1

IssueBRIEF

Methods

The analysis draws on data on 

program use between 2011 and 

2018 from the NSOAAP, 

which AoA collects annually. 

The NSOAAP is a nationally 

representative survey of 

recipients of selected services, 

including congregate meals and 

home-delivered meals. This 

information was combined 

with counts of the number of 

older adults eligible for the 

program from the American 

Community Survey (ACS). 

The ACS is a nationally 

representative survey of the U.S. 

population that the Census 

Bureau conducts annually.

To estimate the share of the 

eligible population entering a 

program, we used a simple 

ratio of participants to the 

eligible population. Total 

1

 In some cases, individuals younger 

than 60 with disabilities are also 

eligible.

2

 In some cases, spouses, caregivers, 

and individuals younger than 60 

with disabilities are also eligible.

June 2020

MATHEMATICA.ORG

Ariella Kahn-Lang, Marisa Shenk, and James Mabli, Mathematica

Program Entrance and Retention in the 

Older Americans Act Title III-C Nutrition 

Services Program

BACKGROUND

Each year, millions of older Americans receive meals as part of the Title III-C Nutrition Services 

Program (NSP), funded by the Administration on Aging (AoA). These programs, including both the 

congregate meal program and the home-delivered meal program, are administered locally through 

grants to states. The programs aim to reduce hunger and food insecurity, promote healthy eating, 

increase socialization, and, in turn, improve participant health (Administration for Community Living 

2019a). Together, the congregate meal and home-delivered meal programs serve over 900,000 meals a 

day (Administration for Community Living 2019a).

The congregate meal program offers healthy meals in a group setting. Although all adults older than 

60 and their spouses are eligible,1

 the program primarily seeks to engage those in social and financial 

need. Meals are offered in community settings designed to be convenient for older adults including 

senior centers, churches, and schools (Administration for Community Living 2019b). In addition 

to providing meals, the congregate meal program also provides participants with social interaction, 

information on healthy aging, and meaningful volunteer roles. Participation in the congregate meal 

program has been shown to be associated with decreases in food insecurity (Mabli et al. 2017), 

improved health outcomes (Mabli et al. 2018), and increased socialization (Mabli and Shenk 2019a). 

The home-delivered meal program provides meals to frail, homebound, or isolated adults older than 

60.2

 In addition to meals, the program offers participants an opportunity for social interactions. Homedelivered meal participants overwhelmingly report that the program helps them eat healthier foods 

and live independently in their own homes (Mabli et al. 2017).

Despite the importance of these programs, little is known about the factors that influence 

participation, including both program entrance and retention (Mabli and Shenk 2019b). Some 

research has estimated factors associated with participation in the home-delivered meal program. 

However, existing studies have limited generalizability due to only focusing on a specific service area 

or state (Hoerr et al. 2016; Weddle et al. 2012; Walker et al. 2004) or using outdated data (Choi 

1999, Frongillo et al. 1987). Other research has examined factors associated with participation in the 

congregate meal program. Mabli and Shenk (2019b) analyzed the share of participants who continue 

to participate over time (retention rates) for the congregate meal program and found that retention 

rates were higher among participants with less local access to food. The associations between retention 

rates and other participant characteristics were limited.

This issue brief assesses program entrance and retention rates in both the congregate meal and homedelivered meal programs using almost 10 years of data from the National Survey of Older Americans 

Act Participants (NSOAAP), a nationally representative survey of program participants, and the 

American Community Survey (ACS). It also assesses how program entrance and retention vary with 

participant characteristics and evaluates how retention and program entrance have changed over time. 

These findings are important for understanding how to best target and retain participants who can 

benefit from services.

PRINCETON, NJ - ANN ARBOR, MI - CAMBRIDGE, MA - CHICAGO, IL - OAKLAND, CA - SEATTLE, WA 

TUCSON, AZ - WASHINGTON, DC - WOODLAWN, MD
2

Methods (continued)

participants and total 

population are estimated 

using total survey responses 

weighted by the surveyprovided population 

weights. Population 

estimates treat anyone who 

is age 60 or older as part of 

the population. This is 

because although the 

congregate meal and 

home-delivered meal 

programs primarily seek to 

engage socially and 

economically vulnerable 

individuals, the programs 

are open to the full 

population. Further, there is 

no comprehensive indicator 

in the data for social or 

economic vulnerability. To 

estimate the size of the 

population eligible to enter 

the program, the number of 

participants from the 

previous year are subtracted 

from the total number of 

adults in the population age 

60 or older.

The program retention rate 

in a given year, t, was 

estimated as the share of 

program participants from 

year t-1 who are still 

participating in year t. 

Because the NSOAAP data 

are cross-sectional, and 

therefore each year of data 

contains a new set of 

participants, individual 

participants cannot be 

tracked across years. 

Therefore, the retention rate 

is estimated using measures 

of how long participants in 

each year have been in the 

program. The mathematical 

calculation of this retention 

rate is rt =P(t,stayers)/P(t-1) where 

rt is the retention rate in 

year t, P(t,stayers) is the number 

of participants in year t who 

have been in the program 

for more than one year, and 

Pt-1 is the number of 

participants in year t-1.

FINDINGS

Participation in congregate and homedelivered meal programs

From 2011 to 2018, approximately 1.6 million 

older adults participated in the congregate meal 

program each year, on average, and approximately 

840,000 received home-delivered meals (Figure 1). 

For congregate meals, there was a slight decline 

in participation between 2011 and 2014—from 

approximately 1.72 million to 1.56 million—but 

participation was stable between 2014 and 2018. 

For home-delivered meals, participation remained 

largely constant over this period, fluctuating 

by less than 50,000 between the years with the 

highest and lowest levels of participation.

The demographic characteristics of program 

participants for congregate meals and homedelivered meals differed from the general 

population age 60 and older. Overall, even among 

adults 60 and over, participants in both programs 

tended to be older than the general population 

(Table 1). About 54 percent of congregate meal 

participants and 66 percent of home-delivered 

meal participants were age 75 or older, relative 

to only 30 percent of the general population. 

Women were also overrepresented in both 

programs, making up more than two-thirds 

of the participants, compared to 55 percent of 

the general population. Consistent with the 

program’s goal of seeking to engage older adults 

in greatest need, participants in both programs 

had lower levels of income and education than 

the general population. There were only small 

differences in the regional and racial composition 

of participants relative to the general population.

Program entrance

Program entrance measures the rate at which 

eligible individuals join the program each 

year. From 2012 to 2017, approximately 5 

out of every 1,000 eligible individuals joined 

the congregate meal and home-delivered 

meal programs. Participant entrance rates for 

congregate meal participants declined over 

this period by approximately 37 percent (from 

0.63 to 0.40 percent) but remained relatively 

steady for home-delivered meal participants 

FIGURE 1: Program participation, by year

Source: NSOAAP, 2011–2018, weighted data.

Note: Program participants estimated as the weighted total number of survey respondents.
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TABLE 1: Percentage of home-delivered meal participants experiencing chronic conditions

 Characteristic

Congregate 

meal participants

Home-delivered 

meal participants

U.S. population 

age 60 and older

Age

60-64 8% 7% 29%

65-74 38% 26% 40%

75-84 37% 34% 21%

85+ 17% 32% 9%

Gender

Male 33% 33% 45%

Female 67% 67% 55%

Race

White 80% 75% 83%

Black 11% 16% 9%

Native American 1% 1% 1%

Other / multiple races 8% 7% 7%

Hispanic 9% 7% 8%

Housing

Live with spouse 39% 23% 55%

Live with others (non-spouse) 14% 19% 21%

Live alone 47% 57% 24%

Education

High school or less 49% 63% 47%

At least some college 51% 37% 53%

Income

Less than $20,000 45% 70% 16%

Over $20,000 55% 30% 84%

Region

Northeast 22% 23% 19%

Midwest 30% 28% 22%

South 22% 31% 37%

West 26% 18% 22%

Sample size 7,205 7,629 5,485,041 

Sources: NSOAAP, 2011–2018, and ACS, 2011-2017, weighted data.

Note: All estimates represent the percent of total survey respondents with a given characteristics over the full study period 

(from 2011 to 2018 for congregate meal participants and home-delivered meal participants and 2011-2017 for US population 

age 60 and older).
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FIGURE 2: Participant entrance rates over time

Sources: NSOAAP, 2011–2017, and ACS, 2011-2017, weighted data.

Note: Total entrants are calculated as the total number of respondents reporting to have been in the program for 

under one year. The total eligible population is estimated as the total number of individuals in the US ages 60 and 

older minus the total number of participants in the previous year. 

(from 0.52 to 0.51 percent) (Figure 2). The 

decline in participant entrance for congregate 

meal participants does not primarily represent 

a decreasing number of entering participants, 

but instead reflects a fairly constant number of 

entrants and a population of eligible individuals 

that was growing over time.

Program entrance rates vary according to the 

characteristics of older adults. The shares of 

eligible individuals entering the congregate and 

home-delivered meal programs were more 

than three times higher for individuals ages 75 to 

84 than for individuals ages 60 to 64 (Figures 3a 

and 3b). Although 6 out of every 1,000 eligible 

women entered each program, only 4 out of every 

1,000 eligible men entered. 

Native Americans were approximately three 

times more likely to enter a program than eligible 

individuals of any other race. However, entrance 

rates for eligible individuals of each of the other 

races (black, white, and “other/multiple”) are 

comparable. Eligible individuals with lower 

incomes entered both programs at substantially 

higher rates. In contrast, there is no meaningful 

variation in entrance rates by education level. 

Eligible individuals who lived alone were more 

than twice as likely to enter a program relative 

to those who are living with their spouse or with 

others. There is also some variation in entrance 

rates by region, with the South reporting lower 

entrance rates than other regions.
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FIGURE 3a: Entrance rates for congregate meal participants, by participant characteristics

FIGURE 3b: Entrance rates for home-delivered meal participants, by participant characteristics

Sources: NSOAAP, 2011–2017, and ACS, 2012-2017, weighted data. 

Note: Total program entrants with a given participant characteristics are estimated as the total number of respondents reporting to have been in the program 

for less than one year multiplied by the share of new respondents with that characteristic. The total eligible population with a given characteristic is estimated 

as the total number of individuals in the United States ages 60 and older multiplied by the share of the population with that characteristic minus the number of 

participants with that characteristic in the previous year. Statistical significance indicators represent the results of a Wald test on each group to analyze whether 

within-group differences are statistically significance. 

* Statistically significant at the p < .1 level; ** statistically significant at the p < .05 level; *** statistically significant at the p < .01 level.
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Program retention

The second key component of program 

participation is retention, or the share of 

participants who continue to participate in the 

program after one year. From 2012 to 2018, the 

average annual retention rate was 78 percent for 

congregate meal participants and 57 percent for 

home-delivered meal participants (Figure 4). 

Retention rates remained consistent over this 

period. The home-delivered meal program has 

substantially lower participant retention than the 

congregate meal program in all years.

Although there is some variation, program 

retention is relatively consistent across 

demographic groups (Figures 5a and 5b). For 

both congregate and home-delivered meal 

participants, retention increases with age. The 

retention rates for participants older than age 85 

were more than twice as high as the retention 

rates for participants age 60 to 64. For congregate 

meals, evidence indicates that new participants 

are 9 percentage points more likely to stay than 

individuals who have participated for longer. For 

home-delivered meals, there is some difference 

in retention rates by living arrangement, with 

those living with spouses being the least likely to 

continue participation. However, retention rates 

were similar, and differences were not statistically 

significant across other participant characteristics.

FIGURE 4: Program retention rates over time

Source: NSOAAP, 2011–2018, weighted data.

Note: Annual program retention in a given year is estimated as the total number of respondents in that year 

reporting to have been in the program for more than one year divided by the total number of individuals in the 

previous year who responded to the question on length of time participating in the program. All estimates are 

weighted using survey-provided population weights.
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FIGURE 5a: Retention rates for congregate meal participants, by participant characteristics

FIGURE 5b: Retention rates for home-delivered meal participants, by participant characteristics

Source: NSOAAP, 2011–2018, weighted data. 

Note: Annual program retention in a given year is estimated as the total number of respondents in that year reporting to have been in the program for more than 

one year divided by the total number of individuals in the previous year who responded to the question on length of time participating in the program. Estimates 

shown are a weighted average of annual retention rates from 2012–2018. Statistical significance indicators represent the results of a Wald test on each group to 

analyze whether within-group differences are statistically significance.

* Statistically significant at the p < .1 level; ** statistically significant at the p < .05 level; *** statistically significant at the p < .01 level.
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DISCUSSION

Despite the importance of the congregate and 

home-delivered meal programs, little is known 

about factors associated with older adults 

participating in these programs. The findings 

presented in this brief offer useful information 

on program entrance and retention rates, which 

can help practitioners effectively target services to 

older adults with the greatest need.

Participation in both congregate meals and homedelivered meals was steady from 2011 to 2018. 

The congregate meal program served almost twice 

as many individuals as the home-delivered meal 

program; however, entrance rates for the two 

programs were similar. Thus, the lower levels of 

participation in home-delivered meals reflected 

lower retention rates for this program, relative 

to the congregate meal program. Although 

participant satisfaction could play a role, Mabli et 

al. (2019a) found that 95 percent of participants 

in both programs reported liking the meals, and 

more than 80 percent reported being satisfied 

with the socialization opportunities. This suggests 

that alternative barriers to continued participation 

or different reasons for program use might exist 

between the two programs. Because the survey 

used in this study does not follow participants 

over time, it is not possible to identify changing 

circumstances of participants using this data.

Both the congregate and home-delivered meal 

programs specifically seek to engage participants 

in social or financial need. The success of both 

programs in reaching out to these individuals is 

evident in the participant entrance rates among 

individuals with lower income and individuals 

living alone. Still, there is substantial participation 

among participants who do not have lower 

income nor live alone based on observable 

characteristics. Using this information, providers 

can gauge whether the current composition of 

participants is consistent with the program’s goals 

and, if not, how participant recruitment could be 

adjusted to target individuals with high need.

In contrast to entrance rates, retention rates 

did not vary over time, despite the fact that the 

economic climate changed substantially over the 

study period (the unemployment rate decreased 

steadily over this period from 8.9 percent in 

2011 to 3.9 percent in 2018 [Bureau of Labor 

Statistics, 2019]). Although participants 

receiving meal services were generally out of 

the labor market, they may have been impacted 

by market changes through spouses, family and 

other caregivers. Still, retention rates not varying 

with economic climate could reflect participants 

being largely shielded from the effects of market 

changes. Similarly, retention rates did not vary 

with participant characteristics other than age, 

including characteristics likely to be associated 

with social and financial need. This is surprising 

given that if older adults in greater need perceive 

greater benefits of participation, they may stay 

on the program longer and therefore have higher 

retention rates. Having similar retention rates 

across levels of need suggests that participants in 

social or financial need may face greater barriers 

to continued participation relative to those with 

a lower level of need. Alternatively, those with 

a lower level of need may have a high perceived 

benefit of participation. Additional research on 

the factors that cause some participants to stay in 

the programs and others to leave would provide 

insight into why retention rates do not vary by 

most demographic characteristics or over time.

This brief uses a cross-section of nationally 

representative data to examine program entrance 

and retention rates. Readers should interpret 

these findings in the context of two limitations. 

First, the length of participation, which is used 

to construct estimates of retention rates, is based 

on self-reported data, which might be affected by 

recall bias (that is, differences in the way people 

remember and report events such as how long ago 

they entered the program). Second, the data do 

not contain reasons for program entrance or exit. 

This brief also emphasizes how understanding 

factors that influence program participation can 

assist providers in effectively serving their target 

populations. Collecting information on why 

participants entered and exited each program will 

help providers to better serve participant needs by 

allowing providers to compare the characteristics 

of program entrants against the populations to 

whom they perform outreach and, among current 

participants, by mitigating barriers to continued 

participation of the program.
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programs/2019-03/MealProgramValueProposition.

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2019. Available at https://data.bls.gov/timeseries/

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