service organizations. ENP meals are targeted to persons aged 60 or older. While there is no means test for program qualification, services are targeted at older persons with the greatest economic or social need. Similar nutrition and supportive services for American Indians, Alaskan Natives and Native Hawaiians are authorized separately under Title VI. Indian Tribal Organizations and agencies serving Native Hawaiians receive grant awards directly from the AoA.
Mathematica Policy Research, Inc., undertook this study for the AoA. A comprehensive research design was used, including in-person surveys of participants and eligible nonparticipants; in-person surveys of staff of congregate meal sites; in-person observation of sanitation and health practices at congregate meal sites, central kitchens, caterers, and home-delivered meal distribution sites; telephone surveys of staff at State Units on Aging, Area Agencies on Aging, Indian Tribal Organizations, and nutrition projects; review of program records on amounts of funding transfers; review of scientific literature related to nutritional requirements for the elderly population; extraction of relevant census data; and extraction of results from the previous national ENP program evaluation published in 1981.
All State Units on Aging were sampled. The sample of Area Agencies on Aging and nutrition projects was selected as a geographically clustered sample to maximize efficiency in conducting surveys. For Title VI programs, the agency sampling was simplified by the fact that each ENP grant is awarded directly to the Indian Tribal Organization, which in turn consists of a single nutrition project, often operating from a single site. In all, data were collected at 197 randomly selected meal sites. Approximately 2,500 interviews were conducted with elderly ENP participants (both home-delivered meal recipients and congregate site meal recipients) and nonparticipants. The nonparticipant sample used for comparison with the Title III program participant sample was selected from lists of Medicare recipients in the same ZIP Code areas as the participant sample, screening for income and disability status to ensure that the samples were matched as closely as possible.
The evidence collected in this evaluation suggests that the ENP has substantial positive effects on participants. Title III participants have higher daily intakes of key nutrients and more social contacts per day than a comparable group of nonparticipants. The average ENP meal meets the program's requirements to provide at least one-third of the relevant Recommended Daily Allowances. Both congregate and home-delivered participants have about 14 more social contacts per month than the comparison group; this finding and interviews of participants suggest that the program increases socialization opportunities for participants. Over 60 percent of all Title III and Title VI participants are satisfied with program services. Approximately 40 percent of Title III ENP service providers have waiting lists for home-delivered meals, suggesting a significant unmet need for these meals.
The evaluation shows that the program has achieved considerable success in efforts to target ENP services to populations in the greatest need. Compared with the overall population in the United States age 60 and older, ENP participants tend to be older, poorer, more likely to be members of racial or ethnic minorities, and more likely to live alone. About one-third of Title III congregate participants and one-half of Title III home-delivered participants have incomes at or below the poverty threshold. More than one-half of Title VI meal participants have incomes at or below this level. The comparable figure for the overall population age 60 and older is 15 percent. Nearly four times as many Title III participants and nine times as many Title VI participants are low-income minorities, compared with the overall population age 60 and older.
Agencies at the various administrative levels of the program have forged close links with other parts of America's emerging home- and community-based long-term care system, primarily through cross-referrals and coordination of service delivery at all levels within the aging network. The ENP provides a continuum of services, including nutrition screening, assessment, education, and counseling. Title III funds support 37 percent of congregate costs and 23 percent of home-delivered costs and are highly leveraged by other funding sources, including U.S. Department of Agriculture commodities or cash in lieu of commodities, State, local, and private funds. Participant contributions support another 20 percent of the program costs. The leveraging rate for Title VI is considerably lower, with over 60 percent of the costs supported by Title VI grants.
Use of Results
This report will provide policymakers with the information they need to determine the future scope of activities of the ENP, as well as future funding levels. The information in this report will also assist service providers in their efforts to improve the operation of their ENP projects and to obtain additional State, local, and private funding to supplement Federal grants.
Office of Program Operations and Development
PIC ID: 6175
Mathematica Policy Research, Inc., Plainsboro, NJ