WASHINGTON STATE
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Aging and Long-Term Support ADMINISTRATION
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CNS providers must serve hot or other appropriate meals at least once a day, five or more days per week. CNS meals may be hot or cold. HDNS providers must provide five or more home-delivered meals per week. Home-delivered meals may be hot, cold, frozen, dried, or shelf-stable with a satisfactory storage life. If a provider operates both CNS and HDNS, the five days per week frequency requirements must be met for congregate and home-delivered meals independently, e.g., if the provider delivers 7 meals to home-delivered participants, congregate meals must still be served on 5 or more days per week.
Exceptions to the frequency of service may be made for CNS:
When funding permits, service providers should consider, where feasible and appropriate, serving two or more meals per day, seven days a week, and providing meals on holidays.
Written program objectives related to the number and frequency of meals to be served by the provider and the service level of nutrition education and, if provided, nutrition outreach, must be developed by or for the service provider. These objectives must be specific, verifiable, and achievable.
There should be written procedures to be followed by the service provider in the event of weather-related or other emergencies, disasters, or situations which may interrupt congregate meal service, home deliveries, or the transportation of participants to the nutrition site.
In no way may a nutrition program operated by specific groups, such as churches, social organizations, senior centers or senior housing developments restrict participation in the program to their own membership or otherwise show discriminating preference for such membership.
The Senior Nutrition Program consists of both Congregate and Home-Delivered Nutrition Services to help increase the nutrient intake of older individuals who might not eat adequately, and, through better nutrition, assist them to remain healthy and independent in their communities. Hot or other appropriate meals are served five or more days per week, where feasible. Each meal served contains at least one-third of the current Recommended Dietary Allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. A variety of nutrition services may also be provided, such as nutrition assessment, education, therapy, and counseling.
Congregate Nutrition Services (CNS) are offered in a variety of settings, such as senior and community centers, churches, schools, and adult day care facilities. In these settings, participants are given the opportunity to form new friendships and to interact in a social environment. In addition to nutrition services, supportive services, such as transportation, shopping assistance, physical activity programs, health screening, health promotion, and other services may be available.
Home-Delivered Nutrition Services (HDNS) provide nutritious meals delivered to individual residences and other nutrition services to older persons who are normally unable to leave their homes without assistance and are vulnerable according to the criteria in Section III. Services are intended to maintain or improve the nutritional status of these individuals, support their independence, prevent premature institutionalization, and allow earlier discharge from hospitals, nursing homes, or other residential care facilities.
The CNS and HDNS are authorized by the Older Americans Act, Public Law 106-510, codified at 42 U.S.C. 3030e through 3030g. The Nutrition Services Incentive Program (NSIP) is codified at 42 U.S.C. 3030a.
The Senior Nutrition Program may be funded by Older Americans Act Titles IIIB, C and E, and the Nutrition Services Incentive Program (NSIP); the Senior Citizens Services Act; local public and private funds; and income generated by the program, including voluntary contributions from participants.
| Funding Source | Allowable Uses | Prohibited Uses/Conditions |
|---|---|---|
| OAA Title IIIB, IIIC Subparts 1 and 2 | Any program costs for eligible participants | Costs must be allowable under applicable OMB Circulars and the AAA contract. These funds can not be used for meals served to individuals 1) for whom the cost of the meal is paid by another source, or is included in the rate for another service the individual is receiving, or 2) who are required to meet income eligibility criteria to receive the service through which the meal is served, e.g., COPES home-delivered meals; COPES adult day care meals; Medicaid Adult day health meals; adult day care or health meals for which Child and Adult Care Food Program (7CFR Part 226) funds have been claimed; SCSA- or Respite-funded adult day care or health meals. |
| OAA Title IIIE | Costs for meals or other nutrition services for caregivers under 60 | Use of IIIE must be in the AAA FCSP Plan and contract with the provider. |
| NSIP | U.S. produced food | Any program costs other than U.S. produced foods are not allowable. Funds can not be used toward the cost of meals served to individuals who are not eligible for OAA-funded CNS or HDNS. |
| SCSA | Any program costs for eligible participants | Costs must be allowable under applicable OMB Circulars and the AAA contract. |
| Local public or private funds | Determined by the fund source | Determined by the fund source. |
| Program income (participant contributions or other income generated by the program) | To expand the service for which the contribution was made. | Participant contributions may not be spent on costs for services other than those for which the contributions were made. Program income must be spent prior to OAA funds. Accumulation of one month’s worth of income is allowable. |
Congregate nutrition sites must be located where there are major concentrations or high proportions of the target group of older persons. They must be located close to, and preferably within walking distance of, areas where members of the target group reside. Examples of appropriate congregate nutrition site locations are community centers in low-income areas, subsidized housing complexes, senior centers, schools, adult day services, and religious facilities. Congregate nutrition sites located in communities where there are significant numbers of minorities should make special efforts to serve these minorities.
In order to provide CNS at an adult day care or adult day health service, the service provider must be contracted to provide CNS in accordance with these SNP Standards. Meals served at the adult day care or health service that can be paid for through the CNS must meet the following criteria:
The nutrition program service provider must provide information for participants to take advantage of benefits available to them under the Basic Food Program. The Basic Food Program helps low-income individuals and families obtain a more nutritious diet by supplementing their income with Basic Food benefits to purchase food. Basic Food Assistance can be applied for at local Community Services Offices or online using the Online Application for Services.
Providers must coordinate their activities with local agencies that conduct outreach for the Basic Food Program to facilitate participation of eligible older persons in the program.
Good nutrition prolongs independence by maintaining physical strength, mobility, endurance, hearing, vision, and cognitive abilities. Eighty-seven percent of older Americans have one or more chronic diseases that can be improved by nutrition therapy, including cancer, chronic lung disease, heart disease, dementia, diabetes mellitus, high blood cholesterol, high blood pressure, osteoporosis, obesity and overweight, and failure to thrive (Draft Nutrition Screening Initiative Policy Statement: Nutrition: Proven Effective in Managing Chronic Disease in Older Americans.)
Nutrition education can be defined as any set of learning experiences designed to facilitate the voluntary adoption of eating and other nutrition-related behaviors conducive to health and well-being. It is an integral part of providing nutrition services to older persons.
Nutrition services providers must conduct nutrition education activities, consistent with the goals and content described below, at a minimum of two times per calendar year at each site. Providers are encouraged to use existing nutrition education resources from the Basic Food Nutrition Education Program, Washington State University Cooperative Extension, Senior Farmers Market Nutrition Program, or Department of Health’s 5-a-Day Program.
Nutrition education should include information on physical activity in addition to nutrition. In recognition of the importance of physical activity on health and the prevention of disease, the Dietary Guidelines for Americans recommend being physically active each day. Regular physical activity sustains the ability of older adults to live independently, and benefits individuals with arthritis and those with depression and anxiety. It may reduce the risk of cognitive decline in older adults, and is effective in helping to manage many chronic diseases.
When nutrition education is being provided by the nutrition program service provider, all costs associated with the delivery of nutrition education services must be budgeted and charged appropriately to that service.
Nutrition outreach is an activity designed to seek out and identify, on an ongoing basis, the hard-to-reach, isolated, and vulnerable target group of eligible individuals throughout the program area. Nutrition outreach should be provided as necessary to reach the target population. It may be provided by the AAA, nutrition services provider, or by another contracted provider on behalf of one or more nutrition services providers.
When nutrition outreach is being provided by the nutrition program service provider, all costs associated with the delivery of nutrition outreach services must be budgeted and charged appropriately to that service.
Nutrition screening is a first step in identifying individuals at nutritional risk or with malnutrition. The OAA requires nutrition programs to provide nutrition risk screening. At a minimum, nutrition program service providers must administer the 10 questions from the Nutrition Screening Initiative Checklist (NSI Checklist, Appendix I, https://www.aafp.org/home.html ) to participants and determine their nutrition risk scores. HDNS providers may administer the NSI checklist alone or incorporate the questions into the participant assessments. The number of participants determined to be at high risk must be included in the data submitted to the AAA for the State Performance Report to the Administration on Aging.
For participants whose screening indicates nutritional risk, service providers should suggest they bring the checklist to their doctor, dietitian or other qualified health or social service professional and ask for help to improve their nutritional health.
Nutrition therapy includes assessment of nutritional status, evaluation of nutritional needs, and interventions or counseling to achieve optimal outcomes. Nutrition counseling, as a component of nutrition therapy, is the provision of individualized advice and guidance to individuals, who are at nutritional risk because of their health or nutritional history, dietary intake, medications use or chronic illnesses, about options and methods for improving their nutritional status, working with the individual's physician as appropriate.
If provided by the nutrition program, nutrition therapy or counseling must be provided by an RD or ICE (see Section VIIB. Staffing). The service includes:
Nutritious meals are served to the eligible population in congregate settings, enabling participants to socialize and participate in other activities that may be provided, and delivered to the homes of eligible participants who have difficulty leaving their homes unassisted. Meals must contain at least one-third of the current Recommended Dietary Allowances (see Section VIIE Menus and Menu Planning for detailed nutrient requirements).
Subject to participant consent, all participants who appear to have need for other services should be referred to the Information and Assistance Program.
Other individuals who are eligible for a meal are:
To the degree feasible, the provider shall ensure that preference is given to those individuals aged 60 and over who meet the vulnerability criteria in Section IIIB3, with further preference given to low-income and minority individuals and to those with the greatest economic and social need.
In accordance with the AAA or service provider policy and the funding available, the following individuals may be served a congregate meal once the needs of the eligible population have been met:
Waiting list policies shall be developed by the AAA and CNS provider in consultation with eligible participants.
AND
Other individuals who are eligible for a home-delivered meal, if resources are available, are:
To the degree feasible, the provider shall ensure that preference is given to low-income and minority individuals and to those with the greatest economic and social need.
Waiting list policies shall be developed by the AAA and HDNS provider in consultation with eligible participants.
In accordance with the AAA or service provider policy, the following individuals may be served a home-delivered meal once the needs of the eligible population have been met:
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:
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.