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INNOVATIONS IN NUTRITION PROGRAMS AND SERVICES (INNU) 

REPLICATION TOOLKIT

Replication Model A: Maryland Department of Aging: Addressing Malnutrition in 

Community Living Adults, A Toolkit for Area Agencies on Aging (AAA)

Also referred to as “AAA Malnutrition Pathways Toolkit”

How to Use This Toolkit

Please begin by reviewing the https://www.grants.gov/ posting for HHS-2022-ACL-AOAINNU-0040, which outlines requirements for ALL Replication projects. The information 

contained in this replication toolkit provides specific information and requirements 

regarding Replication Model A. 

This Replication Model Toolkit outlines the required elements within a Replication 

Project A application for HHS-2022-ACL-AOA-INNU-0040 Replication Grants. 

The toolkit specifies proposed application:

• Required elements. 

• Components which may or should be customized. 

• Areas where flexible approaches are permitted. 

Successful applications will outline a proposed project that includes all required 

elements while also demonstrating that customized and flexible items are planned.

If funded, your project team will receive regular technical assistance from the National 

Resource Center on Nutrition and Aging as well as consultation with members of the 

original grant’s project team, as feasible.

All surveys/forms and other materials are intended to be customized by the grantee, 

and the grantee should review the materials thoroughly to assure the use of customized

information, including dates, contact names, etc. 

If your grant proposal involves any programmatic, policy, organizational, or financial 

system changes, it is your responsibility to make sure the changes are acceptable and 

compatible with your state/local polices and requirements.

Summary of the Project

To replicate this project, applications must propose to design an agency-wide – or larger 

area, such as a statewide or region-wide – document, with associated policies and 

procedures, to identify and address malnutrition in older adults based on the techniques 

presented in the AAA Malnutrition Pathways Toolkit. Organizations are not required to 

have a registered dietitian on staff or as a consultant. However, applicants should 

consider how to appropriately refer individuals who are identified at malnutrition risk to 

supports and services that address their respective risk. 
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Simply put, there are three steps to addressing malnutrition:

• Step 1: Implement validated screening tools. 

• Step 2: Address root cause(s). 

• Step 3: Monitor client progress and quality of services. 

This unique and successful project created training and toolkit materials designed 

specifically for AAAs to help them identify how they can play an important role in 

identifying and supporting community-based older adults who have, or are at risk for, 

malnutrition. When AAAs identify and treat malnutrition, these actions can also help 

improve other chronic conditions like diabetes and heart disease.

The AAA Malnutrition Pathways Toolkit includes:

• Step-by-step process and rationale for why AAAs are so important for addressing

this significant and costly chronic illness. 

• Sample referral guide you can “plug and play” into your organization. 

• Distinct chapters that ask questions, so you can use the toolkit as a training tool. 

• Explanation of how EVERY staff person can identify or address malnutrition risk. 

• Sample screening tools, case studies, and questions to consider as you develop 

an agency-specific plan. 

• Numerous resources for obtaining health care payments, using billing codes, etc. 

(Note: This area may require extensive customization based on your state and 

local healthcare environment). 

Figure: Sample staff training exercise
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Replication Requirements, Anticipated Customization, and Flexibilities

Table: Replication Model A Requirements, Customization, and Flexibilities* 

Category Grant 

Requirements

(Elements that 

must be included)

Required 

Customization

(Elements that must 

be included and 

adjusted to project)

Project Flexibilities

(Optional elements; 

not exclusive)

Application Section

(Bolded sections are 

required; others are 

recommended)

Population 

Served

• 60 and over

• Targeted 

populations

• Specific targeted 

population

• Persons 

screened for 

malnutrition and 

appropriately 

referred

• Risk of hospital 

readmission

• Food insecurity

• Chronic disease

• Abstract

• Problem 

statement

• Approach

Service 

Delivery 

Older Americans 

Act Nutrition 

Program 

(congregate 

and/or homedelivered)

• Agency-wide 

approach to 

screening and 

referrals

• Staff roles

• Virtual 

• In-person

• Volunteers

• Approach

Partnerships Older Americans 

Act programs

Specific 

organizations that 

provide services 

and/or are referral 

entities, including

health care entities, 

emergency feeding 

organizations, 

transportation

entities, and

state programs

• Faith-based 

organizations 

• Schools

• Volunteers

• Housing 

authorities

• Abstract

• Approach

Activities

and Services 

• Establish and 

implement a 

robust referral 

network

• Staff trainings

• Policies and 

procedures

• Screening and 

referral method

• Surveys

• Site visits

• Presentations

• Malnutrition 

awareness class

• Approach

Evaluation Pilot test AAA 

Malnutrition 

Pathways Toolkit

• Planned 

evaluation 

process

• Quality 

assurance 

• Frequency and 

method of data 

collection

• Knowledge of 

malnutrition or 

• Outcomes and 

evaluation
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Category Grant 

Requirements

(Elements that 

must be included)

Required 

Customization

(Elements that must 

be included and 

adjusted to project)

Project Flexibilities

(Optional elements; 

not exclusive)

Application Section

(Bolded sections are 

required; others are 

recommended)

• Malnutrition 

Screening Tool

• Client 

demographics

malnutrition risk 

factors

Outcomes Number and 

percent of total 

participants who 

are identified as 

at risk of 

malnutrition

• Number and 

types of 

referrals to 

address 

identified risks

• Dissemination

(webinars, 

conference 

sessions, etc.) 

• Participant

and/or staff

knowledge 

change

• Policy/procedure 

impacts on staff 

or systems

efficiencies 

• Costs and 

benefits 

• Change in 

malnutrition risk

• Abstract

• Outcomes and 

evaluation

Products Capstone project • Customized AAA 

Malnutrition 

Pathways 

Toolkit

• Policies and 

procedures

• Surveys

• Presentations

• Evaluation 

reports

• Abstract

• Approach

Sustainability • Continue

effective policies 

and procedures 

developed 

during the 

project 

• Schedule for 

updating AAA 

Malnutrition 

Pathways 

Toolkit 

• Funding to 

support 

screening or 

services

• Embed training 

and referral 

processes into 

staff job 

descriptions 

• Include 

malnutrition 

identification 

into 

organization’s 

mission

• Sustainability

*Please refer to HHS-2022-ACL-AOA-INNU-0040 Replication Grants for requirements that apply to all 

Replication Projects.

 
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Grant-related Resources

• AAA Malnutrition Pathway Presentation

• AAA Malnutrition Pathway Site Visit Agenda

• AAA Malnutrition Pathway Survey

• Addressing Malnutrition in Community Living Older Adults, Maryland Department of 

Aging

• Summary Brief: Maryland Department of Aging 
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FAQ for Replication Model A

1. Is field testing required to replicate the AAA Malnutrition Pathways Toolkit?

Proposals should include a planned evaluation approach, which must include 

pilot – also called field – testing.

2. Do we use the same format and structure as the existing toolkit?

Project-customized AAA Malnutrition Pathways toolkits should include all the 

major headings/sections that the existing toolkit of the original AAA Malnutrition 

Pathways Toolkit. Projects are required to customize the specific information to 

reflect local referral resources, screening tools, health care partnerships, 

resource materials, and other items that are current and relevant to their 

respective area. For example, applicant areas may not have Care Transition 

Organizations or Primary Care Program health care entities, and applicants 

should customize the project’s AAA Malnutrition Pathways Toolkit appropriately.

3. There are already several organizations in my jurisdiction that screen for 

malnutrition and refer participants who are at risk or identified with 

malnutrition. Do we have to work with them, or can we select our own 

malnutrition screening tools?

Applicants are responsible for selecting partners they choose to work with and

whether their project will utilize existing screening tools and referral processes or

develop new screening tools or processes. 

4. Do we need to have a dietitian on staff or as a consultant?

No, as outlined in this Replication Model Toolkit, it is not a requirement to have a 

dietitian on staff or as a consultant. However, applicants must consider how to 

appropriately refer individuals who are identified at malnutrition risk to supports 

and services that address their respective risk. 

5. The Maryland 2017 INNU grant produced 4 products, including the AAA 

Malnutrition Pathways Toolkit. Are applicants required to replicate the 

other projects from this grant?

Only the AAA Malnutrition Pathways Toolkit is required to be replicated in 2022-

HHS-ACL-AOA-INNU-0040 Replication Grants. The other three products 

produced during the Maryland 2017 INNU grant (meal packages, home-delivered 

screening tool, evaluation of malnutrition awareness workshop) ARE NOT part of 

this Replication Model Toolkit and are not required projects within HHS-2022-

ACL-AOA-INNU-0040 Replication Grants.