Participant Assessments for Home-Delivered Nutrition Services

Each HDNS service provider must assess individuals requesting home-delivered meals for eligibility according to the criteria in Section IIIB. The HDNS provider may conduct the assessment or have a formal written agreement with another program to conduct the assessment. 
There shall be an initial in-home assessment and subsequent periodic in-home reassessments of the older person. Initial assessments should be completed within two weeks of the participant's first meal. Subsequent reassessments should be completed annually, or sooner if an assessment indicates the participant will need home-delivered meals on a temporary rather than permanent basis, e.g., the participant is recovering from surgery or illness, and is expected to recover their ability to provide for themselves nutritionally. 
The written agreement between the home-delivered nutrition program service provider and the program responsible for doing the assessments (if they are not the same) should include the following information:

  1. Responsibilities and obligations of each program;
  2. Specific programmatic procedures to be followed by each program;
  3. Assessment form to be used;
  4. Orientation and/or training regarding the HDNS and the assessment process.

A HDNS provider which will do its own assessment must also establish specific written procedures on how the assessments will be conducted. 
The assessment of each individual must include a determination of eligibility according to the criteria for HDNS (Section IIIB), however it should focus not only on the individual's deficits but also on his or her strengths and informal supports so that those with the greatest need receive the service when resources are limited. The assessment of strengths and informal supports should furnish answers to alternate means of providing services or assistance. 
It is recommended that the nutrition risk screening be incorporated into the assessment, as well as questions to obtain the data required by the AAA and ALTSA for reporting purposes. 
With the consent of the older person, or his or her representative, conditions or circumstances which place the older person or the household in imminent danger must be brought to the attention of appropriate officials for follow-up.