FINAL REPORT

Needs of and Service Use 

Among Participants in the 

Older Americans Act Title III-C 

Nutrition Services Program 

October 5, 2018

James Mabli

Marisa Shenk

Submitted to:

Center for Policy and Evaluation 

Administration for Community Living 

U.S. Department of Health and Human Services 

330 C Street, SW 

Washington, DC 20201 

Project Officer: Heather Menne, Social Science Analyst, Office of Performance and Evaluation 

Contract Number: HHSP233201500035I/HHSP23337001T 

Submitted by:

Mathematica Policy Research 

955 Massachusetts Avenue, Suite 801 

Cambridge, MA 02139 

Telephone: (617) 491-7900 

Facsimile: (617) 491-8044 

Project Director: James Mabli 

Reference Number: 50158.01.720.471.001 
This page has been left blank for double-sided copying.
MATHEMATICA POLICY RESEARCH

CONTENTS

EXECUTIVE SUMMARY .............................................................................................................................vii

I INTRODUCTION.............................................................................................................................. 1

II BACKGROUND ON NSP EVALUATION AND OVERVIEW OF DATA AND 

METHODOLOGY............................................................................................................................. 3

A. Overview of the Title III-C Nutrition Services Program.............................................................. 3

B. Nutrition Services Program evaluation objectives..................................................................... 4

C. Evaluation sampling design and data collection........................................................................ 5

D. Analytic methods, weights, and item nonresponse ................................................................... 6

III NSP PARTICIPANTS’ NEEDS AND TRADE-OFFS IN MAKING ENDS MEET ............................. 9

A. Characteristics of participants ................................................................................................... 9

B. Experiencing challenges trying to make ends meet................................................................ 10

C. Making trade-offs between purchasing food and other basic needs....................................... 12

D. Experiencing food insecurity.................................................................................................... 15

IV PATTERNS OF PARTICIPATION IN THE NSP............................................................................ 19

A. Frequency of NSP participation among congregate meal participants in 2015–2016 ............ 19

B. Frequency of NSP participation among home-delivered meal participants in 2015–

2016......................................................................................................................................... 23

C. Patterns of congregate meal participation over the course of a year...................................... 24

D. Patterns of home-delivered meal participation over the course of a year............................... 29

V PARTICIPATION IN OTHER PROGRAMS AND USE OF NSP SERVICES ................................ 31

A. SNAP participation .................................................................................................................. 31

B. Emergency food assistance .................................................................................................... 34

C. Nutrition and supportive services ............................................................................................ 39

C. Emergency energy assistance ................................................................................................ 42

VI CONCLUSION ............................................................................................................................... 45

A. NSP participants’ needs and trade-offs in making ends meet ................................................ 45

B. Patterns of participation in the NSP ........................................................................................ 46

C. Participation in other programs and use of NSP services....................................................... 47

D. Implications for policy and future research.............................................................................. 48

REFERENCES............................................................................................................................................ 53

iii
This page has been left blank for double-sided copying.
MATHEMATICA POLICY RESEARCH

TABLES

III.1 Characteristics of participants........................................................................................................ 10

III.2 Percentage of participants reporting challenges making ends meet, by participant 

characteristics ................................................................................................................................ 11

III.3 Percentage of congregate meal participants reporting making trade-offs in purchasing 

food in the past month, by participant characteristics.................................................................... 13

III.4 Percentage of home-delivered meal participants reporting making trade-offs in 

purchasing food in the past month................................................................................................. 14

III.5 Percentage of participants who experienced food insecurity, by participant characteristics......... 16

III.6 Percentage of participants who experienced very low food security, by participant 

characteristics ................................................................................................................................ 17

IV.1 Frequency of participation in congregate meal program ............................................................... 19

IV.2 Percentage of congregate meal participants who ate at a meal site four or more days per 

week, by participant characteristics ............................................................................................... 20

IV.3 Percentage of congregate meal participants who usually visit more than one congregate 

site for meals, by participant characteristics .................................................................................. 22

IV.4 Frequency of participation in home-delivered meal program......................................................... 23

IV.5 Percentage of home-delivered meal participants who received program meals five or 

more days per week, by participant characteristics ....................................................................... 24

IV.6 Percentages of congregate meal participants who continued to participate in the 12 

months after the 2015–2016 interview........................................................................................... 26

IV.7 Percentages of participants who eat at the congregate meal program as often in 2016–

2017 as in 2015–2016, by participant characteristics.................................................................... 28

IV.8 Percentages of home-delivered meal participants who continued to participate in the 12 

months after the 2015–2016 interview, by participant characteristics ........................................... 30

V.1 Percentage of participants currently receiving SNAP benefits, by participant 

characteristics ................................................................................................................................ 32

V.2 Percentage of participants currently receiving SNAP benefits, by agency characteristics............ 33

V.3 Percentage of participants who received food from a food pantry or food bank in the past 

30 days, by participant characteristics ........................................................................................... 35

V.4 Percentage of participants who received food from a food pantry or food bank in the past 

30 days, by agency characteristics ................................................................................................ 36

V.5 Percentage of participants who received any meals provided by churches, soup kitchens, 

or emergency kitchens in the past 30 days, by participant characteristics.................................... 37

V.6 Percentage of participants who received any meals provided by churches, soup kitchens, 

or emergency kitchens in the past 30 days, by agency characteristics......................................... 38

v 
TABLES MATHEMATICA POLICY RESEARCH

V.7 Other nutrition and supportive services participants used in the past six months......................... 39

V.8 Percentage of participants who used any nutrition or supportive services in the past six 

months, by participant characteristics............................................................................................ 40

V.9 Percentage of participants who used any nutrition or supportive services in the past six 

months, by agency characteristics................................................................................................. 41

V.10 Percentage of participants who received emergency assistance to help with heating and 

cooling in the past 30 days, by participant characteristics............................................................. 43

V.11 Percentage of participants who received emergency assistance to help with heating and 

cooling in the past 30 days, by agency characteristics.................................................................. 44

vi
MATHEMATICA POLICY RESEARCH

EXECUTIVE SUMMARY

Each year, hundreds of millions of meals are provided to older adults in America as part of 

the Title III-C Nutrition Services Program (NSP). Authorized under the Older Americans Act 

(OAA), the NSP promotes access to nutritious meals, facilitates social contact, and helps older 

adults maintain their independence in their homes and communities. Participants who are able to 

attend congregate meal sites typically receive lunch on one or more weekdays and, at some sites, 

also receive breakfast, dinner, or weekend meals. Congregate meal sites offer opportunities for 

participants to socialize with peers and receive other services such as nutrition education, 

screening, and counseling. These services help older adults identify their general and specific 

needs related to maintaining their health and managing nutrition-related diseases such as heart 

disease, hypertension, and diabetes. 

Participants who are homebound receive nutritious home-delivered meals, typically five 

days per week. Like congregate meal settings, home-delivered meals offer an opportunity for 

socializing. Home-delivered meal volunteers might be older adults as well and, in addition to 

delivering meals, might offer an opening for face-to-face contact or conversation. This allows 

volunteers to relay important information about participants’ well-being and needs to service 

providers. Homebound participants also receive nutrition education, screening, and counseling as 

well as non-nutrition services. In this way, the NSP provides homebound participants with a 

primary access point for many home- and community-based services to help meet their health 

and nutrition needs. 

As part of its responsibility to administer the NSP, the Administration on Aging (AoA) 

within the Administration for Community Living (ACL) of the U.S. Department of Health and 

Human Services (DHHS) periodically evaluates its efficiency and effectiveness. In the most 

recent evaluation from 2015 to 2017, AoA contracted with Mathematica Policy Research to 

collect information from two main sources: (1) state and local agencies that oversee the program 

and provide program services, and (2) a national sample of program participants and 

nonparticipants. The goal of the evaluation was to examine program administration, service 

delivery, and cost, and to measure the effect of program participation on older adults’ food 

security, socialization, diet quality, and longer-term health outcomes. The findings showed that 

meal provision has experienced a robust expansion over the past 20 years, with more agencies 

providing home-delivered meals and more agencies providing congregate meals that offer 

breakfast, dinner, or weekend meals, in addition to weekday lunches (Mabli et al. 2015). NSP 

participants generally had more favorable outcomes than nonparticipants, as indicated by lower 

rates of food insecurity, greater satisfaction with socialization opportunities, and improved diet 

quality (Mabli et al. 2017). For several outcomes including food security, improvements 

associated with participating in the program were larger for participants with less income than 

for those with more income. 

Although the NSP serves a critical need among its participants, many older adults continue 

to face financial hardships and food access limitations. Among congregate meal and homedelivered meal participants, 15 to 25 percent reported that they experience challenges making 

ends meet, and 4 to 9 percent reported having to make difficult choices of how to spend scarce 

household resources, such as whether to buy food or pay for rent, utility bills, or needed 

medications (Mabli et al. 2017). Although the majority of participants were food secure, 16 

vii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

percent of congregate meal participants and 23 percent of home-delivered meal participants had 

experienced food access limitations during the past month due to lack of money or other 

resources—they were food insecure. For participants in the lowest income quartile 

(approximately below the federal poverty level), these percentages were dramatically higher at 

32 and 35 percent, respectively. 

The evaluation described the level of need among all program participants, but little is 

known about whether specific groups of participants disproportionately experience these 

challenges. Learning more about the characteristics and circumstances of these participants can 

allow AoA and state and local agencies to identify whether there are types of participants the 

program could target to provide services that help mitigate these challenges. Thus, an objective 

of this report is to examine how participants’ level of need varies by participant characteristics. 

The evaluation also found that participants’ frequency of program use differed—43 percent 

of congregate meal participants typically received five or more congregate meals per week and 

57 percent received up to four meals per week (Mabli et al. 2017). For home-delivered meal 

participants, these percentages were 71 and 29, respectively. There was also variation in whether 

congregate meal participants attended multiple congregate meal sites in a given week. Learning 

more about the characteristics and circumstances of participants who receive meals more often, 

who use multiple program sites, and who change their use of the program over the course of a 

year can allow AoA and state and local agencies to identify whether there are specific groups of 

participants who underuse the program and whom the program could target to increase use. 

Thus, a second report objective is to assess patterns of participation in the core program services 

of receiving congregate and home-delivered meals. 

Finally, the evaluation revealed that the ways in which participants met their needs related to 

food and nutrition, health, and personal care differed. Participants reported having access to a 

wide array of services provided through the NSP, as well as other services available in the 

community, yet little is known about the extent to which they use these services. Assessing how 

participants use other food and non-food assistance programs outside of the NSP and use nonmeal services offered through the NSP can help AoA and state and local agencies understand 

more thoroughly how participants meet their basic needs and even identify to whom to target 

outreach and referrals to these programs and services. Thus, a third report objective is to assess 

participation in the Supplemental Nutrition Assistance Program (SNAP) and receipt of 

emergency food, as well as participation in the Low Income Home Energy Assistance Program 

(LIHEAP). This objective also entails assessing participation in services at the meal site, at 

home, or in the community such as nutrition counseling, case management services, 

transportation services, and personal care services.

The report draws on information obtained from comprehensive surveys of congregate and 

home-delivered meal participants in 2015–2016 and 2016–2017. The surveys were administered 

to random samples of congregate and home-delivered meal participants, based on probability 

samples of local NSP agencies that were surveyed as part of an earlier process study conducted 

for AoA (Mabli et al. 2015). Descriptive, tabular analysis was used to characterize NSP 

participants’ needs, frequency of program use, and participation in other programs and use of 

services.

viii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

The following are key findings from this study. 

A. NSP participants’ needs and trade-offs in making ends meet 

The NSP has been shown to have beneficial effects on food security, socialization, and diet 

quality (Mabli et al. 2017), but a nontrivial percentage of participants continue to experience 

challenges making ends meet and face food hardships due to insufficient income. This study 

examined three measures of need: whether participants experienced challenges making ends 

meet, faced trade-offs between purchasing food and meeting other basic needs, and experienced 

food insecurity. 

Challenges making ends meet. About 15 percent of congregate meal participants and 23 

percent of home-delivered meal participants reported that they experience challenges making 

ends meet. Younger congregate and home-delivered meal participants were about three times 

more likely than older participants to have experienced challenges (Figures ES.1 and ES.2). 

Income was also an important factor; congregate meal participants who were poor, defined as 

having income below 100 percent of the DHHS federal poverty guidelines, were five times more 

likely to face hardships than those with income above 200 percent of poverty (35 versus 7 

percent); home-delivered meal participants who were poor were nearly three times more likely to 

face hardships than higher-income participants (33 versus 12 percent). Hardships were also more 

common for participants living in urban areas, participants who were not married, and, for 

congregate meal participants, those living in the West relative to those living in the Northeast (21 

versus 11 percent). 

Figure ES.1. Percentage of congregate meal participants reporting 

challenges making ends meet, by participant characteristics 

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. 

FPL = federal poverty level

ix
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Figure ES.2. Percentage of home-delivered meal participants reporting 

challenges making ends meet, by participant characteristics 

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants.

FPL = federal poverty level

Food hardships and trade-offs. Some participants faced trade-offs in purchasing food each 

month. For congregate meal participants, the most common was choosing between buying food 

and buying medications (7 percent). A similar percentage of congregate meal participants (7 

percent) made trade-offs between buying food and paying utility bills, and a smaller percentage 

made trade-offs between buying food and paying rent (4 percent). Although these percentages 

are fairly small among the full population of congregate meal participants, the percentage of 

participants who made trade-offs between purchasing food and other basic needs was much 

higher for specific groups of people. For example, 10 percent of congregate meal participants age 

74 and younger and 18 percent of congregate meal participants with income below 100 percent 

of poverty made trade-offs between buying food and paying utility bills. Individual trade-offs 

were more common among Hispanic participants (15 to 16 percent) than among non-Hispanic 

black or white participants (0 to 7 percent) and among those living in the West relative to those 

living in the Northeast (11 versus 5 percent). 

Home-delivered meal participants also made trade-offs between purchasing food and 

meeting other basic needs. The most common was choosing between buying food and paying 

utility bills (9 percent), with smaller percentages of participants making trade-offs between 

buying food and buying medications (4 percent) and between buying food and paying rent (5 

percent). As was the case for congregate meal participants, the prevalence of making trade-offs 

among home-delivered meal participants was highest for participants age 74 and younger. 

Participants who were divorced, separated, or never married were also more likely to face these 

x 
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

trade-offs than those who were married or living with a partner. The difference by income for 

home-delivered meal participants was much smaller than it was for congregate meal participants. 

Food insecurity. Food security is having access at all times to enough food for an active, 

healthy life for all household members. Although the majority of NSP participants were food 

secure, 16 percent of congregate meal participants and 23 percent of home-delivered meal 

participants had experienced food access limitations during the past 30 days due to lack of 

money or other resources—they were food insecure. 

Many of the types of participants who were more likely to face financial hardships and face 

trade-offs in purchasing food were also more likely to be food insecure (Figure ES.3). For 

example, the percentages of congregate and home-delivered meal participants who were food 

insecure were lower for older participants. For both congregate and home-delivered meal 

participants, those age 74 and younger experienced the highest rates of food insecurity (24 

percent for congregate and 44 percent for home-delivered meal participants), and those age 85 

and older experienced the lowest rates (5 and 16 percent, respectively). The rate was nearly six 

times higher for congregate meal participants with incomes below 100 percent of poverty than 

for those with income equal to at least 201 percent of poverty (33 versus 6 percent), and was 

three to four times higher for home-delivered meal participants with less income than for those 

with more income (38 versus 11 percent). 

Figure ES.3. Percentage of congregate meal participants who experienced 

food insecurity, by participant characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. 

FPL = federal poverty level

xi
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Food insecurity was nearly twice as high for home-delivered meal participants who had not 

finished high school than for those who had (31 versus 17 percent) (Figure ES.4); there was only 

a small difference for congregate meal participants. The prevalence of food insecurity differed by 

race and ethnicity as well. Among congregate meal participants, the rate was more than twice as 

large for Hispanic participants than for non-Hispanic black or white participants (30 versus 13 

percent). Among home-delivered meal participants, non-Hispanic black participants were more 

than twice as likely as non-Hispanic participants of other races to be food insecure (38 versus 15 

to 16 percent). There were geographic differences in food insecurity rates as well. Similar to the 

prevalence of experiencing challenges in making ends meet and facing trade-offs in purchasing 

food, rates of food insecurity were more than twice as large for congregate meal participants 

living in the West than for those living in the Northeast (22 versus 9 percent). 

Figure ES.4. Percentage of home-delivered meal participants who 

experienced food insecurity, by participant characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. 

FPL = federal poverty level

Summary. Considering all three measures of need and hardships together, many common 

factors were associated with having a higher level of need and a greater likelihood of 

experiencing hardships. Participants who were younger (age 74 and younger) and had less 

income (those with income below 100 percent of poverty) reported the highest level of need and 

were most likely to face hardships. Other common factors were not being married, living in an 

urban area, and, for two of the three measures, being Hispanic. Finally, there were regional 

differences in the prevalence of need and hardships, with participants living in the West 

reporting greater challenges and food hardships than those living in the Northeast. 

xii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

B. Patterns of participation in the NSP 

NSP participants received meals frequently. For congregate meal participants, 43 percent 

received five or more meals per week and 64 percent received four or more meals per week. 

Most participants (79 percent) attended a single site for meals, whereas 12 percent attended two 

meal sites. Similarly, 71 percent of home-delivered meal participants received five or more 

meals per week and 76 percent received four or more meals per week. Nearly all home-delivered 

meal participants (97 percent) received meals from a single site. 

Frequency of NSP use per week. The frequency with which congregate meal participants 

used the program differed by age, gender, marital status, and race and ethnicity (Figure ES.5). 

The percentage of congregate meal participants who received four or more meals per week 

increased with age. Sixty-nine percent of participants age 85 and older ate at a meal site at least 

four days per week compared with 61 percent of participants age 74 and younger. Male 

participants participated more frequently than female participants (70 versus 60 percent) as did 

participants who were divorced, separated, or never married compared with those who were 

married or living with their partner (75 versus 57 percent). Just over three-quarters (76 percent) 

of Hispanic participants ate at the meal site at least four times per week, compared with 54 

percent for non-Hispanic black participants and 61 percent for non-Hispanic white participants. 

Figure ES.5. Percentage of congregate meal participants who ate at a meal 

site four or more days per week, by participant characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. 

FPL = federal poverty level

xiii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Frequency of use also differed by education, income, and employment status. The 

percentage of participants who ate at meal sites at least four days per week was higher among the 

following participants: those who had not completed high school relative to those who had 

completed high school (71 versus 61 percent); those with incomes below 100 percent of poverty 

relative to those with higher income (75 versus 58–65 percent); and among those who were not 

employed relative to those who were employed (66 versus 50 percent). Participants living in 

urban areas used the program more frequently than those in rural areas (67 versus 56 percent). 

Although younger congregate meal participants were less likely than older participants to eat 

at a meal site at least four times per week, they were more likely to visit multiple meal sites. 

About 25 percent of participants age 74 and younger used more than one meal site, compared 

with 17 to 18 percent of older participants. Participants who used multiple meal sites were also 

more likely to be male than female (29 versus 17 percent), to live alone rather than with others 

(23 versus 17 percent), and to be Hispanic rather than non-Hispanic black or white (29 versus 17 

and 19 percent, respectively). 

Participants with less income were not only more likely than participants with higher income

to visit meal sites at least four times per week, they were also more likely to visit multiple meal 

sites. About 31 percent of participants with household incomes below 100 percent of poverty ate 

at multiple meal sites compared with 17 percent of those with higher incomes. Visiting multiple 

sites was also related to geography. Participants who lived in the West were nearly twice as 

likely to visit multiple sites relative to participants living in other regions (32 percent versus 11–

17 percent), as were those living in urban areas relative to those in rural areas (23 versus 14 

percent). 

Unlike congregate meal participants, whose likelihood of eating program meals more often 

increased with age, home-delivered meal participants were less likely to receive program meals 

five or more days per week the older they were (Figure ES.6). About 77 percent of participants 

age 74 and younger received a meal at least five days per week compared with 66 percent of 

participants age 85 and older. Also unlike congregate meal participants, home-delivered meal 

participants who lived with others received meals more frequently than those who lived alone 

(77 versus 68 percent), as did those who lived in rural areas relative to urban areas (80 versus 68 

percent). 

Similar to congregate meal participants, home-delivered meal participants who had not 

completed high school were more likely than those who had completed it to receive meals at 

least five days per week (77 versus 67 percent). Participants in the South and West were also 

more likely to do so, compared with participants in other geographic regions (83–85 versus 54–

63 percent). 

xiv
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Figure ES.6. Percentage of home-delivered meal participants who received 

program meals five or more days per week, by participant characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. 

Patterns of participation over a year. The rate of continued participation in the NSP 

among congregate meal participants was high over the course of a year, with 94 percent of older 

adults receiving congregate meals still participating about 12 months later (Figure ES.7). 

Smaller, yet still sizable, percentages of older adults participated in at least 6 of the next 12 

months (90 percent) and even in each of the next 12 months (71 percent). Thus, the rate of 

retention in the NSP among congregate meal participants was high in terms of their continued 

participation and the number of months in which they participated. 

Figure ES.7. Percentages of participants who continued to participate in the 

NSP over the course of a year 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. 

xv
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Little variation existed in the types of congregate meal participants who continued to 

participate in the NSP about 12 months later, with slightly greater variation in the percentage of 

participants who continued to receive congregate meals for at least 6 months of the next year. 

Participants were more likely to participate in at least 6 months if they were age 84 and younger, 

relative to older participants (90–93 percent versus 84 percent); if they had completed less than 

high school, relative to those who completed high school (94 versus 89 percent), and if they had 

less income (94 percent for those with income below 100 percent of poverty versus 88 percent 

for those with income at or above 201 percent of poverty). 

As was true for congregate meal participants, the rate of continued participation in the NSP 

for home-delivered meal participants was high, with 85 percent of older adults receiving homedelivered meals still participating about 12 months later (Figure ES.7). Eighty-two percent of 

older adults participated in at least 6 months of the year and 65 percent participated in every 

month. Although the rate of retention in the NSP among home-delivered meal participants was 

high, this rate was lower than that for congregate meal participants. Similar to trends among 

congregate meal participants, few characteristics among home-delivered meal participants were 

associated with continued participation about 12 months later. However, unlike the continuation 

rates for congregate meal participants, the percentages of home-delivered meal participants who 

participated in at least 6 months of the year and in every month of the year also varied little by 

participant characteristics. 

Summary. Considering both the frequency of use in a given week and continued 

participation over the following year, many factors were associated with greater use of the NSP. 

For congregate meals, participants who were Hispanic, poor, lived in urban areas, or lived in the 

West were more likely both to receive meals more often and to visit multiple meal sites. Younger 

participants ate at meal sites less often than older participants, but were more likely than older 

participants to visit multiple sites. Other factors associated with frequency of use included male 

gender, not being married, living alone, completing less than high school, and being 

unemployed. Many of these characteristics were also associated with having a higher level of 

need in terms of facing challenges making ends meet, trade-offs purchasing food and other basic 

needs, and experiencing food insecurity (in particular, being Hispanic, poor, and living in the 

West). 

Fewer connections existed between need, hardships, and frequency of use for homedelivered meal participants, however. Younger participants received home-delivered meals more 

frequently than older participants and faced greater challenges and food hardships. However, 

home-delivered meal participants who lived in the West used the program most frequently 

relative to participants in other regions, but had the lowest food insecurity rates. 

C. Participation in other programs and use of NSP services 

Differences existed in how participants attempted to meet their needs related to food and 

nutrition, health, and personal care. Some participated in the Supplemental Nutrition Assistance 

Program (SNAP), received food from emergency food pantries and through soup kitchens and 

shelters, and received heating and cooling assistance through LIHEAP. Some also used non-meal 

services at the meal site, at home, or in the community such as nutrition counseling, case 

management services, transportation services, and personal care services.

xvi
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

SNAP participation. More than one-quarter of congregate and home-delivered meal 

participants received assistance to purchase food through SNAP (27 and 30 percent, 

respectively). Congregate meal participants were more likely to participate in SNAP if they were 

younger (Figure ES.8); 38 percent of individuals age 74 and younger participated, compared 

with 19 percent of those age 75 to 84 and 14 percent of those age 85 and older. SNAP 

participation also was associated with completing less high school relative to being a high school 

graduate (37 versus 24 percent); not being married relative to being married or living with a 

partner (24–41 percent versus 15 percent); and being Hispanic, non-Hispanic black, or nonHispanic other relative to being non-Hispanic white (28–58 percent versus 15 percent). The 

largest differences were across income groups: 63 percent of older adults with household income 

less than or equal to 100 percent of poverty participated in SNAP compared with 22 percent of 

those with income between 101 and 200 percent and less than 1 percent of those with income at 

or above 201 percent of poverty. SNAP participation was highest in the West and Northeast (31 

and 30 percent) and lowest in the South (18 percent). It was also higher among congregate meal 

participants in urban areas than in rural areas (32 versus 12 percent).

Figure ES.8. Percentage of congregate meal participants who received SNAP 

benefits, by participant characteristics

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. 

FPL = federal poverty level

Many of the same factors were associated with SNAP participation among home-delivered 

meal participants (Figure ES.9). The largest differences were across age groups and income 

groups. About 58 percent of individuals age 74 and younger participated, compared with 29 

xvii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

percent of those age 75 to 84 and 17 percent of those age 85 and older. About 50 percent of older 

adults with household income less than or equal to 100 percent of poverty participated in SNAP 

compared with 27 percent of those with income between 101 and 200 percent and 3 percent of 

those with income at or above 201 percent of poverty. Participation was highest in the Northeast 

relative to the other regions (39 versus 25–29 percent). 

Figure ES.9. Percentage of home-delivered meal participants who received 

SNAP benefits, by participant characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. 

FPL = federal poverty level

Emergency food pantries. Receiving food from emergency food pantries was about half as 

likely as participating in SNAP. About 17 percent of congregate meal participants and 14 percent 

of home-delivered meal participants received food from food pantries in the past 30 days (Figure 

ES.10). Many of the factors associated with participating in SNAP were associated with pantry 

use for congregate meal participants, including being younger; being female; completing less 

than high school; being divorced, separated, or never married; being Hispanic or non-Hispanic 

black (relative to non-Hispanic white); having less income; and living in an urban area. Pantry 

use was nearly three times as likely for participants age 74 and younger than for those ages 75 to 

84 (29 versus 9 percent) and was over twice as likely among poor participants than for those who 

were near-poor (40 versus 14 percent). For home-delivered meal participants, the factors 

associated with SNAP participation generally were associated with receiving emergency food. 

Exceptions included higher rates of receiving emergency food in rural areas than in urban areas 

(23 versus 11 percent) and among married participants than non-married participants (24 versus 

8–12 percent). 

Food assistance from soup kitchens. Receiving food from soup kitchens in the past 30 

days was less common than participating in SNAP or receiving food from emergency pantries, 

particularly for home-delivered meal participants. About 11 percent of congregate meal 

participants and 3 percent of home-delivered meal participants received food from soup kitchens 

in the past month. 

xviii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Figure ES.10. Percentage of congregate and home-delivered meal 

participants who received emergency food 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. 

Emergency assistance from LIHEAP. LIHEAP offers financial assistance to low-income 

families, targeting older adults and other vulnerable populations, to help pay home heating and 

cooling bills. Ten percent of congregate meal participants and 13 percent of home-delivered meal 

participants received energy assistance such as LIHEAP.

Non-meal NSP services. Participants also used non-meal services at the meal site, at home, 

or in the community. About 15 percent of congregate meal participants and 19 percent of homedelivered meal participants used these types of nutrition and supportive services. Home-delivered 

meal participants used personal care services or home visits for physical, occupational, or speech 

therapy (11 percent); case management services (10 percent); and light housekeeping services or 

chore services (11 percent). With few exceptions, congregate meal participants were less likely 

than home-delivered meal participants to receive these services. 

Using nutrition and supportive services was more likely among congregate meal participants 

who were female, non-Hispanic black, not employed, had less income, and lived in the 

Northeast. The largest differences were for participants who lived in the Northeast than those 

who lived in the West (25 versus 9 percent), those who had income below 100 percent of poverty 

versus participants who had income at least 201 percent of poverty (19 versus 6 percent), and 

non-Hispanic black and non-Hispanic other participants versus Hispanic participants (20–23 

percent versus 5 percent) (Figure ES.11). Among home-delivered meal participants, receiving 

nutrition and supportive services was more likely among participants who had completed high 

school than those who had not (25 versus 11 percent), those living alone than those living with 

others (22 versus 15 percent), and those living in the Northeast than those living the West (25 

versus 15 percent) (Figure ES.12). 

xix
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Figure ES.11. Percentage of congregate meal participants who used any

nutrition or supportive services in the past six months, by participant 

characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. 

FPL = federal poverty level

Figure ES.12. Percentage of home-delivered meal participants who used any 

nutrition or supportive services in the past six months, by participant 

characteristics 

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants.

xx
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Summary. Considering the full set of food assistance, energy assistance, and other nutrition 

and supportive services together, participants were more likely to participate in these programs 

and receive these services if they were younger; had completed less than high school; were 

divorced, separated, or never married; and were poor. In most cases, the largest differences in 

program participation and service use were by age and income. Although there were several 

exceptions, for most programs and services, participation was associated with living in an urban 

area and being female. For SNAP and emergency pantry participation—the two programs with 

the highest participation rates—participation was greater among Hispanic participants than nonHispanic participants. 

Many of these factors were the same as those associated with higher levels of need. In 

particular, participants who were younger, had less income, were not married, and lived in an 

urban area were more likely (1) to experience food hardships and challenges making ends meet 

and (2) to participate in SNAP, receive emergency food or energy assistance, or use other 

nutrition and supportive services. Thus, participants with the greatest need were the most likely 

to participate in food assistance programs and receive non-meal services. 

D. Implications for policy and future research 

Less than one-quarter of participants reported experiencing challenges making ends meet, 

faced food hardships, or were food insecure; however, specific groups of participants 

disproportionately experienced these challenges and were unable to fully meet their food needs. 

By characterizing these types of participants, AoA and state and local agencies can identify the 

types of participants the program could target to provide additional or more intensive services 

that help mitigate these challenges. In particular, based on the findings in this report, agencies 

can target additional program services to participants who are younger, have less income, are not 

married, and live in an urban area. AoA can take a number of steps to learn more about how to 

meet participants’ needs. Below, we have separated these into steps related to learning more 

about program participation patterns and use of community programs and non-meal NSP 

services. 

Program participation patterns. AoA can assess the number of meals that congregate and 

home-delivered meal participants with these characteristics are receiving. Congregate meal 

participants often decide how many times per week to visit and eat at the meal site, but many 

sites have a set number of days in which they operate. Thus, for congregate meal participants, 

understanding the factors that determine an agency’s number of operating days can help identify 

ways of increasing availability of meals to participants who need them. For sites that already 

offer meals many days per week, understanding why participants who face food hardships do not 

participate more days per week can help identify ways of increasing participation further. 

The findings from the second objective of this report can help AoA understand participation 

patterns and, specifically, whether participants with the greatest need are participating often and 

intensively enough. Congregate meal participants who were Hispanic, were poor, were not 

married, completed less than high school, were not employed, lived in urban areas, and lived in 

the West were more likely to receive meals more often and to visit multiple sites. AoA could 

learn more about the groups that participated relatively less or did not visit multiple meal sites 

(such as participants with more income and those who have completed high school) to learn 

whether lower levels of participation reflect lower levels of need or reflect barriers to 

xxi
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

participation. For example, participants who had less income, were not married, and lived in 

urban areas reported experiencing greater challenges, food hardships, and food security, and 

were also more likely to participate frequently and visit multiple sites. However, although 

younger participants reported experiencing more challenges and food hardships, they 

participated less often than older participants, which might reflect a barrier to participation. 

Similarly, for home-delivered meal participants, fewer connections existed between need, 

hardships, and frequency of use. 

For these reasons, AoA could obtain more information from participants about whether they 

would like to participate more but cannot due to limited availability of meals or program 

services. For congregate meal participants, understanding reasons for visiting multiple meal sites 

is also important. Participants may visit multiple sites because their main meal site operates only 

a few days each week or because the agencies that provide the other services they obtain in the 

community are co-located with other meal sites. 

This report examined for the first time the rates of continued participation in the NSP over 

the course of a year. The rate of continued participation in the NSP over a 12-month period was 

high (94 percent of congregate meal participants), but the rate of participation in every month of 

the following year was lower (71 percent). For home-delivered meal participants, these 

percentages were 85 and 65 percent, respectively. AoA could assess whether participants who 

want to continue receiving program meals can do so or whether participants face barriers to 

continued participation. For example, among the 29 percent of congregate meal participants who 

did not participate each month in the next year, what percentage continued to experience 

challenges meeting their food needs but could not participate because of transportation barriers 

getting to the meal site? What percentage chose not to go out in inclement weather due to fear of 

falling? What percentage could not participate because the meal site was not operational for part 

of the year or because of changes in volume or wait list policies? Knowing more about why 

participants change their frequency and intensity of participation over the course of the year can 

provide AoA with additional information about how participants use the program to help meet 

their needs.

Use of community programs and non-meal NSP services. Helping participants overcome 

challenges making ends meet and fulfilling their food needs is also possible by increasing access 

to existing food assistance programs at the national level such as SNAP or at the local level such 

as those programs providing emergency food. It is also possible by increasing access to non-meal 

nutrition and supportive services at NSP meal sites. 

Participation in SNAP is generally low, particularly given the high level of need among 

many of the NSP participants. Among congregate meal participants, the SNAP participation rate 

was 27 percent among all participants and 63 percent among those who were poor. (The 

analogous percentages for home-delivered meal participants were 30 and 50 percent, 

respectively.) Thus, even among participants who were poor and who were likely incomeeligible for SNAP, 27 to 50 percent of older adults were not participating in SNAP. AoA could 

learn more about whether this reflects older adults’ lack of knowledge about the program or their 

potential eligibility, a sense of social stigma, an inability to cook meals at home, or a perceived 

inconvenience from participating in the program (for example, that receiving program benefits 

do not outweigh requirements associated with participating in the program in terms of 

xxii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

recertifications and reporting changes in one’s circumstances). The same line of inquiry is 

appropriate when asking participants about receiving food from emergency pantries, kitchens, or 

shelters.

The geographic differences in participation in LIHEAP were sizable. However, even in the 

Northeast, only 25 percent of participants received heating and cooling services through the 

program. Even among the program’s target population of low-income people, the participation 

rate was only 19 percent (for participants in all regions of the country). Thus, as for SNAP and 

other food assistance programs, AoA could learn more about whether lower take-up rates reflect 

a lack of awareness about the program or its requirements. Learning how meal sites promote 

access to the program during warm and cold seasons would also be useful. 

Finally, low percentages of participants reported receiving non-meal services at the meal 

site, at home, or in the community, such as home visits for physical, occupational, or speech 

therapy; case management services; and light housekeeping services or chore services (15 

percent for congregate meal participants and 19 percent for home-delivered meal participants). 

Learning more about the variation in receiving these services can help AoA understand whether 

participants who need the services are adequately receiving them. In particular, AoA could 

assess whether the large geographic difference in receiving services between the Northeast and 

other regions reflects differences in agencies’ provision of services or in participants’ use of 

services. 

Implications for future research. The findings of this descriptive study suggest several 

substantive research directions, which include the following: 

1. Examine the reasons why home-delivered meal participants in rural areas were much more 

likely than those in urban areas to face trade-offs between purchasing food and meeting 

other basic needs, whereas congregate meal participants experienced more trade-offs in 

urban areas.

2. Assess the determinants of geographic differences in challenges, food hardships, and food 

insecurity between participants living in the West and the Northeast. Do these differences 

reflect geographic variation in the cost of providing a program meal or the prices that 

participants pay for food where they live? 

3. Examine why NSP participants who were older were less likely to be food insecure than 

those who were younger. Does this reflect differences in education, living arrangements 

(living alone versus with others), ability to cook meals at home, or income? 

4. Examine differences in food insecurity among older adults by ethnicity. Why did Hispanic 

participants have such different food insecurity rates from those who are non-Hispanic? 

5. Identify why some congregate meal participants visit multiple meal sites, especially among 

high-need participants.

6. Describe the characteristics of participants with greater needs who participated less 

frequently than those with lower levels of needs. 

7. Assess whether the rate of retention in the NSP among home-delivered meal participants 

was lower than the rate among congregate meal participants due to having poorer health. 

xxiii
EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

8. Identify the factors associated with SNAP participation among those who were incomeeligible. 

9. Examine the association between SNAP and food security. In particular, were NSP 

participants who did not receive SNAP benefits more likely to be food secure after 

accounting for income? 

10. Identify the reasons why some NSP participants participate less often, or not at all, 

approximately one year later. 

11. Examine the reasons behind large geographic differences in nutrition and supportive 

services at NSP meal sites. 

Answering these questions will enable AoA and state and local agencies to target more 

precisely the populations the NSP serves, identify groups of people who require more intensive 

services that help mitigate food hardships and other challenges, and increase retention in the 

program among older adults who are in greatest need of assistance.

xxiv
MATHEMATICA POLICY RESEARCH

I. INTRODUCTION

Each year, hundreds of millions of meals are provided to older adults in America as part of 

the Title III-C Nutrition Services Program (NSP). Authorized under the Older Americans Act 

(OAA), the NSP promotes access to nutritious meals, facilitates social contact, and helps older 

adults maintain their independence in their homes and communities. Participants who are able to 

attend congregate meal sites typically receive lunch on one or more weekdays and, at some sites, 

also receive breakfast, dinner, or weekend meals. Congregate meal sites offer opportunities for 

participants to socialize with peers and receive other services such as nutrition education, 

screening, and counseling. These services help older adults identify their general and specific 

needs related to maintaining their health and managing individual nutrition-related diseases such 

as heart disease, hypertension, and diabetes. 

Participants who are homebound receive nutritious home-delivered meals, typically five 

days per week. Like congregate meal settings, home-delivered meals offer an opportunity for 

socializing. Home-delivered meal volunteers might be older adults as well and, in addition to 

delivering meals, might offer an opening for face-to-face contact or conversation. This allows 

volunteers to relay important information about participants’ well-being and needs to service 

providers. Homebound participants also receive nutrition education, screening, and counseling as 

well as non-nutrition services. In this way, the NSP provides homebound participants with a 

primary access point for many home- and community-based services to help meet their health 

and nutrition needs. 

As part of its responsibility to administer the NSP, the Administration on Aging (AoA) 

within the Administration for Community Living (ACL) of the U.S. Department of Health and 

Human Services (DHHS) periodically evaluates its efficiency and effectiveness. In the most 

recent evaluation from 2015 to 2017 AoA contracted with Mathematica Policy Research to 

collect information from two main sources: (1) state and local agencies that oversee the program 

and provide program services, and (2) a national sample of program participants and 

nonparticipants. The goal of the evaluation was to examine program administration, service 

delivery, and cost, and to measure the effect of program participation on older adults’ food 

security, socialization, diet quality, and longer-term health outcomes. The findings showed that 

meal provision has experienced a robust expansion during the past 20 years, with more agencies 

providing home-delivered meals and more agencies providing congregate meals that offer 

breakfast, dinner, or weekend meals, in addition to weekday lunches (Mabli et al. 2015). NSP 

participants generally had more favorable outcomes than nonparticipants, as indicated by lower 

rates of food insecurity, greater satisfaction with socialization opportunities, and improved diet 

quality (Mabli et al. 2017). For several outcomes including food security, improvements 

associated with participating in the program were larger for participants with less income than 

for those with more income. 

Although the NSP serves a critical need among its participants, many older adults continue 

to face financial hardships and food access limitations. About 15 to 25 percent of participants 

reported that they experience challenges making ends meet, and 4 to 9 percent reported having to 

make difficult choices of how to spend scarce household resources, such as whether to buy food 

or pay for rent, utility bills, or needed medications (Mabli et al. 2017). Although the majority of 

participants were food secure, 16 percent of congregate meal participants and 23 percent of 

1 
I. INTRODUCTION MATHEMATICA POLICY RESEARCH

home-delivered meal participants had experienced food access limitations during the past month 

due to lack of money or other resources—they were food insecure. For participants in the lowest 

income quartile (approximately below the federal poverty level), these percentages were 

dramatically higher at 32 and 35 percent, respectively. 

The evaluation described the level of need among all program participants, but little is 

known about whether specific groups of participants disproportionately experience these 

challenges. Learning more about the characteristics and circumstances of these participants can 

allow AoA and state and local agencies to identify whether there are types of participants the 

program could target to provide services that help mitigate these challenges. Thus, an objective 

of this report is to examine how participants’ level of need varies by participant characteristics. 

The evaluation also found that participants’ frequency of program use differed—43 percent 

of congregate meal participants typically received five or more congregate meals per week and 

57 percent received up to four meals per week (Mabli et al. 2017). For home-delivered meal 

participants, these percentages were 71 and 29, respectively. There was also variation in whether 

congregate meal participants attended multiple congregate meal sites in a given week and in 

participants’ continued use of the program over the course of a year. Learning more about the 

characteristics and circumstances of participants who receive meals more often, who use 

multiple program sites, and who change their use of the program over the course of a year can 

allow AoA and state and local agencies to identify whether there are specific groups of 

participants who underuse the program and whom the program could target to increase use. 

Thus, a second report objective is to assess patterns of participation in the core program services 

of receiving congregate and home-delivered meals by characteristics and circumstances of 

participants. 

Finally, the evaluation revealed that the ways in which participants met their needs related to 

food and nutrition, health, and personal care differed. Participants reported having access to a 

wide array of services provided through the NSP, as well as other services available in the 

community, yet little is known about the extent to which they use these services. Assessing how 

participants use other food and non-food assistance programs outside of the NSP and use nonmeal services offered through the NSP can help AoA and state and local agencies understand

more thoroughly how participants meet their basic needs and even identify to whom to target 

outreach and referrals to these programs and services. Thus, a third report objective is to assess 

participation in the Supplemental Nutrition Assistance Program (SNAP) and receipt of 

emergency food, as well as participation in the Low Income Home Energy Assistance Program 

(LIHEAP). This objective also entails assessing participation in services at the meal site, at 

home, or in the community such as nutrition counseling, case management services, 

transportation services, and personal care services. 

Organization of the report 

The remaining chapters of this report discuss the methodology used in the analysis and 

present findings. Chapter II provides an overview of the NSP, the evaluation and its study 

design, and the data and methodology used in the analysis. Chapter III describes NSP

participants’ needs and food insecurity, Chapter IV describes patterns of participation in the 

program, and Chapter V presents use of other programs and NSP services. Chapter VI 

summarizes findings to inform policy and discusses implications for future research. 

2 
MATHEMATICA POLICY RESEARCH

II. BACKGROUND ON NSP EVALUATION AND OVERVIEW OF DATA AND 

METHODOLOGY

This chapter provides an overview of the NSP, summarizes the research objectives of the 

evaluation, and describes data and methodology used in the analyses presented in this report. 

A. Overview of the Title III-C Nutrition Services Program 

The NSP is authorized under Title III of the OAA. Through Title III, State Units on Aging 

(SUAs) implement a system of coordinated, community-based services targeted to older adults. 

Title III authorized the provision of nutrition and supportive services, such as meals, nutrition 

education, transportation, personal and homemaker services, and information and referrals. 

Under one part of the legislation—Title III-C of the OAA—AoA provides grants to SUAs to 

support the provision of daily meals and related nutrition services in either group (congregate) or 

home settings to adults age 60 and older. In fiscal year (FY) 2016, the most recent year in which 

counts of meals and individuals served are available, 79 million meals were served to 1.6 million 

people at congregate sites and 145 million home-delivered meals were provided to 868,000 

homebound older adults (ACL 2018). OAA Title III-C funding was $448 million for congregate 

nutrition services and $226 million for home-delivered nutrition services in FY 2016 (ACL 

2017).

Organizations in the National Aging Network, one of the nation’s largest provider networks 

of home- and community-based care for older adults and their caregivers, administer the NSP. 

AoA’s central and regional offices provide overall federal coordination; however, the SUAs and 

the Area Agencies on Aging (AAAs) both support key aspects of program operations. In turn, 

local service providers (LSPs) typically provide the direct nutrition services. Congregate meals 

and supportive services are provided at LSPs’ meal sites (such as senior centers, religious 

facilities, and public or low-income housing facilities). Home-delivered meals are provided to 

homebound individuals through the congregate meal sites, affiliated central kitchens, or 

nonaffiliated food service organizations. 

Adults age 60 and older, and their spouses of any age, may participate in the NSP’s 

congregate meal program.

1

1

 The members of the following groups are also eligible to receive congregate meals: disabled people younger than 

age 60 who reside in housing facilities occupied primarily by older adults where congregate meals are served; 

disabled people who reside at home with, and accompany, people age 60 and older to meal sites; and nutrition 

service volunteers. The evaluation did not collect information from members of these groups. 

For home-delivered meals, people who are homebound because of 

disability, illness, or isolation and are age 60 and older are eligible, as are their spouses of any 

age. Disabled people younger than age 60 living with older adults are also eligible. 

The NSP is not an entitlement program. It also does not have a financial means test, but the 

program specifically targets older adults with the greatest economic or social need, with special 

attention given to low-income older adults, minorities, those living in rural areas, those with 

limited English proficiency, and those at risk of institutional care. Payment for meals is not 

mandatory, but participants are encouraged to make a voluntary contribution toward the total 

 

3 
II. BACKGROUND AND OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

cost of the meal. However, within site capacity, participants’ inability or unwillingness to 

contribute does not deny them meals or other services.

LSPs must provide congregate and home-delivered meals that comply with the most recent 

Dietary Guidelines for Americans (“Dietary Guidelines”; DHHS and U.S. Department of 

Agriculture 2015) and provide a minimum of one-third of the Dietary Reference Intakes (DRIs) 

established by the Food and Nutrition Board of the Institute of Medicine of the National 

Academy of Sciences (Institute of Medicine 2006). In addition to providing meals, LSPs also 

offer nutrition education, nutrition screening and assessment, and nutrition counseling if 

appropriate.2

2 Additional LSP requirements are available in Section 339 of the OAA.

B. Nutrition Services Program evaluation objectives 

The objectives of the Title III-C NSP evaluation included the following: 

• Provide information to support program planning, including an analysis of program 

processes (referred to as the process study) 

• Develop information about program efficiency and cost issues (referred to as the cost study) 

• Assess program effectiveness, as measured by the program’s effects on a variety of 

important participant outcomes, including diet quality, socialization opportunities, health 

outcomes, and—ultimately—helping older adults avoid institutionalization (referred to as 

the outcomes evaluation) 

Separate reports present findings from the process study (Mabli et al. 2015), the cost study 

(Ziegler et al. 2015), and the outcomes evaluation (Mabli et al. 2017; Mabli et al. 2018). The 

process study report used data collected from SUAs, AAAs, and LSPs to assess the ways in 

which the program operates to serve older adults. The process study analyzed NSP structure, 

administration, staffing, coordination, processes, and service delivery. It also described the 

nutrition and supportive services that agencies offer; differences in participant access to services, 

prioritization of services, and the use of waiting lists; and program resources. 

The cost study report (Ziegler et al. 2015) estimated the average costs of a congregate and a 

home-delivered meal provided under the NSP and assessed whether these average costs vary by 

meal preparation method or by other program characteristics. The cost study report also 

examined program efficiency by generating unit cost estimates for individual LSPs and 

examining cost variation within the program by cost component, meal preparation method, 

program size, and other program characteristics. 

The first outcomes evaluation report (Mabli et al. 2017) described NSP participants’ 

characteristics, health status, mobility, eating behaviors, diet quality, and other characteristics; 

described their experiences with and impressions of the NSP and their valuation of meals and 

supportive services received through the program; and estimated the impact of NSP meals and 

related services on participants’ nutrition, food security, and diet quality. The second outcomes 

evaluation report (Mabli et al. 2018) described participants’ health and health care utilization and 

 

4 
II. BACKGROUND AND OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

examined overall wellness measures using longer-term outcomes related to health and avoidance 

of institutionalization based on Medicare claims data. 

C. Evaluation sampling design and data collection 

The evaluation used a multistage clustered sample design. The stages of sampling included 

the following: 

1. AAAs

2. LSPs within AAAs

3. Congregate meal sites and home-delivered meal distribution locations within LSPs

4. Home-delivered meal routes within home-delivered meal distribution locations

5. Congregate meal participants within each congregate meal site and home-delivered meal 

participants within each home-delivered meal route3 

3 In addition, the research team obtained a matched sample of congregate and home-delivered meal nonparticipants. 

Data from nonparticipants are not used in this report, but details about nonparticipant data collection are available in 

Mabli et al. (2017).

The research team conducted two surveys—one from October 2015 to April 2016 and 

another from November 2016 to March 2017. Data collection for the 2015–2016 survey spanned 

one week for each randomly selected congregate meal site and home-delivered meal route. In 

congregate meals sites, field staff attended the main congregate meal (usually lunch) on the first 

day meals were provided during the week. They randomly sampled and interviewed congregate 

meal participants. Similarly, on the first day of meal provision for each home-delivered meal 

distribution location, program staff provided a list of all home-delivered meal participants for the 

sampled route, participants were randomly sampled, and field staff interviewed participants in 

homes or another convenient location. Approximately 12 months after the first survey, the 

research team conducted a second survey by phone of those congregate and home-delivered meal 

participants who had responded to the first survey. 

The 2015–2016 outcomes survey collected information on a comprehensive set of topic 

areas including demographic characteristics, food security, health insurance coverage, health 

status and depression, and loneliness. In addition, the survey asked all respondents about their 

NSP participation history, and asked congregate and home-delivered meal participants about the 

types of services they received, their impressions of the program and services, and monetary 

contributions for program meals. The 2016–2017 outcomes survey assessed program 

participation patterns between the 2015–2016 and 2016–2017 interviews. It collected 

information on whether respondents who had received congregate or home-delivered meals at 

the time of the 2015–2016 survey were still receiving congregate or home-delivered meals about 

12 months later. In addition, the survey asked all respondents how many months in the past year 

they had received meals and, for those who reported receiving meals more or less frequently than 

they had 12 months earlier, the reasons for the change. The response rates for congregate and 

home-delivered meal participants were 76.1 and 54.1 percent for the 2015–2016 survey and 73.3 

and 70.1 percent for the 2016–2017 survey. 

 

5 
II. BACKGROUND AND OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

D. Analytic methods, weights, and item nonresponse

This report presents findings from descriptive analyses of the NSP evaluation data. Tables 

describe NSP participants’ needs, frequency of participation, and service provision, and present 

separate estimates for congregate meal participants and home-delivered meal participants. Tables 

present statistics based on the full samples of congregate and home-delivered meal participants 

and for subgroups defined by participant characteristics. Additionally, tables in Chapter V that 

describe program participation and service provision also contain estimates based on subgroups 

defined using LSP-level data on agency characteristics merged onto participant-level records. 

Chapters III, IV, and V focus on differences in estimates across participant characteristic 

subgroups of at least five percentage points in order to limit the discussion to more meaningful 

differences.

Analysis weights allow one to compute unbiased estimates based on sample survey 

responses from the study population. Weights take into account both the probability of selection 

into the sample and the differential response patterns that may exist in the respondent sample.

Weights for the 2015–2016 and 2016–2017 surveys were constructed separately for congregate 

and home-delivered meal participants. Based on weighted data, the findings for congregate and 

home-delivered meal participants in this report are nationally representative of the population of 

congregate and home-delivered meal participants at the time of the 2015–2016 interviews. 

Details of the weight construction process are available in Appendix A of Mabli et al. (2017) for 

the 2015–2016 weights and in Appendix A of Mabli et al. (2018) for the 2016–2017 weights. 

Although interviewers administered the participant surveys, respondents could respond 

“don’t know” or refuse to answer questions. The percentages and estimates presented in this 

report are based on responses that exclude both types of missing data. As a result, those estimates 

might be subject to item nonresponse bias. Item nonresponse bias occurs when individuals who 

respond to a question differ in meaningful ways from those who do not respond. However, this 

was not a serious problem for most questions in the 2015–2016 and 2016–2017 participant 

surveys, because all of the estimates presented in the tables either had no item nonresponse or 

had a particularly low percentage of item nonresponse, which was defined as at least an 80 

percent response rate. 

Some of the subgroups measuring agency characteristics defined using the LSP agency 

survey were based on variables that had higher item nonresponse, however. The LSP survey 

consisted of two parts: an LSP web survey and a separate editable PDF form that respondents 

completed and returned electronically. The web survey contained the majority of the questions, 

including those that a respondent could likely answer without referring to other data sources, 

such as organizational structure. The editable PDF (referred to as a “fax-back” form) included 

fewer items, which contained questions for which the respondent likely had to look up data from 

sources such as financial reports on program expenditures. After the research team merged the 

LSP information onto the participant-level data file, item nonresponse ranged from 1 to 16 

percent for the LSP web survey variables and 22 to 37 percent for the fax-back form variables 

measuring the number of full-time equivalents and agency expenditures. Because excluding 

observations with missing data can lead to biased findings if the characteristics of LSPs with 

nonmissing information differ from those with missing information, the research team imputed 

missing values for these variables. 

6 
II. BACKGROUND AND OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

The research team used a tiered approach to impute variables with missing information, 

depending on the extent of missingness for each variable. For variables with relatively low 

missing rates (those with missing rates ranging from 0 to 1.5 percent), missing data were 

imputed using simple random imputations based on the empirical distributions of variables. 

Variables with relatively higher rates of nonresponse were imputed using more advanced 

imputation procedures—predictive mean matching for continuous variables and logistic 

regression imputation for binary variables. The research team used Stata’s multiple imputation 

package (mi impute chained) to jointly estimate the imputation model for these variables. This 

suite of statistical commands imputes missing values of multiple variables iteratively by using a 

sequence of imputation equations. 

7 
This page has been left blank for double-sided copying.
MATHEMATICA POLICY RESEARCH

III. NSP PARTICIPANTS’ NEEDS AND TRADE-OFFS IN MAKING ENDS MEET

This chapter examines whether specific groups of congregate and home-delivered meal 

participants disproportionately experience challenges making ends meet. It presents information 

on the extent to which participants experienced hardships and the trade-offs participants made 

between purchasing food and other basic needs such as rent, utilities, and medications. It also 

describes how rates of food insecurity varied by participants’ characteristics and circumstances.

A. Characteristics of participants 

Congregate and home-delivered meal participants were similar in terms of gender, veteran 

status, and presence of others living in the household, but compared with congregate meal 

participants, home-delivered meal participants, on average, were older and had less education. 

Fifty-nine percent of congregate and 79 percent of home-delivered meal participants were age 75 

and older (Table III.1). The percentage of participants who had not completed high school also 

differed (24 percent for congregate meal participants versus 40 percent for home-delivered meal 

participants). More than two-thirds of congregate and home-delivered meal participants were 

women. The percentage of participants who were married was similar across the two programs, 

although 52 percent of home-delivered meal participants were widowed compared with 47 

percent of congregate meal participants. Many participants lived alone (60 percent of congregate 

meal participants and 59 percent of home-delivered meal participants). Twenty-eight percent of 

congregate meal participants and 25 percent of home-delivered meal participants resided in rural 

areas.

Participants in each program were largely non-Hispanic white individuals, but a sizable 

percentage of participants were members of racial and ethnic minority groups. Non-Hispanic 

blacks constituted approximately 13 percent of congregate meal participants and 17 percent of 

home-delivered meal participants (Table III.1). Hispanics accounted for another 14 percent and 9 

percent, respectively, of participants in the two programs.

Although the OAA prohibits financial means tests for participation in the NSP, most 

participants were poor or near poor. Thirty percent of congregate meal participants and 36 

percent of home-delivered meal participants had annual household incomes below 100 percent of 

the DHHS federal poverty guidelines (Table III.1). (For a one-person household, this 

corresponds to $11,770 based on the 2015 poverty guidelines, which corresponds to the initial 

year in which the survey data were collected.) Most of the rest had annual household incomes 

between 100 and 200 percent of the poverty guidelines. Only about one-quarter of congregate 

and 18 percent of home-delivered meal participants had annual household incomes above 200 

percent of the poverty guidelines. 

Reflecting their younger age and better health, nearly 20 percent of congregate meal 

participants had income from employment (full- or part-time work) compared with just 5 percent 

of home-delivered meal participants. 

9 
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

Table III.1. Characteristics of participants 

Characteristic

Congregate meal 

participants (percentage)

Home-delivered meal 

participants (percentage)

Total 100.0 100.0

Age 

74 and younger 41.2 20.9

75 to 84 41.2 36.0

85 and older 17.6 43.1

Gender 

Male 33.1 31.5

Female 66.9 68.5

Highest grade level completed 

Completed less than high school 24.3 40.4

High school graduate, GED, or equivalent 75.7 59.6

Marital status 

Married or living with partner 24.9 24.0

Widowed 46.5 52.0

Divorced, separated, or never married 28.6 24.0 

Presence of other people living in household 

Lives alone 60.2 59.1

Lives with others 39.8 40.9

Race/ethnicity 

Non-Hispanic black 13.1 16.9

Non-Hispanic white 64.7 68.7

Non-Hispanic other 8.3 5.2

Hispanic 13.9 9.0 

Employment status 

Employed 16.9 5.0

Not employed 83.1 95.0

Monthly income-to-poverty ratio 

0 to 100 30.3 36.1

101 to 200 46.6 46.2

201 and above 23.1 17.7

Census region 

Midwest 22.4 28.7

Northeast 26.4 22.0

South 17.7 22.4

West 33.5 26.9

Urbanicity 

Urban 72.3 74.9

Rural 27.7 25.1

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

B. Experiencing challenges trying to make ends meet 

Although many participants reported that their income is sufficient to take care of their 

needs, a nontrivial percentage reported facing financial hardships. About 15 percent of 

congregate meal participants and 23 percent of home-delivered meal participants reported that 

they experience challenges making ends meet (Table III.2). The percentage who reported their 

incomes do not cover their needs was lower for older participants and for participants with 

higher incomes. About 21 percent of congregate meal participants age 74 and younger 

experienced challenges, compared with 12 percent of participants ages 75 to 84 and 7 percent of 

10
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

participants age 85 and older. The differences by age were similar for home-delivered meal 

participants, with relatively younger participants almost three times as likely to experience 

challenges relative to older participants (40 versus 15 percent). Similarly, the percentage was 

larger for those in poorer households. Almost 35 percent of congregate meal participants with 

household incomes below 100 percent of the DHHS federal poverty guidelines faced hardships, 

compared with 7 percent for those with incomes above 200 percent of poverty (Table III.2); for 

home-delivered meal participants, these percentages were 33 and 12 percent, respectively. 

Table III.2. Percentage of participants reporting challenges making ends 

meet, by participant characteristics

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 15.3 22.6

Age 

74 and younger 21.2 39.5

75 to 84 12.1 21.2

85 and older 7.0 15.2

Gender 

Male 13.1 19.6

Female 16.4 24.1

Highest grade level completed 

Completed less than high school 14.3 24.6

High school graduate, GED, or equivalent 15.6 21.1

Marital status 

Married or living with partner 9.9 21.3

Widowed 11.6 18.7

Divorced, separated, or never married 24.5 33.6

Presence of other people living in household 

Lives alone 17.1 20.8

Lives with others 12.8 25.2

Race/ethnicity 

Non-Hispanic black 12.2 44.8

Non-Hispanic white 10.9 16.5

Non-Hispanic other 45.7 NA

Hispanic 21.0 NA

Employment status 

Employed 5.4 NA

Not employed 17.3 20.8

Monthly income-to-poverty ratio 

0 to 100 34.8 32.6

101 to 200 10.4 20.4

201 and above 6.7 11.9

Census region 

Midwest 16.1 27.4

Northeast 10.7 19.4

South 10.7 28.8

West 21.2 15.9

Urbanicity 

Urban 18.4 24.3

Rural 7.0 17.7

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due

to item nonresponse to individual questions.

NA = Not available due to small cell size

11
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

The percentage of participants who experienced challenges making ends meet was larger for 

those living in urban areas, relative to rural areas, and those who were divorced, separated, or 

never married, relative to participants who were married or were living with their partner. About 

18 percent of congregate meal participants living in an urban area faced hardships, compared 

with 7 percent among those living in a rural area (Table III.2). The difference was smaller, yet 

still sizable, for home-delivered meal participants (24 versus 18 percent). Participants who were 

divorced, separated, or never married had the highest rates (25 percent among congregate meal 

participants) compared with married participants or those living with partners (10 percent). 

The relationship between the prevalence of challenges making ends meet and participant 

characteristics differed for congregate and home-delivered meal participants for several 

characteristics. Challenges were most common in the West for congregate meal participants but 

were least common in the same region for home-delivered meal participants. Challenges also 

were much more common for non-Hispanic black participants than for non-Hispanic white 

participants receiving home-delivered meals (45 versus 17 percent), but were not appreciably 

different for the two groups among congregate meal participants (12 versus 11 percent). 

C. Making trade-offs between purchasing food and other basic needs 

Some participants faced trade-offs in purchasing food each month. For congregate meal 

participants, the most common trade-off was having to choose between buying food and buying 

medications (7 percent) (Table III.3). A similar percentage of congregate meal participants made 

trade-offs between buying food and paying utility bills (7 percent), and a smaller percentage 

made trade-offs between buying food and paying rent (4 percent). 

Similar to experiencing financial hardships more broadly, the percentage of congregate meal 

participants who made trade-offs between purchasing food and other basic needs was largest for 

participants age 74 and younger and lower for participants in the older age categories (Table 

III.3). In fact, few participants age 85 and older reported making these types of trade-offs. 

Choosing between buying food and other basic needs was much more common among 

congregate meal participants in poorer households than among those with greater income. About 

13 to 18 percent of congregate meal participants with household incomes below 100 percent of 

the DHHS federal poverty guidelines made trade-offs, compared with 1 to 8 percent for those 

with higher incomes. Making these choices was also higher for Hispanics (15 to 16 percent) than 

for non-Hispanic whites and blacks (0 to 7 percent). Finally, like experiencing challenges 

making ends meet, the prevalence of trade-offs associated with buying food generally was much 

higher in the West than in the other regions. 

Home-delivered meal participants also made trade-offs between purchasing food and other 

basic needs. The most common was choosing between buying food and paying utility bills (9 

percent), with smaller percentages of participants making trade-offs between buying food and 

buying medications (4 percent) and between buying food and paying rent (5 percent) (Table 

III.4). 

12
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

Table III.3. Percentage of congregate meal participants reporting making 

trade-offs in purchasing food in the past month, by participant 

characteristics 

Characteristic

Buying food and 

buying 

medications

Buying food and 

paying utility bills

Buying food and 

paying rent

Total 7.0 6.7 3.8

Age 

74 and younger 10.0 10.1 6.5

75 to 84 6.4 4.9 2.1

85 and older 0.0 1.4 0.9

Gender 

Male 4.8 3.7 3.7

Female 8.0 8.1 3.9

Highest grade level completed 

Completed less than high school 6.3 7.9 3.6

High school graduate, GED, or equivalent 7.1 6.3 3.9

Marital status 

Married or living with partner 11.6 9.5 9.5

Widowed 3.7 2.3 1.1

Divorced, separated, or never married 7.0 10.8 3.1

Presence of other people living in household 

Lives alone 5.9 5.9 2.4

Lives with others 8.7 7.9 6.1

Race/ethnicity 

Non-Hispanic black 5.4 7.2 0.0

Non-Hispanic white 3.3 3.2 1.5

Non-Hispanic other 24.9 20.9 11.3

Hispanic 15.7 14.5 15.6

Employment status 

Employed 2.7 2.2 1.7

Not employed 7.8 7.5 4.3

Monthly income-to-poverty ratio 

0 to 100 12.8 18.4 12.7

101 to 200 4.7 1.3 0.9

201 and above 8.2 4.7 0.9

Census region 

Midwest 6.4 4.5 3.8

Northeast 4.7 8.2 0.9

South 4.2 5.4 2.3

West 10.6 7.2 7.2

Urbanicity 

Urban 7.9 7.7 4.8

Rural 4.3 3.7 1.2

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

13
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

Table III.4. Percentage of home-delivered meal participants reporting making 

trade-offs in purchasing food in the past month 

Characteristic

Buying food and 

buying 

medications

Buying food and 

paying utility bills

Buying food and 

paying rent

Total 3.9 8.8 4.9

Age 

74 and younger 10.5 18.2 12.2

75 to 84 2.4 4.9 2.1

85 and older 1.9 7.1 3.6

Gender 

Male 3.6 7.5 2.6

Female 4.2 9.4 6.1

Highest grade level completed 

Completed less than high school 3.3 10.8 6.1

High school graduate, GED, or equivalent 4.4 7.2 4.1

Marital status 

Married or living with partner 1.9 5.7 2.5

Widowed 4.0 8.8 5.4

Divorced, separated, or never married 6.0 11.8 6.2

Presence of other people living in household 

Lives alone 4.4 8.2 5.3

Lives with others 3.3 9.5 4.5

Race/ethnicity 

Non-Hispanic black 2.3 22.6 10.2

Non-Hispanic white 4.7 6.6 3.8

Non-Hispanic other NA NA NA

Hispanic NA NA NA

Employment status 

Employed NA NA NA

Not employed 4.2 8.3 5.3

Monthly income-to-poverty ratio 

0 to 100 5.2 8.5 4.7

101 to 200 3.7 8.4 4.0

201 and above 4.0 7.7 2.1

Census region 

Midwest 5.1 14.3 9.6

Northeast 2.2 4.7 2.7

South 5.5 5.5 2.0

West 3.2 9.4 4.5

Urbanicity 

Urban 2.8 7.7 4.6

Rural 7.2 11.7 5.9

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

NA = Not available due to small cell size

As was the case for congregate meal participants, the prevalence of making trade-offs 

among home-delivered meal participants was highest for participants age 74 and younger than 

for older participants. For example, 18 percent of participants age 74 and younger chose between 

buying food and paying utility bills, compared with 7 percent of those age 85 and older (Table 

III.4). There was much less of a difference by income for home-delivered meal participants than 

for congregate meal participants. 

14
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

D. Experiencing food insecurity 

Food security is having access at all times to enough food for an active, healthy life for all 

household members (Coleman-Jensen et al. 2015). Although the majority of NSP participants 

were food secure, 16 percent of congregate meal participants and 23 percent of home-delivered 

meal participants had experienced food access limitations during the past 30 days due to lack of 

money or other resources—they were food insecure (Table III.5).4

 

4 The research team used the six-item food security module (Bickel et al. 2000) to create a binary variable indicating 

whether an individual lived in a household that was food insecure in the past 30 days. 

The percentages of congregate and home-delivered meal participants who were food 

insecure were lower for older participants. For both groups, participants age 74 and younger 

experienced the highest rates of food insecurity (24 percent for congregate and 44 percent for 

home-delivered meal participants), and participants age 85 and older experienced the lowest 

rates (5 and 16 percent, respectively) (Table III.5). 

Although the food insecurity rate was only slightly higher for congregate meal participants 

who had completed less than high school than it was for those who had completed high school, 

the rate was nearly twice as high for home-delivered meal participants who had not finished high 

school than it was for those who had (31 versus 17 percent) (Table III.5). The patterns of food 

insecurity by income as a percentage of poverty correspond with conventional wisdom. The rate 

was nearly six times higher for congregate meal participants with incomes below 100 percent of 

poverty than for those with income equal to at least 201 percent of poverty (33 versus 6 percent). 

This rate was three to four times higher for home-delivered meal participants with less income 

than for those with more income. Food insecurity was most common among congregate meal 

participants living in urban areas, relative to rural areas (20 versus 8 percent), with only a small 

difference for home-delivered meal participants (24 versus 20 percent). Similar to the prevalence 

of experiencing challenges in making ends meet, food insecurity rates were highest for 

congregate meal participants living in the West and lowest for home-delivered meal participants 

living in the Northeast and West.

The prevalence of food insecurity differed by race and ethnicity as well. Among congregate 

meal participants, the rate was more than twice as large for Hispanic participants than for nonHispanic black or white participants (30 versus 13 percent). The rate was largest among nonHispanic participants who were Asian, American Indian, or other races (listed as “non-Hispanic 

other” in the table) (31 percent). Among home-delivered meal participants, non-Hispanic black 

participants were more than twice as likely to be food insecure than were non-Hispanic 

participants of other races (38 versus 15–16 percent). 

 

15
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

Table III.5. Percentage of participants who experienced food insecurity, by 

participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 16.4 22.5

Age 

74 and younger 24.4 44.1

75 to 84 13.4 17.7

85 and older 4.8 15.9

Gender 

Male 22.4 17.6

Female 13.5 24.7

Highest grade level completed 

Completed less than high school 17.8 30.8

High school graduate, GED, or equivalent 16.0 16.9

Marital status 

Married or living with partner 15.0 18.5

Widowed 9.7 24.8

Divorced, separated, or never married 28.2 21.9

Presence of other people living in household 

Lives alone 17.3 20.4

Lives with others 15.2 25.6

Race/ethnicity 

Non-Hispanic black 12.9 37.6

Non-Hispanic white 12.5 16.0

Non-Hispanic other 31.1 14.7

Hispanic 29.8 NA

Employment status 

Employed 12.3 NA

Not employed 17.2 22.7

Monthly income-to-poverty ratio 

0 to 100 32.6 37.8

101 to 200 14.5 16.7

201 and above 5.9 10.6

Census region 

Midwest 14.7 27.2

Northeast 9.4 18.4

South 18.0 23.6

West 22.3 19.8

Urbanicity 

Urban 19.8 23.5

Rural 7.6 19.5

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

Table III.6 examines whether participants experienced a particularly severe level of food 

insecurity, referred to as “very low food security.” The rate of very low food security was higher 

for home-delivered meal participants than for congregate meal participants (7 percent versus 4 

percent). Like food insecurity, the percentages of congregate and home-delivered meal 

participants who experienced very low food security were lower for older participants.

Participants age 74 and younger experienced the highest rates (8 percent for congregate and 15 

percent for home-delivered meal participants), and participants age 85 and older experienced the 

16
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

lowest rates (slightly greater than zero and 6 percent, respectively) (Table III.6). Like food 

insecurity, the rate of very low food security was higher for congregate meal participants with 

incomes below 100 percent of poverty than for those with income equal to at least 201 percent of 

poverty (9 versus 3 percent). The same was true for home-delivered meal participants (7 versus 2 

percent). 

Table III.6. Percentage of participants who experienced very low food 

security, by participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 4.3 6.7

Age 

74 and younger 8.1 15.2

75 to 84 2.3 2.4

85 and older 0.1 6.2

Gender 

Male 2.8 5.8

Female 5.0 7.1

Highest grade level completed 

Completed less than high school 1.6 5.9

High school graduate, GED, or equivalent 5.2 7.2

Marital status 

Married or living with partner 5.3 4.6

Widowed 1.6 8.6

Divorced, separated, or never married 7.8 4.6

Presence of other people living in household 

Lives alone 4.9 7.7

Lives with others 3.4 5.5

Race/ethnicity 

Non-Hispanic black 3.2 19.1

Non-Hispanic white 3.2 4.5

Non-Hispanic other 18.3 4.5

Hispanic 2.2 NA

Employment status 

Employed 3.2 NA

Not employed 4.5 7.2

Monthly income-to-poverty ratio 

0 to 100 9.0 6.7

101 to 200 2.6 6.3

201 and above 3.4 1.6

Census region 

Midwest 5.2 15.0

Northeast 6.7 2.9

South 2.8 5.1

West 2.6 2.1

Urbanicity 

Urban 5.3 7.8

Rural 1.7 3.3

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

17
III. PARTICIPANTS NEEDS AND TRADE-OFFS MATHEMATICA POLICY RESEARCH

The prevalence of very low food security differed by race. Among congregate meal 

participants, the rate was largest among non-Hispanic participants who were Asian, American 

Indian, or other races (18 percent). Among home-delivered meal participants, the rate was largest 

among non-Hispanic black participants (19 percent). The rates of very low food security were 

generally similar across regions for congregate meal participants. For home-delivered meal 

participants, however, the Midwest had the highest rate of very low food security (15 percent), as 

it did for food insecurity. 

18
MATHEMATICA POLICY RESEARCH

IV. PATTERNS OF PARTICIPATION IN THE NSP

This chapter examines how specific groups of congregate and home-delivered meal 

participants use the NSP. It presents information on how the frequency of program use and the 

use of multiple meal sites varied by participants’ characteristics and circumstances. Additionally, 

it describes whether older adults who participated in the NSP in 2015–2016 continued to 

participate over the next year and, if so, whether the extent to which they used the program 

changed. It also describes how these patterns of participation differed by participants’ 

characteristics and circumstances

A. Frequency of NSP participation among congregate meal participants in 

2015–2016

Congregate meal participants received meals frequently. Forty-three percent received five or 

more meals per week, 64 percent received four or more meals per week, and 82 percent received 

three or more meals per week (Table IV.1). Most congregate meal participants (79 percent) 

attended a single site for meals, while 12 percent attended two meal sites. 

Table IV.1. Frequency of participation in congregate meal program 

Participation frequency 

Congregate meal 

participants (percentage)

Number of days in a typical week participant ate a meal at the congregate meal site 

1 6.4

2 12.0

3 18.1

4 20.4

5 42.1

6 0.0

7 1.0

Number of congregate sites the participant usually visits for meals 

1 79.4

2 11.8

3 or more 8.9

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

The percentage of congregate meal participants who received four or more meals per week

was higher for older participants. Sixty-nine percent of participants age 85 and older ate at a 

meal site at least four days per week compared with 61 percent of participants age 74 and 

younger (Table IV.2). Male congregate meal participants were more likely to participate than 

female participants (70 versus 60 percent) as were participants who were divorced, separated, or 

never married compared with those who were married or living with their partner (75 versus 57 

percent) and those who lived alone compared with participants who lived with others (66 versus 

60 percent). 

19
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.2. Percentage of congregate meal participants who ate at a meal 

site four or more days per week, by participant characteristics 

Characteristic

Congregate meal 

participants

Total 63.5

Age 

74 and younger 61.0

75 to 84 63.9

85 and older 68.6

Gender 

Male 70.2

Female 60.3

Highest grade level completed 

Completed less than high school 71.1

High school graduate, GED, or equivalent 61.1

Marital status 

Married or living with partner 56.6

Widowed 61.2

Divorced, separated, or never married 74.5

Presence of other people living in household 

Live alone 66.1

Lives with others 60.1

Race/ethnicity 

Non-Hispanic black 53.5

Non-Hispanic white 60.8

Non-Hispanic other 80.1

Hispanic 76.4

Employment status 

Employed 50.2

Not employed 66.1

Monthly income-to-poverty ratio 

0 to 100 74.9

101 to 200 58.4

201 and above 64.5

Census region 

Midwest 55.3

Northeast 65.0

South 67.4

West 65.9

Urbanicity 

Urban 66.5

Rural 55.7

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

The likelihood of receiving more meals per week differed by race and ethnicity as well. The 

percentages of participants who ate at the meal site at least four times per week were largest 

among non-Hispanic participants who were Asian, American Indian, or other races (listed as 

non-Hispanic other in the table) and Hispanic participants (80 and 76 percent, respectively), than 

for non-Hispanic black or white participants (54 and 61 percent, respectively). 

20
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Frequency of receipt of meals also differed by education, income, and employment status. 

Congregate meal participants who had not completed high school were more likely to participate 

at least four days per week than those who had completed high school (71 versus 61 percent). 

Poorer participants used the program more frequently: 75 percent of participants with household 

incomes below 100 percent of poverty had eaten at a meal site at least four times per week 

compared with 58 and 65 percent of those with income between 101 and 200 percent of poverty 

and those with income at least 201 percent of poverty, respectively. There were also sizable 

differences in use between participants who were not employed and those who were employed 

(66 versus 50 percent). 

There were few differences by geographic region. Congregate meal participants living in the 

Northeast, South, and West had similar frequency of use, ranging from 65 to 67 percent; those 

living in the Midwest, however, had noticeably lower levels of use with 55 percent eating at meal 

sites at least four days per week (Table IV.2). Participants living in urban areas used the program 

more frequently than those in rural areas (67 versus 56 percent). 

Relative to older participants, congregate meal participants age 74 and younger were less 

likely to eat at a meal site at least four times per week, although they were more likely to visit 

multiple meal sites. Twenty-five percent of participants age 74 and younger used more than one 

meal site, compared with 17 to 18 percent of older participants (Table IV.3). Male participants 

were more likely than female participants to use multiple meal sites (29 versus 17 percent); other 

characteristics associated with using multiple sites included living alone rather than with others 

(23 versus 17 percent) and being Hispanic rather than non-Hispanic black or white (29 versus 17 

and 19 percent, respectively). 

Not only were poorer participants more likely than participants with higher income to visit 

meal sites at least four times per week, they were more likely to visit multiple meal sites as well. 

About 31 percent of participants with household incomes below 100 percent of poverty ate at 

multiple meal sites compared with 17 percent of those with higher incomes (Table IV.3). 

Visiting multiple sites was also related to geography. Participants who lived in the West were 

nearly twice as likely as participants living in other regions to visit multiple sites (32 percent 

versus 11–17 percent), as were those living in urban areas, compared with those in rural areas 

(23 versus 14 percent). 

21
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.3. Percentage of congregate meal participants who usually visit 

more than one congregate site for meals, by participant characteristics 

Characteristic

Congregate meal 

participants

Total 20.6

Age 

74 and younger 25.0

75 to 84 17.4

85 and older 17.8

Gender 

Male 28.7

Female 16.7

Highest grade level completed 

Completed less than high school 18.6

High school graduate, GED, or equivalent 21.3

Marital status 

Married or living with partner 21.7

Widowed 19.0

Divorced, separated, or never married 22.0

Presence of other people living in household 

Live alone 22.9

Lives with others 17.3

Race/ethnicity 

Non-Hispanic black 17.4

Non-Hispanic white 18.9

Non-Hispanic other 26.4

Hispanic 28.9

Employment status 

Employed 16.5

Not employed 21.6

Monthly income-to-poverty ratio 

0 to 100 31.4

101 to 200 16.6

201 and above 17.2

Census region 

Midwest 17.0

Northeast 16.5

South 10.7

West 31.5

Urbanicity 

Urban 23.1

Rural 14.0

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

22
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

B. Frequency of NSP participation among home-delivered meal participants 

in 2015–2016 

Like congregate meal participants, home-delivered meal participants also received meals 

frequently. Seventy-one percent received five or more meals per week, 76 percent received four 

or more meals per week, and 85 percent received three or more meals per week (Table IV.4).5

5 The outcomes survey did not collect information on the number of meals provided in each delivery. Based on 

information collected in the process survey of local service providers, however, an overwhelming majority (80 

percent) of agencies provide a single meal at each delivery (Mabli et al. 2015). 

Nearly all home-delivered meal participants (97 percent) received meals from a single site. 

Table IV.4. Frequency of participation in home-delivered meal program 

Participation frequency

Home-delivered meal 

participants (percentage)

Number of days in a typical week participant received a delivered meal from the 

nutrition program 

1 14.3

2 0.7

3 8.4

4 5.7

5 69.2

6 0.0

7 1.4

Number of home-delivered meal sites that deliver meals to the participant 

1 97.4

2 2.5

3 or more 0.1

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

Unlike congregate meal participants, whose likelihood of eating program meals more often 

was higher for older participants, home-delivered meal participants were less likely to receive 

program meals five or more days per week the older they were. Seventy-seven percent of 

participants age 74 and younger received a meal at least five days per week compared with 66 

percent of participants age 85 and older (Table IV.5). Also unlike congregate meal participants, 

home-delivered meal participants who lived with others used the program more frequently than 

those who lived alone (77 versus 68 percent), as did those who lived in rural areas compared 

with those in urban areas (80 versus 68 percent). 

Similar to congregate meal participants, home-delivered meal participants who had not 

completed high school were more likely to receive meals at least five days per week than those 

who had completed high school (77 versus 67 percent). Participants in the South and West were 

also more likely to do so, relative to participants in other geographic regions (83–85 versus 54–

63 percent).

 

23
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.5. Percentage of home-delivered meal participants who received 

program meals five or more days per week, by participant characteristics 

Characteristic Home-delivered meal participants

Total 70.7

Age 

74 and younger 76.6

75 to 84 73.0

85 and older 66.1

Gender 

Male 70.6

Female 70.8

Highest grade level completed 

Completed less than high school 76.9

High school graduate, GED, or equivalent 66.6

Marital status 

Married or living with partner 73.1

Widowed 65.2

Divorced, separated, or never married 80.1

Presence of other people living in household 

Lives alone 68.0

Lives with others 76.5

Race/ethnicity 

Non-Hispanic black 35.1

Non-Hispanic white 75.8

Non-Hispanic other 91.8

Hispanic NA

Employment status 

Employed NA

Not employed 71.3

Monthly income-to-poverty ratio 

0 to 100 75.7

101 to 200 69.2

201 and above 78.6

Census region 

Midwest 54.2

Northeast 63.0

South 85.4

West 82.6

Urbanicity 

Urban 67.7

Rural 79.8

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

NA = Not available due to small cell size

C. Patterns of congregate meal participation over the course of a year 

Whereas the previous two sections described the frequency of participating in the NSP at the 

time of the 2015–2016 interview, this section assesses changes in participation over the 

following year. The rate of continued participation in the NSP among congregate meal 

participants was high (Table IV.6). Ninety-four percent of older adults receiving congregate 

meals at the time of the 2015–2016 interview participated about 12 months later at the time of 

24
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

the 2016–2017 interview (Table IV.6). Smaller, yet still sizable, percentages of older adults 

participated in at least 6 of the next 12 months (90 percent) and even in each of the next 12 

months (71 percent). Thus, the rate of retention in the NSP among congregate meal participants

was high in terms of whether people continued to participate and the number of months in which 

they participated. 

Very few characteristics were associated with receiving congregate meals 12 months after 

the 2015–2016 interview (Table IV.6). Participation was more likely among individuals who 

were married or living with their partner than among those who were divorced, separated, or 

never married (97 versus 92 percent) and if they lived in the Northeast rather than in the West 

(98 versus 90 percent). Overall, however, there was little variation in the characteristics of 

congregate meal participants who continued to participate in the NSP about 12 months after the 

initial interview. 

There were greater differences in the percentage of participants who continued to receive 

congregate meals for at least six months of the next year. Participants were more likely to 

participate in at least six months if they were ages 84 and younger, relative to older participants, 

(90–93 percent versus 84 percent); if they had completed less than high school, relative to those 

who completed high school (94 versus 89 percent); and if they had less income (94 percent for 

those with income below 100 percent of poverty compared with 88 percent for those with 

income at or above 201 percent of poverty) (Table IV.6). 

Although differences also existed in the percentage of participants who continued to receive 

congregate meals for each of the next 12 months, the characteristics associated with continuing 

to receive meals over the next year were different from those for participants who continued to 

receive meals in at least 6 months of the year. Men were more likely than women to participate 

in every month (76 versus 69 percent), as were those who lived alone rather than with others (74 

versus 68 percent) and those who lived in a rural, rather than urban, area (77 versus 69 percent). 

Although having less income was associated with participating in at least 6 months of the year, 

having more income was associated with participating in every month: 76 percent for those with 

income at or above 201 percent of poverty participated in every month compared with around 70 

percent with less income. Similar to receiving weekly meals, participants who lived in the 

Midwest were less likely to participate in at least 6 months and participate in every month 

compared with those who lived in the Northeast, South, and West (84 versus 91–94 percent for 6 

months and 62 versus 72–76 percent for every month). 

25
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.6. Percentages of congregate meal participants who continued to 

participate in the 12 months after the 2015–2016 interview 

Characteristic

Congregate meal 

participant in the 

2015–2016 

interview who 

continued to be a 

participant 12 

months later

Congregate meal 

participant in the 

2015–2016 

interview who 

participated in at 

least 6 of the next 

12 months

Congregate meal 

participant in the 

2015–2016 

interview who 

participated in all 

of the next 12 

months

Total 94.0 90.3 71.2

Age 

74 and younger 94.4 90.0 68.3

75 to 84 92.9 93.2 74.3

85 and older 96.0 83.6 70.6

Gender 

Male 94.5 92.3 75.5

Female 93.8 89.5 69.3

Highest grade level completed 

Completed less than high school 93.9 94.0 72.2

High school graduate, GED, or equivalent 94.0 89.2 70.9

Marital status 

Married or living with partner 96.8 95.0 67.9

Widowed 93.3 87.5 74.8

Divorced, separated, or never married 92.3 91.5 68.1

Presence of other people living in household 

Lives alone 94.2 89.4 73.5

Lives with others 93.7 91.5 67.7

Race/ethnicity 

Non-Hispanic black 95.6 93.8 69.3

Non-Hispanic white 94.9 89.6 73.4

Non-Hispanic other NA NA NA

Hispanic NA NA NA

Employment status 

Employed 90.8 88.6 73.1

Not employed 94.6 90.7 70.7

Monthly income-to-poverty ratio 

0 to 100 93.6 93.9 69.5

101 to 200 93.7 89.4 70.6

201 and above 91.8 88.2 75.6

Census region 

Midwest 92.3 84.3 62.2

Northeast 97.6 93.6 76.4

South 97.2 90.5 74.1

West 90.3 92.1 72.0

Urbanicity 

Urban 93.7 89.8 69.0

Rural 94.9 91.8 77.3

Source: AoA NSP outcomes surveys, 2015–2016 and 2016–2017, weighted data.

Note: Tabulations are based on an unweighted sample size of 431 congregate meal participants who completed 

the 2015–2016 and 2016–2017 surveys. Individual estimates within the table may have slightly fewer 

observations due to item nonresponse to individual questions.

NA = Not available due to small cell size

26
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Among congregate meal participants who reported eating at a congregate meal site at the 

time of the 2016–2017 interview, approximately one year after the initial interview in 2015–

2016, the majority (71 percent of participants) eat at the program at least as often as they did one 

year earlier (Table IV.7). Age was associated with intensity of use, with greater percentages of 

participants ages 75 to 84 and age 85 and older eating at the program at least as often as they did 

one year earlier, compared with those age 74 and younger (73–75 percent versus 67 percent). 

The following characteristics were also associated with maintaining or increasing use of the 

program: completing less than high school relative to completing high school (80 versus 68 

percent), being a non-Hispanic black participant relative to being a non-Hispanic white 

participant (83 versus 67 percent), having less income (77 percent among participants with 

income less than 100 percent of poverty compared with 68 to 71 percent among those with 

income from 101 to 200 percent of poverty or greater than 200 percent of poverty), geography 

(78 percent in the West versus 67 percent in the Midwest), and urbanicity (73 percent in urban 

areas versus 67 percent in rural ones). Most, but not all, of these are similar to the characteristics 

associated with participating all 12 months of the year. 

27
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.7. Percentages of participants who eat at the congregate meal 

program as often in 2016–2017 as in 2015–2016, by participant 

characteristics 

Characteristic

Currently eat at program at least as 

often as 12 months ago

Total 71.2

Age 

74 and younger 66.5

75 to 84 75.1

85 and older 73.0

Gender 

Male 73.2

Female 70.3

Highest grade level completed 

Completed less than high school 80.4

High school graduate, GED, or equivalent 68.3

Marital status 

Married or living with partner 66.8

Widowed 74.6

Divorced, separated, or never married 69.3

Presence of other people living in household 

Lives alone 69.6

Lives with others 73.1

Race/ethnicity 

Non-Hispanic black 82.8

Non-Hispanic white 67.3

Non-Hispanic other NA

Hispanic NA

Employment status 

Employed 82.5

Not employed 68.8

Monthly income-to-poverty ratio 

0 to 100 76.7

101 to 200 70.5

201 and above 68.1

Census region 

Midwest 67.1

Northeast 69.7

South 67.9

West 77.7

Urbanicity 

Urban 72.8

Rural 66.8

Source: AoA NSP outcomes surveys, 2015–2016 and 2016–2017, weighted data.

Note: Tabulations are based on an unweighted sample size of 396 congregate meal participants who still eat at 

program 12 months after the 2015–2016 interview. Individual estimates within the table may have slightly 

fewer observations due to item nonresponse to individual questions.

NA = Not available due to small cell size

28
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

D. Patterns of home-delivered meal participation over the course of a year 

As was true for congregate meal participants, the rate of continued participation in the NSP 

was high for home-delivered meal participants. Eighty-five percent of older adults receiving 

home-delivered meals at the time of the 2015–2016 interview participated about 12 months later 

at the time of the 2016–2017 interview (Table IV.8). Eighty-two percent of older adults 

participated in at least six months of the year and 65 percent participated in every month. 

Although there was a high rate of retention in the NSP among home-delivered meal participants, 

these rates are lower than those for congregate meal participants. 

Similar to congregate meal participants, few characteristics were associated with receiving 

home-delivered meals 12 months after the 2015–2016 interview (Table IV.8). Participation was 

more likely among those who were living with others than those who lived alone (89 versus 82 

percent); were married or living with their partner than those who were divorced, separated, or 

never married (88 versus 83 percent); and were living in the Midwest, relative to those in the 

Northeast (91 versus 78 percent). 

Unlike the continuation rates for congregate meal participants, however, the percentages of 

home-delivered meal participants who participated in at least six months of the year and in every 

month of the year also varied little by participant characteristics (Table IV.8). There were some 

differences by age, with older participants more likely to participate at least six months, and 

differences by income, with higher-income participants more likely to participate than lowerincome participants. The percentage also varied geographically, with older adults living in the 

Midwest being most likely to participate at least six months.

The likelihood of participating in each of the next 12 months varied by participants’ 

characteristics. In some cases there was no clear pattern. For example, the continuation rate 

differed by age, but was higher (69 percent) for the youngest group (74 and younger) and the 

oldest group (85 and older) and lower (58 percent) for the middle group (75 to 84 years old). In 

other cases, some groups were clearly more likely to continue to participate for all 12 months: 

men rather than women (71 versus 62 percent); participants who lived alone rather than with 

others (67 versus 62 percent); higher-income participants, relative to lower-income participants 

(81 versus 62–66 percent); and participants who lived in the West, relative to those in the 

Northeast (69 versus 53 percent).

29
IV. PATTERNS OF PARTICIPATION MATHEMATICA POLICY RESEARCH

Table IV.8. Percentages of home-delivered meal participants who continued 

to participate in the 12 months after the 2015–2016 interview, by participant 

characteristics 

Characteristic

Home-delivered 

meal participant in 

the 2015–2016 

interview who 

continued to be a 

participant 12 

months later

Home-delivered 

meal participant in 

the 2015–2016 

interview who 

participated in at 

least 6 of the next 

12 months

Home-delivered 

meal participant in 

the 2015–2016 

interview who 

participated in all 

of the next 12 

months

Total 85.0 82.1 64.6

Age

74 and younger 87.0 77.2 68.6

75 to 84 82.0 81.4 57.6

85 and older 86.4 85.7 68.5

Gender

Male 88.4 84.4 71.0

Female 83.6 81.1 61.9

Highest grade level completed

Completed less than high school 87.1 81.8 66.8

High school graduate, GED, or equivalent 83.4 82.3 63.2

Marital status

Married or living with partner 87.6 83.7 59.3

Widowed 84.9 81.1 66.1

Divorced, separated, or never married 82.8 82.3 65.6

Presence of other people living in household

Lives alone 82.1 80.6 67.3

Lives with others 88.7 83.6 62.3

Race/ethnicity

Non-Hispanic black 85.4 87.0 76.2

Non-Hispanic white 84.8 81.6 62.3

Non-Hispanic other NA NA NA

Hispanic NA NA NA

Employment status

Employed NA NA NA

Not employed 85.2 81.6 66.2

Monthly income-to-poverty ratio

0 to 100 87.5 81.2 65.5

101 to 200 82.1 80.0 61.6

201 and above 90.6 92.2 81.0

Census region 

Midwest 90.5 87.1 67.8

Northeast 77.9 75.6 53.1

South 84.8 79.8 66.9

West 85.5 84.9 69.4

Urbanicity

Urban 83.9 82.1 66.2

Rural 88.0 82.0 60.3

Source: AoA NSP outcomes surveys, 2015–2016 and 2016–2017, weighted data.

Note: Tabulations are based on an unweighted sample size of 323 home-delivered meal participants who 

completed the 2015–2016 and 2016–2017 surveys. Individual estimates within the table may have slightly 

fewer observations due to item nonresponse to individual questions.

NA = Not available due to small cell size

30
MATHEMATICA POLICY RESEARCH

V. PARTICIPATION IN OTHER PROGRAMS AND USE OF NSP SERVICES

This chapter examines how participants meet their needs related to food and nutrition, 

health, and personal care. It presents information on NSP participants’ take-up of a wide array of 

services provided through the program, as well as other services available in the community. It 

assesses how participation in the Supplemental Nutrition Assistance Program (SNAP) and 

receipt of emergency food, as well as participation in the Low Income Home Energy Assistance 

Program (LIHEAP), differs by participants’ characteristics and circumstances and agency (local 

service provider) characteristics. It also assesses differences across types of participants in their 

use of services at the meal site, at home, or in the community such as nutrition counseling, case 

management services, transportation services, and personal care services.

A. SNAP participation 

A variety of federal, state, and local food assistance programs are available to help older 

adults meet their food and nutritional needs. Congregate and home-delivered meal participants 

receive assistance to purchase food through SNAP and directly receive food through other food 

and nutrition assistance programs, such as food pantries and soup kitchens. Twenty-seven 

percent of congregate meal participants and 30 percent of home-delivered meal participants 

reported participating in SNAP (Table V.1).

For congregate meal participants, participating in SNAP was associated with being younger: 

38 percent of individuals age 74 and younger participated, compared with 19 percent of those 

ages 75 to 84 and 14 percent of those age 85 and older (Table V.1). The following characteristics 

were also associated with SNAP participation: female versus male gender (29 versus 23 percent); 

completing less high school relative to being a high school graduate (37 versus 24 percent); not 

being married relative to being married or living with a partner (24–41 percent versus 15 

percent); and being Hispanic, non-Hispanic black, or non-Hispanic other relative to being nonHispanic white (28–58 percent versus 15 percent). The largest differences were across income 

groups: 63 percent of older adults with household income less than or equal to 100 percent of 

poverty participated in SNAP compared with 22 percent of those with income between 101 and 

200 percent and less than 1 percent of those with income at or above 201 percent of poverty.6

6 This largely reflects program eligibility rules based on income—most households with elderly members have gross 

income net of allowable deductions below 100 percent of the federal poverty level, though some participants can be 

categorically eligible for SNAP even if their income exceeds this amount.

SNAP participation was highest in the West and Northeast (31 and 30 percent) and lowest in the 

South (18 percent). It was also higher among congregate meal participants in urban areas than in

rural areas (32 versus 12 percent). 

Many of the same factors were associated with SNAP participation among home-delivered 

meal participants. The largest differences were across age and income groups. Fifty-eight percent 

of individuals age 74 and younger participated, compared with 29 percent of those ages 75 to 84 

and 17 percent of those age 85 and older (Table V.1). Regarding income, 50 percent of older 

adults with household income less than or equal to 100 percent of poverty participated in SNAP 

compared with 27 percent of those with income between 101 and 200 percent and 3 percent of 

 

31
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

those with income at or above 201 percent of poverty. Participation was highest in the Northeast 

than in other regions (39 versus 25–29 percent).

Table V.1. Percentage of participants currently receiving SNAP benefits, by 

participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 26.7 29.9

Age 

74 and younger 38.2 57.8

75 to 84 19.2 28.8

85 and older 14.0 16.8

Gender 

Male 22.8 26.2

Female 28.6 31.8

Highest grade level completed 

Completed less than high school 37.0 39.0

High school graduate, GED, or equivalent 24.0 23.0

Marital status 

Married or living with partner 14.5 26.0

Widowed 24.2 25.1

Divorced, separated, or never married 40.6 45.7

Presence of other people living in household 

Lives alone 28.1 28.9

Lives with others 24.7 31.7

Race/ethnicity 

Non-Hispanic black 57.6 50.9

Non-Hispanic white 15.3 26.6

Non-Hispanic other 57.5 NA

Hispanic 28.4 NA

Employment status 

Employed 35.6 NA

Not employed 25.0 30.2

Monthly income-to-poverty ratio 

0 to 100 63.1 50.3

101 to 200 22.3 27.0

201 and above 0.4 2.7

Census region 

Midwest 22.2 29.4

Northeast 30.0 38.9

South 18.2 25.9

West 30.5 24.9

Urbanicity 

Urban 32.3 31.0

Rural 11.5 26.6

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

SNAP participation differed by several agency characteristics as well (Table V.2). 

Congregate meal participants were more likely to participate in SNAP if they received meals 

from a smaller agency than from a larger one based on the number of full-time equivalent 

32
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

employees (FTEs) (33 versus 17 percent) and if the agency did not provide nutrition counseling 

(29 versus 19 percent), social activities (41 versus 20 percent), or nutrition health promotion and 

disease prevention activities (30 versus 24 percent). SNAP participation was more likely among 

NSP participants who received meals from agencies that provided nutrition education as opposed 

to those that did not (30 versus 17 percent). 

Table V.2. Percentage of participants currently receiving SNAP benefits, by 

agency characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 26.7 29.9

Type of organization 

Public 23.7 26.7

Private 27.6 31.0

Structure of Organization 

Standalone organization 26.2 36.2

Part of another organization 27.5 22.2

Agency size (number of FTEs) 

Above median number of FTEs 17.0 34.1

At or below median number of FTEs 33.1 26.1

Agency size based on program expenditures 

Above median amount of expenditures 26.8 36.6

At or below median amount of expenditures 26.6 22.7

Agency provides nutrition counseling 

Yes 19.2 28.8

No 28.8 30.2

Agency provides nutrition education 

Yes 30.4 30.1

No 16.6 29.5

Agency provides nutrition assessment 

Yes 26.8 32.8

No 26.6 23.6

Agency provides social activities 

Yes 19.8 24.9

No 40.5 37.1

Agency provides nutrition health promotion and 

disease prevention activities 

Yes 23.7 24.7

No 30.3 34.8

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Many of the findings were different for home-delivered meal participants (Table V.2). 

SNAP participation was higher at standalone organizations than at those that were part of another 

organization (36 versus 22 percent), larger agencies (34 versus 26 percent based on FTEs and 37 

versus 23 percent based on expenditures), and at agencies that offered nutrition assessment (33 

versus 24 percent). Similar to congregate meal participants, home-delivered meal participants 

were more likely to participate in SNAP if they received meals from agencies that did not 

provide social activities (37 versus 25 percent) or nutrition health promotion and disease 

prevention activities (35 versus 25 percent). 

33
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

B. Emergency food assistance 

Receiving food from emergency food pantries in the past 30 days was about half as likely as 

participating in SNAP. About 17 percent of congregate meal participants and 14 percent of 

home-delivered meal participants received food from food pantries (Table V.3). Many of the 

factors that were associated with participating in SNAP were associated with pantry use for 

congregate meal participants, including being younger; being female; completing less than high 

school; being divorced, separated, or never married; being Hispanic or non-Hispanic black 

(relative to non-Hispanic white); having less income; and living in an urban area. Pantry use was 

nearly three times as likely for participants age 74 and younger than it was those 75 to 84 (29 

versus 9 percent) and was over twice as likely among poor participants than it was for those who 

were near poor (40 versus 14 percent). For home-delivered meal participants, the factors 

associated with SNAP participation also generally were associated with receiving emergency 

food. Exceptions included higher rates of receiving emergency food in rural areas than in urban 

areas (23 versus 11 percent) and among married participants than among non-married 

participants (24 versus 8–12 percent). 

For congregate meal participants, emergency food pantry use was associated with receiving 

meals from agencies that did not provide nutrition counseling, nutrition assessment, social 

activities, or nutrition health promotion and disease prevention activities (Table V.4). Like 

SNAP participation, however, it was associated with receiving meals from agencies that 

provided nutrition education. There were fewer and smaller associations for home-delivered 

meal participants, but they generally indicated higher pantry use for participants who received 

meals from agencies that did not provide specific services such as nutrition counseling and 

assessment.

34
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

Table V.3. Percentage of participants who received food from a food pantry 

or food bank in the past 30 days, by participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 17.3 14.0

Age 

74 and younger 28.6 26.9

75 to 84 9.3 12.5

85 and older 6.0 8.9

Gender 

Male 13.9 9.6

Female 19.0 16.3

Highest grade level completed 

Completed less than high school 23.3 16.8

High school graduate, GED, or equivalent 15.8 12.0

Marital status 

Married or living with partner 12.7 24.3

Widowed 14.8 12.3

Divorced, separated, or never married 25.0 8.0

Presence of other people living in household 

Live alone 16.0 9.8

Lives with others 18.7 20.5

Race/ethnicity 

Non-Hispanic black 27.0 20.3

Non-Hispanic white 10.4 12.5

Non-Hispanic other 42.0 NA

Hispanic 26.0 NA

Employment status 

Employed 18.0 NA

Not employed 17.2 14.4

Monthly income-to-poverty ratio 

0 to 100 39.9 22.5

101 to 200 13.7 15.6

201 and above 1.6 3.2

Census region 

Midwest 18.2 14.9

Northeast 9.7 7.4

South 15.3 22.9

West 24.6 12.5

Urbanicity 

Urban 19.3 11.0

Rural 11.9 23.0

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

35
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

Table V.4. Percentage of participants who received food from a food pantry 

or food bank in the past 30 days, by agency characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 17.3 14.0

Type of organization 

Public 15.2 9.7

Private 18.0 15.6

Structure of organization 

Standalone organization 18.5 15.9

Part of another organization 15.5 11.8

Agency size (number of FTEs) 

Above median number of FTEs 10.2 13.9

At or below median number of FTEs 22.0 14.1

Agency size based on program expenditures 

Above median amount of expenditures 20.5 11.2

At or below median amount of expenditures 14.0 17.2

Agency provides nutrition counseling 

Yes 10.5 9.2

No 19.3 15.7

Agency provides nutrition education 

Yes 20.1 13.8

No 9.6 14.3

Agency provides nutrition assessment 

Yes 11.8 12.1

No 24.0 18.2

Agency provides social activities 

Yes 12.6 15.1

No 26.6 12.4

Agency provides nutrition health promotion and 

disease prevention activities 

Yes 14.8 14.2

No 20.4 13.8

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Receiving meals from soup kitchens in the past 30 days was less common than participating 

in SNAP or receiving food from emergency pantries, particularly for home-delivered meal 

participants. About 11 percent of congregate meal participants and 3 percent of home-delivered 

meal participants received meals from soup kitchens in the past 30 days (Table V.5). The 

characteristics of participants associated with receiving meals from an emergency kitchen 

generally were similar to those for receiving food from emergency pantries. Congregate meal 

participants were more likely to receive meals from a kitchen if they were younger; had 

completed less than high school; were divorced, separated, or never married; had less income; or 

lived in an urban area. The largest differences across groups were for income: 23 percent of 

participants with income less than 100 percent of poverty received food from an emergency 

kitchen compared with 9 percent of those with income from 101 to 200 percent of poverty and 3 

percent of those with income greater than 201 percent of poverty. Unlike receiving meals from

pantries, men were more likely than women to receive meals from emergency kitchens (16 

versus 8 percent), as were those who lived alone than those who lived with others (13 versus 8 

36
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

percent). For home-delivered meal participants, this use was associated most strongly with being 

younger: 9 percent of individuals age 74 and younger received meals from an emergency kitchen 

compared with 1 to 2 percent of individuals ages 75 and older. 

Table V.5. Percentage of participants who received any meals provided by 

churches, soup kitchens, or emergency kitchens in the past 30 days, by 

participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 10.7 3.0

Age 

74 and younger 13.5 9.0

75 to 84 10.8 2.2

85 and older 2.5 0.7

Gender 

Male 16.1 1.5

Female 8.1 3.8

Highest grade level completed 

Completed less than high school 15.6 2.9

High school graduate, GED, or equivalent 9.5 3.2

Marital status 

Married or living with partner 6.5 2.5

Widowed 5.4 1.8

Divorced, separated, or never married 21.9 6.5

Presence of other people living in household 

Lives alone 12.5 2.2

Lives with others 8.0 4.4

Race/ethnicity 

Non-Hispanic black 13.3 1.9

Non-Hispanic white 9.8 3.7

Non-Hispanic other 12.9 NA

Hispanic 9.9 NA

Employment status 

Employed 13.8 NA

Not employed 10.1 2.6

Monthly income-to-poverty ratio 

0 to 100 23.4 5.1

101 to 200 9.3 2.5

201 and above 3.4 3.4

Census region 

Midwest 5.2 3.8

Northeast 14.4 1.1

South 9.4 6.9

West 11.6 0.9

Urbanicity 

Urban 12.9 3.1

Rural 5.0 2.8

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

37
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

The percentage of congregate meal participants that received meals from an emergency 

kitchen differed by several characteristics of the agencies from which participants receive 

congregate meals. Receiving food from kitchens was more likely for participants at private 

organizations than for those at public organizations (14 versus 2 percent), smaller agencies (15 

versus 5 percent based on FTEs and 13 versus 8 percent based on expenditures), and at agencies 

that offered nutrition counseling (13 versus 5 percent) (Table V.6). Similar to SNAP 

participation and receiving food from emergency pantries, receiving food from emergency 

kitchens was greater for those who received meals from agencies that provided nutrition 

counseling (13 versus 5 percent). As was the case for participant characteristics, small 

differences in receiving food from emergency kitchens by agency characteristics also existed for 

home-delivered meal participants. 

Table V.6. Percentage of participants who received any meals provided by 

churches, soup kitchens, or emergency kitchens in the past 30 days, by 

agency characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 10.7 3.0

Type of organization 

Public 1.6 3.4

Private 13.5 2.9

Structure of organization 

Standalone organization 9.4 2.4

Part of another organization 12.7 3.8

Agency size (number of FTEs) 

Above median number of FTEs 4.7 2.4

At or below median number of FTEs 14.7 3.6

Agency size based on program expenditures 

Above median amount of expenditures 8.4 1.7

At or below median amount of expenditures 13.1 4.5

Agency provides nutrition counseling 

Yes 4.7 0.7

No 12.5 3.8

Agency provides nutrition education 

Yes 12.7 2.0

No 5.3 4.6

Agency provides nutrition assessment 

Yes 4.6 2.0

No 18.1 5.2

Agency provides social activities 

Yes 10.9 2.9

No 10.3 3.2

Agency provides nutrition health promotion and 

disease prevention activities 

Yes 12.0 2.4

No 9.2 3.7

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

38
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

C. Nutrition and supportive services 

About 15 percent of congregate meal participants and 19 percent of home-delivered meal 

participants used NSP nutrition and supportive services other than program meals (Table V.7). 

Home-delivered meal participants used personal care services or home visits for physical, 

occupational, or speech therapy (11 percent); case management services (10 percent); and light 

housekeeping services or chore services (11 percent) (Table V.7). With few exceptions, 

congregate meal participants were less likely than home-delivered meal participants to receive 

these services. 

Table V.7. Other nutrition and supportive services participants used in the 

past six months 

Service

Congregate meal 

participants (percentage)

Home-delivered meal 

participants (percentage)

Any help or services from program, Area Agency 

on Aging, or some other agency or provider 15.0 18.8

Adult day care services 0.7 0.3

Personal care services for help with dressing or 

bathing, or home visit from nurse or therapist to 

provide physical, occupational, or speech therapy 2.0 10.8

Nutrition counseling 3.1 1.9

Case management services 1.8 10.2

Free or discounted housing 2.4 2.6

Support group 2.3 2.7

Light housekeeping services or chore services for 

heavier housecleaning or yard work 3.6 10.9

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due

to item nonresponse to individual questions.

Use of nutrition and supportive services was more likely among congregate meal 

participants who were female, non-Hispanic black, not employed, had less income, and lived in 

the Northeast (Table V.8). The largest differences were for participants who lived in the 

Northeast relative to those in the West (25 versus 9 percent), those who had income below 100 

percent of poverty versus participants who had income at least 201 percent of poverty (19 versus 

6 percent), and non-Hispanic black and non-Hispanic other participants versus Hispanic 

participants (20–23 percent versus 5 percent). Among home-delivered meal participants, 

receiving nutrition and supportive services was more likely among participants who had 

completed high school (25 versus 11 percent), those living alone than those living with others 

(22 versus 15 percent), and those living in the Northeast, relative to those living in the West (25 

versus 15 percent). 

39
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

Table V.8. Percentage of participants who used any nutrition or supportive 

services in the past six months, by participant characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 15.0 18.8

Age 

74 and younger 15.1 16.9

75 to 84 15.4 20.7

85 and older 13.9 18.0

Gender 

Male 9.6 17.5

Female 17.8 19.4

Highest grade level completed 

Completed less than high school 13.7 10.5

High school graduate, GED, or equivalent 15.4 24.5

Marital status 

Married or living with partner 15.0 17.1

Widowed 13.3 15.7

Divorced, separated, or never married 17.5 27.5

Presence of other people living in household 

Lives alone 15.3 21.9

Lives with others 14.8 15.2

Race/ethnicity 

Non-Hispanic black 19.8 24.1

Non-Hispanic white 14.9 17.7

Non-Hispanic other 22.5 NA

Hispanic 5.3 NA

Employment status 

Employed 4.9 NA

Not employed 17.2 19.0

Monthly income-to-poverty ratio 

0 to 100 18.6 20.2

101 to 200 17.9 20.3

201 and above 6.4 22.7

Census region 

Midwest 15.3 17.6

Northeast 24.6 25.4

South 11.5 17.6

West 8.9 15.2

Urbanicity 

Urban 15.1 19.6

Rural 14.8 16.4

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

The use of any nutrition or supportive services in the past six months also differed by 

several agency characteristics (Table V.9). Congregate meal participants were more likely to use 

services if they received meals from an agency that was part of another organization rather than a 

standalone organization (21 versus 11 percent), a smaller agency rather than a larger one based 

on the number of FTEs (18 versus 10 percent) and based on program expenditures (19 versus 11 

percent), and if the agency provided nutrition health promotion and disease prevention activities 

40
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

(19 versus 10 percent). For home-delivered meal participants, service use was also related to 

receiving meals from public agencies rather than private ones (26 versus 17 percent); from 

smaller agencies rather than larger ones based on program expenditures (22 versus 16 percent); 

and from those that did not provide nutrition counseling (20 versus 14 percent) or social 

activities (22 versus 17 percent). 

Table V.9. Percentage of participants who used any nutrition or supportive 

services in the past six months, by agency characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 15.0 18.8

Type of organization 

Public 17.5 25.9

Private 14.2 16.6

Structure of organization 

Standalone organization 11.2 19.4

Part of another organization 20.9 18.0

Agency size (number of FTEs) 

Above median number of FTEs 9.9 16.9

At or below median number of FTEs 18.3 20.4

Agency size based on program expenditures 

Above median amount of expenditures 11.2 15.6

At or below median amount of expenditures 19.1 21.9

Agency provides nutrition counseling 

Yes 13.0 14.1

No 15.7 20.4

Agency provides nutrition education 

Yes 16.4 18.6

No 11.4 19.0

Agency provides nutrition assessment 

Yes 13.9 17.9

No 16.3 20.4

Agency provides social activities 

Yes 16.1 16.5

No 12.8 22.1

Agency provides nutrition health promotion and 

disease prevention activities 

Yes 19.2 19.6

No 9.8 18.1

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

41
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

C. Emergency energy assistance 

Energy assistance such as the Low-Income Home Energy Assistance Program (LIHEAP) 

was received by 10 percent of congregate meal participants and 13 percent of home-delivered 

meal participants (Table V.10). Congregate meal participants were more likely to receive energy 

assistance if they were younger, female, completed less than high school, were non-married, 

were non-Hispanic black, were not employed, had less income, and lived in the Northeast. Some 

of the largest differences were between participants who were non-Hispanic black and those who 

were non-Hispanic white or Hispanic (24 versus 4–8 percent), those with income less than 100 

percent of poverty and those with income greater than 201 percent of poverty (22 versus 1 

percent), and those living in the Northeast versus the other regions (19 versus 5–8 percent). 

Fewer participant characteristics were associated with receiving energy assistance among homedelivered meal participants. Energy assistance was particularly higher among poorer homedelivered meal participants and those who were divorced, separated, or never married. 

Several characteristics of agencies from which participants receive congregate meals were 

also associated with participants’ use of energy assistance. Receiving heating and cooling 

assistance was more likely for participants at private organizations than those at public 

organizations (12 versus 5 percent), agencies that are part of another organization than at 

standalone organizations (13 versus 8 percent), and smaller agencies (12 versus 7 percent based 

on FTEs and 15 versus 6 percent based on expenditures) (Table V.11). Receiving such assistance 

was also more likely at agencies that offered nutrition education (12 versus 6 percent) and 

agencies that provided nutrition health promotion and disease prevention activities (15 versus 5 

percent). Among home-delivered meal participants, energy assistance was more likely among 

those who received food from agencies that offered nutrition assessment and agencies that did 

not offer nutrition counseling, nutrition education, social activities, or health promotion 

activities. 

42
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

Table V.10. Percentage of participants who received emergency assistance 

to help with heating and cooling in the past 30 days, by participant 

characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 10.2 13.3

Age 

74 and younger 13.2 17.0

75 to 84 9.0 15.6

85 and older 5.3 9.6

Gender 

Male 1.7 12.5

Female 14.4 13.7

Highest grade level completed 

Completed less than high school 19.3 13.9

High school graduate, GED, or equivalent 7.9 12.8

Marital status 

Married or living with partner 5.4 7.9

Widowed 8.1 10.2

Divorced, separated, or never married 17.7 26.5

Presence of other people living in household 

Lives alone 11.9 16.5

Lives with others 7.6 8.8

Race/ethnicity 

Non-Hispanic black 23.5 23.7

Non-Hispanic white 7.6 10.6

Non-Hispanic other 16.9 NA

Hispanic 4.0 NA

Employment status 

Employed 4.7 NA

Not employed 11.3 12.9

Monthly income-to-poverty ratio 

0 to 100 21.7 25.5

101 to 200 9.3 11.6

201 and above 0.6 1.7

Census region 

Midwest 8.2 13.9

Northeast 19.2 19.2

South 6.8 12.3

West 4.8 7.7

Urbanicity 

Urban 10.5 12.9

Rural 9.3 14.6

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = Not available due to small cell size

43
V. PARTICIPATION IN OTHER PROGRAMS MATHEMATICA POLICY RESEARCH

Table V.11. Percentage of participants who received emergency assistance 

to help with heating and cooling in the past 30 days, by agency 

characteristics 

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 10.2 13.3

Type of organization 

Public 5.4 16.2

Private 11.7 12.3

Structure of organization 

Standalone organization 8.3 14.2

Part of another organization 13.2 12.1

Agency size (number of FTEs) 

Above median number of FTEs 7.1 15.3

At or below median number of FTEs 12.3 11.5

Agency size based on program expenditures 

Above median amount of expenditures 5.8 14.2

At or below median amount of expenditures 14.7 12.3

Agency provides nutrition counseling 

Yes 8.0 3.5

No 10.9 16.6

Agency provides nutrition education 

Yes 11.6 10.8

No 6.3 16.8

Agency provides nutrition assessment 

Yes 10.4 15.1

No 9.9 9.3

Agency provides social activities 

Yes 11.3 11.5

No 8.0 15.9

Agency provides nutrition health promotion and 

disease prevention activities

 

Yes 14.7 10.9

No 4.6 15.5

Source: AoA NSP outcomes survey, 2015–2016, weighted data.

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

44
MATHEMATICA POLICY RESEARCH

VI. CONCLUSION

This chapter summarizes the findings from the assessment of participants’ needs, patterns of 

NSP participation, receiving food assistance from other programs, and use of non-meal NSP 

services. It also presents recommendations for additional information collection and research 

motivated by the study findings. 

A. NSP participants’ needs and trade-offs in making ends meet 

The NSP has been shown to have beneficial effects on food security, socialization, and diet 

quality (Mabli et al. 2017), but a nontrivial percentage of participants continue to experience 

challenges making ends meet and face food hardships due to insufficient income. This study 

examined three measures of need: whether participants experienced challenges making ends 

meet, faced trade-offs between purchasing food and other basic needs, and experienced food 

insecurity. 

Challenges making ends meet. About 15 percent of congregate meal participants and 23 

percent of home-delivered meal participants reported that they experience challenges making 

ends meet. Experiencing these types of challenges was more common among participants who 

were younger, were poor, lived in urban areas, were not married, and, for congregate meal 

participants, those living in the West.

Food hardships and trade-offs. Some participants faced trade-offs in purchasing food each 

month. For congregate meal participants, the most common was choosing between buying food 

and buying medications (7 percent). A similar percentage of participants (7 percent) made tradeoffs between buying food and paying utility bills, and a smaller percentage made trade-offs 

between buying food and paying rent (4 percent). Although these percentages are fairly small 

when calculated among the full population of congregate meal participants, the percentage of 

participants who made trade-offs between purchasing food and other basic needs was much 

higher for specific groups of people, including participants who were younger, poor, Hispanic, or 

lived in the West. 

Home-delivered meal participants also made trade-offs between purchasing food and other 

basic needs. The most common was choosing between buying food and paying utility bills (9

percent), with smaller percentages of participants making trade-offs between buying food and 

buying medications (4 percent) and between buying food and paying rent (5 percent). As was the 

case for congregate meal participants, the prevalence of making trade-offs among homedelivered meal participants was highest for participants who were younger and were not married. 

The difference by income for home-delivered meal participants was much smaller than it was for 

congregate meal participants. 

Food insecurity. Although the majority of NSP participants were food secure, 16 percent of 

congregate meal participants and 23 percent of home-delivered meal participants had 

experienced food access limitations during the past month due to lack of money or other 

resources—they were food insecure. Many of the types of participants who were more likely to 

encounter financial hardships and face trade-offs in purchasing food were also more likely to be 

food insecure, including participants who were younger, had less income, were Hispanic, and 

45
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

lived in the West. For home-delivered meal participants, food insecurity was also higher for 

participants who had not finished high school or were non-Hispanic black. 

Summary. Considering all three measures of need and hardships together, many common 

factors were associated with having a higher level of need and a greater likelihood of 

experiencing hardships. Participants who were younger (age 74 and younger) and had less 

income (those with income below 100 percent of poverty) reported the highest level of need and 

were most likely to face hardships. Other common factors were not being married, living in an 

urban area, and, for two of the three measures, being Hispanic. Finally, there were regional 

differences in the prevalence of need and hardships, with participants living in the West 

reporting greater challenges and food hardships than those living in the Northeast. 

B. Patterns of participation in the NSP 

NSP participants received meals frequently. For congregate meal participants, 43 percent 

received five or more meals per week and 64 percent received four or more meals per week. 

Most participants (79 percent) attended a single site for meals. Similarly, 71 percent of homedelivered meal participants received five or more meals per week and 85 percent received three 

or more meals per week. Nearly all participants (97 percent) received meals from a single site. 

Frequency of use per week. The frequency with which participants used the program 

differed by age, gender, marital status, and race and ethnicity. Participants who used the program 

more frequently were more likely to be older, male, poor, not married, and Hispanic, and more 

likely to have completed less than high school and live in an urban area. Using multiple meal 

sites was more common among participants who were younger, male, poor, living alone, 

Hispanic, and living in the West. Unlike congregate meal participants, home-delivered meal 

participants used the program more frequently if they were older, lived with others, and lived in a 

rural area. Similar to congregate meal participants, home-delivered meal participants used the 

program more if they had not completed high school. 

Continued participation over a year. The rate of continued participation in the NSP 

among congregate meal participants was high over the course a year, with 94 percent of older 

adults receiving congregate meals still participating about 12 months later. Smaller, yet still 

sizable, percentages of older adults participated in at least 6 of the next 12 months (90 percent) 

and even in each of the next 12 months (71 percent). Thus, the rate of retention in the NSP 

among congregate meal participants was high in terms of their continued participation and the 

number of months in which they participated. Little variation existed in the types of congregate 

meal participants who continued to participate in the NSP about 12 months later, with slightly 

more variation in the percentage of participants who continued to receive congregate meals for at 

least 6 months of the next year. 

As was true for congregate meal participants, the rate of continued participation in the NSP 

for home-delivered meal participants was high, with 85 percent of older adults receiving homedelivered meals still participating about 12 months later. Eighty-two percent of older adults 

participated in at least 6 months of the year and 65 percent participated in every month. Although 

the rate of retention in the NSP among home-delivered meal participants was high, this rate was 

lower than that for congregate meal participants. Similar to trends among congregate meal 

46
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

participants, few characteristics among home-delivered meal participants were associated with 

continued participation about 12 months later. 

Summary. Considering both the frequency of use in a given week and continued 

participation over the following year, many factors were associated with greater use of the NSP. 

For congregate meals, participants who were Hispanic, poor, lived in urban areas, or lived in the 

West were more likely to receive meals more often and to visit multiple meal sites. Younger 

participants ate at meal sites less often than older participants, but were more likely than older 

participants to visit multiple sites. Other factors associated with frequency of use included male 

gender, not being married, living alone, completing less than high school, and being 

unemployed. Many of these characteristics were also associated with having a higher level of 

need in terms of facing challenges making ends meet, trade-offs purchasing food and other basic 

needs, and experiencing food insecurity (in particular, being Hispanic, poor, and living in the 

West). 

Fewer connections existed between need, hardships, and frequency of use for homedelivered meal participants, however. Younger participants received home-delivered meals more 

frequently than older participants and faced greater challenges and food hardships. However, 

home-delivered meal participants who lived in the West used the program most frequently 

relative to participants in other regions, but had the lowest food insecurity rates. 

C. Participation in other programs and use of NSP services 

Differences existed in how participants attempted to meet their needs related to food and 

nutrition, health, and personal care. Some participated in SNAP, received food from emergency 

food pantries and through soup kitchens and shelters, and received heating and cooling assistance 

through LIHEAP. Some also used non-meal services at the meal site, at home, or in the 

community such as nutrition counseling, case management services, transportation services, and 

personal care services.

SNAP participation. More than one-quarter of congregate and home-delivered meal 

participants receive assistance to purchase food through SNAP. Congregate meal participants 

were more likely to participate in SNAP if they were younger; had completed less than high 

school; were not married; or were Hispanic, non-Hispanic black, or non-Hispanic other. The 

largest differences were between income groups. SNAP participation was highest in the West 

and Northeast and higher among congregate meal participants in urban areas. Many of the same 

factors were associated with SNAP participation among home-delivered meal participants, with 

the largest differences across age and income groups. 

Emergency food pantries. Receiving food from emergency food pantries was about half as 

common as participating in SNAP. About 17 percent of congregate meal participants and 14 

percent of home-delivered meal participants received food from food pantries in the past 30 

days. Many of the factors associated with participating in SNAP were associated with pantry use 

for congregate meal participants, including being younger; being female; completing less than 

high school; being divorced, separated, or never married; being Hispanic or non-Hispanic black 

(relative to non-Hispanic white); having less income; and living in an urban area. For homedelivered meal participants, the factors associated with SNAP participation generally were 

associated with receiving emergency food. 

47
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

Food assistance from soup kitchens. Receiving food from soup kitchens in the past 30 

days was less common than participating in SNAP or receiving food from emergency pantries, 

particularly for home-delivered meal participants. About 11 percent of congregate meal 

participants and 3 percent of home-delivered meal participants received food from soup kitchens 

in the past month. 

Emergency assistance from LIHEAP. LIHEAP offers financial assistance to low-income 

families, targeting older adults and other vulnerable populations, to help pay home heating and 

cooling bills. Ten percent of congregate meal participants and 13 percent of home-delivered meal 

participants received energy assistance such as LIHEAP.

Non-meal NSP services. Participants also used non-meal services at the meal site, at home, 

or in the community. About 15 percent of congregate meal participants and 19 percent of homedelivered meal participants used these types of nutrition and supportive services, including 

personal care services or home visits for physical, occupational, or speech therapy; case 

management services; and light housekeeping services or chore services. With few exceptions, 

congregate meal participants were less likely than home-delivered meal participants to receive 

these services. Using nutrition and supportive services was more likely among congregate meal 

participants who were female, non-Hispanic black, not employed, had less income, and lived in 

the Northeast. Among home-delivered meal participants, receiving nutrition and supportive 

services was more likely among participants who had completed high school, lived alone, and 

lived in the Northeast.

Summary. Considering the full set of food assistance, energy assistance, and other nutrition 

and supportive services together, participants were more likely to participate in these programs 

and receive these services if they were younger, had completed less than high school, were not 

married, and were poor. In most cases, the largest differences in program participation and 

service use were by age and income. Although there were several exceptions, for most programs 

and services, participation was associated with living in an urban area and being female. For 

SNAP and emergency pantry participation—the two programs with the highest participation 

rates—participation was greater among Hispanic participants than non-Hispanic participants. 

Many of these factors were the same as those associated with higher levels of need. In 

particular, participants who were younger, had less income, were not married, and lived in an 

urban area were more likely (1) to experience food hardships and challenges making ends meet 

and (2) to participate in SNAP, receive emergency food or energy assistance, or use other 

nutrition and supportive services. Thus, participants with the greatest need were the most likely 

to participate in food assistance programs and receive non-meal services. 

D. Implications for policy and future research 

Less than one-quarter of participants reported experiencing challenges making ends meet, 

faced food hardships, or were food insecure; however, specific groups of participants 

disproportionately experienced these challenges and were unable to fully meet their food needs. 

By characterizing these types of participants, AoA and state and local agencies can identify the 

types of participants the program could target to provide additional or more intensive services 

that help mitigate these challenges. In particular, based on the findings in this report, agencies 

can target additional program services to participants who are younger, have less income, are not 

48
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

married, and live in an urban area. AoA can take a number of steps to learn more about how to 

meet participants’ needs. Below, we have separated these into steps related to learning more 

about program participation patterns and use of community programs and non-meal NSP 

services. 

Program participation patterns. AoA can assess the number of meals that congregate and 

home-delivered meal participants with high levels of need are receiving. Congregate meal 

participants decide how many times per week to visit and eat at the meal site, but many sites 

have a set number of days in which they operate. Thus, for congregate meal participants, 

understanding the factors that determine an agency’s number of operating days can help identify 

ways of increasing availability of meals to participants who need them. For sites that already 

offer meals many days per week, understanding why participants who face food hardships or 

experience challenges making ends meet do not participate more each week can help identify 

ways of increasing participation further. 

The findings from the second objective of this report can help AoA understand participation 

patterns and, specifically, whether participants with the greatest need are participating often and 

intensively enough. Congregate meal participants who were Hispanic, were poor, were not 

married, completed less than high school, were not employed, lived in urban areas, and lived in 

the West were more likely to receive meals more often and to visit multiple sites. AoA could 

learn more about the groups that participated relatively less or did not visit multiple meal sites 

(such as participants with more income and those who have completed high school) to learn 

whether lower levels of participation reflect lower levels of need or if they reflect barriers to 

participation. For example, participants who had less income, were not married, and lived in 

urban areas reported experiencing greater challenges, food hardships, and food security, and 

were also more likely to participate frequently and visit multiple sites. However, although 

younger participants reported experiencing more challenges and food hardships, they 

participated less often than older participants, which might reflect a barrier to participation. 

Similarly, for home-delivered meal participants, fewer connections existed between need, 

hardships, and frequency of use. 

For these reasons, AoA could obtain more information from participants about whether they 

would like to participate more but cannot due to limited availability of meals or program 

services. For congregate meal participants, understanding reasons for visiting multiple meal sites 

is also important. Participants may visit multiple sites because their main meal site operates only 

a few days each week or because the agencies that provide the other services they obtain in the 

community are co-located with other meal sites. 

This report examined for the first time the rates of continued participation in the NSP over 

the course of a year. The rate of continued participation in the NSP over a 12-month period was 

high (94 percent of congregate meal participants), but the rate of participation in every month of 

the following year was lower (71 percent). For home-delivered meal participants, these 

percentages were 85 and 65 percent, respectively. AoA could assess whether participants who 

want to continue receiving program meals can do so or whether participants face barriers to 

continued participation. For example, among the 29 percent of congregate meal participants who 

did not participate each month during the year, what percentage continued to experience 

challenges meeting their food needs but could not participate because of transportation barriers 

49
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

getting to the meal site? What percentage chose not to visit meal sites in inclement weather due 

to fear of falling? What percentage could not participate because the meal site was not 

operational for part of the year or because of changes in volume or wait list policies? Knowing 

more about why participants change their frequency and intensity of participation over the course 

of the year can provide AoA with additional information about how participants use the program 

to help meet their needs. 

Use of community programs and non-meal NSP services. Helping participants overcome 

challenges making ends meet and fulfilling their food needs is also possible by increasing access 

to existing food assistance programs at the national level such as SNAP or at the local level such 

as those programs providing emergency food. It is also possible by increasing access to non-meal 

nutrition and supportive services at NSP meal sites. 

Participation in SNAP is generally low, particularly given the high level of need among 

many of the NSP participants. Among congregate meal participants, the SNAP participation rate 

was 27 percent among all participants and 63 percent among those who were poor. (The 

analogous percentages for home-delivered meal participants were 30 and 50 percent, 

respectively.) Thus, even among participants who were poor and who were likely incomeeligible for SNAP, 27 to 50 percent of older adults were not participating in SNAP. AoA could 

learn more about whether this reflects older adults’ lack of knowledge about the program or their 

potential eligibility, a sense of social stigma, an inability to cook meals at home, or a perceived 

inconvenience from participating in the program (for example, that receiving program benefits 

do not outweigh requirements associated with participating in the program in terms of 

recertifications and reporting changes in one’s circumstances). The same line of inquiry is 

appropriate when asking participants about receiving food from emergency pantries, kitchens, or 

shelters. 

The geographic differences in participation in LIHEAP were sizable. However, even in the 

Northeast, only 25 percent of participants received heating and cooling services through the 

program. Even among the program’s target population of low-income people, the participation 

rate was only 19 percent (for participants in all regions). Thus, as for SNAP and other food 

assistance programs, AoA could learn more about whether lower take-up rates reflect a lack of 

awareness about the program or its requirements. Learning how meal sites promote access to the 

program during warm and cold seasons would also be useful. 

Finally, low percentages of participants reported receiving non-meal services at the meal 

site, at home, or in the community, such as home visits for physical, occupational, or speech 

therapy; case management services; and light housekeeping services or chore services (15 

percent for congregate meal participants and 19 percent for home-delivered meal participants). 

Learning more about the variation in receiving these services can help AoA understand whether 

participants who need the services are adequately receiving them. In particular, AoA could 

assess whether the large geographic difference in receiving services between the Northeast and 

other regions reflects differences in agencies’ provision of services or in participants’ use of 

services. 

50
VI. CONCLUSION MATHEMATICA POLICY RESEARCH

Implications for future research. The findings of this descriptive study suggest several 

substantive research directions, which include the following: 

1. Examine the reasons why home-delivered meal participants in rural areas were much more 

likely than those in urban areas to face trade-offs between purchasing food and meeting 

other basic needs, whereas congregate meal participants experienced more trade-offs in 

urban areas.

2. Assess the determinants of geographic differences in challenges, food hardships, and food 

insecurity between participants living in the West and the Northeast. Do these differences 

reflect geographic variation in the cost of providing a program meal or the prices that 

participants pay for food where they live? 

3. Examine why NSP participants who were older were less likely to be food insecure than 

those who were younger. Does this reflect differences in education, living arrangements 

(living alone versus with others), the ability to cook meals at home, or income? 

4. Examine differences in food insecurity among older adults by ethnicity. Why did Hispanic 

participants have such different food insecurity rates from those who are non-Hispanic? 

5. Identify why some congregate meal participants visit multiple meal sites, especially among 

high-need participants.

6. Describe the characteristics of participants with greater needs who participated less 

frequently than those with lower levels of needs. 

7. Assess whether the rate of retention in the NSP among home-delivered meal participants 

was lower than the rate among congregate meal participants due to having poorer health. 

8. Identify the factors associated with SNAP participation among those who were incomeeligible. 

9. Examine the association between SNAP and food security. In particular, were NSP 

participants who did not receive SNAP benefits more likely to be food secure after 

accounting for income? 

10. Identify the reasons why some NSP participants participated less often, or not at all, 

approximately one year later. 

11. Examine the reasons behind large geographic differences in nutrition and supportive 

services at NSP meal sites. 

Answering these questions will enable AoA and state and local agencies to target more 

precisely the populations the NSP serves, identify groups of people who require more intensive 

services that help mitigate food hardships and other challenges, and increase retention in the 

program among older adults who are in greatest need of assistance. 

51
This page has been left blank for double-sided copying.
MATHEMATICA POLICY RESEARCH

53

REFERENCES

Administration for Community Living. “Administration for Community Living Operating Plan 

for FY 2015.” Washington, DC: U.S. Department of Health and Human Services, 

Administration for Community Living, 2017. Available at https://www.acl.gov/aboutacl/budget. Accessed December 6, 2017. 

Administration for Community Living. “Aging Integrated Database.” Washington, DC: U.S. 

Department of Health and Human Services, Administration for Community Living, 2018. 

Available at https://agid.acl.gov/CustomTables/. Accessed September 21, 2018. 

Bickel, G., M. Nord, C. Price, W.L. Hamilton, and J.T. Cook. “Guide to Measuring Household 

Food Security (Revised 2000).” Alexandria, VA: U.S. Department of Agriculture, Food and 

Nutrition Service, 2000. Available at http://www.fns.usda.gov/guide-measuring-householdfood-security-revised-2000. Accessed November 1, 2016. 

Coleman-Jensen, Alisha, Matthew P. Rabbitt, Christian Gregory, and Anita Singh. “Household 

Food Security in the United States in 2016.” Economic Research Report No. 237. 

Washington, DC: U.S. Department of Agriculture, Economic Research Service, September 

2017. Available at https://www.ers.usda.gov/webdocs/publications/84973/err237.pdf?v=42979. Accessed May 15, 2018. 

Institute of Medicine. “Dietary Reference Intakes: The Essential Guide to Nutrient 

Requirements.” Washington, DC: National Academies Press, 2006. Available at 

https://www.nal.usda.gov/sites/default/files/fnic_uploads//DRIEssentialGuideNutReq.pdf. 

Accessed November 1, 2016. 

Mabli, James, Nicholas Redel, Rhoda Cohen, Erin Panzarella, Mindy Hu, and Barbara Carlson. 

“Process Evaluation of Older Americans Act Title III-C Nutrition Services Program.” 

Washington, DC: U.S. Department of Health and Human Services, Administration for 

Community Living, September 30, 2015. Available at https://www.mathematicampr.com/download-media?MediaItemId={D5791C01-B219-4884-8715-DB7BF055FD15}. 

Accessed October 15, 2016.

Mabli, James, Elizabeth Gearan, Rhoda Cohen, Katherine Niland, Nicholas Redel, Erin 

Panzarella, and Barbara Carlson. “Evaluation of the Effect of the Older Americans Act Title 

III-C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet 

Quality.” Washington, DC: U.S. Department of Health and Human Services, Administration 

for Community Living, April 21, 2017. Available at https://www.mathematicampr.com/our-publications-and-findings/publications/evaluation-of-the-effect-of-the-olderamericans-act-title-iii-c-nutrition-services-program. Accessed January 23, 2018. 

Mabli, James, Arkadipta Ghosh, Bob Schmitz, Marisa Shenk, Erin Panzarella, Barbara Carlson, 

and Mark Flick. “Evaluation of the Effect of the Older Americans Act Title III-C Nutrition 

Services Program on Participants’ Health Care Utilization—Draft Report.” Washington, 

DC: U.S. Department of Health and Human Services, Administration for Community 

Living, February 1, 2018. 
REFERENCES MATHEMATICA POLICY RESEARCH

54

U.S. Department of Health and Human Services, and U.S. Department of Agriculture. “Dietary 

Guidelines for Americans 2015–2020 (8th Edition).” December 2015. Available at 

http://health.gov/dietaryguidelines/2015/guidelines. Accessed December 6, 2016. 

Ziegler, Jessica, Nicholas Redel, Linda Rosenberg, and Barbara Carlson. “Older Americans Act 

Nutrition Programs Evaluation: Meal Cost Analysis.” Washington, DC: U.S. Department of 

Health and Human Services, Administration for Community Living, September 30, 2015. 
This page has been left blank for double-sided copying.
www.mathematica-mpr.com 

Improving public well-being by conducting high quality, 

objective research and data collection

PRINCETON, NJ ■ ANN ARBOR, MI ■ CAMBRIDGE, MA ■ CHICAGO, IL ■ OAKLAND, CA ■ 

SEATTLE, WA ■ TUCSON, AZ ■ WASHINGTON, DC ■ WOODLAWN, MD

Mathematica® is a registered trademark 

of Mathematica Policy Research, Inc.