RESEARCH BRIEF NUMBER 8 • SEPTEMBER 2015

Older Americans Benefit from 

Older Americans Act Nutrition Programs
	

by Niranjana Kowlessar, Kristen Robinson, and Claudia Schur, Social & Scientific Systems, Inc. 

Since the passage of the Older Americans Act (OAA) in 1965, the Administration on Aging (AoA) has supported 

older adults by helping them to maintain their independence and remain in their homes. Through its “Aging Services 

Network,” including State Units on Aging, Area Agencies on Aging, Native American Tribes and organizations, and 

local service providers, AoA provides services designed to promote health and functionality, engage older adults in the 

community, maintain needed community and family supports, and mitigate the effects of declining physical health and 

functioning. This brief, the eighth in a series that represents findings from AoA’s National Survey of OAA Participants, 

explores the Older Americans Act Nutrition Program (OAA NP). It 1) describes program requirements, 2) discusses the 

link between nutrition, health, and the ability of older adults to remain at home, 3) describes the high risk population 

served, and 4) shows participants’ perceptions of the positive impact programs have on their quality of life. 

Summary 

The Administration for Community Living and the 

Aging Services Network strive to help older adults 

remain safely in their homes and communities. One 

important way this is accomplished is by providing 

regular and adequate sources of nutrition to older adults 

who are in greatest social and economic need. While it 

can be difficult to isolate the beneficial effects of nutrition programs from other community supports (such as 

availability of caregivers), it is clear that AoA nutrition 

programs are serving those most in need. As this brief 

demonstrates, adults receiving congregate and homedelivered meals are older and in poorer health than the 

older population as a whole. They are also more likely 

to be living alone. This suggests that the OAA NP1

, is 

fulfilling its mission by providing the most frail and 

vulnerable older adults with nutrition services that are 

helping them to stay in their homes. 

Background 

Good nutrition is a key component in maintaining the 

health of vulnerable, older adults. The OAA recognizes 

the importance of providing adequate nutrition to older 

adults through the OAA NP. In 2013, 2.4 million older 

adults received 219 million meals; 62 percent of meals 

This brief is specific to programs under OAA Title III-C. 

What Is the Aging Services Network? 

The Aging Services Network (funded under Title III 

of the OAA) provides a range of community-based 

services – home-delivered and congregate nutrition services, case management, transportation, and 

homemaker and caregiver support to individuals age 

60 and over and their caregivers. These services are 

intended to reach the most vulnerable older adults 

in greatest social and economic need. Such services 

enhance both quality of life and social interaction, 

and minimize the impact of disability. Funding for 

OAA services is provided by the Administration for 

Community Living’s (ACL) AoA. 

were served to people in their homes, and 38 percent 

were served in congregate settings (Adminstration for 

Community Living, 2013). 

One of the consequences of longer life spans is the higher 

incidence of chronic conditions which may negatively 

affect quality of life, contribute to declines in health and 

functionality, limit individuals’ ability to remain at home 

in the community, contribute to caregiver burden, and 

contribute to increased hospitalizations and health care 

costs. Adequate food and quality nutrition services are 

a prevention, risk reduction, and treatment modality for 

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many of the most common chronic conditions, such as 

hypertension, heart disease, diabetes, osteoporosis, and 

obesity (Bernstein & Munoz, 2012). 

The OAA NP provides funding for both congregate and 

home-delivered nutrition programs through formula 

grants to states and U.S. territories. Congregate nutrition programs are provided in senior centers, adult day 

care centers, and other community venues, while homedelivered nutrition programs are provided to frail, older 

adults who have difficulty leaving their homes. In addition to providing meals, these nutrition programs also 

offer nutrition education, nutrition counseling, and other 

nutrition services as appropriate. 

Nutrition Services as Part of Homeand Community-Based Services 

The OAA NP is not a stand-alone service or program 

but functions as part of a home- and community-based 

service (HCBS) system. The OAA emphasizes that 

services provided are to be part of a comprehensive 

and coordinated service system designed to secure and 

support maximum independence and dignity in the home 

environment for older adults (Bernstein & Munoz, 2012). 

As part of a HCBS system, providing adequate quality 

food and nutrition is part of the broader OAA purpose. 

The OAA NP is not simply focused on meal provision 

or nutrition outcomes, but on how to maintain the health 

and functionality of older adults in the community. To 

maintain health and functionality, the OAA indicates 

that the OAA NP has specific purposes in addition to 

the overall OAA purposes. These specific purposes 

focus on how the role of nutrition contributes to: 

1) reducing hunger and food insecurity 

2) promoting socialization 

3) promoting health and well-being 

4) delaying adverse health conditions 

Reducing Hunger and Food Insecurity 

Food insecurity is often used to assess and evaluate 

hunger within specific populations (Opsomer, Jensen, 

& Pan, 2003). Based on a review by the Committee 

on National Statistics (CNSTAT), the United States 

Department of Agriculture (USDA) uses the following 

terms to refer to food security and insecurity: food 

security, marginal food security, low food security, and 

very low food security. 

Although low and very low food security are less 

prevalent in the older population than other populations 

(Coleman-Jensen, Gregory, & Singh, 2014), older adults 

Nutrition Requirements 

The OAA requires that nutrition service providers 

ensure that meals meet food and nutrient requirements, are safe to serve and are appealing to older 

adults. 

Dietary Guidelines for Americans 

Meals offered must meet the most recent Dietary 

Guidelines for Americans (DGAs) which are 

issued every 5 years by the Secretaries of Health 

and Human Services and Agriculture. Based on 

the most current science, the DGAs are designed 

to promote health and reduce the risk of chronic 

disease through healthy eating and physical activity. 

The DGAs serve as the nutrition basis for all federal 

nutrition programs, aid policymakers in designing 

and implementing nutrition programs, and provide 

the basis for nutrition messages and consumer materials developed by nutrition and health professionals 

(U.S. Department of Health Human Services & U.S. 

Department of Agriculture, 2010). 

Dietary Reference Intakes 

Meals must provide at least one-third of the Dietary 

Reference Intakes. The Dietary Reference Intakes 

(DRIs) are nutrient reference values developed by 

the Institute of Medicine of The National Academies. They are intended to serve as a guide for good 

nutrition and provide the scientific basis for the 

development of food guidelines in both the United 

States and Canada (National Academies. Institute of 

Medicine, 2010). 

Food Safety and Sanitation 

Meals offered are to meet state and local foodservice laws, rules, and regulations to ensure that the 

meals served are safe and sanitary. Most states base 

their state and local foodservice codes on the most 

recent edition of the Food Code published by the 

U.S. Public Health Service and the Food and Drug 

Administration (U.S. Department of Health and 

Human Services. Public Health Service. Food and 

Drug Administration, 2013). 

Meal Appeal 

Meals offered are designed to be appealing to older 

adults and it is intended that older adults provide 

input into the planning process (Older Americans 

Act of 1965. Section 339 (2)(B), n.d.). 

For additional information visit: 

http://www.aoa.acl.gov/AoA_Programs/HPW/ 

Nutrition_Services/index.aspx 

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who are less food secure are more likely to have adverse 

health consequences than food secure older adults. For 

example, food insecure older adults are 50 percent more 

likely to be diabetic, 60 percent more likely to have 

congestive heart failure, and 3 times more likely to 

suffer depression (Ziliak & Gundersen, 2014). Chronic 

health conditions combined with food insecurity can 

negatively affect older adults’ ability to remain in the 

community. 

To address these conditions, meals provided in the OAA 

NP are to comply with federal requirements. These 

federal requirements are designed to promote health 

and reduce the risk of chronic disease (see textbox for 

further detail). While most OAA NP providers serve 

one meal per day about 5 days a week or about 25 

percent of the meals considered a usual eating pattern 

over a week’s time (5 of 21 meals), more than half of 

the 2.4 million older participants (56 percent of congregate nutrition service participants and 60 percent of 

home-delivered nutrition service participants) report 

that these meals make up one-half or more of their food 

intake for the day. In addition, the meal service provides 

socialization opportunities for both congregate and 

home-delivered participants that positively affect their 

ability to stay at home. 

Promoting Socialization 

The OAA NP promotes socialization for vulnerable 

older adults who may be isolated due to physical or 

mental conditions, living alone, lack of transportation, or other issues. The day-to-day contact in group 

settings or in-person contact that occurs when meals 

are delivered is designed to decrease isolation. Isolation 

has been linked to higher mortality for older men and 

women (Steptoe, Shankar, Demakakos, & Wardle, 2013). 

Recent research compared individuals receiving dailydelivered meals, once-a-week frozen delivered meals, 

and individuals who were on a waiting list to receive 

home-delivered meals on a number of dimensions 

including social contact. The research indicated that 

those receiving daily-delivered meals were more likely 

to report improvements in mental health, self-rated 

health, and reductions in feelings of isolation as well as 

less worry about being able to remain at home (Thomas 

& Dosa, 2015). 

Promoting Health and Well-being 

The OAA NP promotes the health and well-being of 

older individuals by assisting them in accessing other 

disease prevention and health promotion services that 

may delay the onset of adverse health conditions (Older 

Americans Act. OAA amendments of 2006.P.L.109-365, 

n.d.). Among people currently receiving congregate 

nutrition services, 43 percent are also receiving one or 

more other HCBS. Likewise, among people receiving 

home-delivered nutrition services, 59 percent reported 

receiving one or more additional HCBS. 

Delaying Adverse Health Conditions 

Another purpose of the OAA NP is to delay adverse 

health conditions. Because the prevalence of multiple 

chronic conditions is higher among congregate and 

home-delivered program participants (see next section) 

than the general Medicare population, the provision of 

healthy meals, access to lifestyle modification programs 

and nutrition education and counseling are important to 

promoting health, modifying risk, helping to treat these 

multiple chronic conditions, helping to maintain functionality, and reducing health care utilization. 

Recent research compared individuals on waiting lists 

to individuals receiving meals delivered to their homes 

by one of two methods: daily delivery of a single meal 

or once-a-week frozen delivery of multiple meals. The 

research indicated that individuals on waiting lists 

needed a variety of supports beyond meals, and that 

those receiving home-delivered meals (regardless of 

delivery method) had greater improvements in anxiety, 

and self-rated health, and reduced rates of hospitalizations and falls. Those receiving daily-delivered meals 

reported greater health benefits compared to the group 

receiving frozen meals (Thomas & Dosa, 2015). 

Who Receives OAA Home-Delivered/ 

Congregate Nutrition Services? 

The OAA NP (both congregate and home-delivered 

nutrition services) specifically targets and provides 

services to older adults who are in poor health and 

functionally impaired. For example, 45 percent of 

congregate participants and 63 percent of home-delivered participants have six or more medical conditions; 

44 percent of congregate and 62 percent of home-delivered participants take over five medications daily and 17 

percent of congregate and 38 percent of home-delivered 

participants have been in the hospital in the past year. 

Providing appropriate services to high risk individuals 

supports these older adults and their desire to live at 

home. This brief examines the older adults who use 

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these programs by looking at a number of different 

demographic, socioeconomic and health characteristics 

and comparing them to the general population. 

Recipients of OAA Congregate and HomeDelivered Nutrition Services and the National 

Population Age 60 and Over 

There are approximately 61.4 million communitydwelling adults age 60 and over in the United States 

(U.S. Census Bureau, n.d.). Within this group, those who 

use Title III congregate and home-delivered nutrition 

services are more vulnerable compared with the general 

population. The characteristics shown in Figure 1 are 

often indicative of a higher risk for institutionalization. 

The overall purpose of the OAA programs is to help 

older adults remain in their homes through the provision 

of long-term services and supports. 

•		 In 2013, the mean age of congregate meal participants 

was 76.05 years and the average age of homedelivered meal participants was 79.53 years. 

•		 Eighteen percent of congregate nutrition service 

participants and 35 percent of home-delivered nutrition service users are age 85 or older. This equates to 

being twice as likely and four times as likely (respectively) as the general population to be aged 85 years 

and over. 

Older women are more likely to live alone and have 

lower incomes than men, placing them at higher risk for 

institutionalization. 

•		 72 percent of congregate nutrition service participants 

are older women, as are 65 percent of home-delivered 

nutrition service participants, compared with 55 

percent of the general population. 

•		 Compared with the general population, congregate 

and home-delivered nutrition service participants 

are much more likely to live alone (50 percent and 55 

percent, respectively, compared with 26 percent for 

the general population). 

Individuals in rural areas may experience more difficulties in accessing and obtaining services as needed to 

maintain independence. 

•		 Twenty-eight percent of congregate nutrition service 

participants and 22 percent of home-delivered nutrition service participants live in rural areas of the 

country. These groups are almost one and one-half 

times as likely as the general population to be living 

in rural areas. 

Figure 1. Comparison of Older Americans Act Nutrition 

Program Participant Characteristics to the 

U.S. Population Age 60 and Over, 2013 

85 and over 

Female 

Live Alone 

Rural 

Poor or 

Fair Health 

Difficulties 

with 3 or 

more ADLs 

18%
 

35%
 

8%
 

72% 

65% 

55% 

50% 

55% 

26% 

28%
 

22%
 

15%
 

23% 

52% 

24% 

8%
 

34%
 

3%
 

0% 25% 50% 75% 100% 

Congregate Nutrition Services (N=1,614,874) 

Home-Delivered Nutrition Services (N=841,039) 

U.S. Population, 60 Years and Over 

Sources:National Survey of Older Americans Act Participants 

(2013); National Health Interview Survey (2012); Medical 

Expenditure Panel Survey (2012). 

Services for congregate participants such as access to 

healthy meals and other health promotion interventions 

may promote better health behaviors, delay complications of chronic disease, and slow the decline to a more 

restrictive living environment. 

•		 While the proportion of congregate nutrition service 

participants in poor or fair health (23 percent) was 

similar to the general population (24 percent), homedelivered nutrition service participants are over twice 

as likely (52 percent) as these two groups to report 

being in poor or fair health. 

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Assistance with activities of daily living (ADL) impairments may decrease the risk for institutionalization and 

allow individuals to remain at home longer (BanaszakHoll et al., 2004). 

•		 Differences with respect to ADLs2 are particularly 

striking: congregate nutrition service participants are 

over twice as likely (8 percent) while home-delivered 

nutrition service participants are over ten times as 

likely (34 percent) as the population age 60 and over 

to have difficulties with 3 or more ADLs. 

•		 Both home-delivered nutrition service participants (91 

percent) and congregate meal participants (64 percent) 

reported that the nutrition programs helped them stay 

in their own home (see Figure 4). 

Nutrition Service Users and Food 

Insecurity 

Many older adults live on fixed incomes that force them 

to choose between paying for rent, utilities, or medication 

versus paying for groceries (Mabli, Cohen, Potter, Zhao, 

& America, 2010; Sattler & Lee, 2013). Congregate and 

home-delivered nutrition services help bolster seniors’ 

food intake by providing an additional source for meeting 

their nutritional needs. Data indicate that both homedelivered nutrition service participants and congregate 

nutrition service participants have limited incomes, with 

63 percent of home-delivered nutrition service participants reporting annual income below $20,000 and 42 

percent of congregate nutrition service participants 

reporting annual income below $20,000 (data not shown). 

It is therefore not surprising that both groups face greater 

barriers to meeting their nutritional needs. As shown in 

Figure 2, congregate nutrition service participants and 

home-delivered nutrition service participants both report 

often choosing between buying food or paying rent or 

utility bills (8 percent and 14 percent, respectively), as 

well as having to choose between food and medication 

(9 percent and 18 percent, respectively). In addition, 14 

percent of congregate nutrition service participants and 

29 percent of home-delivered nutrition service participants report not always having enough money or food 

stamps to buy the food they need. 

2 ADLs are basic activities people complete to care for themselves, 

including: personal hygiene activities, such as bathing or using the 

toilet; dressing; eating; walking without an assistive device, such 

as a cane; and transferring from a seated to a standing position 

and getting in and out of bed. 

Figure 2. Purchasing Decisions of Congregate and HomeDelivered Nutrition Service Participants, 2013 

During the past

 month, skipped

 meals because you

 had no food and

 no money or food

 stamps to buy food 

During the past

 month, chose

 between buying

 food or paying

 your rent or

 utility bills 

During the past

 month, chose

 between buying

 food or buying

 medication 

Do not always

 have enough 

money or food 

stamps to buy the 

food you need 

5% 

10% 

8% 

14% 

9% 

18% 

14% 

29% 

0 25 50 75 100 

Congregate Nutrition Services 

Home-Delivered Nutrition Services 

Source: National Survey of Older Americans Act Participants (2013). 

Are Title III Services Meeting the Needs 

of Program Users 

Both congregate and home-delivered participants value 

the meals and services that they receive from the OAA 

NP. Congregate and home-delivered nutrition service 

participants rated the programs highly in terms of meal 

and service quality as well as how the program affected 

their ability to maintain their health, and functionality, 

and ability to remain at home in the community. 

As shown in Figure 3, 95 percent of congregate and 86 

percent of home-delivered meal participants rated the 

meals as good, very good, or excellent. Participants in 

both programs indicated that they are highly satisfied 

with meal taste and variety. 

Over 90 percent of participants in both programs 

indicate that they would recommend the program to 

a friend (data not shown). Independent research of 

several home-delivered programs indicates that 99 

percent of participants would recommend the program 

to others (Thomas & Dosa, 2015). The individuals 

in this study indicate that the social contact with the 

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Figure 3. Congregate and Home-Delivered Nutrition Figure 4. Congregate and Home-Delivered Nutrition 

Service Participants Rating of the Nutrition Program Service Participants Rating of the Meal Program, 2013 

Overall, 2013 

Excellent 

Very Good 

Good 

Fair 

Poor 

37% 

24% 

39% 

35% 

19% 

27% 

5% 

9% 

1% 

3% 

0 25% 50% 75% 100% 

Congregate Nutrition Services 

Home-Delivered Nutrition Services 

Source: National Survey of Older Americans Act Participants (2013). 

person delivering the meals makes them feel less lonely. 

These data indicate that the program is helping with 

socialization. 

Over 80 percent of congregate nutrition service participants indicate that they see their friends more often as a 

result of participation. Congregate and home-delivered 

nutrition service participants rated the programs highly 

in terms of benefits to their health and well-being. As 

shown in Figure 4, 73 percent of congregate and 81 

percent of home-delivered participants reported eating 

healthier foods as a result of program participation, 

while 79 percent of congregate and 85 percent of homedelivered participants indicated that the program helped 

them feel better. These data indicate that the program 

is helping to meet individuals’ needs as well as the 

program purpose of maintaining health and well-being. 

Meal programs 

help you stay in 

your own home 

Eat healthier foods 

as a result of the 

meal program 

Feel better 

as a result of 

receiving meals 

As a result of 

receiving meals, 

see friends 

more often* 

0 25% 50% 75% 100% 

91% 

64% 

73% 

81% 

79% 

85% 

83% 

Congregate Nutrition Services 

Home-Delivered Nutrition Services 

*This question is only applicable to congregate nutrition services. 

Source: National Survey of Older Americans Act Participants (2013). 

Conclusion 

The number of older adults in the United States is 

projected to continue increasing over the next two 

decades. By 2030, adults age 65 and over will constitute 

approximately one-fifth of the U.S. population. This 

growth in the number and proportion of older adults 

combined with their changing demographic composition 

is expected to have profound impacts on the demand for 

social services. These services must address the unique 

nutritional, cultural, and social needs and challenges 

faced by older adults, including not only poor diets and 

health problems but also food insecurity and social 

isolation. 

Congregate and home-delivered nutrition services are 

designed to provide more than daily nutrition, and 

provide important avenues for meeting the social needs 

of consumers. In the case of congregate nutrition services, 

participants have the opportunity to interact with each 

other in a communal setting where they also have access 

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to other community-based services. In the case of home- Data 

delivered nutrition services, the people who deliver 

these meals may be the only source of social contact for 

nutrition service recipients. It is also a “check-in” opportunity in which the delivery personnel can report back 

to their Aging Services Network contacts if they see a 

dangerous or unhealthy situation unfolding or a need for 

other services such as nutrition education or nutrition 

counseling. Finally, both sources of socialization can help 

older adults better address feelings of depression, anxiety, 

or loneliness they may be experiencing. 

More research into nutrition services as part of homeand community-based services may provide greater 

insight into the program’s impact on improved food 

security, social connectedness, nutrient intake, health, 

and health care utilization among the older adult population. While it goes beyond the scope of this brief to draw 

any conclusions as to whether congregate and homedelivered nutrition services help people remain in their 

homes longer, based on survey responses, recipients of 

these programs report that the nutrition programs are key 

to helping them remain in their homes and communities 

as they age. ACL has contracted for a rigorous program 

evaluation that addresses all of these questions. 

Acknowledgments 

We would like to thank the Administration for 

Community Living’s Office of Performance and 

Evaluation, Center for Policy and Evaluation, and 

the Administration on Aging, Office of Nutrition and 

Health Promotion Programs, for their guidance and 

feedback while completing this brief. We would also 

like to extend particular thanks to Jean Lloyd who 

recently retired from AoA as their National Nutritionist, 

and provided considerable guidance in the development 

of this brief. 

Information on Title III participants was drawn from 

the Eighth National Survey of OAA Participants. 

Westat, Inc., conducted the telephone survey in 2013, 

administering it to over 5,000 people who reported 

receiving Title III services. This brief includes data for 

2,038 recipients who were surveyed about their experiences with congregate and home-delivered nutrition 

services. The survey used a two-stage sample design, 

first selecting a sample of AAAs and then randomly 

sampling participants from each selected AAA by 

service type. The number of participants selected from 

each AAA was proportional to the number of participants served in that particular service by the sampled 

AAA. All analyses in this brief apply sample weights to 

account for this design. Additional data from, and more 

detailed documentation about, the NSOAAP and other 

AoA data sources are available on the AGing Interactive 

Database (AGID) located at http://www.agid.acl.gov. 

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Herzog, A. R., Kabeto, M. U., Kent, D. M., Straus, 

W.L., and Langa, K.M. (2004). Predicting nursing 

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F. (2010). Hunger in America 2010: National Report 

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evaluation of the U.S. Department of Agriculture food 

security measure with generalized linear mixed models. 

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Sattler, E. L. P., & Lee, J. S. (2013). Persistent food 

insecurity is associated with higher levels of costrelated medication nonadherence in low-income 

older adults. Journal of Nutrition in Gerontology and 

Geriatrics, 32(1), 41–58. 

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J. (2013). Social isolation, loneliness, and all-cause 

mortality in older men and women. Proceedings of the 

National Academy of Sciences of the United States of 

America, 110(15), 5797–5801. 

Thomas, K. S., & Dosa, D. (2015). More than a Meal: 

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About This Series 

This series is funded by ACL, and presents 

analyses conducted by Social & Scientific Systems 

using data from AoA’s National Survey of Older 

Americans Act Participants. This survey collects 

information from Title III recipients about their 

demographics, socioeconomic status, health, 

and functioning, as well as their service use and 

client-reported service impact and quality. For 

more information about this study, please contact 

Niranjana Kowlessar at Social & Scientific Systems, 

NKowlessar@s-3.com. 

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