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CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM STANDARDS TRAINING- OAA AND OPI. Presented by: Judy Bowen, OAA Program Analyst 3 DHS/SPD State Unit on Aging 676 Church Street NE Salem, Oregon 97301 (503) 373-1842 [email protected] OAA Nutrition.

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congregate and home delivered nutrition program standards training oaa and opi
CONGREGATE AND HOME-DELIVERED NUTRITION PROGRAM STANDARDS TRAINING- OAA AND OPI

Presented by:

Judy Bowen, OAA Program Analyst 3

DHS/SPD State Unit on Aging

676 Church Street NE

Salem, Oregon 97301

(503) 373-1842

[email protected]

oaa nutrition
OAA Nutrition
  • The goal of this Netlink training is to provide Administration on Aging data for older adults and an overview of the Older Americans Act Standards and Guidelines for both the Congregate and Home-Delivered Meal Programs.

The learning objectives for this session are:

  • Increase understanding of the OAA Nutrition Program.
  • Apply this knowledge to your individual OAA meal operation sites.
poverty rates
Poverty Rates

Racial/ethnic

7% White

22.7% African American

12.0% Asian American

19.4% Hispanic Americans

Gender

6.6% men

11.5% women

Living arrangements

5.6% living with families

16.9% living alone

Location, higher than average

12.7% principal cities

11.0% rural

11.7% South

Highest poverty rates

40.5% Hispanic women, living alone

37.5% Black women, living alone

4

Administration on Aging. A Profile of Older Americans: 2008.

slide6

Inter-related Factors Affecting

the Nutritional Well-Being of Older Adults

6

slide7

AGE-RELATED

CONDITIONS / DISEASES

(Hearing Loss; Macular Degeneration; Destructive Joint Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health)

CHRONIC DISEASES

(Heart Disease; Hypertension; Diabetes; Osteoporosis; Some Cancers: colon and breast; Arthritis; COPD; Renal Disease)

ACUTE CONDITIONS

(Dehydration; Pressure Ulcers; Infections; Pneumonia; Influenza; Fractures; Tooth Abscesses;

Gum Disease)

Impacts of Food & Nutrition on Health

POOR DIETS

    • Without Adequate Healthy, Safe Food & Nutrition Services:
  • (Deafness; Blindness; Reduced Smell &Taste; Chewing & Swallowing Problems; Joint Destruction--Costly Replacements; Confusion, Forgetfulness, Memory Loss; Uncontrolled High Blood Pressure--Heart Attack, Stroke; Uncontrolled Diabetes--Amputations, Blindness, Nerve Disorders, Dialysis; Osteoporosis--Weakened Bones, Decreased Mobility and Falls; Decreased Immune Response--Flu, Colds, Upper Respiratory Infections, HIV/AIDS; Decreased Organ Function & Organ Failure; Wasting--“Dwindles” or “Failure to Thrive”; Involuntary Weight Loss:  Body Mass Index,  Muscle Mass; Excessive Weight Gain--Obesity;
  •  Serum Albumin--Protein Malnutrition; Pressure Ulcers)

Slower Recovery

Low Stamina

Longer Hospital Stays

SleepDisturbance

Hospital

Re-Admissions

Depression & Anxiety

PoorAppetite

Premature Institutionalization

Increased Morbidity & Mortality

7

Reduced Quality of Life - Lessened Independence - Increased Healthcare Costs

slide9

IMPACT OF MALNUTRITION ON FUNCTIONALITY

Malnutrition

UnderweightObesity

Limits Muscle Strength

Reduces Stamina

Prevents Physical Activity

Decreases ability to:

Perform ADLs & IADLs:

Eat, Walk, Grocery Shop, Prepare Meals

Grip Items & Lift Heavy Objects

Increases Dependency

Increases Need for Caregiver Assistance

Increases Risk for Falls & Fractures

Threatens Independence  Reduces Quality of Life Increases Healthcare Costs

9

diseases affected by diet future nh use
Diseases Affected by Diet & Future NH Use

Valiyeva E, et al. Lifestyle-Related Risk Factors & Risk of Future Nursing

Home Admission. Archives of Internal Medicine. 2006; 166:985-90.

persons 70 with obesity related conditions
Persons 70+ with Obesity Related Conditions

18% Diabetes

50% Hypertension

65% Osteoarthritis

Villareal, et al. Obesity in older adults: technical review and position statement of the Am. Soc. For Nutrition and NAASO, the Obesity Society. Am J Clin Nutr. 2005

11

food security
Food Security

Access by all members of a household to be food sufficient for a healthy life, including at a minimum, the ready availability of nutritionally adequate and safe foods and the assured ability to acquire acceptable food in socially acceptable ways.

Economic Research Service, USDA

12

prevalence of food insecurity in the us household food security in the united states 2007 ers usda
Prevalence of Food Insecurity in the USHousehold Food Security in the United States, 2007, ERS, USDA

http://www.ers.usda.gov/Briefing/FoodSecurity/stats_graphs.htm#food_secure

older americans act programs services
Older Americans Act Programs & Services

Established 1965Nutrition Program established 1972

No income requirementsForbids means-testing

Means-testing: determination of eligibility for services based on a specific level of income

For persons 60+, targetingservices to persons in greatest economic & social need, with particular attention to low income minorities & individuals residing in rural areas & limited English speaking

14

oaa nutrition program purpose section 330
OAA Nutrition Program Purpose: Section 330

Reduce hunger & food insecurity

Promotesocialization of older individuals

Promote the health & well-being of older individuals

15

objectives of the oaa nutrition programs
Objectives of the OAA Nutrition Programs
  • Provide healthy, appealing meals
  • Promote health and prevent disease
  • Reduce malnutrition risk and improve nutrition
  • Reduce social isolation
  • Link older adults to community-based services
  • Provide an opportunity for community development, such as volunteering
nutrition programs service descriptions
NUTRITION PROGRAMS SERVICE DESCRIPTIONS

CONGREGATE NUTRITION SERVICES (Title III, Subpart C1)

  • Helps to prevent health deterioration and social isolation
  • Meals provide a minimum of 33 1/3% of the current daily

RDA’s

  • Promotes health and independence
  • Provides a positive motivation for self care
nutrition programs service descriptions cont d
NUTRITION PROGRAMS SERVICE DESCRIPTIONS (cont’d)

HOME-DELIVERED MEALS (Title III, Subpart C2)

  • Critical to maintaining independence and remain in their homes
  • Provide a minimum of 33 1/3% of the current daily recommended RDA’s
  • Programs can provide nutritional support added care and support to high-risk individuals.
nutrition health
Nutrition & Health

Adequate nutrition is essential for

Health

Functionality

Independence

Quality of life

19

oaa meals eligibility
OAA MEALS ELIGIBILITY
  • Congregate meals will be available to persons:

Please refer to Nutrition Standards (page 3)

oaa meals eligibility1
OAA Meals Eligibility
  • To be eligible for home-delivered meals a person must:
  • Please refer to Nutrition Standards ( Page 3)
congregate nutrition service standards
Congregate Nutrition Service Standards
  • Nutrition providers shall provide at least one hot meal or other appropriate meal at least once a day, five or more days/week.
  • In rural areas the nutrition provider must provide a written request to the SUA for approval of a lesser frequency or meal service.
  • Must make every effort to obtain required NAPIS data. Clients who decline may not be denied service.
  • Nutrition screening tool located in Oregon Access and is done at the time of intake and updated annually. Make appropriate referrals.
  • Congregate meal participants should be advised to keep an emergency food shelf at home; in case of emergencies.
congregate nutrition standards cont d
Congregate Nutrition Standards – (cont’d)
  • Nutrition providers shall make available nutrition education to meal site participants at a minimum of quarterly.
  • Develop a strategy to allow participants to make a confidential donation
  • Site Location and physical interior( see page 6 of the Nutrition Standards).
  • Site Management includes- staffing, safe and appetizing meals, meeting clients interests and needs, referral to community services, volunteer opportunities, and accurate reporting.
  • Compliance with federal, state and local code and regulations
  • Projects must develop an operating policy manual
  • Staff should be instructed in: portion control, Food Safety, safety policies and procedures, and the process for reporting concerns
congregate nutrition standards cont d1
Congregate nutrition standards (cont’d)
  • Confidentiality
  • Meets ADA requirements
  • Meets compliance with the Food Protection Program
  • Compliance with State of Oregon Public Health Code
home delivered meal standards
Home-Delivered Meal Standards
  • Meals may be hot, cold, frozen, dried, or canned with a satisfactory storage life
  • In rural areas a waiver request must seek approval for less than 5 meals per week
  • Client assessments are needed
  • OAA Screening Survey (Oregon Access) should be completed and NAPIS information updated annually
  • Clients declining NAPIS data may not be denied service
  • Initial assessment and reassessments (see Page 9 & 10 in the Nutrition Standards)
home delivered meal standards cont d
Home-Delivered Meal Standards (cont’d)
  • All nutrition providers will have a plan to insure clients will receive meals during emergencies, weather-related condition and disasters
  • It is acceptable to provide a combination of meals
  • Providers will develop a strategy for confidential contributions
  • Home-delivery staff and volunteers should be trained in food safety
  • Providers will develop and update annually operating procedure manuals
  • Meal temperature procedure shall be developed
nutrition education
Nutrition Education
  • Definition : Promotes better health through education
  • Each nutrition project shall provide education. Can you give me some examples?
  • Goals; Education Content ; and Nutrition Resources (see pages 11-13 of the Nutrition Standards)
  • Nutrition Counseling
menus and menu planning
Menus and Menu Planning
  • Each meal must meet the 2005 Dietary Guidelines and must contain at least 1/3 of the current RDA’s.
  • New dietary Reference Intakes (DRI’s) provide values for men and women aged 51-70 and over 70 years.
  • Special needs of the elderly must be considered in menu planning.
  • A menu pattern is best used as a tool.
  • Dietician or Nutritionist will certify that each meal will meet one-third of the Recommended Dietary Allowances.
healthy diet dietary guidelines for americans 2005
Healthy DietDietary Guidelines for Americans, 2005

Food Components

Fruit, vegetables

Whole grains

Low fat dairy

Low fat meat, poultry, fish

Lower fat, added sugar & salt

Low income households must spend more time and money to consume palatable, nutritious meals*

*http://www.ers.usda.gov/AmberWaves

/November08/Features/AffordHealthyDiet.htm

menu planning cont d
Menu Planning – (cont’d)
  • A food identified and counted in one food group category cannot be counted as a food in another food group category.
  • AAA’s are encouraged to evaluate meals for meeting nutritional requirements using computer-assisted nutrient analysis and Registered Dieticians to ensure nutrient adequacy of meals.
  • Resources: http://nutritionandaging.fiu.edu/creative_solutions/meal_patterns.asp
food service sanitation and safety
Food Service, Sanitation and Safety
  • Requirements for Central Kitchens and Congregate Meal Sites:
    • Compliance with codes, regulations and licensor requirements
    • Inspection Reports should be kept on file and posted
    • Temperature checks should be taken with a food thermometer daily three times- leaving site, arrival off site and at serving time- Hot foods at or above 140 degrees and cold food at or below 41 degrees F
    • Control access to the kitchen to those who work in it
    • Foods must be prepared, served and transported with the least possible manual contact. Sanitize utensils to prevent cross contamination
    • Procedures for sanitizing should be written and posted
sanitation safety requirements for home delivered meals
Sanitation/Safety Requirements for Home-Delivered meals
  • Shall be individually plated, packaged and prepared
  • Delivered directly to the participant with food safety guidelines
  • Hot foods must be maintained at or above 140 degrees F and cold food items maintained at or below 41 degrees F
  • AAA shall develop procedure for taking and documenting meal temperature of the last meal served on each route
meal packaging supplies and carriers cont d
Meal Packaging Supplies and Carriers- (cont’d)
  • Meal packaging supplies and carriers:
    • Must be used to ensure hot foods and cold foods are separate
    • Cleaned and sanitized daily
    • Refrigerated foods requiring refrigeration will be pre-chilled and kept at or

below 40 degrees F throughout transport

    • Hot foods requiring heated storage will be held at or above 140degrees F throughout transport
nutrition services incentive program nsip formerly usda meals
Nutrition Services Incentive Program (NSIP) formerly USDA meals
  • Changed in 2003 to the NSIP program
  • Eligibility:
    • Must be served by a providers under the AAA
    • Meals served to eligible persons, as defined by the OAA
    • Title XIX or private reimbursement are not eligible
    • AAA must document meals served to qualify for reimbursement
    • Must operate in compliance with all federal requirements
    • Reimbursements shall be disbursed as requested monthly by the AAA
meal donations
Meal Donations
  • Voluntary contributions shall be allowed and shall not deny services to those who do not contribute. Protect privacy and inform that there is no obligation to contribute and is purely voluntary.
  • A clearly visible and easy-to-read sign may be posted for suggested donations and cost for those under 60
  • Volunteers should be encouraged to donate towards the cost of their meal
  • Develop a strategy that allows home delivered meal participants to voluntarily contribute
  • Drivers receiving contributions should be instructed to bring all donations back to the meal site and given to the appropriate person.
use of program income and administrative and program requirements
Use of Program Income and Administrative and Program Requirements
  • See Pages 25 & 26 of the Nutrition Standards
nutrition advisory council
Nutrition Advisory Council
  • Each AAA shall establish a nutrition advisory council
  • The council shall advise on all matters relating to the delivery of nutrition and support services within the program area
  • Suggested Council roles and Responsibilities ( page 27 & 28)
napis reporting
NAPIS Reporting
  • Please see Pages 28, 29 and 30 of the OAA Nutrition Standards
resources
Resources

www.aoa.gov

www.aoa.gov/about/results/index.aspx

http://www.data.aoa.gov

http://agingstats.gov/agingstatsdotnet/main_site/default.aspx

www.usda.gov

www.fns.usda.gov/fns/

www.ers.usda.gov/briefing/foodsecurity/

www.mowaa.org/

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