1

IssueBRIEF

Purpose

The purpose of this issue brief 

is to examine the types of 

congregate meal sites that 

offer social activities and 

whether the effect of 

congregate meal participation 

on socialization outcomes 

differs for participants who 

attend meal sites that offer 

social activities and those who 

attend meal sites that do not 

offer these activities.

January 2019

MATHEMATICA-MPR.COM

By James Mabli and Marisa Shenk, Mathematica Policy Research

Older Americans Act Title III-C Nutrition 

Services Program: 

An Examination of Social Activities at 

Congregate Meal Sites and Their Role 

in Improving Socialization Outcomes 

of Participants 

BACKGROUND

Good health is determined not only by nutrition, physical activity, and access to quality health services, 

but by the circumstances in which people are born, live, work, and age (World Health Organization 

2008). These social determinants of health include access to food, housing, and transportation; 

quality of education and employment opportunities; and a diverse set of socioeconomic and cultural 

conditions (U.S. Department of Health and Human Services [DHHS] 2018). They also include 

opportunities both for socialization in the form of social support from family, friends, and community 

members and for recreational and leisure-time activities (DHHS 2018). 

Socialization is a determinant of health and quality of life for people of all ages, but is especially 

important for older adults who are more likely to experience isolation. Many people spend the 

majority of their lives interacting with others—at school, in the workplace, at home with family 

or while raising children, and in their communities. As people age, they experience life changes 

that often decrease the opportunities for socialization. This might include children moving out 

of the house, adults retiring from work, and loved ones dying. For many older adults, health and 

mobility impairments also limit the extent to which they can move about the community, which 

can lead to social isolation. This can negatively impact older adults’ health and well-being and has 

been identified as a critical public health risk (Chatters et al. 2018; Linenberg 2016). 

Research has shown that social integration and increased opportunities for socialization can delay 

memory loss among older adults (Ertel et al. 2008); reduce the risk of obesity, hypertension, and 

metabolic dysregulation (Yang et al. 2013; Cheng et al. 2014; Sneed and Cohen 2014); and lower 

mortality (Holt-Lunstad et al. 2015; Barger 2013). Greater social integration among older adults 

has also been associated with savings of approximately $7 billion annually in federal spending on 

Medicare (Shaw et al. 2017). Because of the increased risk of social isolation among older adults 

and the associated health risks, it is important to evaluate the effects of programs that seek to 

increase socialization opportunities among older adults.

One purpose of the Older Americans Act (OAA) Title III-C Nutrition Services Program (NSP)—

administered by the Administration on Aging (AoA) within the Administration for Community 

Living of the U.S. Department of Health and Human Services—is to promote socialization of 

older adults. The program also strives to reduce hunger and food insecurity and promote health and 

well-being by providing congregate and home-delivered meals, nutrition education, nutrition-risk 

screening, and nutrition counseling to older adults. Meals and other services provided in congregate 

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

TUCSON, AZ - WASHINGTON, DC - WOODLAWN, MD
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1 The study team also examined the 

sensitivity of the findings to two 

alternative measures, one in which 

at least 75 percent of sites offered 

social activities and another in which 

at least 50 percent of sites offered 

social activities. 

sites are located in a variety of settings, including 

senior centers, senior cafes, schools, churches, 

farmers markets, and other community settings. 

In addition, the NSP provides home-delivered 

meals and services to homebound older adults. 

The most recent evaluation of the effectiveness 

of the NSP in achieving the program’s 

socialization purpose showed that congregate 

meal participants had greater socialization 

outcomes compared to similar nonparticipants 

(Mabli et al. 2017). Participants had greater 

satisfaction with their socialization opportunities 

than nonparticipants. The percentage of 

individuals who were very satisfied with their 

socialization opportunities was 12 percentage 

points greater for congregate meal participants 

than for nonparticipants (68 versus 56 percent). 

The higher level of satisfaction with socialization 

opportunities among congregate participants 

may be due to the routine contact they have with 

other older adults participating in the program 

and with staff and volunteers at meal sites. It 

may also be due to structured social activities 

offered by some congregate local service 

providers (LSPs) that operate the meal sites.

This issue brief examines the types of local 

agencies that offer social activities. It also assesses 

whether participants who attend congregate 

meal sites that offer social activities have more 

favorable socialization outcomes than participants 

who attend sites that do not offer these activities. 

Finally, it identifies whether the effect of 

congregate meal participation on socialization 

outcomes differs for participants who attend meal 

sites that offer social activities and those who 

attend meal sites that do not offer these activities. 

These findings can help organizations in the 

National Aging Network, an informal network 

of home- and community-based care providers, 

understand how LSPs providing congregate 

meals invest in and offer social activities and 

whether these activities affect the impact of the 

NSP on participants’ outcomes.

METHODS

The data used in the analysis were collected as 

part of the Title III-C NSP Evaluation, which 

Mathematica Policy Research conducted for 

AoA. The evaluation consisted of a process 

evaluation of program administration and service 

delivery (Mabli et al. 2015); an analysis of the 

cost of providing a meal (Ziegler et al. 2015); 

and an evaluation of the effect of the program on 

participants’ outcomes, including food security, 

socialization, and diet quality (Mabli et al. 2017). 

To estimate the effect of receiving a congregate 

or home-delivered meal on these outcomes, the 

study team compared outcomes for participants 

and a matched comparison group of programeligible nonparticipants using data collected 

in surveys conducted in 2015 and 2016. The 

purpose of the matched comparison group of 

eligible nonparticipants was to represent what 

would happen to participants in the absence of 

the program. The study team selected comparison 

group members whose health care utilization 

profiles two years before the survey were similar 

to those for participants and who were living in 

the same local geographic area as participants. 

The study team also used statistical methods 

to control for any remaining differences in the 

characteristics of participants and their respective 

group of nonparticipants that could affect both 

outcomes and program participation decisions.

The analysis of the types of local agencies that 

offer social activities was based solely on LSP 

data from the process evaluation. The process 

evaluation consisted of data from a census of 

56 State Units on Aging, a sample of 333 Area 

Agencies on Aging (AAAs) making up over half 

of the AAAs in the country, and a sample of 199 

LSPs from the sampled and participating AAAs. 

The LSP survey consisted of two parts: a web 

survey and an editable PDF form. The web survey 

contained the majority of the questions, most of 

which respondents could likely answer without 

referring to other data sources. The editable 

PDF form contained a much smaller number of 

questions that would likely require respondents 

to look up the data from sources such as financial 

reports on staff hours or program expenditures. 

Information on LSP characteristics came from 

the LSP web survey. The following measures of 

the ways in which LSPs provided social activities 

were constructed using information from both 

the web survey and the editable PDF form: 

• An indicator of whether the LSP offered 

social activities (through a grant or contract 

with the AAA) 

• An indicator of whether all of the congregate 

meal sites operated by an LSP offered social 

activities1

• An indicator of whether the LSP offered at least 

25 hours of social activities at the congregate 

meal sites it operated in a typical week
3

The survey did not collect information on the 

specific types of activities offered, but typical 

activities might include exercise classes, games, 

arts and crafts, cooking classes, discussion 

groups, and off-site trips. The intent of the 

survey was to collect information about the 

socialization that occurs as part of these 

structured activities and not simply the 

socialization that takes place in congregate sites 

when participants eat meals with one another.

Regression analysis was used to examine the 

association between the ways in which LSPs 

provided social activities and LSP characteristics. 

Differences by LSP characteristics were tested 

for statistical significance at the 0.10 level.

The analyses that assess how the outcomes of 

congregate meal participants differ by the ways 

in which LSPs provide social activities used 

data from two sources: the process evaluation 

on LSPs’ social activities and the outcomes 

evaluation on participants’ satisfaction with 

socialization opportunities. The main outcome 

measure was constructed based on a single 

question measuring individuals’ self-reported 

satisfaction with their opportunities to spend 

time with other people. The variable indicates 

whether a respondent was very satisfied 

(compared with somewhat satisfied, not too 

satisfied, and not at all satisfied). The findings 

were robust to using an alternative measure of 

whether a respondent was either very satisfied 

or somewhat satisfied (compared with not too 

satisfied or not at all satisfied).

Regression analysis served two purposes. The 

first was to examine the association between 

participants’ satisfaction with socialization 

opportunities and the ways in which LSPs 

provided social activities. The second was 

to estimate how the effect of congregate 

meal participation on satisfaction differs for 

participants who attend meal sites that offer 

social activities and those who attend meal sites 

that do not offer these activities.

FINDINGS

Incidence of LSPs that provided 

social activities

About 65 percent of LSPs reported providing 

social activities (Figure 1). The majority (60 

percent) of LSPs operated one congregate site; 

another 23 percent administered two to five sites; 

and 17 percent administered more than five sites. 

Most LSPs (83 percent) offered social activities 

at all of the congregate meal sites they operate 

(Figure 1). Nearly all (95 percent) LSPs offered 

activities in at least half of their sites. Finally, just 

over half of LSPs (52 percent) offered at least 25 

hours of social activities at their congregate meal 

sites in a typical week (Figure 1). 

Characteristics associated with LSPs 

that provided social activities

Several characteristics were associated with 

LSPs that offered social activities. Although 

all LSPs offered lunch, about 11 percent also 

offered breakfast and 11 percent also offered 

dinner (Mabli et al. 2017). The percentage of 

LSPs that offered social activities was markedly 

FIGURE 1:

Percentage of LSPs providing social activities

Source: AoA LSP survey, 2014, weighted data. 
4

less among LSPs that offered breakfast than 

among those that did not (37 versus 74 percent) 

(Figure 2). In contrast, there was no statistical 

differences in the percentage that offered social 

activities according to whether the LSP offered 

dinner (66 versus 84 percent) (not shown). 

Although only 6 percent of LSPs are faith-based 

organizations (Mabli et al. 2017), offering social 

activities was much more likely among these 

organizations than others (98 versus 67 percent). 

However, the following LSP characteristics—

private nonprofit organization versus public 

entity and being a standalone organization 

versus being part of another organization—

were not associated with the LSP offering these 

activities (not shown).

LSPs provided a variety of nutrition and nonnutrition services, including nutrition education 

(77 percent of LSPs), nutrition counseling (28 

percent), transportation services (76 percent), 

and case management (53 percent) (Mabli et 

al. 2015). LSPs that provided these services 

were much more likely than those that did not 

provide such services to offer social activities 

(Figure 3). The percentage of LSPs that offered 

social activities was 29 percentage points greater 

for those that provided nutrition education 

compared to those that did not (73 versus 

44 percent). There were also large differences 

depending on whether the LSP provided 

nutrition counseling (81 versus 62 percent), 

transportation (76 versus 59 percent), and case 

management (76 versus 63 percent).

FIGURE 2:

Percentage of LSPs providing social activities, by whether LSP offered breakfast or was 

a faith-based organization

Source: AoA LSP survey, 2014, weighted data. 

* Difference statistically significant at the 0.10 level, two-tailed test.

FIGURE 3:

Percentage of LSPs providing social activities, by other services provided

Source: AoA LSP survey, 2014, weighted data. 

* Difference statistically significant at the 0.10 level, two-tailed test.
5

2

 Donated congregate meal sites have 

their facilities costs covered by other 

entities. For example, a community 

center or city housing facility that 

is financed through public taxation 

may allow a LSP to serve meals at its 

site for free. 

Although several LSP characteristics were 

associated with offering social activities, most 

characteristics were not associated with offering 

activities at all of the LSP-operated congregate 

meal sites or with the number of hours of 

activities in a typical week. LSPs located in the 

South were much more likely than those in the 

West to offer social activities at all of the sites 

they operated (87 versus 61 percent; Figure 4); 

however, differences in the percentages for LSPs 

located in the Northeast or the Midwest were 

not statistically significant (63 and 70 percent, 

respectively). Similarly, the only characteristic 

that was associated with the number of hours 

of activities provided was whether LSPs 

owned, rented, or used donated meal sites.2

 The 

percentage of LSPs that provided at least 25 

hours of social activities was larger for LSPs that 

rented, but did not own, meal sites (55 percent; 

Figure 5) and for LSPs that owned, but did not 

rent, meal sites (59 percent), compared with LSPs 

that used only donated meal sites (26 percent).

Other LSP characteristics were not associated 

with offering social activities, offering activities 

at all of the LSP-operated congregate meal 

sites, or the number of hours of activities in 

a typical week. These characteristics include 

offering meals on the weekend; providing 

nutrition screening services; having a Medicaid 

waiver that allows Medicaid funds to help pay 

for the costs of providing services to Medicaid 

participants; serving participants in an urban, 

suburban, or rural area or having service areas 

in a single city, multiple cities, or counties; 

offering home-delivered meals; the number of 

FIGURE 4:

Percentage of LSPs providing social activities at all congregate meal sites, by region

Source: AoA LSP survey, 2014, weighted data. 

* Difference from percentage for LSPs in the West statistically significant at the 0.10 level, two-tailed test.

FIGURE 5:

Percentage of LSPs providing social activities for at least 25 hours in a typical week, by 

type of facilities used

Source: AoA LSP survey, 2014, weighted data. 

* Difference from percentage for LSPs that use donated sites statistically significant at the 0.10 level, two-tailed test.
6

congregate meal sites operated; the number of 

years the LSP has provided congregate meals; 

using an electronic system for menu planning 

and analysis, tracking or ordering food, client 

tracking or referrals, or accounting; and the 

amount of monetary contributions per meal that 

LSPs request of participants.

Outcomes of participants who attended 

meal sites that offer social activities

Participants who attended congregate meal sites 

that offered social activities reported higher levels 

of satisfaction with socialization opportunities 

than participants who attended sites that did not 

offer these activities. The percentage of participants 

who were very satisfied with their opportunities 

for socialization was greater at sites that offered 

social activities than at sites that did not (71 versus 

59 percent; Figure 6). There were no significant 

differences between participants’ satisfaction with 

socialization opportunities and (1) the number of 

hours of activities the LSP provided in a typical 

week or (2) attending a meal site operated by an 

LSP that offered activities at all of its sites.

The impact of program participation 

on socialization outcomes

Congregate meal participants who attended 

meal sites that offered social activities had 

more positive socialization outcomes than 

nonparticipants. In contrast, the outcomes of 

participants who attended meal sites that did 

not offer social activities were statistically similar 

to those for nonparticipants. 

Compared with nonparticipants, congregate 

meal participants who attended meal sites that 

offered social activities had greater satisfaction 

with their opportunities to spend time with 

other people. The percentage of individuals 

who were very satisfied with their socialization 

opportunities was 16 percentage points higher 

for congregate meal participants than for 

nonparticipants (71 versus 55 percent; Table 

1). This was not the case for congregate meal 

participants who attended meal sites that did not 

offer social activities, for which the percentage of 

participants and nonparticipants who were very 

satisfied with their socialization opportunities 

was nearly equal (59 versus 58 percent).

Based on two additional measures of the ways 

in which LSPs provided social activities—

offering activities at all of the LSP-operated 

congregate meal sites and the number of 

hours of activities offered in a typical week—

congregate meal participants who attended 

meal sites that offered activities generally had 

more positive socialization outcomes than 

nonparticipants, whereas the outcomes of 

participants who attended meal sites that did 

FIGURE 6:

Percentage of participants very satisfied with socialization opportunities, by their 

attendance at site that offers social activities

Source: AoA NSP outcomes survey, 2015–2016, and LSP survey, 2014, weighted data. 

* Difference between participants who attended a site that provides social activities and who attended 

a site that does not provide activities was statistically significant at 0.10 level, two-tailed test.
7

TABLE 1:

Percentage of older adults very satisfied with socialization opportunities, 

by affiliation with a meal site that offers social activities

Affiliated with meal a site that offers 

social activities

Affiliated with a meal site that does 

not offer social activities

Measure Participants Nonparticipants Difference Participants Nonparticipants Difference

LSP provides social 

activities 71 55 16***, † 59 58 1

LSP provides social 

activities at all meal sites 68 54 14*** 65 60 5

LSP provides at least 25 

hours of social activities 

in typical week

70 55 15*** 65 57 8

Source: AoA NSP outcomes survey, 2015–2016, and LSP survey, 2014, weighted data. 

***Significantly different from zero at the .01 level, two-tailed test.

† Difference between the effect of congregate meal participation on satisfaction between older adults affiliated with a meal site that offers 

socialization activities and older adults not affiliated with such a meal site significantly different from zero at the 0.10 level.

not offer activities were statistically similar to 

those for nonparticipants. Congregate meal 

participants who attended meal sites operated 

by LSPs that offered activities at all of their 

sites had higher levels of satisfaction with their 

socialization opportunities than nonparticipants. 

Similarly, congregate meal participants who 

attended meal sites operated by LSPs that 

offered at least 25 hours of social activities in a 

typical week also had higher levels of satisfaction 

with their socialization opportunities than 

nonparticipants. The percentage of individuals 

who were very satisfied with their socialization 

opportunities was 14 and 15 percentage 

points higher, respectively, for congregate meal 

participants than for nonparticipants (Table 1). 

There were no differences in the satisfaction 

of nonparticipants and participants who either 

attended sites operated by LSPs that did not 

offer activities at all of its sites or did not offer at 

least 25 hours of activities per week. 

DISCUSSION

Promoting the socialization of older adults is a 

central objective of the NSP, yet little is known 

about the types of LSPs that provide social 

activities. The findings in this brief offer useful 

information about the extent to which LSPs 

provide these activities and, for those that do, 

the prevalence of activities across meal sites and 

the hours of activities provided in a typical week. 

The findings also identify the types of LSPs that 

provide these activities. 

LSPs that offered breakfast were much less 

likely to offer social activities. These LSPs might 

have faced constraints related to the availability 

of facilities, resources, or staff that required 

them to choose between offering breakfast and 

providing other services; however, the data were 

not specific enough to confirm this hypothesis. 

Learning more about these trade-offs can help 

AoA ensure that providers interested in offering 

both additional meals and social activities 

can do so. Additionally, learning more about 

whether the social activities offered by LSPs that 

provided breakfast took place immediately after 

the meal or later in the day can help providers 

plan activities that mitigate transportation 

challenges participants experience traveling to 

and from the meal site.

Offering non-meal services, including nutrition 

education, nutrition counseling, transportation 

services, and case management, was associated 

with offering social activities. Group-based 

activities are an important component of 

nutrition education and counseling, as this 

information is usually shared in classes at 

the meal site. Although case management 

activities typically consist of one-on-one 
8

meetings between clients and staff, some of 

these activities might be group based such as 

orientations to site services and workshops on 

financial preparedness, stress management, and 

self-care that promote overall wellness. Finally, 

in addition to bringing clients to sites for meals, 

transportation services help clients attend 

program activities and services. Learning more 

about how LSPs integrate social activities into 

the diverse set of non-meal nutrition service 

offerings can further providers’ understanding 

of how best to allocate scarce program resources 

while providing services that best meet their 

clients’ needs.

The associations between LSP characteristics 

and other measures of socialization (offering 

activities at all of an LSP’s meal sites and the 

number of hours of activities offered in a typical 

week) were sparse, indicating the need for more 

research on why some LSPs offer social activities 

at only some—rather than all—of their sites, and 

why some LSPs offer more hours of activities 

than others. The two characteristics that were 

associated with these measures suggest that LSP 

resources may play a role. LSPs in the South 

were more likely than LSPs in other regions 

to offer social activities at all meal sites, which 

may reflect their lower costs of providing a 

meal ($9.14 per meal versus $10.97 to $12.13 

per meal in other regions); their lower facilities 

costs ($0.39 per meal versus $0.44 to $1.83 per 

meal in other regions); or their reported value 

of the salary that staff would receive if the work 

were paid rather than voluntary ($0.16 per 

meal versus $0.98 to $1.29 per meal in other 

regions) (Ziegler et al. 2015). Similarly, the fact 

that sites that rented or owned their meal sites 

were more likely to offer more hours of social 

activities than those with donated sites may 

reflect availability of resources that enables LSPs 

to pay for both facilities and additional hours of 

providing social activities. It also may reflect that 

LSPs with donated sites have limited access to 

their facilities’ meeting spaces, resulting in less 

flexibility in scheduling social activities. 

In addition to identifying the types of LSPs 

that offer social activities, the findings in this 

brief also show that participants’ socialization 

outcomes are more favorable at meal sites that 

offer these activities. Although not based on 

causal evidence—LSPs may be more likely to 

offer social activities in areas where there is a 

greater need for them—the findings suggest 

that the NSP is more effective in improving 

participants’ socialization outcomes at LSPs that 

offer these activities. 

Given the consistency of findings across several 

measures of LSPs providing social activities, 

these results highlight a need to learn more 

about the types of social activities offered at 

LSPs. Congregate meal programs offer a variety 

of activities, including those meant to promote 

fitness and active, healthy lifestyles via group 

activities such as exercise classes, dancing, and 

sightseeing tours; those meant to promote 

mental stimulation and creativity in groups such 

as bingo, arts and crafts, singing and playing 

music, painting, and cooking classes; and those 

simply meant to foster interaction with other 

people such as discussion groups, birthday 

parties, and drop-in game clubs. By collecting 

information from two key groups—LSPs, to 

learn more about the types of social activities 

they offer, and participants, to learn more about 

which activities they value most—the Aging 

Network can identify the specific types of social 

activities that are most effective in improving 

participants’ lives.

More information is also needed about the 

structure of social activities and the resources 

required to offer them across all meal sites. 

Learning about the following characteristics—

whether activities are coordinated by paid 

staff or volunteers, include transportation to 

and from the site, and are free or have a fee 

to participate—and assessing the degree of 

staff training in planning and directing social 

activities could help shape the effectiveness of 

the program activities and the efficiency with 

which they are provided.

More generally, the finding that participants’ 

socialization outcomes are more favorable 

at meal sites that offer these activities 

underscores the need to identify best practices 

in programming models for providing social 

activities among older adults. Collecting 

information about the development of the 

programming models, the types of services 

offered, and the attendant staffing and resource 

requirements—and sharing this information 

with the Aging Network and the LSPs—will 

help sustain and build upon the positive impacts 

found in the current evaluation. 
9

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