1

IssueBRIEF

Marisa Shenk and James Mabli, Mathematica

The Title III-C Nutrition Services Program: 

Understanding Participants’ Monetary 

Contributions

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. Participants who are homebound receive 

nutritious home-delivered meals, typically five days a week. Congregate meal sites and homedelivered meals are opportunities for participants to socialize with peers and program staff and 

receive other services such as nutrition education, screening, and counseling. 

The NSP is overseen by the Administration for Community Living (ACL) of the U.S. Department 

of Health and Human Services (HHS). ACL provides overall federal coordination, and the State 

Units on Aging (SUAs) and the Area Agencies on Aging (AAAs) both support key aspects of 

program operations. In turn, local service providers (LSPs) typically are responsible for direct 

nutrition services. Congregate meals and supportive services take place 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.

There is no financial means test for the NSP, but the program specifically targets older adults 

with the greatest economic or social need, with special attention given to those with low incomes, 

minorities, residents of rural areas, those with limited English proficiency, and those at risk of 

institutional care. Paying for meals is not mandatory, but at some meal sites, participants are 

encouraged to make a voluntary contribution toward the total cost of the meal. Participants are 

not denied meals or other services based on an inability or unwillingness to contribute.

LSPs offering meals and services often have limited resources and prioritize their services based 

on policies set by the SUA, AAA, or LSP (Mabli et al. 2015). LSPs may request contributions 

from participants to help meet the needs of current clients or to expand their reach to more older 

adults or to those with different needs. With demand for meals expected to rise as older adults 

make up an increasingly large share of the U.S. population, it is important to understand how 

LSPs find the resources to keep offering meals and services. 

This brief examines how widespread the practice of encouraging participants to make 

contributions is, and, for those LSPs who do encourage it, the amount of the suggested donation. 

It also describes the types of LSPs that are more likely to encourage participant contributions, the 

characteristics of participants served by those LSPs, and the characteristics of participants who 

make monetary contributions.

August 2020

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

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The data used in the analysis were collected 

as part of the Title III-C NSP Evaluation, 

which Mathematica conducted for ACL. This 

encompassed 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 

program’s effect on participants’ outcomes, including 

food security, socialization, and diet quality (Mabli 

et al. 2017). The process evaluation collected survey 

data from SUAs, AAAs, and LSPs on many topics, 

including policies on how participant contributions 

were collected, managed, and spent (Mabli et al. 

2015). The outcomes survey collected information 

from older adults on many topics as well, including 

their monetary contributions for program meals 

(Mabli et al. 2017). This brief uses data from 

both the process evaluation’s LSP survey and the 

evaluation’s outcome survey. 

METHODS

Descriptive analysis was used for all sets of 

analyses. The analysis of the types of LSPs with 

recommended amounts 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 AAAs 

making up over half of the AAAs in the country, 

and a sample of 199 LSPs from the sampled 

and participating AAAs. Limiting the sample 

to LSPs with nonmissing responses to the 

recommended contributions questions resulted 

in a sample of 180 LSPs serving congregate 

meals and 171 LSPs serving home-delivered 

meals. Data from the LSP survey and the 

outcomes survey were combined for the analysis 

of the populations served by agencies with 

recommended amounts. The original evaluation 

sample consisted of 596 congregate meal 

participants and 504 participants who received 

home-delivered meals. Limiting the sample to 

participants with matched LSP information 

resulted in 569 congregate meal participants and 

468 who received home-delivered meals. The 

analysis of participant characteristics was based 

solely on the outcomes survey. Limiting the 

sample to participants with nonmissing responses 

to the question on monetary contributions 

resulted in 511 congregate meal participants and 

389 who received home-delivered meals. 

FINDINGS

How many LSPs have a recommended 

contribution amount, and how much 

is it?

In 2015–2016, most LSPs (87 percent) 

recommended that participants contribute a 

certain amount of money to congregate meals 

(Table 1). Among those that did, the average 

recommended amount per meal was $2.68. 

Thirty percent of LSPs recommended $1.50 or 

less, and 20 percent recommended more than 

$3.50. A slightly lower percentage of LSPs (80 

percent) encouraged their home-delivered meal 

participants to contribute, though the average 

recommended amount was higher, at $2.95 per 

meal. For home-delivered meals, 22 percent of 

LSPs recommended $1.50 or less, and 28 percent 

recommended more than $3.50. 

TABLE 1: Participant contributions recommended by LSPs

Congregate meals Home-delivered meals

LSPs with a recommended contribution amount (%) 87 80

Amount of recommended contributions (%)

$0.01 to $1.50 30 22

$1.51 to $2.50 21 19

$2.51 to $3.50 29 31

$3.51 or more 20 28

Average ($) $2.68 $2.95

Sample size 180 171

Source: ACL LSP survey, 2014, weighted data. 
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TABLE 2: Recommended contributions and amounts for congregate meals, by LSP characteristic

Percentage of LSPs that had a 

recommended contribution (%)

Average recommended 

amount ($)

All LSPs serving congregate meals 87 2.68

LSP characteristic Yes No Difference Yes No Difference

Is a private organization 86 84 2 2.84 2.74 0.10

Is a faith-based organization 100 87 13*** 2.84 2.68 0.16

Is a stand-alone organization 83 92 -9 3.02 2.64 0.38

Offers breakfast 68 89 -21 2.66 2.87 -0.21

Offers dinner 88 87 2 3.54 2.77 0.77**

Offers weekend meals 84 88 -5 3.75 2.56 1.20***

Offers social activities 86 88 -1 3.00 2.08 0.91*

Offers nutrition screening 86 87 -1 2.38 3.01 -0.64

Offers nutrition education 87 87 0 2.74 2.38 0.36

Offers nutrition counseling 82 89 -6 3.13 2.48 0.65

Offers transportation 87 99 -13** 2.48 2.85 -0.37

Offers case management 90 88 2 2.14 3.11 -0.97

Offers health promotion activities 85 91 -6 2.71 2.58 0.13

Midwest 96 84 12** 3.19 2.51 0.67**

Northeast 92 86 6 2.31 2.77 -0.46

South 78 94 -16* 2.20 2.99 -0.79

West 93 86 7 3.45 2.53 0.93***

Sample size 180 158

Source: ACL LSP survey, 2014, weighted data.

***/**/* Significantly different from zero at the 0.01/0.05/0.10 level, two-tailed test.

Which types of LSPs are likely to have a 

recommended contribution, and how 

do contribution amounts vary?

Some types of LSPs were more likely to have 

a recommended contribution amount for 

congregate meals (Table 2). Every faith-based 

LSP, for example, recommended a certain 

amount, whereas 87 percent of non-faith–based 

LSPs did. Almost all LSPs in the Midwest had 

a recommended amount (96 percent), and fewer 

LSPs in other regions did, although more than 

four in five (84 percent) recommended an amount. 

LSPs offering transportation services were less 

likely to have a recommended amount than LSPs 

that did not offer them (87 versus 99 percent). 

Among LSPs with a recommended contribution 

amount, the average amount per meal varied 

depending on certain characteristics of the LSP. 

LSPs offering dinner or weekend meals, and those 

located in the Midwest or West, had higher average 

recommended amounts ($3.00 or more) than LSPs 

that were in other regions or that did not offer these 

meals. LSPs offering social activities also had a 

higher recommended amount compared with LSPs 

that did not offer them.

Some types of LSPs were also more likely to 

have a recommended contribution for homedelivered meals (Table 3). All LSPs that offered 

dinner had a recommended amount, and threequarters (74 percent) of those that did not offer 

dinner recommended a contribution. Regionally, 

those in the South were less likely (62 percent) 

to have a recommended amount than those in 

other regions (93 percent).

The average recommended amount per homedelivered meal also varied depending on certain 

characteristics of the LSP. LSPs had higher 

recommended amounts if they were faithbased or offered weekend meals and had lower 

amounts if they offered nutrition screening or 

case management (Table 3).
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1

 Supplemental Tables 1 and 2 

illuminate the characteristics of 

congregate and home-delivered 

meal participants overall and 

according to whether the LSP had 

any recommended contribution 

amount, or a high or low 

recommended amount.

What types of participants receive 

meals from the LSPs that recommend 

meal contributions?

Compared with the LSPs that did not have 

recommended monetary contributions for 

congregate meals, LSPs that did have them 

served participants who were more likely to 

be female, be older than 74, be non-Hispanic 

White, have higher income, live with others, 

have limited geographic access to food 

(measured by not having access to a supermarket 

close to home), live in the Midwest or 

Northeast, be food secure, and be satisfied with 

their opportunities to socialize (Supplemental 

Table 1). Among those LSPs that recommended 

contributions, those with higher amounts were 

more likely to serve participants who were 

older, non-Hispanic Whites, and living in the 

Midwest or West.1

A similar comparison of the characteristics of 

home-delivered meal participants revealed that 

LSPs with recommended meal contributions 

served participants who were more likely to 

not have completed high school, be nonHispanic White or Hispanic, have higher 

income, live alone, have limited access to food, 

live in the Midwest, be food insecure, and be 

unsatisfied with their opportunities to socialize 

(Supplemental Table 2). LSPs with higher 

recommended amounts for home-delivered 

meals were more likely to serve participants 

who were female, older, had higher levels 

of education, non-Hispanic Black or nonHispanic White, have higher income, live alone, 

live in the Midwest but not the South, be food 

secure, and be satisfied with their opportunities 

to socialize.

TABLE 3: Recommended contribution amounts for home-delivered meals, by LSP characteristic

Percentage of LSPs that had

a recommended amount (%)

Average recommended

amount ($)

All LSPs serving home-delivered meals 80 2.95 

LSP characteristic Yes No Difference Yes No Difference

Is a private organization 87 66 21 3.23 3.07 0.15

Is a faith-based organization 92 79 13 3.77 2.89 0.88**

Is a stand-alone organization 83 80 4 3.16 3.21 -0.05

Offers breakfast 73 77 -4 2.69 3.06 -0.37

Offers dinner 100 74 26*** 3.52 2.97 0.55

Offers weekend meals 93 77 16* 3.58 2.71 0.87**

Offers social activities 81 82 -1 3.11 2.78 0.34

Offers nutrition screening 80 83 -3 2.52 3.51 -1.00**

Offers nutrition education 84 76 7 2.88 3.24 -0.36

Offers nutrition counseling 74 85 -11 2.98 2.97 0.01

Offers transportation 79 76 3 2.72 2.92 -0.20

Offers case management 81 76 5 2.16 3.40 -1.24**

Offers health promotion activities 81 83 -2 2.80 3.25 -0.45

Midwest 96 75 21*** 3.37 2.78 0.59

Northeast 92 78 14* 3.05 2.94 0.11

South 62 93 -31*** 2.31 3.28 -0.98*

West 91 77 14* 3.31 2.84 0.47

Sample size 171 140

Source: ACL LSP survey, 2014, weighted data. 

***/**/* Significantly different from zero at the 0.01/0.05/0.10 level, two-tailed test.
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Which types of participants are likely

to contribute to program meals?

Eighty percent of congregate meal participants 

said they contributed to the NSP for meals they 

consumed (Table 4). Participants were more 

likely to contribute if they lived in a rural area 

(93 percent, in contrast with 76 percent of urban 

participants), lived in the Northeast (92 percent, 

versus 67 percent of participants in the West), 

were non-Hispanic Whites (89 percent, versus 

56 percent of Hispanic participants of any race), 

had at least a high school education (84 percent 

versus 68 percent of participants who did not 

complete high school), or were food secure (84 

versus 62 percent of food-insecure participants). 

Participants with higher incomes were also more 

likely to contribute than those with lower incomes 

(86 percent versus 75 percent) and those who lived 

alone were more likely to contribute than those 

who lived with others (84 versus 76 percent). 

More than half (58 percent) of the participants 

who received home-delivered meals said 

they contributed to the NSP for meals they 

consumed. Contributions were more likely among 

participants who had completed high school (67 

percent, compared with 47 percent of participants 

who had not completed high school) or were 

food secure (65 percent versus 32 percent of 

food-insecure participants). Participants age 74 or 

younger were less likely to contribute (47 percent, 

versus 69 percent of participants age 85 and older). 

TABLE 4: Percentage of meal program participants who reported making a contribution, 

by participant characteristics

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Total 80 58

Age

74 and younger 74 47**

75 to 84 85 53

85 and older 88 69

Gender

Male 73 57

Female 84 59

Military service

Veteran 85 53

Non-veteran 80 59

Highest grade level completed

Did not complete high school 68*** 47**

High school graduate, GED, or equivalent 84 67

Presence of other people living in household

Lives alone 84* 61

Lives with others 76 54

Race/ethnicity

Non-Hispanic Black 72 41

Non-Hispanic White 89* 66

Non-Hispanic othera 66 31

Hispanic 56 43

Income

Monthly income-to-poverty lower than medianb 75* 52

Monthly income-to-poverty higher than median 86 64
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Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Geographic access to food

Has access to supermarket 80 56

Does not have access to supermarket 82 67

Food security

Food insecure 62** 32***

Food secure 84 65

Satisfaction with socialization opportunities

Satisfied 82 58

Not satisfied 56 56

Census region

Midwest 88* 61

Northeast 92** 57

South 77 54

West 67 60

Urbanicity

Urban 76** 56

Rural 93 64

Sample size 511 389

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

***/**/* Difference significantly different from zero at the 0.01/0.05/0.10 level, two-tailed test. Categorical variables were tested against only one referent group 

(85 and older, Hispanic, and West).

a

“Other” includes Asian, American Indian, or Alaska Native; Native Hawaiian or other Pacific Islander, and races not identified by respondents in the survey.

bIncome-to-poverty based on HHS poverty guidelines (https://aspe.hhs.gov/2015-poverty-guidelines). Median income as a percentage of poverty was equal to 

128 percent for congregate meal participants and 122 percent for those who received home-delivered meals.

DISCUSSION

This brief describes the prevalence of 

recommended monetary contributions for 

NSP meals, the types of clients served by LSPs 

that do recommend certain amounts, and 

the characteristics of participants who make 

contributions. Main findings are the following.

Most (at least 80 percent of) LSPs had 

a recommended meal contribution 

amount in 2015–2016. Some LSPs 

recommended less than $2.00, but a nontrivial 

percentage recommended more than $3.50 per 

meal. Although allowing participants to make 

voluntary contributions to NSP meals is a 

known characteristic of the program, the finding 

that most LSPs had recommended amounts 

suggests a need for ACL to assess whether 

LSPs request contributions to help cover 

basic expenses of providing meals and services 

or to offer an expanded set of meal options 

and services. It would be useful to review the 

adequacy of program funding if LSPs are asking 

for contributions simply to provide a minimal 

level of services to participants.

There was generally little variation in 

the types of LSPs that recommended 

contributions and in the amounts they 

recommend. Notable exceptions include 

the regions LSPs operate in and whether they 

offer dinner or offer meals on the weekend. 

Midwestern LSPs were more likely to 

recommend a contribution and have a higher 

recommended amount, whereas those in the 

South were less likely to recommend one. 

In an analysis of the component costs of 

producing a meal, the NSP evaluation’s cost study 

revealed that, in comparison with other regions, 

the Midwest had the lowest paid labor costs per 

congregate meal and the highest value of donated 

nonlabor resources per meal (such as food, 

facilities, and gasoline for deliveries). In contrast, 

the South had the highest paid labor costs and the 
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lowest value of donated nonlabor resources (Ziegler 

et al. 2015). Similarly, the value of volunteer labor 

and donated nonlabor resources as a component 

of the cost of producing a home-delivered meal 

was highest in the Midwest and lowest in the 

South. Based on these per meal component costs, 

it is not clear why there is a greater prevalence 

and higher amounts of participant contributions 

in the Midwest, and lower prevalence in the 

South, except if LSPs with greater amounts of 

donated nonlabor resources have less of a need for 

participant contributions. More research is needed 

to understand the relationship between participant 

contributions, LSP budgets, and per-meal costs. 

Offering meals on the weekend and offering 

dinner were also associated with LSPs being 

more likely to recommend higher contribution 

amounts for congregate meals and more likely 

to recommend contributions for home-delivered 

meals. It is unclear whether larger participant 

contributions are needed for LSPs to offer these 

expanded meal options, because they could 

potentially be expensive components of LSPs’ 

program models. Reassessing the extent to which 

program funding adequately covers expanded meal 

options for older adults could play an important 

role in ensuring that older adults with insufficient 

access to food can still have this essential service 

available to them.

NSP participants with more resources—

including more education, food security, 

and income—were more likely to make 

contributions, but sizable percentages 

of older adults with less education, 

less food security, and lower income 

also contributed. The high contribution 

rate among resource-constrained participants 

highlights the need to learn more about why 

participants contribute to NSP meals and whether 

they can afford to. Because the outcomes survey 

did not examine the amount that participants 

contributed, future research should determine 

how often and how much participants with 

lower incomes contribute to meal programs. In 

addition, although Mabli et al. (2017) found that 

few NSP participants sensed pressure to make 

monetary contributions to meals (just 3 percent 

of congregate meal participants and 1 percent of 

home-delivered meal participants), 15 percent of 

congregate meal participants and 23 percent of 

home-delivered meal participants reported broader 

challenges making ends meet (Mabli and Shenk 

2018). Having a nontrivial share of food-insecure 

participants make monetary contributions to 

program meals—63 percent of congregate meal 

participants and 32 percent of home-delivered 

meal participants—underscores the need to 

understand the role participant contributions play 

in the provision of meals and services. Allocating 

federal funds to help cover that amount could 

allow resource-constrained older adults to pay for 

their medical expenses, utility bills, rent, and other 

necessities instead, and still have access to nutritious 

meals through the NSP. In particular, having 

food-insecure participants reallocate those limited 

resources to support personal food spending outside 

of the NSP would complement the NSP’s mission 

to reduce food insecurity in older adults.

REFERENCES

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.mathematica-mpr.

com/our-publications-and-findings/publications/

evaluation-of-the-effect-of-the-older-americansact-title-iii-c-nutrition-services-program. Accessed 

January 23, 2018.

Mabli, James and Marisa Shenk. “Needs of and 

Service Use Among Participants in the Older 

Americans Act Title III-C Nutrition Services 

Program.” Washington, DC: U.S. Department of 

Health and Human Services, Administration for 

Community Living, October 5, 2018.

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.

mathematica.org/our-publications-and-findings/

publications/process-evaluation-of-olderamericans-act-title-iiic-nutrition-services-program. 

Accessed June 15, 2020. 

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. 

Available at https://acl.gov/sites/default/files/

programs/2017-02/NSP-Meal-Cost-Analysis.pdf. 

Accessed June 15, 2020.
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SUPPLEMENTAL TABLE 1: Characteristics of congregate meal participants, by presence and 

amount of recommended meal contributions

Characteristic

All congregate 

meal 

participants

Participants 

served by 

LSPs with a 

recommended 

amount

Participants 

served by LSPs 

without a 

recommended 

amount

Participants 

served by 

LSPs with high 

recommended 

amounta

Participants 

served by 

LSPs with low 

recommended 

amount

Age

74 and younger 41 36 70 30 43

75 to 84 41 44 26 49 37

85 and older 18 21 4 21 20

Male 33 28 57 30 25

Veteran 17 15 19 21 7

Did not complete 

high school

24 24 23 24 25

Lives alone 60 60 66 61 58

Race/ethnicity

Non-Hispanic 

Black

13 13 17 4 25

Non-Hispanic 

White

65 67 44 76 55

Non-Hispanic 

otherb

8 9 9 8 9

Hispanic 14 12 29 12 11

Monthly incometo-poverty lower 

than medianc

50 47 69 45 49

Has access to 

supermarket

81 77 94 76 79

Food insecure 16 12 41 11 13

Satisfied with 

socialization 

opportunities

93 95 85 95 96

Census region

Midwest 22 27 9 33 18

Northeast 26 31 14 12 55

South 18 14 20 10 20

West 34 29 57 45 7

Urban 72 74 78 67 84

Sample size 596 494 75 284 210

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

a

LSPs with recommended amounts above the median were considered high, and those at or below the median were considered low. The median was $2.50 for 

congregate meal sites.

b“Other” includes Asian, American Indian, or Alaska Native; Native Hawaiian or other Pacific Islander, and races not identified by survey respondents.

c

Income-to-poverty based on HHS poverty guidelines (https://aspe.hhs.gov/2015-poverty-guidelines). Median income as a percentage of poverty was equal to 

128 percent for congregate meal participants.
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SUPPLEMENTAL TABLE 2: Characteristics of participants in home-delivered meals, by presence 

and amount of recommended meal contributions

Characteristic

All homedelivered meal 

participants

Participants 

served by 

LSPs with a 

recommended 

amount

Participants 

served by LSPs 

without a 

recommended 

amount

Participants 

served by 

LSPs with high 

recommended 

amounta

Participants 

served by 

LSPs with low 

recommended 

amount

Age

74 and younger 21 20 23 12 24

75 to 84 36 38 28 38 39

85 and older 43 42 49 50 38

Male 32 32 32 23 35

Veteran 15 16 13 16 17

Did not complete 

high school

40 42 34 29 49

Lives alone 58 60 46 68 57

Race/ethnicity

Non-Hispanic 

Black

17 10 38 19 6

Non-Hispanic 

White

69 72 60 76 70

Non-Hispanic 

otherb

5 6 2 3 8

Hispanic 9 12 0 3 15

Monthly incometo-poverty lower 

than medianc

50 47 58 38 52

Has access to 

supermarket

82 80 88 74 81

Food insecure 22 24 17 20 26

Satisfied with 

socialization 

opportunities

81 78 95 82 77

Census region 

Midwest 29 33 0 43 30

Northeast 22 23 28 26 19

South 22 14 49 4 19

West 27 30 23 27 32

Urban 75 77 71 77 76

Sample size 504 383 85 107 270

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

a

LSPs with recommended amounts above the median were considered high, and at or below the median considered low. The median was $3.00 for homedelivered meal sites.

b“Other” includes Asian, American Indian, or Alaska Native; Native Hawaiian or other Pacific Islander, and races not identified by respondents in the survey.

c

Income-to-poverty based on HHS poverty guidelines (https://aspe.hhs.gov/2015-poverty-guidelines). Median income as a percentage of poverty was equal to 122 

percent for home-delivered meal participants.