Insights from 

State Units on 

Aging on 

Combating 

Malnutrition 

through OAA 

State Plans

August, 24, 2023
Supported by grant

This project was supported, in part by grant 

number 90PPNU0002, from the Administration for 

Community Living, U.S. Department of Health and 

Human Services, Washington, D.C. 20201. Grantees 

undertaking projects with government sponsorship 

are encouraged to express freely their findings and 

conclusions. Points of view or opinions do not, 

therefore, necessarily represent official ACL policy.

Agenda

• Background on Malnutrition and State Units on Aging (5 min)

• Malnutrition Learning Collaboration overview (5 min)

• Technical Experts share their approach (20 min)

• Learning Collaborative Members share their experience (20 min)

• Questions (10 min)
The Malnutrition Quality Collaborative. National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update. Accessed August 9, 2023. https://defeatmalnutrition.today/blueprint

DEFEAT MALNUTRITION TODAY. THE NATIONAL BLUEPRINT: ACHIEVING QUALITY MALNUTRITION CARE FOR OLDER ADULTS, 2020 UPDATE.
Malnutrition impacts functionality and health

The Malnutrition Quality Collaborative. National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update. Accessed August 9, 2023. https://defeatmalnutrition.today/blueprint

DEFEAT MALNUTRITION TODAY. THE NATIONAL BLUEPRINT: ACHIEVING QUALITY MALNUTRITION CARE FOR OLDER ADULTS, 2020 UPDATE.
Incidence of malnutrition and food insecurity in 2022 

National Survey of Older Americans Act Participants 

NSOAAP is an annual survey of older adults who participate in OAA 

programs and seeks to answer important questions: are OAA programs 

serving at-risk populations and how well are they doing it? 

OAA Program

Screen positive 

malnutrition 

risk MST (>=2)

Screen positive 

Food insecurity risk

Homemaker 23% 23%

Case Management 22% 29%

Transportation 21% 19%

Home Delivered Meals 19% 29%

Congregate 17% 17%

Source: agid.acl.gov
NSOAAP Screening Questions

Malnutrition Screening Questions

• Have you recently lost weight without trying?

• No (0)

• Unsure (2)

• If yes, how much weight have you lost?

• 2-13 lb (1)

• 14-23 lb (2)

• 24-33 lb (3)

• 34 lb or more (4)

• Unsure (2)

• Have you been eating poorly because of decreased 

appetite?

• No (0)

• Yes (1)

Food Insecurity Screening Questions

• In the last 12 months, 

• How often was this statement true for your 

household: the food that we bought just didn’t last and we didn’t have money to get more? 

• How often was this statement true for your 

household: we couldn't afford to eat balanced 

meals? 

• Did you or other adults in your household ever 

cut the size of your meals or skip meals because there wasn't enough money for food? How 

often?

• Did you ever eat less than you felt you should 

because there wasn't enough money for food? 

• Were you ever hungry but didn't eat because 

there wasn't enough money for food? 
Older Americans Act Nutrition Programs and 

role in addressing malnutrition

• Purpose of the OAA Nutrition Programs is to reduce 

hunger, food insecurity and malnutrition

• Malnutrition was added in 2020 Update and programs may 

include malnutrition screening in OAA-funded programs 

• OAA requires multi-year State Plans on Aging (SPAs)

• Baseline research of SPAs in 2020, before 

malnutrition was added to purpose, found 33% of 

plans mentioned malnutrition but only 8% as 

goals/objectives and 15% as strategies/actions

• Federal requirement to screen with DETERMINE 

Checklist

• Malnutrition screening authorized but not required

Resource: https://pubmed.ncbi.nlm.nih.gov/35963994/
The DETERMINE checklist-self assessment for 

participant nutritional intake

Source: Nutrition Screening Initiative
Malnutrition Learning Collaborative

Including Malnutrition in State Plan on Aging

• Learning collaborative formed to assist SUAs in adding malnutrition language to 

their state plan and implementing malnutrition actions

• 9 states participated

• 4 focused on writing malnutrition into their state plan

• 5 focused on executing malnutrition plans

• 6 technical experts
Group 1-Plans due in 2023/24

Participants

• Maureen Brown, Bureau of Elderly and Adult 

Services, NH

• Amanda Stoess, KT Dept for Aging and Independent 

Living 

• Kelly Wright, VA Department for Aging and 

Rehabilitative Services

• Aleatha Dickerson, RI Office of Healthy Aging

• Kristin Cox, State of AK Senior and Disability Services

Technical Experts

• Carmen Clutter, OH Department of Aging

• Mary Beals-Luedtka, NACOG AAA (AZ)

• Mary Beth Arensberg, Abbott Nutrition

• Adam Mosey, ADvancing States

Group 2-plans due after 2024

Participants

• Lesley Farmen, SD Department of Human Services

• Elizabeth Fridley, IA Department on Aging

• Julie Craigo, WV Bureau of Senior Services

• Johanna Schneider, Community Living, Aging and 

Protective Services/OK Human Services

• Sara Koenig, WI Bureau of Aging and Disability Resources

• Kristie Garner, IN Family & Social Services Administration 

Division of Aging

Technical Experts

• Shirley Chao, MA Executive Office of Elder Affairs 

• Pam VanKampen, Greater WI Agency on Aging Resources

• Jaime Gahche, NIH

• Ryann Hill, SCAN Health Plan
Technical Experts Weigh in
Shirley Chao 

Former Director of Nutrition, MA Executive Office of Elder Affairs

Principal, FoodPolicy Insights 
Why Include Malnutrition in the State Plan

• Community malnutrition screening is important, malnutrition is preventable 

and treatable if identified early

• Malnutrition prevention and treatment in the community can help seniors 

reduce hospitalizations, promote wound healing, improve recovery and reduce 

readmissions. 

• Reduce caregiver and health care cost burden.

• Screening is unethical unless those at risk will then be further assessed and 

treated

• Assessment and treatment empower and enhance AAA’s capacity building for 

food and nutrition services, and further generates revenue and other 

resources for the organization. 
Important Steps to Include Malnutrition in the State Plan 

There are many risk factors that cause Malnutrition in older adults: food 

insecurity, limited income; lack of services/access, food deserts, lack of medical 

tailored meals, oral health, etc. 

• Identify the most needed/challenge areas in the state that can reduce 

malnutrition risk or raise malnutrition awareness

• Study the state geography, the cultural and ethnic diversity, and the number of 

AAAs; it makes difference if it is a single state AAA or multiple AAAs

• Weigh the SUA relationship with each AAA, and the working relationship with 

other state agencies including SNAP, public health or agriculture agencies. 

• Assess the nutrition capacity of each AAA. Are they able to conduct nutrition 

assessment, counseling and intervention?
Buy-In 

What Health Care Facilities (e.g., hospitals, ACOs) want from Community 

Nutrition Programs (AAAs) 

Risk factors

1. Chronic health conditions

2. Malnutrition

3. Metabolic conditions, other - malnutrition, obesity

4. At risk for a nutritional deficiency or imbalance due to food insecurity

Goods and Services

1. Medically Tailored meals

2. Food boxes

3. Food vouchers

4. Intake, assessment, coordination, and nutrition counseling

5. Nutrition Referral Coordination & Education

Source: Housing, Transportation, And Food: How ACOs Seek To Improve Population Health By Addressing Nonmedical Needs Of Patients.2016 

https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0727
Other Goods and Services AAA Can Offer Through 

Malnutrition Prevention/Treatment Programs 

• State/AAA level has RD –

• Nutrition standards for a healthy diet

• Nutrition education, nutrition counseling

• Malnutrition screening, nutrition assessment, documentation of 

malnutrition diagnosis, and development of a nutrition care plan.

• Technology

• Computerized recipe and menu reporting 

• Collaborate with other resources

• Medical nutrition therapy 

• Medicare advantage, Medicare MNT 

• Medically tailored meals, grocery box prescription, Food is Medicine
MA Commission on Malnutrition Prevention 

Among Older Adults

Est. November 29, 2016

2018-2022

https://www.mass.gov/lists/commission-on-malnutrition-preventionamong-older-adults
Massachusetts Commission of Malnutrition Prevention 

for Older Adults 

1. Consider strategies to improve data collection and analysis to identify malnutrition risk, health 

care cost data and protective factors for older adults; 

2. Assess the risk and measure the incidence of malnutrition occurring in various settings across 

the continuum of care and the impact of care transitions; 

3. Identify evidence-based strategies that raise public awareness of older adult malnutrition 

including, but not limited to, educational materials, social marketing, statewide campaigns and 

public health events; 

4. Identify evidence-based strategies, including community nutrition programs, used to reduce 

the rate of malnutrition among older adults and reduce the rate of re-hospitalizations and health 

care acquired infections related to malnutrition; 

5. Consider strategies to maximize the dissemination of proven, effective malnutrition prevention 

interventions, including community nutrition programs, medical nutrition therapy and oral 

nutrition supplements, and identify barriers to those interventions;
2018

• Baseline survey of 280 targeted long term care facilities on their use of malnutrition 

screening tools.

• Research to determine best methods for raising awareness

2019

• SUA added the Malnutrition Screening Tool (MST) to the Nutrition Intake Assessment for 

all new clients. 

• OAA nutrition programs started CMS Medical Nutrition Therapy (MNT) pilot programs. 

• The Commission introduced PatientPing, This technology can be used to identify 

patients/consumers with malnutrition or risk factors for malnutrition upon hospital 

discharge and allow for timely interventions. In 2019, 70 hospitals in Massachusetts 

(95%), 400 post-acute facilities, 30 provider groups, and some AAAs were a part of the 

PatientPing network. https://bamboohealth.com/
2019 

Malnutrition week promoted during Older Americans Month (May 2019). 

“Whereas critical programs such as the Senior Nutrition Program, and the work of the Commission 

on Malnutrition Prevention Among Older Adults, are key to the Commonwealth’s efforts to 

prevent malnutrition and improve the health, wellbeing and independence of older adults.” – Gov. 

Charlie Baker

Conduct Statewide Community Malnutrition Prevention clinics and screenings

• 82 senior nutrition clinics held statewide;

• 3,000 participants and 1,000 were screened (200 homebound)

were screened during ASPEN Malnutrition WeekTM

• Screening tools : Malnutrition Screening Tool (MST) 

• FRAIL Scale score (Fatigue, Resistance, Ambulation, Illnesses,

• Weight Loss)

• 10% of community living seniors, and 33% of home bound seniors at risk.

• Findings in line with literature on community-dwelling seniors 

• Community homebound seniors at higher risk of malnutrition and frailty

Chao 2022
2020-2021 (COVID-19) 

True Challenge for Malnutrition Among Older Adults 

In 2021, the Malnutrition Prevention Commission (MPC) continued to meet challenges exacerbated 

by the COVID-19 pandemic. At the same time, both the food insecurity rate and SNAP enrollment 

rate in Massachusetts were rising.

Many MPC member’s agency participated in the Governor’s Food Security Task Force (FSTF) to 

incorporate the FSTF actions into the MPC work to raise the awareness of malnutrition among 

older adults.

MPC recognized the adverse impact to older adults both physically and mentally and selected key 

areas and encouraged the membership organizations to maximize initiatives in those key areas 

Community response to prevent malnutrition during COVID-19 

• Reducing food insecurity 

• Increasing socialization 

• Promoting community nutrition services (OAA programs, farmer’s market program, and 

other community nutrition programs)

• Raising malnutrition prevention awareness

• Promoting nutrition education and disease management

Chao 2022
2020-2021

Raising malnutrition prevention awareness 

1. #Doacovidcheck There were more than 15,000 followers on 

these postings 

2. Statewide Food Assistance Decision Tree #Covid19MA -Need 

groceries or meals this week? You are not alone. Find the right 

program for you. Visit Mass.gov/FindFoodHelp #Covid19MA

3. #BeaNutritionNeighbor -The campaign had 32 engaged groups 

who posted the campaign message over 100 times, resulting in 

close to 110,000 impressions

Chao 2022
2022

MPC participation:

• White House Conference on Hunger, Nutrition and Health 

• CMS the Global Malnutrition Composite Score (GMCS) 

• Food is Medicine Inventory Advisory Panel

Statewide survey demonstrates encouraging results 

Promote Food Security 

• Over 1/3 of home delivered meal respondents reported they would have a shortage of food in the 

house if it were not for the program. 

• 69% of home delivered meal respondents reported it is their main meal of the day. 

Promote Quality of Life

• 81% of home delivered meal recipients reported that the meals help them to live independently. 

• 80% of respondents receive at least one daily meal, some of them receive three meals a day plus 

weekend meals. 

• Sixty-one of the participants who completed surveys were 100-yearsold or older.

Chao 2022
2022

Promotes Nutritional Health and Wellness 

• 90% reported eating healthier, 81% maintained weight and improved health, 

• 50% of the respondents successfully maintained their blood pressure and blood sugar levels.

Medical Tailored Meals (Food as Medicine)

• While all meals meet nutrition standards, 96% of the programs also offer medically tailored meals 

(e.g., cardiac, renal, diabetic). 

Chao 2022
OHIO’S 2023-2026 

STATE PLAN ON AGING

CARMEN CLUTTER, MS, RDN, LD

Chief | Elder Connections Division

CClutter@age.ohio.gov

MALNUTRITION PREVENTION COMMISSION REPORT

Key Findings

• The Population in Ohio is Shifting

• The Risk for Malnutrition is High

• Malnutrition is Costly

Recommendations

• Education and Awareness

• Data and Evaluation

• Prevention Models: Team-Based Care
2023-2026 STATE PLAN ON 

AGING

Comprehensive roadmap to 

advance elder justice and 

equity and achieve optimal 

health and well-being for older 

Ohioans
ACHIEVING THE GOAL 

AND VISION

The State Plan on Aging lays a foundation to 

ensure that all partners in the aging 

network are rowing in the same direction to 

improve the health and well-being of older 

Ohioans.
2023-2026 

State Plan on 

Aging 

Framework

Strategy 

Categories

Specific policies, programs, and services 

within each strategy category are listed in 

Attachment E
ATTACHMENT E: 

DETAILED STRATEGY 

TABLES

Additional Resources
ATTACHMENT F: 

DETAILED OBJECTIVE 

TABLES
Call to 

Action 6 Action Steps to Achieve Ohio’s Vision and Goals
IMPLEMENTATION 

TOOLKIT

The Toolkit provides guidance, best 

practices, tools, and resources that state 

and local partners can use to ACT. 
2023-2026 STATE PLAN ON AGING 
Malnutrition Learning Collaborative 

Participants Weigh in
Elizabeth Fridley

Health Promotion Director

Iowa Department of Health and Human Services

Division of Aging and Disability Services
Approach

 Review state plans than have already included malnutrition

 Look at current state plan’s goals and objectives to find where 

malnutrition might naturally fit

 Example: “Improve the reach of nutrition education and counseling to 

older Iowans at high nutrition risk or at risk of malnutrition”

 Current plan runs 2022-2025, planning for 2026 plan

 Connect with technical experts

 Utilize shared resources as a starting point

 Toolkit
Strategies

 Discuss malnutrition with AAA nutrition and health promotion 

directors

 Defined malnutrition

 Reviewed differences between nutrition risk and malnutrition

 Shared estimated cost of malnutrition using Defeat Malnutrition Today 

infographics

 Reviewed validated screening tools for malnutrition

 Identified where AAAs are already screening for malnutrition

 Discussed interventions and referrals to address malnutrition and 

malnutrition risk factors

 Identified opportunities to pilot malnutrition screening

 Worked with database administrator to get the Malnutrition 

Screening Tool (MST) added in Wellsky for optional use

 Ongoing meetings with the planning and performance evaluation 

team to create a malnutrition dashboard
Challenges

 Developing comprehensive intervention and referral pathways to 

utilize in response to a consumer screening positive for malnutrition

 Finding ways to measure and capture the impact OAA services have 

on malnutrition and malnutrition risk factors 
45
Approach for 

SPOA 2024-2027

with submission deadline of June 30, 2023
What we learned during PHE 47
Asking, What was already happening in NH? 48
Approaches - general 49

1. Gather information regarding current state plans 

that contained malnutrition or those that were 

planning to

2. Reviewed state plans that contained malnutrition

3. Seek support of technical experts in the field of 

nutrition, advocacy, and data collection 

4. Ongoing education and advocacy for nutritional 

health of OAs

Strategies - general

1. Utilize listserve to connect with states whose 

plans contained malnutrition or were in process 

of adding malnutrition

2. Compare NH state plan for similarities in 

structure and content to facilitate updates

3. MLC participant

DPHS (data) 

NH Center for Justice & equity (data & advocacy) 

NH Hunger Solutions (data & advocacy)

4. Continue and expand active representation of 

OAs in statewide/local food and nutrition work 

groups to advocate and inform re: needs of OAs; 

as well as receive input and support for OAs.
50

Strategies - specific

1. Achieve uninterrupted continuation 

of grab-n-go post PHE

2. Maintenance and expansion of 

RVP to meet ongoing needs/ 

preferences of participants & staffing 

challenges of programs

3. Promote greater awareness of need 

and understanding of food and 

nutrition services for OAs

Challenges/Outcomes 

1. Adopt Administrative Rule (TIII) 

prior to end of PHE - achieved

2. Survey: 65% of participants are 

new to program; reconnecting 

w/neighbors, friends and churches; 

joining other community activities

3. Sustain collaboration w/state & 

local food programs and work & 

advocacy groups to expand 

awareness and participation in 

nutrition programs
51

Strategies - specific (continued)

1. Educate and Inform research and 

data collection for better 

representation of OAs

2. Establish evaluation methods to 

show effectiveness of Grab-n-Go and 

RVP in: maintaining and expanding 

participation; and reducing risk of food 

insecurity and malnutrition

Challenges/Outcomes (continued)

1. Initiate review of SPR data 

collection; Work with NHHA, DPHS, 

BFA, and other data collection 

sources for inclusion

2. In process – demonstrating 

effectiveness of expanding 

participation is proving doable, 

however challenge will be 

demonstration of the latter
52

Strategies - specific (continued)

1. Leverage opportunities to expand 

participation in pilot: create and 

implement Universal screening, 

intervention, and referral process to 

reduce food insecurity and 

malnutrition risk in OAs 

Challenges/Outcomes (continued) 

1. Maintain active participation (in 

pilot) of NHH Food & Nutrition 

Services, Adult Protective Services 

case workers, and contracted nutrition 

program staff; Foster ongoing 

relationship with research and data 

collection/ outcomes of the NHAH; 

Developing new partnerships; 

Consistent tracking of interventions 

and outcomes/impact.
Resources

• Nutrition and Aging Resource Center- Malnutrition Page

• https://acl.gov/senior-nutrition/food-insecurity-malnutrition

• State Plans on Aging

• http://www.advancingstates.org/initiatives/aging-policy-andprograms/map-state-plans-aging

• ACL Guide to Prioritizing Participants with DETERMINE

• https://acl.gov/sites/default/files/programs/2020-

12/SNPGuidetoPrioritizingClients.pdf
How to Self Register CPE for RDNs

• A RD/DTR can earn 1 CPE credit for this program under CPE Activity Type 170 –

Lectures/Seminars or Type 171 - Teleseminars/Webinars

• Only available for the live presentation 

• Can use the agenda or request certificate of completion 

• Helpful Resource: https://secure.eatright.org/CGIBIN/lansaweb?wam=LOGFAQ2&webrtn=entrywr&ml=LANSA:XHTML&part=PRD&

lang=ENG#175a
Thank You

This project was supported in part by grant number 90PPNU0002-01-00 from the U.S. Administration for Community Living, 

Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government 

sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, 

necessarily represent official ACL policy.

Thank you