Report on 

Service Equity in Older Americans Act Nutrition Programs 

Nadine Sahyoun, PhD, RD 

University of Maryland, College Park 

May, 2022 

Prepared for Administration for Community 

Living, Office of Performance and 

Evaluation 
Table of Contents 

Summary 3 

Introduction 4 

Methods 4 

Results 6 

The information obtained from the two methods described above is presented here: 6 

Literature Review 6 

Outreach, targeting and retention 6 

Barriers and challenges 7 

State Level Diversity Initiatives 8 

Community-based programs 10 

State Units on Aging Interviews 12 

State plans 13 

Training for state, AAA, Local Service providers (LSP) 15 

Resources, awareness, availability 16 

Building capacity, sustainability, growth 16 

Cultural awareness and responsiveness 17 

Partnerships 17 

Data collection and use 18 

Languages 19 

Barriers to service equity initiatives 19 

Recommendations 20 

Conclusion 25 

Appendices 29 

2 
Summary 

The intent of this project was to learn about best practices and suggest approaches and 

opportunities on reaching and serving the neediest and most diverse older adult populations 

under the Older Americans Act Nutrition Program (OAANP) in order to redress inequities in 

service. 

To obtain best practices, a literature search was conducted and State Unit on Aging (SUA) Lead 

Nutritionists and/or directors of nine states were interviewed. The literature review centered on 

reviewing peer-reviewed publications, grey literature and federal and state government websites. 

Medline, Google Scholar and Google Search engine were used to search for appropriate 

references. The purpose of the interviews of the SUA Lead Nutritionists and/or directors was to 

learn about state policies, program initiatives and best practices and those of their Area Agencies 

on Aging (AAA) that may enhance equity in Title III program participation and increase cultural 

competence among staff. The criteria used to select states to interview were those with a large 

older adult population, a high proportion of ethnic population(s) or a high prevalence of food 

insecure households and, the geographic location of the states. The AGing, Independence, and 

Disability (AGID) Program Data Portal and Census Bureau information were used to select these 

states. 

Through these methods, many successful approaches that were undertaken or recommended for 

application at the state, local and federal levels were identified. These were compiled and serve 

as a basis for developing suggestions on what states can do to reach and diversify the population 

served. 

These suggested approaches and opportunities are organized based on the spheres of influence 

of the socioecological model (SEM) framework. This model considers the complex interplay 

between individual, relationship, organizational, community, and policy factors. It allows us to 

understand the range of factors that interact at one level to influence factors at another level. 

Therefore, a concerted effort to intervene at each of the levels is more likely to be effective in 

achieving sustainable change towards equity. 

3 
Introduction 

This is a crucial time in U.S history where public, government and service provider institutions 

are examining their practices in order to correct some of the inequities that have led to health 

disparities among specific population groups. The intent of this project was to learn about best 

practices that are currently used by the Older Americans Act Nutrition Program (OAANP) to 

reach and serve the neediest and most diverse populations in the country. OAANP is the only 

federal program that reaches out to older adults who have difficulties leaving home without 

assistance, by providing them with healthy meals delivered to their homes. This program also 

provides meals to mobile older community-dwelling individuals in congregate settings in order to 

promote socialization while consuming a healthy meal. Along with nourishing meals, OAANP 

provides periodic nutrition screening, needs assessment, education, and counseling to 

participants. Older adults tend to prefer community living and aging-in-place, and this program 

helps people remain in their homes. 

The racial and ethnic minority populations in the US, ages 65 years and over, represented 24 

percent of the population in 2019 and is expected to increase to 34 percent by 2040 (ACL, 2020). 

African Americans, in particular, have the lowest life expectancy of all race/ethnicities and the 

greatest health inequity (Johnson et al., 2022. As stated by Espinosa and Accius (2020), by the 

time people of color reach older age, they have experienced a lifetime of discrimination with 

impact on their physical, emotional and economic well-being. Because of these experiences, this 

population faces more serious age-related vulnerabilities that are higher than their white 

counterparts, including economic insecurity, social isolation, physical and cognitive decline, 

malnutrition and chronic health conditions. There is growing urgency to reach out to these 

populations with needed services. The latest version of the OAA, enacted in 2020 (Older 

Americans Act of 1965 [Public Law 89–73]), targets those most at risk for nutritional 

deficiencies, social isolation, and institutionalization. Minority populations, be they racial, 

ethnic, cultural, or sexual minorities, are at high risk for all three. 

Methods 

In order to learn about best practices and offer suggestions on reaching and serving minority 

populations that traditionally have not been well served, such as African American, 

4 
Black, Latinx, Hispanic, Asian and LGBTQ populations, a literature search was conducted and 

SUA Lead Nutritionists/directors of nine states were interviewed. 

The literature search centered on reviewing peer-reviewed publications, grey literature and 

federal and state government websites. Grey literature sources, (outside of the traditional 

publishing and distribution channels), included policy and practice publications, video 

presentations, reports and blogs. Medline, Google Scholar and Google Search engine were used 

to search for appropriate references and, the following search terms in various combinations 

were utilized: Older Americans Act Nutrition Program, OAANP, home-delivered meals, Meals 

on Wheels, congregate meals, health disparity, outreach, targeting, health equity, racial minority, 

best practices. A large number of references were generated but after reading the abstracts, 

articles and following the website links, the number of references and websites were reduced to 

those referenced in this document. 

SUA Lead Nutritionists and/or directors were then interviewed to learn about state policies, 

program initiatives and best practices and those of their Area Agencies on Aging (AAA) that 

enhance equity in Title III program participation and increase cultural competence among staff. 

The criteria used to select the states to interview were: those with a large older adult population, 

a high proportion of ethnic population(s) or a high prevalence of food insecure households and, 

the geographic location of the states. The AGing, Independence, and Disability (AGID) Program 

Data Portal and Census Bureau information were used to select these states. The AGID data 

portal contains programmatic information on nutrition services provided to older adults and on 

the demographic and racial profile of people served in all 50 states and territories. Information 

from the Census Bureau was added for comparative information. Appendix 1 includes an excel 

document with the percent of minority populations for the 50 states and Washington DC, and 

the percent of minority populations that participated in Title III programs in 2019. Also included 

in the table is the percent of individuals ages 60 years and older who in 2019 were under the 

poverty line by state and the percent of poor individuals served by the Title III programs in 

2019. A chart depicting the percent of minority populations by state is also included in 

Appendix 1. 

The following states were invited and participated in the survey: Arizona, Colorado, Georgia, 

Mississippi, Nevada, New York, Texas, Washington and Wisconsin. A set list of questions was 

5 
used (Appendix 2). Information was collected from eight SUAs. Texas SUA was not interviewed 

due to scheduling conflicts, however, some information, albeit limited, was obtained mostly 

through online research. 

Results

The information obtained from the two methods described above is presented here: 

Literature Review 

Information obtained from the literature review can be divided into 4 sections followed by 

suggestions and approaches synthesized from the review. They are as follows: 

Outreach, targeting and retention 

Older adults tend to prefer community living and aging-in-place (Barrett, 2008). It is, therefore, 

important to find ways to reach the neediest people in the different communities, especially 

minority and marginalized populations, to assist them in remaining independently living. Along 

with nourishing meals, the OAANP provides periodic nutrition screening, assessment, education, 

and counseling to participants. Nutrition screening and education are especially important 

considering that individuals may not be knowledgeable in nutrition and its effect on health status, 

especially as people age, because they may develop chronic conditions that require adjustments 

to their diets. Studies have shown that the home-delivered meals (HDM) of the OAA are well 

liked, provide quality food to needy individuals and help individuals remain living independently 

(Sahyoun and Vaudin, 2014). Despite the multifactorial effect on health status, HDMs were also 

shown to decrease institutionalization of older adults and consequently healthcare expenditures 

(Thomas and Mor, 2013). However, funding has not kept up with increased demand for this 

program and may likely remain flat in the future (Congressional Research Service, 2022; 

NANASP (a), 2020). This may lead to waiting lists and a limit on program participation. 

With the increase in racial and ethnic diversity in the different neighborhoods, and, in order to 

reach people most at risk, outreach, targeting and retention are essential. According to a 2015-

2016 national evaluation of the OAANP, 66% of Congregate Meal participants and 71.8% of 

6 
Barriers and challenges 

home delivered meal participants were non-Hispanic whites. Just 0.3% of home-delivered meal 

participants were Asian, 8.7% were Hispanic, and 17.7% were non-Hispanic black (Mabli et al., 

2017). This is an underrepresentation of the minority population considering that they are at 

higher risk of food insecurity and experience a higher prevalence of chronic conditions and 

disabilities. In a study of a rural community in Texas, the authors showed that MexicanAmericans were at higher nutritional risk than non-Mexican Americans (Sharkey, 2004). Also, 

in another Texas rural community, more African Americans reported having a chronic illness or 

condition, ate alone, had malfunctioning cooking appliances and sometimes did not have enough 

money to buy food compared to White older adults (Getty et al. 2016). In 2008, a study was 

conducted in 11 states where AAA directors and local providers were interviewed to learn about 

practices used to identify individuals for the HDM program. The authors reported many barriers 

to service delivery overall but they stated that HDM participants with special health or 

religious/cultural needs may be inappropriately or sub optimally served (Lee et al., 2008). In a 

presentation by Edwin Walker, Deputy Assistant Secretary for Aging, emphasized the need to 

continue targeting minority populations because without it, the goals to include a larger 

percentage of minority populations within those programs will not be met (NANASP (a), 2020). 

Targeting, outreach and retention present many challenges. Several studies reported on these 

challenges and despite the fact that some of these studies are dated, they describe barriers and 

challenges that are still relevant to this day. For example, in 2004, Choi and Smith conducted a 

study in a large metropolitan area in the Pacific Northwest to identify barriers to the participation 

of racial/ethnic minority older adults in the OAANP. The data were collected from a survey of 

OAANP staff and volunteers and from three focus groups of professionals working with 

minority older adults and minority community leaders. Several reasons were cited for low 

participation by older minority populations in the OAA meal program, including misinformation 

due to language barriers, lack of menus that can accommodate cultural preferences, discomfort 

with staff due to cultural and linguistic differences, fear and distrust of formal systems, and 

inadequate transportation to congregate meal sites. Choi (1999) also identified the unfamiliarity 

with and dislike of the foods served by the programs. The authors reported that a much higher 

proportion of African Americans than Whites discontinued participation in the OAANP due to 

7 
State Level Diversity Initiatives 

their dissatisfaction with the quality of the meals. Taste and cultural food preferences are 

critically important in attracting and retaining racial, ethnic, and cultural minority populations in 

the programs. For example, programs may lack culturally appropriate foods such as dairy-free 

meals for Asians who are largely lactose intolerant (Choi, 2002, 2004). Another study showed 

that African Americans were less likely to prefer most foods offered by the meal programs 

compared with Caucasians (Song et al. 2014) 

A few studies were conducted to examine diversity initiatives in outreach for Congregate Meals 

Programs (CMP) among states. In 2014, Porter and Cahill (2015) conducted a national study to 

determine the potential barriers to meeting the needs of minority populations and to explore the 

types of diversity initiatives employed at congregate meal sites to reach minority individuals. A 

survey was administered to the 50 SUAs and the District of Columbia and all but three states 

responded. The majority of states (64.6%) had CMP targeted to a specific racial, ethnic, or 

cultural minority and five states targeted sexual minorities (lesbian, gay, bisexual, and 

transgender (LGBT)). However, seventeen states offered no diversity initiatives, with six of 

these states having a high prevalence of minority populations. The authors identified three main 

themes as barriers, namely, lack of funding, lack of need, and issues specific to rural areas. 

Funding was a major reason with comments such as “the increase in the number of older adults 

can barely be satisfied, let alone targeting for the needs of ethnic populations” or that with so 

many different ethnicities in the state “it would not be financially feasible to provide meal sites 

that catered to any one population.” Also, in some states, respondents stated that there were 

small minority populations and there were no requests for ethnic meals and no identified needs. 

This statement indicates that there is potentially no outreach to minority communities and there 

may be a discrepancy between understanding of need by providers and actual need. One stated 

barrier referred to is the lack of cultural competency in the leadership: ‘‘We have found a clear 

relationship between the meal site coordinator’s ability to relate and be culturally sensitive to the 

participants and the success of an ethnic site.’’ These responses and other similar comments 

indicate a lack of cultural competence and it appears that not all programs recognize the 

importance of being culturally competent. Some programs stated that they did not feel that 

outreach to minority communities was necessary because they serve “all people.” Nevertheless, 

8 
the results of this survey showed that the percentage of minority populations in a state was 

predictive of the number of diversity initiatives used in CMPs. States with LGBT CMPs reported 

the highest levels of racial/ethnic/cultural diversity initiatives and high levels of statewide LGBT 

protective policies. The results of this study also indicate that states develop different strategies 

to reach specific populations. 

According to Adams and Tax (2017), some states have been leaders in targeting minority and 

LGBT older adults for services and support. For example, in 2012, Massachusetts’ SUA, the 

Executive Office of Elder Affairs (EOEA), designated LGBT older adults as a population at 

greatest social need and requested that local agencies that work with older adults ‘‘identify and 

assess the LGBT population as a part of their plan development.’’ As a result of this directive, a 

number of Massachusetts AAAs hosted community needs assessment meetings, particularly for 

LGBT older adults and caregivers. Updated information is needed to determine outcomes of 

these assessment meetings. 

Similarly, the New York State Office for the Aging targeted LGBT older adults for services, and 

implemented sexual orientation and gender identity data collection, but as of 2017, it had not 

designated the LGBT older adult population at greatest social need. As of Fall 2016, only nine 

states and the District of Columbia have attempted to assess and meet the needs of LGBT older 

adults, according to the National Resource Center on LGBT. This was determined by a review of 

the State Plans on aging. A total of 22 states had some mention of LGBT older adults in their 

state plans and attempted to address their needs in various capacities (Adams and Tax, 2017, 

National Resource Center on LGBT, 2017). 

A state that is particularly active in its efforts to develop programs to reach out to minority 

populations is Wisconsin. The State of Wisconsin, Office on Aging, developed an equity plan that 

it is actively following, as described at a workshop presentation on May 13, 2021 (ACL, 2021). 

Also, at that workshop, an example of work done at the county level in the metropolitan Chicago 

area, Suburban Cook County, to reach a minority population during the pandemic was described 

(ACL, 2021). That county has a 30% minority population. During the fasting month of Ramadan, 

the organization contracted with an Arab-American food supplier to create custom boxes for that 

community. The Home-Delivered Food Boxes were tailored to Middle-Eastern preferences.

9 
Community-based programs 

Additional initiatives were posted on the ACL National Resource Center on Nutrition and 

Aging website. This Resource Center was developed to build capacity of the aging network and 

identify current and emerging issues and opportunities. It reports on best practices, case studies, 

and other information of use to the network. For example, the Connecticut Senior Dine Program 

allows participants an option of going to a local restaurant for their meals. A registered dietitian 

works closely with restaurant owners on menu development to ensure that meals meet Title III 

C nutrition requirements. In addition, in rural Erie County, NY, the ACL-funded “Go & Dine” 

Senior Dining Program gives seniors an option to use vouchers at restaurants. It is, however, 

unclear whether any of the programs work with restaurants that offer ethnic food. These 

initiatives present opportunities for doing so. Another state’s initiative was reported in South 

Bend Indiana where a food truck service was started to supplement the income of local service 

providers in order to serve more people. The truck creates a variety of menus and although one 

of their offerings is chipotle chicken tacos, it is not clear if the populations targeted are ethnic 

minorities. Although this truck was used to raise funds, the concept of a truck to target lowincome minority populations is appealing and may need to be explored from an outreach 

potential and a cost perspective. 

There are limited peer-reviewed publications describing successful outreach and retention of 

OAANP programs at the community level. One such program, described by Mower (2008), 

shows how meal programs were developed targeting older adults in Korean, Vietnamese and 

Chinese communities in Montgomery County, Maryland. A group of Korean businesspersons 

who were concerned about the isolation of older family members contacted senior nutrition 

programs to request congregate meals. The nutrition program developed a partnership plan with 

the Korean organization to design a nutrition program tailored to the interests and needs of 

Korean seniors. Implementing the plan required staff to become knowledgeable about Korean 

culture and food consumption and to work with Korean seniors to develop a program appropriate 

to their needs while meeting local state and OAA requirements. The ethnic group provided a site 

at a church, staffed the program with Korean volunteers, and managed culturally tailored 

10 
activities that included nutrition education and physical fitness. A Korean restaurant provided 

meals at a reasonable cost. A year later, a Vietnamese organization requested a similar 

arrangement and this was followed later by a similar arrangement with a Chinese organization. 

These programs expanded and served an increasing number of older adults. The success of such 

programs requires a champion in the ethnic communities and a willingness by the providers to be 

educated in the needs of different communities. However, according to the author, funding must 

be secured to provide such programs. In addition, to address dietary preferences of ethnic groups 

while considering nutritional benefit, these food choices must be adjusted to conform to the 

dietary guidelines by decreasing, for example, the sodium content of the menus or reducing the 

saturated fats (Sandarangani et al., 2020). 

In the studies presented in this review, authors recommended several strategies to increase 

participation of minority populations. These recommendations include holding cultural events in 

addition to serving of ethnic foods, organizing ethnic food cooking demonstrations and working 

with religious or community-based organizations. Additionally, dissemination of information 

about the OAANP at senior housing was considered somewhat effective, and, extending hours of 

service for early and late comers, offering free food or grocery bags to take home and providing 

regular health screening and checkup service were all determined to be effective recruitment and 

retention strategies. Other recruitment and retention strategies included creating a warm, 

welcoming atmosphere, and a menu plan that allows participants diverse food and cafeteria-style 

choices. Other frequently mentioned strategies included increasing staffing devoted to focusing 

on outreach efforts, increasing bilingual and bicultural staff and volunteers, recruitment of 

drivers/volunteers from the same ethnic background. In addition, a recommendation was to train 

and hire staff with increased awareness of diversity issues and develop multilingual outreach 

materials so that information on availability of the meal programs can be disseminated to 

homebound older adults and their families in ethnic neighborhoods. Finally, the most frequent 

outreach strategy mentioned was reliable transportation. All these suggestions may require more 

staffing and resources. 

Other recommended outreach strategies included: involvement of family members in the 

information dissemination process; establishment of good working relationships with community 

leaders and contact with key older persons and request of input from current participants. In 

11 
essence, understanding food preferences of older adults is one of the means to improve the 

quality of nutritional services, and to retain participants in the programs. 

The results of a recent survey of SUA, presented at a workshop (NANASP(b), 2020), reported 

mixed results by states to increase minority participation in the OAANP. While some states are 

actively embracing cultural competence in training and planning outreach activities, others may 

be reluctant to undertake new approaches or may have limited resources. Nevertheless, in his 

presentation at the same workshop, Edwin Walker, Deputy Assistant Secretary for Aging, 

reported that the percentages of minority populations on the OAANP increased from 29% to 

32% in FY14 to FY18. He attributed this increase to the number of initiatives undertaken by 

AAA, such as hiring of minority staff, developing materials in languages other than English, 

locating programs in communities identified by Census data as low income or high minority 

populations and marketing programs through minority media. 

State Units on Aging Interviews 

As expected, states vary widely in their commitment to social equity and in their interactions 

with their state AAAs and local service providers (LSPs) and, consequently, in their knowledge 

of program initiatives at the local level. In response to our questions about best practices and 

initiatives at the local level, some states surveyed their AAAs in order to obtain information that 

could assist them in responding to our questions. Others did not. This means that the information 

obtained may not be complete or a true reflection of best practices in those states that did not. It 

is also possible that state level officials may be unaware of initiatives taken at the local level. 

Therefore, some follow-up internet searches were undertaken on some states by: checking State 

Plans, and looking for more information on specific programs that were discussed at the 

interviews. From the interviews and follow-up reviews, it appears that some states may not have 

initiatives in place to increase cultural competence and service equity at the state and local levels 

while others have several. 

The following are findings of activities that are in place to enhance social equity under Title III, 

for the nine states that were surveyed. The findings are presented under eight categories as 

follows: 

12 
State plans 

The SUAs are an integral part of the aging network, and are responsible for developing and 

administering a multi-year State Plan on aging. The State Plan provides goals and objectives for 

the aging programs related to assisting older residents, their families, and caregivers. 

Interviewees from seven out of the nine states that were surveyed have articulated a specific 

policy in their current state plans to encourage outreach and service to the underserved and 

diverse populations within their state or included a statement to that effect while the other two 

states did not. However, the federal government has provided guidance that requires any new 

State Plan taking effect on or after October 1, 2022 to include goals and objectives to increase 

service equity to underserved populations and address activities to support these goals. Serving 

individuals with the greatest economic and social need means ensuring equity in all aspects of 

plan administration. The Guidance for Developing State Plans on Aging which was released by 

Alison Barkoff, Acting Assistant Secretary for Aging states that 

“As you develop your State Plans, ACL encourages states and AAAs to take a 

broad approach to ensuring services are reaching older adults in greatest social 

need in line with recent Executive Orders by President Biden. These populations 

include: individuals who are Black, Latino, and Indigenous and Native American 

persons, Asian Americans and Pacific Islanders, and other persons of color; 

members of religious minorities; lesbian, gay, bisexual, transgender, and queer 

(LGBTQ+) persons; persons with disabilities; and persons who live in rural 

areas.” 

The Biden Administration has articulated four key priorities, which are COVID-19 recovery, 

advancing equity, expanding access to home and community-based services (HCBS), and 

building a caregiving infrastructure. 

The guidance to incorporate a plan for diverse and culturally competent approaches has 

stimulated those states that currently do not have a plan that emphasizes equity or the ones that 

are in the process of revising theirs. In addition to the federal guidance, the tragic 

13 
death of George Floyd has spurred action in some states, according to the information obtained 

through the interviews. For example, several of the states interviewed stated that a new 

department of equity diversity, and inclusion (EDI) was created to lead initiatives, train 

employees and develop educational materials or hire one or more individuals to strengthen their 

EDI programs. Wisconsin, Washington and Georgia have, or will shortly, conduct listening 

sessions throughout the state, together with AAAs and/or with community organizations and 

populations of interest, to learn about needs and to understand why underserved populations do 

not access some services. 

Texas submitted a new State Plan to the Administration for Community Living on July 1, 2022. 

One of the key areas of the State Plan is titled Equity and one of its objectives is to ‘Ensure meals 

can be adjusted for cultural considerations and preferences.’ Its strategies include an increase in 

awareness of nutritional needs based on cultural and ethnic considerations and preferences. A 

dietitian must provide AAA and LSP information on cultural and ethnic nutritional preferences 

once a year and share resource information for culturally and ethnically appropriate meals on the 

aging services website(s). In NY, the current State Plan includes goals and objectives to increase 

service to underserved populations and the AAA plans are required to reflect the state plan. 

Annually, in a performance review, the AAA must report on what they did, how they did it and 

how much they have accomplished. 

The State Plan for Nevada that was released in 2021 has a goal that specifies, “Lead efforts to 

strengthen equity in service delivery throughout Nevada for targeted populations through 

collaborations and networking.” The Nevada SUA is in the planning phase to initiate programs 

for that purpose. Wisconsin’s State Plan expired and those of Mississippi and Arizona expire in 

2022 and are due to be updated. Mississippi’s current plan addresses cultural competence by 

stating that guidance must be provided to service providers so that they are aware of cultural 

sensitivities and take into account linguistic and cultural differences. The Arizona state plan does 

not have a goal on equity and cultural competence but does suggest an increase in the 

cultural/linguistic competency of aging services statewide. Finally, Colorado whose state plan is 

from 2019-2023 mentions the following in its plan: “providing guidance to individuals engaged 

in the delivery of supportive services under the area plan involved to enable such individuals to 

14 
be aware of cultural sensitivities and to take into account effectively linguistic and cultural 

differences.” 

Training for state, AAA, Local Service providers (LSP) 

Some states, such as Arizona, Georgia and Colorado, require their employees to take a course in 

EDI. Other states have optional programs; and provide activities irregularly while others have 

more extensive and regular ones. For example, in Colorado, in addition to the required training in 

EDI, there are optional activities, such as a book club that meets monthly to discuss books 

related to equity. For example, on Women’s Day, the book club discussed a book that focused on 

equity in women. Colorado also provides webinars on similar topics. Arizona holds weekly 

meetings for all staff where they regularly discuss issues of EDI. This state has diverse staff and 

generally engages in regular EDI exercises. 

It was clear from my interviews that states with a commitment to service equity and who had a 

champion tended to set a standard that trickled down to the various departments. For example, 

in Nevada, the governor urged a concerted effort to address equity and fairness issues in state 

programs. As of January 2022, every agency had to designate a diversity and inclusion liaison, 

trained by the Nevada Office of Minority Health and Equity, to maintain ongoing 

communication between the state agency and members of minority groups. The SUA is 

beginning to develop strategic plans to include cultural competence training and service equity 

initiatives for their staff. New York, for example, has a strong advocate within the SUA and this 

has led to policies that require similar commitments at the AAA and community levels. 

However, due to lack of adequate staffing, New York has informal trainings at irregular 

intervals. 

In Colorado, each AAA must have two goals to expand and improve their outreach. They are 

required to serve a higher proportion of individuals from ethnic populations than there are in the 

state and these are measured annually. The Wisconsin SUA director hosts a monthly statewide 

meeting and always includes an agenda item that deals with EDI. 

15 
Resources, awareness, availability 

Knowledge of the availability of EDI resources varied widely, with some states reporting being 

unaware of training, tools and information while others knew of the existence of a few. Some 

states that had an accessible office of equity within their organization responded that they had 

some resources internally. Four of the states interviewed expressed a need for more resources 

and training and were hoping that ACL could provide speakers and webinars. 

In Arizona, the Department of Economic Security that houses the State Department of Aging 

established an office dedicated to Equity, Diversity and Inclusion and one of their initiatives is to 

look at all elements throughout the structure of the organization, including the demographics of 

staff and leaders, job postings, customer feedback and other pertinent data. 

Wisconsin provides access to training through their Office of Health Equity although the 

Milwaukee AAA, which is ethnically diverse, is initiating discussions on equity in their county 

and conducts weekly meetings with their staff for that purpose. 

Building capacity, sustainability, growth 

In Wisconsin, the staff must fulfill a certain number of hours of training each fall and so 

resources on gender identity, cultural humility, and cultural competence are available upon 

demand. 

In Arizona, meal sites are selected because of their geographical, racial, ethnic and cultural 

diversity. Some Arizona AAAs also stated that they hire people who speak and look like those in 

the community that they serve. 

The New York AAA must submit goals every 4 years that reflect the State Plan and must include 

specific services to their diverse populations. The Chief Diversity Officer at each state agency 

works with its various departments to consider diversity in hiring. New York conducts annual 

client surveys and focus groups to understand their clients and their needs. 

Georgia is beginning to consider initiatives on increasing service equity and their first step is to 

train AAAs on understanding the data that they collect and their implications. 

16 
Cultural awareness and responsiveness 

Partnerships 

Washington stated that programs within their counties reflect the population diversity and needs 

of that county and they are hiring individuals with similar ethnicities and background. King 

county, which is the most diverse and includes Seattle, targets ethnic populations and provides 

ethnic food in half of its 15 sites. 

New York had a Vietnamese population that was underserved and so the New York city AAA 

made a connection to open a congregate site in that community. New York reaches out to ethnic 

populations regarding special meals and posts pictures of food on their website and distributes 

brochures of their services. 

Except for one state that was not aware of the existence of any partnerships, all other states had 

some formal or informal partnerships and some had plans to develop more of them. It was not 

always clear whether these partnerships included collaboration with the Title III programs. 

Arizona has a full-time individual who works as the community outreach liaison and one of their 

partnerships is with the Arizona Refugee Resettlement Program, where they work with the older 

refugees. Similarly, Georgia works with the Center for Pan-Asian Community to reach refugee 

populations and immigrant seniors. The center translates information into four Asian languages; 

Burmese, Korean, Chinese and Bhutanese. Nevada also has partnerships with refugee 

organizations. Colorado has a partnership with Easter Seals, which provides services for people 

with disabilities. They also have a Colorado Dental Health Care Program for Low-Income 

Seniors, which provides oral care for Latinx older adults through two AAA. 

Nevada, Wisconsin and New York already do or are planning to partner with faith-based 

organizations of different ethnic groups such as Hispanic, black or African-American 

communities. In Nevada, one of the purposes of the diversity and inclusion liaisons is to 

collaborate with other state agencies to increase the accessibility and inclusivity of services to 

members of minority groups. Wisconsin has a partnership with the Great Lakes Inter-Tribal 

Council and works with 11 tribes who are encouraged to collaborate with the nearest counties to 

coordinate services. Wisconsin also has plans to collaborate with the Black Chamber of 

Commerce. New York stated having informal partnerships with the Alzheimer Association, 

17 
Hispanic Heritage Council and the Pride Center. They also partner with SNAP-Ed specifically 

because they discovered that older adults were underserved by that program. Washington has 

also established partnerships with seven tribal organizations to provide home delivered meals. 

Arizona has ongoing partnerships with a variety of community organizations serving Hispanic, 

African American and refugee groups. This enables them to expand outreach and provide 

services to diverse populations. 

In Wisconsin, one of the AAAs developed a meal program in collaboration with the Urban 

Economic Association, and with restaurants owned by people of color to serve culturally 

appropriate meals and are marketing this program to the targeted communities. In addition, 

individuals from the Hmong community approached the SUA to open a site that caters to this 

population. The AAA opened a site but due to the pandemic, this population was no longer 

interested once they lost the physical location. Similarly, NY offers many ethnic menus, and 

their AAAs partner with restaurants to offer ethnic meals. 

Data collection and use 

All states do collect demographic data that they submit to ACL, as per federal requirement, and 

several states use their data to ensure that they meet their targets. However, some states use this 

information more extensively to guide their responses within the state. For example, Colorado 

overhauled its data collection tools and uses performance measures yearly to evaluate whether 

the AAAs hit their targets in service provision to the underserved populations. Nevada uses the 

data generated by their Analytics Office to create a report to inform legislators to drive state 

funding. Wisconsin is currently in the process of updating its policy manual to include statewide 

malnutrition screening and food security tools. 

New York uses data to reach numerical objectives. If the AAAs do not reach those objectives, 

then the SUA takes corrective action and provides them with technical assistance. New York 

collects demographic data from participants at congregate meal sites and through HDM program 

on an ongoing basis. These data are a basis for the agency to select sites for the congregate 

meals, recommend closing of sites, if necessary, and alerts the state about low enrollment in 

some sites. The state also uses county-level census data to compare ethnicity of residents to those 

who participate in their programs. 

18 
Barriers to service equity initiatives 

Arizona AAAs are quite varied in their approach to service equity and some of them use data to 

identify gaps in service to ethnic minorities in an attempt to identify reasons for these gaps. The 

state is beginning to conduct a comprehensive needs assessment. Wisconsin compared ethnic 

populations served with the percent of residents in some counties and found discrepancies in 

services to Latinx and Asian populations. They are working to remedy this by including a goal in 

their new State Plan. 

The AAA of San Antonio, Texas uses the Texas Equity Atlas to locate services in areas of need. 

The Texas Equity Atlas is an interactive tool that highlights the demographics, disparities and 

some infrastructure distribution within the city. This AAA hires staff from the communities to 

reflect the people who are being served. Many of the services are bilingual. 

Languages 

In Nevada, the governor has requested that every agency develop a language access plan, which 

is a document that spells out how to provide services to individuals who are Limited English 

Proficient. This is expected to provide fair and equal access to services and resources. The SUA 

is developing this language access plan. 

Washington and Colorado have a sign language interpreter for the deaf and hard of hearing. 

Washington State has interpreter services in 16 languages at the local level for no extra charge. 

Additionally, Colorado has interpreters to translate materials in culturally appropriate Spanish. 

Arizona has translated its menus in multiple languages although the menu is the same and does 

not necessarily include ethnic foods. Colorado has translated its nutrition educational materials 

and its messaging in Spanish, Mandarin and Russian. Most states have materials translated in 

other languages and Spanish is the language most frequently available. 

Several barriers were discussed that hindered states from increasing cultural competence and 

developing and implementing initiatives that would increase service equity. Some of these 

barriers include staff shortages, hiring freezes, frequent changes in management, lack of 

communication with local providers, lack of commitment at the State level, lack of awareness of 

resources available for training, lack of providers of ethnic meals, difficulty in reaching rural 

19 
populations without internet, and lack of staff of color. An observation was made that AAAs 

with no diversity in their staff were the ones who struggled the most. 

Suggested Approaches and Opportunities 

From the literature review and interviews of the SUA Lead Nutritionists/directors, several best 

practices were identified as were barriers to reaching and providing equitable services to the 

diverse populations within the states. These best practices, and an analysis of the barriers and 

how to overcome them form the basis for the suggested approaches on how to increase diversity 

in the OAANP. First, the barriers are divided into three categories as presented below, followed 

by suggested approaches and opportunities. 

Barriers at the state level include, lack of funding, lack of understanding of cultural food needs, 

lack of cultural competence, hiring freezes, revolving management, and lack of communication 

with local providers. 

Barriers to service delivery include, staff shortages, lack of understanding of communities’ 

needs, lack of cultural competence, lack of awareness of resources available for training, lack of 

providers of ethnic meals, difficulty in reaching rural populations without the internet, ineffective 

outreach due to language barriers and lack of staff reflecting the background of the people being 

served. 

Barriers to participation by ethnic populations include, lack of menus that can accommodate 

cultural preferences, discomfort with staff due to cultural and linguistic differences, fear and 

distrust of formal systems, inadequate transportation to congregate meal sites, unfamiliarity with 

and dislike of the foods served by the programs. Taste and cultural food preferences are critically 

important in attracting and retaining racial, ethnic, and cultural minority populations. 

As stated earlier, to increase outreach and services to the underserved and diverse populations 

within each state, ACL has taken a crucial step forward by requesting that OAA State Plans 

released after October 1, 2022 include goals and objectives to increase service equity to these 

populations and address activities to support these goals. With this guidance, serving individuals 

with the greatest economic and social need will mean ensuring that equity provisions in all 

aspects and levels of plan administration and implementation are incorporated. 

20 
There are a number of best practices that were identified through this project that could be used 

to begin to remedy some of the institutional and service biases towards ethnic minorities. These 

are presented below and organized using the Socioecological model (SEM) framework. This 

model considers the complex interplay between individual, relationship, organizational, 

community, and policy factors. It allows us to understand the range of factors that interact at one 

level to influence factors at another level. This approach provides a guide to individuals from 

any sphere of the model to arrive at a common understanding of the intended goals of redressing 

inequities in service because they are receiving and utilizing the same information and strategies 

to achieve a common goal. 

Therefore, suggested approaches are organized below according to the spheres of influence of 

the SEM framework as illustrated in the diagram below. 

Figure—Socioecological Model 

21 
Public Policy: National, state, local laws and regulations (Develop policies, initiatives and 

guidelines to protect against economic or social inequities between groups in society). 

• Require mandatory training in cultural competence of all state employees. The staff 

could be required to take a certain number of hours of training a year in topics of gender 

identity, cross-cultural awareness, and cultural competence. 

Develop a standardized training program by ACL on cultural competence that can be 

adapted for use by states to train their staff. In interviews with the states, some requested 

additional training tools and expressed the desire for ACL to provide them. 

Create or strengthen the office of Equity Diversity and Inclusion (EDI) at the state 

level to provide ongoing training of employees and develop educational materials for 

use at AAA and at the local service providers’ (LSP) level. 

Evaluate agency structures for the demographics of staff and leaders, job postings, 

customer feedback and other pertinent data to determine need for diverse staff and 

programs. 

Identify a champion at the SUA level whose responsibility is to set a standard that 

would trickle down to the various departments. 

Identify an EDI community outreach liaison to maintain ongoing communication 

between the state agency and members of minority groups. 

Establish the proportion of minority individuals that must be targeted by the OAANP 

to expand and improve outreach, and measure and evaluate this effort annually. 

Develop a language access plan that spells out how to provide services to individuals 

who are Limited English Proficient. 

•

•

•

•

•

•

•

Community factors: (establishing or strengthening relationships between local 

organizations by collaborating and creating partnerships to effect change in the 

community). 

• Leverage resources and expand partnerships with religious, community-based 

organizations and other community institutions. Partnerships can result in sharing limited 

resources and developing shared programs targeted to specific communities. 

22 
• Partner with restaurants or expand partnerships with restaurants owned by different 

ethnicities to offer congregate meals to ethnic groups. 

• Expand the use of the ACL Nutrition and Aging Resource Center website as repository 

of best practices, case studies, and other information of use to the network. The 

Resource Center which already has useful materials, such as ethnic-specific menus shared 

by users, can continue to expand as a depository for menus and materials in various 

languages, including developing a database of menus of ethnic foods. 

Organizational factors: Organizations, social institutions—(Changing policies and 

practices of organizations) 

• Train employees on cultural competence and obtain available educational materials. 

Designate a liaison at the AAA level, as at the state level, to interact with community 

organizations and members of minority groups. 

Expand and improve outreach to minority communities. Develop an understanding of 

community needs by providers. 

Require that AAA plans reflect the state plan in goals and objectives for outreach and 

service to ethnic populations. 

Conduct annual client surveys and focus groups to understand clients and their needs. 

Train employees in understanding data and how they can be applied to improve 

outreach, identify gaps in service to ethnic minorities and identify reasons for these gaps. 

From these data, evaluate whether the AAAs hit their targets in service provision to the 

underserved populations. Demographic data may lead the agency to select sites for 

congregate meals, recommend closing of sites, if necessary, and alert the state about low 

enrollment in some sites. 

Explore the development of passive data collection as a monitoring system to collect the 

demographics of clients. This will facilitate the gathering of information without 

additional burden on the staff. 

Hire minority staff that reflect the ethnic make-up of ethnic communities served and 

who have an increased awareness of diversity issues. Preferably, hire staff from the 

communities served. Recruit volunteers from those same communities. 

Develop multilingual outreach materials targeting the areas of need. 

•

•

•

•

•

•

•

•

23 
• Locate programs in communities identified by Census data as low income or high 

minority populations and market programs through minority media. 

Interpersonal processes: Families, friends, social networks-- Increasing support from 

friends, family and peers at the local level 

• Provide or sponsor cultural events while serving ethnic foods or organizing ethnic food 

cooking demonstrations in partnership with local institutions, community organizations 

and families. 

Disseminate information about the nutrition programs at senior housing. 

Disseminate outreach materials to homebound older adults and their families in ethnic 

neighborhoods. 

Extend hours of service for early and late comers, offer free food or grocery bags to take 

home and provide regular health screening and checkup services. 

Create a warm, welcoming atmosphere, and a menu plan that allows participants 

diverse food and cafeteria-style choices. 

Increase bilingual and bicultural staff and volunteers, including recruiting 

drivers/volunteers from the same ethnic background as clients served. 

Provide reliable and affordable transportation. 

Involve family members in the information dissemination process. 

Establish good working relationships with community leaders and with key older 

persons. 

Request input from current program participants. Understanding food preferences of the 

older adults is one of the means to improve the quality of nutritional services, and to 

retain participants in the programs. 

•

•

•

•

•

•

•

•

•

Individual factors: Knowledge, attitudes, skills-- Enhancing skills, knowledge, attitudes and 

motivation of individuals working in OAANP 

• Require mandatory training of employees in cultural competence to understand the 

needs of the communities that they serve. 

• Increase self-awareness of nutritional needs based on cultural and ethnic considerations 

and preferences. 

24 
• Obtain information from a dietitian on cultural and ethnic nutritional preferences and 

share resource information for culturally and ethnically appropriate meals on the aging 

services website(s). 

Ensure menus can be adjusted for cultural considerations and preferences. 

Become aware of cultural sensitivities and take into account linguistic and cultural 

differences. 

•

•

The SEM framework is useful as a guide to effect sustainable changes because of the 

interconnectedness of all its levels. An intervention at one level will have repercussions at all the 

other levels. Interventions may involve institutions and individuals working at various levels of 

governmental structures, (federal, state and local) as well as institutions and community 

groups/organizations at the local level. These approaches are in line with the HHS Office of 

Minority Health National CLAS Standards (culturally and linguistically appropriate services) 

which are a set of 15 action steps intended to advance health equity, improve quality, and help 

eliminate health care disparities (U.S. Health and Human Services). 

Conclusion 

Overall, this was a productive exercise. It was very enlightening to the interviewer but also to the 

individuals that were interviewed. Several interviewees stated that the questions were very 

stimulating, encouraged discussions within their state on current and future programs and, spurred 

some of them to contact or survey their AAAs and LSPs to learn about their best practices. 

The results show that the states are very different in their readiness to initiate programs that 

would increase equity in services. Some states are highly aware of health disparities and service 

inequities and have ongoing programs to rectify these issues while other states are just beginning 

to consider approaches to it. 

State Plans with a specific guidance on this topic from the federal government are a good conduit 

to begin to develop goals and objectives on increasing cultural competence among staff and 

outreach to underserved communities. This guidance from the federal government and the 

initiation of some programs or the expansion of others is essential because promoting social 

equity can contribute to dismantling systemic racism, reverse centuries of inequality, and ensure 

that all people can participate and reach their full potential. 

25 
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• Getty MD, Mueller M, Amella EJ, Fraser AM. Differences in Medical and Lifestyle Risk Factors for Malnutrition in Limited-Resource Older Adults in a Rural 

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Americans Act Title III-C Nutrition Services Program on participants’ food 

security, socialization, and diet quality. 

https://acl.gov/sites/default/files/programs/2017-

07/AoA_outcomesevaluation_final.pdf. Accessed December 6, 2021. 

Mower MT. Designing and implementing ethnic congregate nutrition programs for 

older Americans. J Nutr Eld. 2008, 27:417-430. DOI: 

10.1080/01639360802265954. 

NANASP(a) and Benjamin Rose Institute on Aging. (2020, October 19). Racial 

Equity: Perspectives on Delivery of OAA Programs. Edwin Walker [Video]. 

YouTube. https://www.youtube.com/watch?v=Fh2ea0WdxrE. Accessed December 

6, 2021. 

NANASP(b) and Benjamin Rose Institute on Aging. (2020, October 19). Racial 

Equity: Perspectives on Delivery of OAA Programs. Bob Blancato [Video]. 

YouTube. https://www.youtube.com/watch?v=cSStbZafkkA&t=502s Accessed 

December 6, 2021. 

National Resource Center on LGBT Aging and Services and Advocacy for GLBT 

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expanding the inclusion of LGBT older adults. 2017. 

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www.lgbtagingcenter.org/resources/pdfs/Sage_StrengtheningGuidebook2017.pdf 

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04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Pub 

lic% 20Law%20116-131%20on%203-25-2020.pdf. Accessed December 10, 2021. 

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28 
Appendices 

29 
Appendix 1--Table. US and Title III program characteristics sorted by minority status 

Total NonMinority 

Persons 

Served 

(White 

(Alone) -

NonHispanic) 

(4) 

Minority 

and 

poverty 

on 

program 

(8) 

Total 

Minority** 

Persons 

Served 

(3) 

US 

Minority 

below 

poverty 

State level (9) 

US 

Population 

60+ (1) 

US Minority 

population 

(2) 

US 

Poverty 

by state 

(5) 

Poverty 

status on 

program 

(6) 

Rural on 

program 

(7) 

Percent 

Hawaii 25.30% 73.10% 77.74% 20.95% 8.58% 18.50% 60.00% 14.40% 8.30% 

District of 

Columbia 26.40% 67.10% 89.76% 6.20% 16.11% 52.10% 0.00% 49.20% 20.58% 

California 20.50% 45.80% 53.61% 39.32% 10.44% 45.60% 12.50% 28.80% 13.05% 

New Mexico 24.50% 44.00% 51.18% 38.60% 14.81% 28.20% 32.90% 18.70% 21.22% 

Texas 18.20% 40.00% 54.74% 42.89% 10.44% 43.80% 35.00% 29.80% 16.24% 

Maryland 22.30% 36.70% 51.93% 44.36% 7.92% 24.20% 27.30% 11.70% 11.66% 

Georgia 20.10% 33.00% 28.99% 41.17% 10.63% 39.50% 33.20% 11.70% 15.83% 

New York 23.40% 32.80% 38.51% 44.30% 11.70% 31.80% 14.00% 15.50% 19.19% 

Mississippi 22.70% 32.20% 53.32% 44.38% 14.15% 57.10% 83.60% 37.00% 24.41% 

Nevada 22.10% 31.70% 22.29% 67.74% 10.42% 31.30% 41.80% 9.70% 13.86% 

Louisiana 22.30% 31.50% 42.90% 50.17% 14.08% 39.50% 40.60% 21.40% 24.07% 

New Jersey 23.20% 30.10% 34.28% 63.06% 8.70% 27.70% 0.00% 14.60% 15.12% 

Florida 27.50% 29.10% 57.20% 42.59% 10.90% 47.00% 1.30% 37.30% 18.35% 

US Total 22.80% 26.50% 32.70% 58.40% 9.77% 32.60% 33.60% 14.70% 16.20% 

Virginia 22.10% 26.50% 41.78% 54.57% 7.42% 36.50% 27.90% 18.70% 11.44% 

Alaska 18.70% 26.10% 35.86% 59.20% 8.34% 40.50% 78.50% 21.60% 15.88% 

South Carolina 

24.80% 25.40% 54.93% 41.93% 10.56% 48.90% 55.40% 31.10% 20.13% 

Illinois 22.50% 25.30% 37.20% 60.05% 8.92% 36.60% 20.10% 14.30% 15.90% 

Alabama 23.90% 24.80% 39.18% 43.39% 11.36% 27.30% 43.80% 12.50% 18.59% 

North Carolina 23.00% 24.00% 41.68% 55.43% 9.94% 43.30% 44.00% 22.00% 16.59% 

Arizona 23.90% 22.90% 38.65% 47.09% 9.80% 29.70% 37.10% 18.50% 15.78% 
Delaware 26.40% 22.40% 28.09% 69.40% 7.99% 7.10% 44.20% 3.40% 14.54% 

Oklahoma 22.10% 19.30% 18.38% 81.16% 10.26% 43.40% 56.20% 11.00% 15.75% 

Colorado 20.70% 17.80% 23.47% 64.85% 7.99% 23.70% 23.60% 9.50% 13.46% 

Connecticut 24.60% 17.70% 22.71% 77.20% 8.22% 15.70% 13.70% 7.70% 17.76% 

Washington 22.10% 16.50% 19.93% 61.74% 8.10% 32.90% 28.70% 12.50% 14.25% 

Arkansas 23.60% 16.40% 18.89% 80.18% 11.70% 29.90% 58.20% 9.20% 21.56% 

Tennessee 23.10% 16.10% 25.46% 73.67% 10.23% 46.90% 47.80% 16.30% 16.25% 

Michigan 24.60% 15.70% 14.86% 74.20% 9.06% 25.60% 46.50% 7.10% 17.25% 

Massachusetts 23.50% 15.00% 17.04% 62.58% 8.88% 10.70% 5.40% 3.20% 20.63% 

Ohio 24.30% 13.20% 25.54% 70.68% 8.84% 43.80% 37.70% 14.90% 18.84% 

Pennsylvania 25.70% 13.00% 21.97% 73.72% 9.08% 26.10% 28.70% 8.20% 21.54% 

Rhode Island 24.60% 12.80% 9.86% 73.06% 9.82% 15.90% 2.60% 3.80% 23.63% 

Missouri 23.90% 12.60% 18.54% 77.67% 9.50% 38.40% 67.00% 9.90% 18.29% 

Kansas 22.60% 11.60% 9.98% 85.54% 7.59% 23.50% 61.40% 4.10% 12.72% 

Utah 16.00% 11.30% 10.70% 80.34% 6.49% 16.80% 33.90% 3.60% 12.51% 

Indiana 22.50% 11.20% 28.35% 62.45% 7.98% 34.10% 18.10% 9.70% 13.28% 

Oregon 24.60% 10.80% 7.43% 49.67% 8.22% 15.10% 24.20% 3.90% 12.28% 

Kentucky 23.30% 8.90% 13.25% 86.71% 12.56% 46.10% 67.00% 7.30% 20.43% 

Nebraska 22.30% 8.50% 5.34% 91.32% 9.22% 17.30% 78.20% 1.80% 18.50% 

Wyoming 24.10% 8.30% 5.41% 88.65% 8.26% 19.50% 72.30% 2.00% 7.91% 

Idaho 22.40% 8.00% 5.98% 87.59% 8.00% 22.60% 50.80% 2.00% 13.62% 

Wisconsin 24.40% 7.70% 8.78% 90.71% 7.15% 23.30% 68.00% 4.20% 18.09% 

Minnesota 22.80% 7.50% 8.30% 86.14% 7.84% 19.00% 72.40% 4.30% 17.37% 

Montana 26.50% 6.50% 8.21% 53.84% 8.87% 24.70% 15.30% 3.30% 17.80% 

South Dakota 23.80% 6.50% 13.16% 84.46% 7.82% 37.30% 77.60% 8.00% 13.72% 

North Dakota 21.90% 5.10% 4.61% 95.34% 7.61% 21.50% 65.10% 2.60% 17.48% 

West Virginia 27.70% 4.80% 7.83% 91.31% 10.05% 39.50% 75.90% 3.50% 10.96% 

Iowa 24.00% 4.80% 4.01% 91.57% 7.93% 20.50% 41.40% 1.60% 17.05% 

New Hampshire 

26.30% 4.10% 0.37% 37.03% 6.94% 15.80% 71.10% 0.10% 12.70% 

Vermont 27.70% 3.30% 3.45% 90.51% 6.85% 23.00% 89.60% 1.70% 8.05% 

Maine 29.10% 2.90% 5.87% 82.58% 8.24% 46.30% 82.30% 3.90% 14.03% 
(1) Persons 60+ in the US, as a percent of all ages 

(2) Persons 60+ who are minority served by the program, as a percent of all the served population 

(3) Persons 60+ who are minority served by the program, as a percent of all the served population 

(4) Persons 60+ who are White (non-Hispanic) served by the program, as a percent of all the served population 

(5) Persons 60+ under the poverty level, as a percent of the US population 

(6) Persons 60+ under the poverty level, as a percent of all the served population 

(7) Persons 60+ who live in a rural area, as a percent of all the served population 

(8) Persons 60+ who are minority and under the poverty level, as a percent of all the served population 

(9) Persons 60+ who are minority and below poverty level, as a percent of minority 60+ population in the US 

Datasets used: 

AGID State Profile. https://agid.acl.gov/StateProfiles/Profile/Pre/?id=109&topic=l&startyear=2019&endyear=2019 

https://agid.acl.gov/StateProfiles/Profile/Pre/?id=101&topic=0&years=2019 

Table 3. Persons Registered (Clusters 1 and 2) and Served Under OAA Title Ill by Racial/Ethnic Characteristics. https:ljagid.acl.gov/ 

StateProfiles/Profile/Pre/?id=101&topic=0&years=2019 
 

 

100.00% 

90.00% 

80.00% 

70.00% 

60.00% 

50.00% 

40.00% 

30.00% 

20.00% 

10.00% 

0.00% 

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 

US Minority population % (2) Total Minority** 

Persons Served 

Percent (3) 

US and Title III program minority populations by States (numbers on 

X-axis correspond to the state numbers in the data table) 

Appendix 1 
Appendix 2 

Service Equity Project--Site questions 

ACL and the University of Maryland 

February 2022 

1. Has your organization made a public commitment to service equity? Have you included 

an approach to it in your work plan? 

If so, how? 

2. Do you provide to your staff and/or receive any training in cultural competence at the 

state level? 

3. Are you aware of any such training at the AAA or LSP level? If so can you provide 

specific examples of such activities? 

4. Are you aware of current resources available to you such as training, tools, information? 

5. How are you building capacity to ensure Service Equity sustainability and growth within 

your staff? and staff at the AAA and LSP level? Please provide concrete examples. 

6. How do you encourage cultural awareness and responsiveness of your staff? 

and also staff at the AAA/LSP levels? 

7. Does your organization have formal partnerships with other organizations serving 

communities with known disparities? 

8. What efforts are in place now at the state level to engage with AAA and LSP on service 

equity? 

9. How are you currently collecting relevant data to determine Service Equity practices, 

needs and assessment? How do you use and apply this data? 
10. What data do you currently use to drive decisions on Service Equity? Can you share any 

policies and procedures that were instituted as a result? 

11. Have you identified any gaps and disparities vis-a-vis Equity within your policies that 

you plan to change? If yes, what changes do you plan to make? 

12. Have you identified best practices in your state or within the local programs? 

If so, can you provide some examples of those best practices? 

13. Do any of the meal sites in your state publicize their services in culturally sensitive ways 

to target specific racial, ethnic, or cultural communities? If so, can you provide 

examples? 

14. Does your state offer services in languages other than English? Are your information and 

educational materials available in languages other than English? If so, which languages? 

What specific materials?