Introduction

“Times...they are changing” may be a cliché, 

but it is true, and the changing times affect how 

nutrition programs function every day and their 

need to change to meet both current and future 

needs. As others have said, people change, things 

change, programs change, and systems change. 

Societal expectations, science, technology, media, 

healthcare, social services, home and communitybased care and long-term services and supports 

are also changing. An increasingly competitive 

environment for public and private funding means 

that programs need to provide quality, more personcentered, effective, efficient services, and enhance 

their revenues through multiple funding streams 

and improved business acumen to address service 

system changes.

This brief will address components of quality 

nutrition services and provide data that 

demonstrates that the Older Americans Act Nutrition 

Program (OAA NP) provides quality products and 

services. It will also address some aspects of 

the role that the OAA NP may play in home and 

community-based services (HCBS) and health care.

What is quality?

The definition of quality depends on who you 

ask. A common definition might be, “I know it 

when I see it,” but the components of quality 

might be more specific than that.

Or you go into a pleasant restaurant, order a 

meal, and have it delivered in a timely fashion by 

an attentive server at a reasonable cost. And the 

meal quality, quantity, texture, temperature, and 

its presentation are what you expected. You don’t 

even think about whether the meal will make you 

sick. But you evaluate the quality on whether you 

got what you ordered, whether it was what you 

preferred, whether it looked good, the restaurant 

atmosphere was what you want, and the service 

was timely. These components are more detailed 

than “I know it when I see it.”

The dictionary may define quality differently as 

a standard of something as measured against 

other things of a similar kind; the degree of 

excellence of something (https://www.merriamwebster.com/dictionary/quality). Business may 

define quality as “fit for the purpose” or a product 

or process that conforms to requirements or 

adheres to the “best” known standards, process 

or specifications (https://business.simplicable.

com/business/new/7-definitions-of-quality). 

But the definition may be different if the audience 

are social services organization, food assistance 

providers, home and community-based services 

(HCBS), healthcare providers, public health 

organizations, publicly funded or privately funded 

organizations or an individual. Because the 

OAA NP is functioning in a social, healthcare, 

publicly and privately funded HCBS system that 

is attempting to be more person-centered and 

appealing to a diverse group of people, there is a 

wide degree of diversity of definitions.

How does quality apply to the OAA 

NP? 

The OAA NP is producing products (congregate 

and home-delivered meals, including special 

dietary meals or possibly “medically-tailored 

meals”) and services (nutrition screening/

assessment, education, counseling, referrals 

to food assistance and other economic 

benefits, senior center activities and 

coordination/collaboration with services 

Quality Nutrition Services for Senior Nutrition 

Programs 101

The National

Resource Center on

Nutrition & Aging

1

Extended Brief
such as transportation). These products and 

services are produced by an organization. So, 

who defines quality for these products and 

services for the organization? Even though the 

OAA NP has existed for 47 years, there are no 

commonly agreed upon definitions of quality for 

all these foundational products, services and 

organizations. In part, this is because the OAA 

NP is a state-administered program and each 

state is responsible for quality development and 

assurance for all products/services as well as the 

quality of the organizations that they fund with 

OAA funds. 

The OAA NP whether at the federal, state, 

Area Agency on Aging (AAA) or local level 

needs to look at current quality as well as what 

quality means for the future given the changes 

in diversity of the older adult population, 

societal expectations, science, technology, 

media, healthcare, social services, home and 

community-based care and long-term services 

and supports, and funding. 

How do you measure quality?

Quality measures depend on who you ask.

Most businesses may measure it by adherence 

to these various measures (https://business.

simplicable.com/business/new/7-definitions-ofquality):

1. Performance

2. Adherence to a standard

3. Adherence to a process

4. Evaluation of value

5. Evaluation of outcomes

Evidence-based or evidence-informed 

programs, funded by ACL define quality with 

these characteristics (https://acl.gov/programs/

health-wellness/disease-prevention#future):

1. Demonstrated through evaluation to be 

effective for improving the health and wellbeing or reducing disease, disability and/or 

injury among older adults; and

2. Proven effective with the older adult 

population, using Experimental or QuasiExperimental Design; 

3. Research results published in a peer-review 

journal; 

4. Fully translated in one or more community 

site(s); 

5. Developed dissemination products that are 

available to the public.

Program participants may view the quality of a 

meal by whether they like or dislike it, whether 

it arrives on time, whether the service provides 

value, and whether it enhances their lives.

Funders may view the meal or the service by 

whether it meets standards, is of a reasonable 

cost, is efficient, effective, produces anticipated 

outcomes, and whether it is of value. Funders 

may expect SMART or the achievement of 

specific (S), measurable (M), attainable (A), 

realistic (R) and timely (T) accomplishments 

(https://en.wikipedia.org/wiki/SMART_criteria).

Others. Social services systems such as SUAs, 

tribes, AAAs and local providers; healthcare 

systems such as hospitals, physicians or health 

insurance; private industry receiving contracts—

all may view performance, standards, processes, 

value and outcomes differently.

Whatever the definition, quality needs to be 

built into an organization’s business, strategic or 

funding plans; product and service requirements; 

implementation; monitoring; and evaluation. 

Common to all plans is identifying the vision, 

mission, goals, objectives, activities and 

evaluation of those activities to determine if one 

is successful and how the products and services 

relate both the funders stated needs and the 

participants’ needs and wants.

What are different aspects of quality for 

the OAA NP?

Not only does the OAA NP produce a product 

such as a meal but it also provides other services 

by a public or private non-profit organization. As 

a result, there are various quality aspects that 

can be monitored and evaluated:

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1. Menu development and implementation

2. Meal production

3. Meal service, delivery

4. Participant satisfaction

5. Value (to participants and funders)

6. Other service implementation and 

coordination/collaborations, such as 

nutrition education, transportation, social 

activities, food assistance, etc.

7. Communication, marketing, branding

8. Administration, including funding and 

sustainability

9. Organizational structure, trust and reputation 

Who is responsible for quality?

Every level of the aging services network is 

responsible—from the federal Administration 

on Community Living (ACL) that offers technical 

assistance on the OAA NP, to state units on 

aging (SUAs), tribal organizations, AAAs and 

local nutrition service providers—all play a role in 

establishing and implementing quality assurance 

practices.

Does ACL or other entities have any 

tools to help develop quality measures 

and help programs determine how to 

improve?

This document has listed various resources for 

quality measurement, including questions that 

programs can include in surveys. But how can 

SUAs, tribes, AAAs, and local nutrition service 

providers approach this task? The Performance 

Outcome Measurement Project (POMP, https://

acl.gov/programs/pomp) was an ACL initiative to 

help SUAs and AAAs assess their own program 

performance while assisting ACL to meet federal 

accountability requirements. Partners in the 

project included SUAs, AAAs, local providers 

and university personnel. The POMP resulted 

in a tool kit with survey instruments, a sample 

calculator, and other resources. Many of the 

survey instruments provided the basis for the 

current National Survey of Older Americans 

Act Programs (NSOAAP). There is a link to 

Florida’s Senior Center Toolkit, developed as a 

part of this project (http://elderaffairs.state.fl.us/

doea/sc_toolkit.php). The ACL-funded Center for 

Healthy Aging (https://www.ncoa.org/center-forhealthy-aging/) has toolkits and resources from a 

multiplicity of sources. 

Are there other measures of a quality 

nutrition program?

Besides product and service-related quality 

aspects of the program, other aspects of a 

quality nutrition program include how an OAA NP 

operates. Some of these indicators might include:

1. Organizational structure, including Board 

management practices;

2. Administrative operations such as personnel, 

funding, sustainability, fiscal management, 

reporting, IT integration and interoperability;

3. Planning, implementing, monitoring, 

corrective action practices;

4. Business acumen and partnerships; 

5. Community partnerships and collaborations 

(outreach, information sharing, 

transportation);

6. Communication, marketing, and branding;

7. Public trust and reputation; and 

8. Advocacy.

No ACL data addresses all these other quality 

components.

Who does quality assurance for the 

OAA NP?

Everyone... older adults, the community, and the 

entities charged in the OAA. 

The entity responsible for quality assurance 

varies by state. Section 305 indicates that the 

SUA is responsible for program planning, policy 

development, administration, coordination, 

priority setting, and evaluation of all state 

activities related to the OAA activities, and the 

SUA may spell out specific policies, procedures, 

implementation methods in various state rules, 

regulations, manuals, guidance or the State Plan. 

Section 306 places significant responsibility

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Written by: Jean L. Lloyd, Consultant. Commissioned by the NRCNA. 4

on the AAAs to assure quality service 

implementation and this quality may be ensured 

through grants/contracts conditions with local 

nutrition service providers. Both entities may 

monitor for adherence to the quality standards 

that they develop. In addition, both entities may 

establish performance, CQI or TQM or other 

plans, or the local nutrition service provider may 

do it themselves. And other entities such as 

healthcare, public health, food assistance, HCBS, 

and LTSS may influence the quality standards 

applied to the OAA NP.

Opportunities for the OAA NP

The OAA NP is a trusted community service 

entity, but the data indicate that it can enhance 

service quality, value, effectiveness and proven 

outcomes.

The ACL offers opportunities for SUAs, tribes, 

AAAs, local providers and other eligible entities 

to explore systematic testing and documentation 

of innovative and promising practices that 

enhance quality, effectiveness and other proven 

outcomes of the nutrition programs and services 

through the aging services network by awarding 

Innovations in Nutrition Programs and Services 

Grants (https://acl.gov/grants/innovationsnutrition-programs-and-services-4). These 

discretionary grant awards require grantees 

to look at their current services, document 

the need for change and propose changes by 

exploring how to introduce something new such 

as an idea, program, methodology or change 

to their existing product, idea, partnerships 

and practices. Information on previous grantee 

awards are available both on the ACL website 

and through webinars at the National Resource 

Center on Nutrition and Aging

(https://nutritionandaging.org/).

Summary

The diversification of the older American 

population and changes in societal expectations, 

science, technology, media, healthcare, social 

services, HCBS, and long-term services and 

supports (LTSS) influence how the OAA NP 

changes and how these changes translate into 

quality. 

Overall, nationally, the OAA NP provides quality 

service as evidenced by data from the State 

Program Reports (SPR), the NSOAAP, and 

the National Evaluation. Quality will continue 

to be measured by performance, adherence 

to standards or processes, evaluation of value 

and outcomes, but will need to evolve to meet 

future challenges. Programs at all levels will 

need to consider their participants’ needs and 

wants; funding availability from both public 

and private sources; the healthcare, HCBS and 

LTSS environment; prioritization of services; 

clarification of what quality and success in their 

own community looks like; and envision their 

future with their current and future funders as 

well as more diverse program participants.

In an increasingly competitive environment for 

public and private funding, and increasingly 

competitive private industry, OAA NP must 

continue to demonstrate quality, enhance 

their products and services to meet the future 

challenges, and maintain the trust and respect of 

their participants, the public and their funders.