Nutrition Assistance: Additional Efficiencies Could Improve Services to Older Adults
Released: 2011-06-21T00:00:00

Letter

In Recent Years Nearly a Fifth of Low- Income Older Adults Were Food Insecure and Most Did Not Receive Assistance from Meals Programs Despite Increased Demand

Analysis of data from the Current Population Survey’s (CPS) Food Security Supplement shows that in 2009, about 19 percent of households with adults ages 60 and over with low incomes—under 185 percent of the poverty line—were food insecure. These adults were uncertain of having or unable to acquire enough food because they lacked resources. In comparison, slightly less than 15 percent of all households were food insecure. A small but significant portion of households with older adults had very low food security in 2009—about 8 percent of those with households under 185 percent of poverty and about 14.5 percent of those with incomes under the poverty line. In these households, one or more household members’ eating patterns were disrupted and their food intake reduced, at least some time during the year because they could not afford enough food. (See Figure 1.)

Older adults can and do access a number of resources to help alleviate food insecurity; however, many low-income older adults likely to need assistance from meals programs did not receive it, according to 2008 data. Through our analysis of information from the CPS, we found that in 2008 approximately 9 percent of an estimated 17.6 million low-income older adults received home-delivered or congregate meals services including those provided by the OAA Elderly Nutrition Program: Home-Delivered and Congregate Meals Services (Elderly Nutrition Program) and other organizations such as churches or nonprofits. However, many more older adults did not receive these meals services, but likely needed them due to food insecurity, difficulties with daily activities, and/or limited social interaction, as shown in table 1.

It should be noted that there are many reasons why older adults may not receive nutrition assistance through the Elderly Nutrition Program. They may not know about the available services, may not have access to services due to limited supply in their area, may receive informal assistance from family or neighbors, or may choose to remain self- sufficient rather than request government benefits. In addition, some older adults may choose to participate in a separate program instead, such as the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, where they can purchase their preferred foods.

Requests for Elderly Nutrition Program services have increased and demand will likely continue to grow. Through our survey of area agencies on aging (local agencies) conducted during the summer of 2010, we found that an estimated 79 percent of agencies had seen increased requests for home-delivered meals, and 47 percent had seen increased requests for congregate meals since the start of the economic downturn. Further, requests for OAA services are increasing as more seniors stay in their homes longer rather than move to assisted living facilities or nursing homes, according to agency officials. According to U.S. Census data, more than 9 million more Americans were 60 years and older in 2009 than in 2000, and the Census Bureau projects that population group will continue to grow.

Further, demand for Elderly Nutrition Program home-delivered meals is growing compared to congregate meals. In our 2010 survey, an estimated 22 percent of agencies reported they were generally or very unable to serve all clients who request home-delivered meals, compared to an estimated 5 percent of agencies who were generally or very unable to serve all clients who requested congregate meals. To adjust to these changes in requests for services, most state and some local agencies utilized the flexibility provided by the law to transfer OAA funds among Title III programs. Agencies most commonly transferred funds from congregate meals to home-delivered meals or other Title III services. Nationally, from fiscal year 2000 through fiscal year 2008, states collectively transferred an average of $67 million out of the congregate meal program each year (see Figure 2).

Actions Needed to Reduce Administrative Overlap among Domestic Food Assistance Programs

In part because food insecurity is a national problem that affects not only older adults but also many other vulnerable groups, the federal government spent more than $90 billion on domestic food assistance programs in 2010. This represents an increase of approximately 44 percent over 2008 spending, driven largely by increased spending on the SNAP. We identified 18 different federal programs that provide nutrition assistance, programs that emerged piecemeal over the past several decades to address a variety of needs. Agency officials and local providers have indicated that the multiple food assistance programs work together and provide various points of entry to the system to help increase access to food for vulnerable or target populations at high risk of malnutrition or hunger. Those officials and providers told us that, since no one program alone is intended to meet a household’s full nutritional needs, the variety of food assistance programs can help households fill gaps and address the specific needs of individual members. However, we have previously reported signs of overlap and inefficient use of resources in the delivery of benefits through these programs. In addition to the Departments of Agriculture (USDA), Health and Human Services (HHS), and Homeland Security (DHS) multiple state and local government and nonprofit organizations work together to administer a complex network of programs and providers.

We have found that some of these programs, including those serving older adults, provide comparable benefits to similar or overlapping populations. For example, the Elderly Nutrition Program administered by the Administration on Aging (AoA), provides home-delivered and congregate meals primarily to individuals 60 years and older. Separately, other programs administered by USDA, including the Commodity Supplemental Food Program, targets a similar population, providing food to older adults, as well as women, infants and children who are also served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). program. In addition, individuals eligible for groceries through the Commodity Supplemental Food Program or services through the Elderly Nutrition Program may also be eligible for groceries through the Emergency Food Assistance Program and for targeted benefits that are redeemed in authorized stores through the largest program, SNAP. In fact, a recent AoA report conducted by Mathematica found that seven percent of congregate meal recipients and 16 percent of home-delivered meal recipients were also receiving SNAP benefits. The availability of multiple programs with similar benefits helps ensure that those in need have access to nutritious food, but can also increase administrative costs, which account for approximately a tenth to more than a quarter of total costs among the largest of these programs. In addition, our previous work has shown that overlap among programs can lead to inefficient use of federal funds, duplication of effort, and confusion among those seeking services.

We have found in previous work that despite the potential benefits of varied points of entry, program rules related to determining eligibility often require the collection of similar information by multiple entities. For example, an older adult might apply for congregate meals through the Elderly Nutrition Program at their local area agency on aging, electronic benefits through SNAP at the Health and Human Services office, and vouchers for fresh fruit and vegetables through the Senior Farmers’ Market Nutrition Program at a local food bank. Most of the 18 programs have specific and often complex administrative procedures that federal, state, and local organizations follow to help manage each program’s resources. According to our previous work and state and local officials, rules that govern these and other nutrition assistance programs often require applicants who seek assistance from multiple programs to submit separate applications for each program and provide similar information verifying, for example, household income. This can create unnecessary work for both providers and applicants and may result in the use of more administrative resources than needed.

Moreover, not enough is known about the effectiveness of many of these programs. Research suggests that participation in 7 of the 18 programs— including the Elderly Nutrition Program and SNAP—is associated with positive health and nutrition outcomes consistent with programs’ goals. For example, studies on the Elderly Nutrition Program found that the program increases socialization and may have a positive effect on food security. In addition, research suggests the program improves participants’ dietary and nutrient intake—an outcome related to the program’s goal of promoting the health and wellbeing of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. However, little is known about the effectiveness of the remaining 11 programs because they have not been well studied.

Agencies do regularly collect performance and other data on nutrition assistance programs but these data are not sufficient to determine program effectiveness and do not always provide all the information needed to effectively and efficiently manage their programs. Agency data show that the 11 less-studied programs provide food and nutrition assistance to millions of individuals and households each year—an outcome related to their goals—however, this alone does not demonstrate the overall effectiveness of these programs. Other data—such as on need and unmet need for services—could help agencies better target limited resources and more efficiently serve their target populations but agencies often do not have this information. For example, while the OAA requires AoA to design and implement uniform data collection procedures for states to assess the receipt, need, and unmet need for Title III services, AoA does not provide standardized definitions or measurement procedures for need and unmet need that all states are required to use. Instead, AoA provides states with non-binding guidance on these issues and an assortment of tools and resources that they can use to evaluate need and limited information about measuring unmet need. States use a variety of approaches to measure need and measure unmet need to varying extents, but no agencies that we spoke with fully estimate the number of older adults with need and unmet need in their service area. Such information could help providers make informed decisions about serving those most in need as the number of older adults increases and resource constraints are likely to continue.

In April 2010, we recommended that USDA, as the principal administrator of the federal government’s food assistance programs, identify and develop methods for addressing potential inefficiencies among food assistance programs and reducing unnecessary overlap among its smaller food assistance programs while ensuring that those who are eligible receive the assistance they need. These methods could include conducting a study as a first step; convening a group of experts; identifying which of the lesser-studied programs need further research and taking steps to fill the research gap; or identifying and piloting proposed changes.

Further, in February 2011 we recommended that, to help ensure that agencies have adequate and consistent information about older adults’ needs and the extent to which they are met, the Secretary of Health and Human Services partner with other government agencies that provide services to older adults and, as appropriate, convene a panel or work group of researchers, agency officials, and others to develop consistent definitions of need and unmet need and to propose interim and long-term uniform data collection procedures for obtaining information on older adults with unmet needs for services provided from sources like Title III.

In addition to our specific recommendations to USDA and HHS, we have also noted in prior work that agencies can reduce program inefficiencies by broadening their efforts to simplify, streamline, or better align eligibility procedures and criteria across programs to the extent that it is permitted by law. Consolidating or eliminating overlapping programs also have the potential to reduce administrative costs but may not reduce spending on benefits unless fewer individuals are served as a result. More broadly, essential to all these efforts is collaboration among many entities. Achieving meaningful results in many policy and program areas, including food and nutrition services, requires some combination of coordinated efforts among various actors across federal agencies with other governments at state and local levels and nongovernmental organizations.

Conclusion

In conclusion, as I have outlined in my testimony, opportunities exist to streamline and more efficiently carry out these important domestic food assistance programs. Specifically, addressing duplication, overlap, and fragmentation could help to minimize the administrative burdens faced by those entities—including states and localities as well as nonprofit organizations—that are delivering these programs’ services. Such administrative burdens range from eligibility requirements and the application process to costs associated with carrying out the program and reporting requirements. Improving consistency among these various requirements and processes as well as considering how multiple agencies could better coordinate their delivery of programs could result in benefits both for those providing and those receiving the services. In addition, collection of adequate and consistent information about older adults’ needs and the extent to which they are met could help providers make informed decisions about serving those most in need. It is particularly important to use resources efficiently given that the need for meals programs among low-income older adults will likely continue to outpace available services given the growing older population and continued economic constraints.

Careful, thoughtful actions will be needed to address issues involving potential duplication, overlap, and fragmentation among federal programs and activities. These are difficult issues to address because they may require agencies and Congress to re-examine within and across various mission areas the fundamental structure, operation, funding, and performance of a number of long-standing federal programs or activities. Continued oversight will be critical to ensuring that unnecessary duplication, overlap, and fragmentation are addressed.

Thank you, Mr. Chairman, Ranking Member Paul, and Members of the Subcommittee. This concludes my prepared statement. I would be pleased to answer any questions you may have.

For further information on this testimony, please contact Kay Brown, Director, Education, Workforce, and Income Security, who may be reached at (202) 512-7215, or BrownKE@gao.gov.

Appendix I: Selected Federal Food and Nutrition Assistance Programs, by Agency

Child and Adult Care Food Program Community Food Projects Competitive Grant Program Food Distribution Program on Indian Reservations Fresh Fruit and Vegetable Program Nutrition Assistance for Puerto Rico Senior Farmers’ Market Nutrition Program 12. Supplemental Nutrition Assistance Program (SNAP)

The Emergency Food Assistance Program 15. WIC Farmers’ Market Nutrition Program DHS Federal Emergency Management Agency 16. Emergency Food and Shelter National Board Program 17. Elderly Nutrition Program: Home-Delivered and Congregate Nutrition Services 18. Grants to American Indian, Alaska Native, and Native Hawaiian Organizations for Nutrition and Supportive Services nity Food Project Competitive Grnt Progrm i dminitered y the Ntionl Intitte of Food nd Agricltre (formerly the Coopertive Ste Rerch, Edtion, nd Extenion Service, CSREES) of USDA. All other USDA progr lited above re dminitered y the Food nd Ntrition Service. Commnity Food Project Competitive Grnt Progrm prticiption informtion i from CSREES Updte: Septemer 17, 2009, Office of the Adminitrtor, CSREES, USDA.

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