CONGREGATE AND HOME-DELIVERED MEALS

The Nutrition Program for the Elderly (NPE), part of the Older Americans Act (OAA) grants for state and community programs on aging, helps ensure a healthy, well-balanced diet for older Americans. Through this program, seniors who might otherwise be isolated and lonely, or who cannot afford to buy or prepare meals for themselves, do not have to go without food. They can eat a meal and socialize with their friends in a neighborhood setting, or they can have nutritious meals delivered to their home, often by a volunteer.

The NPE is administered by the Administration on Aging of the U.S. Department of Health and Human Service through the national network of state and area agencies on aging. The U.S. Department of Agriculture (USDA) Food and Nutrition Service contributes cash and commodity foods to support the NPE.

Congregate and home-delivered meals are available to seniors free of charge, though participants are encouraged to contribute toward their costs. Any senior who is at least age sixty is eligible for the program, and so are spouses, regardless of age. Seniors do not have to meet any income test or other requirements to receive meals under the program.

Community nutrition programs are especially important for the very old, people living alone, people at or near the poverty line, minorities, and people with failing health or physical or mental impairments. NPE therefore tries to locate meal sites where vulnerable and at-risk frail older persons live.

During the 1960s senior citizen advocates began to push for a national program to protect the nutritional health of seniors. Their advocacy was spurred, in part, by a 1965 USDA nutrition study that attracted attention with its finding that 95 million Americans did not consume an adequate diet, including 6 to 8 million older persons. In response, Congress appropriated $2 million in 1968 for nutrition demonstrations and research. These groundbreaking demonstrations led to the creation of community nutrition programs for the elderly. The federal legislation authorizing the NPE was sponsored by Senator Edward M. Kennedy and signed into law March 1972 by President Richard M. Nixon.

For the fiscal year 2000, Congress appropriated $512 million for the NPE. The federal government uses a population-based formula to apportion NPE funds to states. State Units on Aging transfer the funds to Area Agencies on Aging (AAA), which in turn contract with community nutrition providers. In some cases, the AAAs also provide services themselves. Community nutrition programs have various other sources of funding that include state and local government, in-kind contributions, private donations, and voluntary contributions from participants. In 1997 these additional resources totaled $621 million.

A similar nutrition program for Native American elders is authorized by Title VI of the OAA. The Administration on Aging awards funds directly to federally recognized Indian tribal organizations and nonprofit private organizations serving Native Hawaiians. Indian tribal organizations may select an age below sixty for defining an "older" person for their tribes.

Good nutrition and healthy aging

Good nutritional health is vital to healthy aging, and a proper diet provides the energy and nutrients the body and mind need. Experts agree that the risk for malnutrition is high among specific groups of elder Americans, especially those with inadequate income to purchase food, those who are isolated, and those who suffer from illness, disease, and other conditions affecting independence.

The dangers of poor nutrition have been well documented. Risks include: decreased life span, premature nursing home admission, increased disease incidence and chronic disability, increased hospitalization, and longer hospital stays. In addition to severe health problems, seniors who are malnourished are more likely to need home care or to be placed in an institution.

Community nutrition programs are a first line defense against hunger and can change older people's lives. The following list (Nutrition Screening Initiative; Older Americans 2000 ) shows why:

• Four out of five older adults have chronic diseases that are affected by diet.
• Only 13 percent of older adults eat the minimum amount of fruits and vegetables they need.
• Older persons living in poverty are nearly twice as likely to have a poor diet (21 percent) as those at or above the poverty level (11 percent).
• One of every five older people has trouble walking, shopping, and/or buying and cooking food, especially as they get older.

Warning signs of poor nutritional health

The Nutrition Screening Initiative, a multifaceted national health initiative led by the American Academy of Family Physicians, the American Dietetic Association, and the National Council on the Aging, has developed a screening tool to identify signs of malnutrition in older adults. Some of the risk factors are the following:

• Eating too little or too much
• Tooth or mouth problems that make it hard to eat
• Poverty (not enough money to buy food)
• Eating meals alone (social isolation)
• Taking three or more different prescription or over-the-counter drugs a day
• Involuntary weight loss/gain (ten pounds in the last six months)
• Alcohol abuse (three or more drinks almost every day)
• Acute/chronic illness or recent hospitalization

Help in staying healthy

Across the country, in neighborhoods small and large, community nutrition programs serve over 1 million meals a day to seniors at least once a day, five or more days a week. In 1997, more than 116 million meals were served to about 2 million older persons in congregate settings and over 123 million meals were served to about 890,000 homebound older persons.

Congregate meals. Congregate meal sites are located in senior centers, senior housing projects, schools, churches, and other community settings. Community nutrition programs also deliver supportive services other than a meal, including nutrition and health screening, and nutrition education. When possible, transportation is offered to and from meal sites for those who need it. Many meal sites have outreach programs and linkages with other community agencies to locate hard-to-reach, isolated, or underserved older people. As a result, the NPE helps provide access to many other health, housing, and social services.

The costs of a congregate meal in 1997 averaged $4.60. While many elders drop in at community meal sites quite frequently (60 percent usually participate four or five days a week), others participate only occasionally.

Home-delivered meals. The first Meals on Wheels program was established in 1954, in Philadelphia. Today, home-delivered meals are available throughout the country. They are provided by congregate meal sites, affiliated and nonaffiliated food service establishments, and other community organizations.

In 1997, the cost of preparing a home-delivered meal averaged $3.65. The use of volunteers to deliver the meals and provide friendly visiting helps keep the costs low. Persons may be homebound because of illness, disability, or isolation. Some homebound elders may need meals delivered for only a short while, following a hospital stay. People with more extensive needs may require home-delivered meals in addition to other community-based long-term care and social support services. For these people, home delivery of meals is crucial to their ability to remain independent.

Where to go for more information

To learn more about community nutrition programs, contact the local office on aging, go to www.aoa.gov, or call (in the United States) the Eldercare Locator at 800-677-1116. More information about nutrition and aging can be obtained from the organizations listed below.

Food and Nutrition Information Center, Room 304, National Agriculture Library Building, U.S. Department of Agriculture, Beltsville, MD 20705-2351; Tel (301) 504-5719; Fax (301) 504-6409; E-mail [email protected]; Web site www.nalusda.gov/fnic/ The Food and Nutrition Information Center provides information to professionals and the general public on human nutrition, food service management, and food technology.

Meals on Wheels Association of America (formerly the National Association of Meal Programs), 1414 Prince Street, Suite 202, Alexandria, VA 22314; Tel. (703) 548-5558; Fax (703) 548-8024; E-mail mowaa@ tbg.dgsys.com; association's web site is at www.projectmeal.org MOWAA is the oldest trade association in the United States for nutrition services providers. It offers training and technical assistance to those who plan and conduct congregate and home-delivered meal programs.

National Association of Nutrition and Aging Services Programs, P.O. Box 9007, Grand Rapids, MI 49509-0007; Tel. (616) 531-9909 or (800) 999-6262; Fax 616-531-3103; E-mail [email protected]. NANASP is a membership and advocacy organization for professionals working in or interested in the fields of aging, community-based services, and nutrition and the elderly.

National Policy and Resource Center on Nutrition and Aging, Department of Dietetics and Nutrition, Florida International University, University Park, OE200, Miami, FL 33199; Tel (305) 348-1517; Fax (305) 348-1518; TTY (800) 955-8771; E-mail nutrelder@ solix.fiu.edu; Web site www.fiu.edu The National Policy and Resource Center on Nutrition and Aging works with the Administration on Aging to improve the nutritional status of older Americans.

The Nutrition Screening Initiative, 1010 Wisconsin Avenue, NW, Suite 800, Washington, DC 20007. E-mail [email protected]; Web site www.aafp.org/nsi/index.html

Robert C. Ficke Susan Coombs Ficke

See also Area Agency on Aging: State Unit on Aging; Malnutrition; Nutrition Program for the Elderly (NPE); Older Americans Act; Senior Centers; Social Services.

BIBLIOGRAPHY

Administration on Aging. Administration on Aging State Program Report: A Summary of State and Community Programs Under Title III of the Older Americans Act of 1965, as Amended, Federal Fiscal Year 1997. Washington, D.C.: Administration on Aging. U.S. Department of Health and Human Services, 2000.

Codispoti, C. L., and Bartlett, B. J.. Food and Nutrition for Life: Malnutrition and Older Americans. Report by the Assistant Secretary for Aging, Administration on Aging, Department of Health and Human Services. Washington D.C.: 1994.

Nutrition Screening Initiative. Keeping Older Americans Healthy at Home: Guidelines for Nutrition Programs in Health Care. Washington, D.C.: Greer, Margolis, Mitchell, Burns & Associates, 1996.

Older Americans 2000: Key Indicators of Well-Being, Hyattsville Md.: Federal Interagency Forum on Aging-Related Statistics, 2000.

Ponza, M.; Ohls, J. C.; and Millen, B. E. Serving Elders at Risk. The Older Americans Act Nutrition Programs: National Evaluation of the Elderly Nutrition Program, 1993–1995, 3 vols. Princeton, N.J.: Mathematica Policy Research, 1996.