# Senior Nutrition Program Solutions Forum

# Critical Issues Resources

## Background

The Administration for Community Living's (ACL) Office of Nutrition and Health Promotion Programs (ONHPP) recently focused on addressing key challenges in the national Senior Nutrition Program. This task involved reviewing insights from the White House Conference on Hunger, Nutrition, and Health, as well as feedback from the Older Americans Act (OAA) regulations update sessions. These discussions raised important questions about how well the Nutrition and Aging Resource Center resources were known and used. To find answers, ONHPP brought together various national partners and stakeholders in a forum in 2023, aiming for a more comprehensive view of the network’s needs. This also included a group of representatives from state units on aging (SUA), area agencies on aging (AAA), and local service providers.

The Senior Nutrition Program Solutions Forum, through a thorough evaluation of resources, found that many in the network were not aware of the resources available at the Nutrition and Aging Resource Center. As a result, the group identified many relevant resources from the center and elsewhere, directly tackling the critical issues identified. This document is the result of those efforts.

This is a critical step in ONHPP's continuous effort to improve the Senior Nutrition Program, driven by well-informed, inclusive, and collaborative approaches. ONHPP is grateful to all the forum participants and the network for their valuable contributions to both this document and the process that led to its development.

Unless otherwise noted, the resources and webpages in this document are from the Nutrition and Aging Resource Center. 

## Health Care Collaboration

Health care organizations can be great partners for nutrition programs. Learning how to foster ties within the sector can help programs expand services, reach more people, and achieve better outcomes for everyone involved.

### Building a Referral Process

· Tackling Malnutrition Through a Statewide Delivery System in Maryland

· Taking a Systems Approach to Referrals

### Establishing Referrals Between Health Care and Community

· Personal Health Nursing for Seniors Receiving Title III Home-Delivered Meals

· Triage Guidelines for Food and Meal Needs, Older Adults (University of MD)

· Prioritizing Clients Webpage

### Hospital Transitions, Community Resource "Hub" for Home and Community-Based Services (HCBS)

· Partnership Assessment Tool (NCOA)

· Medicare and Medicaid Basics Webpage

· Care Transitions Webpage

· Looking to Innovate Webpage

· Resources for Developing a Community Care Hub (Aging and Disability Business Institute)

· Improving Nutrition and Health of Rural Older Adults Following Hospital Discharge

· Care Transitions Community (ACL Technical Assistance Community)

· ACL: Federal Hospital Care Transitions Resources and the Aging and Disability Network - Care Transitions Resources (ACL Technical Assistance Community

· Care Transitions Discussion Board (ACL Technical Assistance Community)

### Billing for Services and Funding Options

· The Roadmap to Community-Integrated Health Care (NCOA)

· Nutrition Counseling Webpage

· Medicare and Medicaid Basics Webpage

· Resource Guide Partnerships with Community-based Organizations (Aging and Disability Business Institute)

· Addressing Nutrition and Food Access in Medicaid (The Food Trust)

· Guide to Establishing a Fee-for-Service Private Pay System

### Educating Health Care Providers on OAA Nutrition Services

· OAA Nutrition Services Basics Webpage

· Looking to Innovate Webpage

· Quick Tips: OAA Basics

### Business Acumen Quick Start Tools

· Health Care Partnership Readiness Assessment (Aging and Disability Business Institute)

· Business Skills Webpage

· Instructional Campus on Aging Nutrition (ican!)

· Quick Tips: OAA Nutrition Program Funding Options

## Enhancing & Restoring Congregate Meal Programs

Congregate meal programs serve meals in community centers, schools, restaurants, faith-based locations, and other community gathering places — sometimes including virtual settings. They are a source of healthy meals for older adults and provide opportunities for social engagement, learning, and volunteering.

### Getting People Back to Congregate Meals

· Collaborating with Community Partners — Congregate Meal Delivery Model in Iowa

· Looking to Innovate Webpage

· Basics of Congregate Webpage

· Improving the Congregate Meal Dining Experience

· Tips to Keep Those We Serve at the Table Webinar (NCOA/ACL)

· Tips to Keep Those We Serve at the Table Takeaway Sheet

· Tips to Attract New Participants Webinar (NCOA/ACL)

· Tips to Attract New Participants Takeaway Sheet

· Tips to Create a Welcoming Environment for Men Webinar (NCOA/ACL)

· Tips to Create a Welcoming Environment for Men Takeaway Sheet

· Data and Reports Webpage

· Program Entrance and Retention in OAA Title III-C Nutrition Service Program

· Creativity & Innovation Webpage

· Institutional or Innovative? What the Setting of a Congregate Meal Site Says to Guests

· Revamp Your Congregate Meal Program Webinar Series (ACL on YouTube)

· Part 1: Food Trucks 

· Part 2: Cafe Connection

· Part 3: Restaurant Model

· Part 4: Dining Dollars 

### What is Allowable in Congregate Settings

· Basics of Congregate Webpage

· Quick Tips: Congregate Meals

· The Dining Experience — Congregate Meal Policy Myth Busters

· Nutrition Services Incentive Program (NSIP) Webpage

### Congregate Program Promotion

· Marketing Webpage

· Marketing & Communications Guide

· How to Customize Marketing for Programs in Indigenous Communities (NCOA)

· Quick Tips: OAA Title III-C1, Congregate Meals

### Congregate Program Modernization

· Meal Site Environment Quickinars (YouTube)

· Texas Congregate Meal Initiatives

· Creativity & Innovation Webpage

· Looking to Innovate Webpage

### Choices in Types of Meals

· Restaurant Partnerships Webpage

· Increasing Choice Through a Flexible, Technology-Driven Meal Program in New York

### Grab-and-Go Meals

· OAA Nutrition Basics Webpage

· Understanding Title III-C Flexibilities

· Grant Reporting Webpage

· Title III-C1 and -C2 Service Delivery Decision Tree

· Creativity and Innovation Webpage

· Sullivan Senior Center's St. Patrick's Day Grab & Go

## State Policy Variation in Flexibilities

Policies and procedures ensure nutrition programs function with structure, consistency, and accountability in every area of operations, from food safety and sanitation to managing personnel and volunteers. States may often tailor their policies to work for their regions and communities.

### Guidance on State Policies

· Grantee Reporting Webpage

· What’s New for Reporting and Connecting with Clients (ACL on YouTube)

· What's New for Reporting and Connecting with Clients Slides

· Nutrition Services Incentive Program (NSIP) Webpage

### AAA Interpretation of Service Delivery

· Nutrition Counseling Webpage

· Nutrition Counseling for the AAA and LSP

· AAA and LSP Playlist (YouTube)

· Nutrition Counseling for the RD

· RD Playlist (YouTube)

### Communicating

· OAA Nutrition Services Basics Webpage

· Policies and Procedures Webpage

· Map of State Plans on Aging (ADvancing States)

### Person Centered Care

· Tackling Malnutrition Through a Statewide Delivery System in Maryland

· Creating Connections & Inspiring Trust

· Identifying Participant Needs

· Taking a Systems Approach to Referrals

### Flexibility to Meet the Needs of Different Populations, Ages, and Demographics 

· Creativity and Innovation Webpage

· Sharing Our Space Toolkit for Intergenerational Sites (Generations United)

· Updating Programming to Attract Baby Boomers

· Iowa Cafe Guide for Partners

· Collaborating with Community Partners on a Congregate Meal Delivery Model in Iowa

· OAA Nutrition Services Basics Webpage

### Senior Nutrition Programs Flexible Delivery 

· Sullivan Senior Center's St. Patrick's Day Grab & Go

· Social Enterprising Aging Network Example: REAL Grille

· The Diner: Promising Practices from the Network

· Innovations and Lessons Learned from COVID-19

· Meals in Motion Food Truck

· Understanding Title III-C Flexibilities

· Looking to Innovate Webpage

· Increasing Choice Through a Flexible, Technology-Driven Meal Program

## Nutritional Requirements and Flexibilities

Nutrition guidelines, such as the Dietary Guidelines for Americans (DGAs) and Dietary Reference Intakes (DRIs), provide direction for creating healthy menus for senior nutrition programs. There are many ways to meet the basic requirements of Title III-C nutrition services.

### Understanding Different Ways to Meet the Nutrition Requirements

· Nutrition Education: What are the Requirements?

· General Resources and Strategies Webpage

· Nutrition Guidelines Webpage

· Nutrition Requirements of the Older Americans Act

· Instructional Campus on Aging Nutrition (ican!)

· DGA Toolkit

· Quick Tips: Nutrition Guidelines

### Sample Menus and Flexibility Examples

· Menus & Recipes Webpage

· Menu Creation Toolkit

· Plan and Shop for Simple Healthy Meals

· Salad Bar Guide

· Instructional Campus on Aging Nutrition (ican!) Module 9

### Focusing on Client Preferences and Choice

· Increasing Choice Through a Flexible, Technology-Driven Meal Program in New York

· Cultural Competency Webpage

· Choice Menu Quick Guide

### Menu Planning Guidance

· Dietary Guidelines for Americans and Older Adults: Toolkit for Senior Nutrition Programs

· Instructional Campus on Aging Nutrition (ican!)

### Encouraging People to Exercise Flexibility

· Creativity & Innovation Webpage

· Updating Programming to Attract Baby Boomers

· Understanding Title III-C Flexibilities

· OAA Nutrition Services Basics Webpage

· Instructional Campus on Aging Nutrition (ican)

### Flexibility on Delivery Methods

· Quick Tips: OAA Title III-C2 Home-Delivered Meals

· Modernizing Home-Delivered Meals Through Frozen Meals and a Web-Based App

· Looking to Innovate Webpage

### Culturally Appropriate Meal Resources, Best Practices, Innovations

· Cultural Competency Webpage

· Reframing Language Guide (E4 Center)  

· Cultural Toolkits (USDA) 

· Cooking Up Diversity and Inclusion: Innovative Menu Planning and Design (YouTube)

· Cultural Competency Webpage

· Grantee Spotlight Webpage

## Screening Requirements to Include Food Insecurity, Malnutrition, and Socialization

Reducing hunger, food insecurity, and malnutrition is an essential intent of the Older Americans Act Senior Nutrition Program. Many older adults are at increased nutritional risk, which can lead to adverse health impacts. Social connections are also of vital importance for everyone, but older adults are at increased risk of loneliness and social isolation — factors that negatively affect mental and physical health.

### Development of New Standard Screening Tool for States

· Malnutrition Webpage

· Malnutrition Screening Practices Quick Guide

· Addressing Malnutrition in Community Living Older Adults

· Expanded Food Insecurity Screener & Food Insecurity Assessment Tools (YouTube)

· Expanded Food Security Screener Home-Delivered Meals Prioritization Tool

· Placing the 'Value' in Evaluation: Practical Tips for Measuring Impact (YouTube)

· Placing the 'Value' in Evaluation Slides

· Social Isolation Basics & Materials Webpage

· Malnutrition Learning Collaborative — State Resources

· Screen & Intervene Page (FRAC)

· Screen & Intervene: Addressing Food Insecurity Among Older Adults (FRAC)

### Once You Screen, Taking the Next Step to Engage in Benefit Counseling

· Nutrition Counseling Webpage

· Registered Dietitian vs. Nutritionist

· Medical Nutrition Therapy Works for Seniors

· Making the Case for Nutrition Therapy

· Nutrition Counseling for the AAA and LSP

· AAA and LSP Playlist (YouTube)

· Find a Registered Dietitian (EatRight.org)

### Recommended Interventions and Referrals Based on Scores for Screenings

· Nutrition Counseling Webpage

· Nutrition Counseling for the AAA and LSP

· AAA and LSP Playlist (YouTube)

· Nutrition Counseling for the RD

· RD Playlist (YouTube)

· Addressing Malnutrition Risk Through a Home Visitation Program in Utah

· Service Referrals Training

· Creating Connections & Inspiring Trust

· Identifying Participant Needs

· Taking a Systems Approach to Referrals

### Preferred Resources to Screen for Social Isolation

· Assessing for Suicide in Community-Based Research

· Equipping the Aging Network to Address SILES During COVID-19 and Beyond (ACL on YouTube)

· Supporting Older Adults at Risk of Suicide Through Nutrition Services

### Expanded (Reliable and Validated) Screens for Malnutrition & Food Insecurity

· Malnutrition Learning Collaborative State Resources

· Addressing Malnutrition in Community Living Older Adults

· Food Insecurity and Malnutrition (YouTube)

· Food Insecurity and Malnutrition Slide Deck

· Food Insecurity and Malnutrition Takeaway Sheet

· Food Insecurity and Malnutrition Tip Sheet

· Placing the 'Value' in Evaluation: Practical Tips for Measuring Impact (YouTube)

### Example Screening Tools

· Enhanced DETERMINE Tool (YouTube)

· Enhanced DETERMINE Checklist (GWAAR)

· Expanded Food Security Screener

## Enhance and Strengthen Research Initiatives

Research on senior nutrition programs, older adults, health rankings, food systems, and more can help inform decision-making and improve program participants' outcomes.

· Data and Reports Webpage

· Data Collection & Analysis 101

· Program Evaluation

· Evaluation of the Effect of Title III-C Nutrition Services on Participants’ Longer-Term Health Care Utilization

### Health Impact of Community-Delivered Meals and Social Engagement Services, Outcomes of the SNP

· Evaluation of the Effect of the OAA Title III-C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet Quality

· Briefing Slides

· Responses to Questions Posed

· OAA Nutrition Services Basics

· Trifecta (Nutrition, Socialization, Health and Well-being) Webinar Takeaways

· Food Insecurity & Malnutrition Webinar Tip Sheet

· Socialization Webinar Tip Sheet

· Health & Well-Being Webinar Tip Sheet

### Addressing Socialization

· Socialization Tip Sheet

· Social Isolation Basics & Materials Webpage

· The State of Mental Health and Aging in America: What Do the Data Tell Us? (CDC)

### Capacity to Develop and Implement Evaluation Instruments

· Addressing Malnutrition in Community Living Older Adults

· Malnutrition Learning Collaborative State Resources

· Program Evaluation Webpage

· Using Data Effectively in Federal Grant Applications (YouTube)

· Using Data & Satisfaction Surveys to Solicit the Voice of the Customer in Menu Planning (YouTube)

· Placing the 'Value' in Evaluation: Practical Tips for Measuring Impact (YouTube)

### How State and AAA Programming Can Address Multiple Needs at Once

· Prioritizing Clients Webpage

· Senior Nutrition Program Meal Services Elements for Sustainability: Guide to Prioritizing Clients

· Meal Prioritization (GWAAR)

· HDM Assessor Training: Using Enhanced DETERMINE (GWAAR)

## Preventing Older Adults from Needing More Care

Senior nutrition program participants often experience gaps between the OAA and healthcare options.  Senior nutrition services can identify service or referral options that can help address those gaps.   Identifying short- and long-term outcomes can help leverage more services and improve prevention factors. 

### Medicare/Medicaid and the OAA: Where Are Funding Availability and Requirements Available

· Medicare and Medicaid Basics Webpage

### Data on Preventative Models to Help Increase Coverage with Insurance

· Partnering to Integrate Health and Long-Term Care (Aging and Disability Business Institute)

· Social Determinants of Health Webpage

· AAAs: Hub for Community Supports Addressing Social Determinants of Health

· Social Determinants of Health (CDC)

· Health Equity (CDC)

· Social Determinants of Health (World Health Organization)

· Health Equity (World Health Organization)

· Social Determinants of Health: What Are They and How Do They Impact the Health of Populations? (Clinical Scholars on YouTube)

· ACL Fact Sheet on the CPSTF Results

· Nutrition: Home Delivered and Congregate Meal Service for Older Adults CPSTF Finding and Rationale Statement (The Community Guide)

### Long Term Outcomes Need to be Included (Savings are More Long Term) Spotlights on Models

· Activating Cross-Sector Partnerships to Address the Social Determinants of Health

· Grantee Spotlight Webpage

### Expand Research on Cost-saving and Preventative Care 

· Offering Nutrition-Focused Diabetes Self-Management in Pennsylvania

· Finances Webpage

· Business Planning & Sustainability

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