1. Congregate Nutrition Services
   Any individual aged 60 and over is eligible for CNS, however, services should be targeted to individuals aged 60 and over who are unable to prepare meals for themselves because of:
   1. A disabling condition, such as limited physical mobility, cognitive or psychological impairment, sight impairment, or
   2. Lack of knowledge or skills to select and prepare nourishing and well balanced meals, or
   3. Lack of means to obtain or prepare nourishing meals, or
   4. Lack of incentive to prepare and eat a meal alone.

   Other individuals who are eligible for a meal are:

   1. The primary participant’s spouse, regardless of age;
   2. Individuals with disabilities who are not older individuals but who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided;
   3. Individuals with disabilities, regardless of age, who reside at home with and accompany older eligible individuals to the congregate site;
   4. Individuals, regardless of age, providing volunteer services during the meal hours;
   5. An eligible participant’s unpaid caregiver aged 18-59 whose meal is paid for through Title IIIE Family Caregiver Support Program or other funds.

   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:

   1. Staff of the nutrition program;
   2. Anyone who pays the full cost of the meal.

   Waiting list policies shall be developed by the AAA and CNS provider in consultation with eligible participants.

1. Home-Delivered Nutrition Services 
   To be eligible for HDNS, individuals must be aged 60 and older and:
   1. Homebound; the definition of homebound is normally unable to leave home unassisted, and for whom leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious services. 
      AND
   2. Unable to prepare meals for themselves because of:
      1. A disabling condition, such as limited physical mobility, cognitive or psychological impairment, sight impairment, or 
         Lack of knowledge or skills to select and prepare nourishing and well balanced meals, or
      2. Lack of means to obtain or prepare nourishing meals, or
      3. Lack of incentive to prepare and eat a meal alone.

      AND

   3. Meet the vulnerability criteria. A person is considered vulnerable if s/he:
      1. Is unable to perform one or more of the activities of daily living (ADL’s) or instrumental activities of daily living (IADL’s) listed below without assistance due to physical, cognitive, emotional, psychological or social impairment.
         Activities of daily living are eating, dressing, bathing, toileting, transferring in and out of bed/chair, walking.
         Instrumental activities of daily living are preparing meals, shopping, medication management, managing money, using the telephone, doing housework, transportation; or 
         Has behavioral or mental health problems that could result in premature institutionalization; or is unable to perform the activities of daily living listed in #1, or is unable to provide for his/her own health and safety, primarily due to cognitive, behavioral, psychological/emotional conditions which inhibit decision-making and threaten the ability to remain independent. 
         AND
      2. Lacks an informal support system: Has no family, friends, neighbors or others who are both willing and able to perform the service(s) needed, or the informal support system needs to be temporarily or permanently supplemented.

   Other individuals who are eligible for a home-delivered meal, if resources are available, are:

   1. The spouse, regardless of age, of a participant receiving home-delivered meals funded through OAA or the Medicaid Waiver home-delivered meal service (COPES);
   2. Individuals with disabilities who are not older individuals but who reside in the same home with other individuals eligible for the service;
   3. Individuals, regardless of age, providing volunteer services in the home-delivered meals program.
   4. An eligible participant’s unpaid caregiver aged 18-59 whose meal is paid for through Title IIIE Family Caregiver Support Program or other funds.

   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:

   1. Staff of the nutrition program;
   2. Anyone who pays the full cost of the meal.

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.