016.19.16 Ark. Code R. 001
Each Area Agency on Aging (AAA) shall, through a comprehensive and coordinated system, provide for nutrition services to older Arkansans in their planning and service area, with particular attention to target groups identified by the Older Americans Act. Nutrition services must include, but are not limited to, congregate and home-delivered meals which meet Older Americans Act and DAAS requirements and which may also include special diets where feasible, nutrition screening and nutrition education for participants, in-service training, including food preparation and nutrition, for both paid and volunteer workers, and outreach. Nutrition assessment and counseling are also to be provided, when appropriate and feasible. The AAAs will incorporate the provisions of this policy and accompanying procedures into their policies and procedures, provide training on these provisions to nutrition service staff, monitor compliance with the policy and procedures, and provide appropriate technical assistance to subcontractors in meeting this and other DAAS, Older Americans Act, and AAA requirements.
To ensure that older Arkansans, particularly those in target groups identified by the Older Americans Act, have access to low cost, nutritionally sound meals served in strategically located centers such as schools, churches, community centers, senior centers, and other public or private facilities where they can obtain other social and rehabilitative services. The Nutrition Services Program seeks:
The Older Americans Act of 1965, as amended 45 CFR 1321
Social Services Block Grant-CSPP
Rules and Regulations Pertaining to Food Service Establishments, Arkansas State
Health Department
Arkansas Code Annotated Section 25-10-101 et. seq.
Acceptable Macronutrient Distribution Ranges (AMDR) - Range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients. If an individual consumes in excess of the AMDR, there is a potential of increasing the risk of chronic diseases and/or insufficient intakes of essential nutrients.
Activities of Daily Living (ADLs) - Tasks performed regularly, daily or multiple times daily, which are necessary for self care and/or independent living (eating, dressing, bathing, toileting, and transferring in and out of bed). (See also Instrumental Activities of Daily Living.)
Adequate Intakes (AI) - A recommended average daily nutrient intake level based on observed or experimentally determined approximations or estimates of mean nutrient intake by a group (or groups) of apparently healthy people. The AI is used when the Estimated Average Requirement (EAR) cannot be determined.
Assistive Technology - Technology, engineering methods, or scientific principles appropriate to meet the needs of, and address barriers confronted by, persons with functional limitations. (Nutrition related examples: devices that allow such persons to feed themselves or prepare their own meal, or the devices or processes used to modify food to allow a person to consume food by mouth.)
Certified Dietary Manager (CDM) - Designation used by persons who have completed a 12-18 month food service manager's course approved by the Dietary Managers Association or have an Associates or Bachelor's degree in a food-related field, and successfully completed a national registration exam. Course includes sections of training in nutrition and food service management.
Comprehensive and Coordinated System - An organized, interactive network for providing all necessary supportive services, including nutrition services, to older individuals in the service area, in a manner designed to: facilitate access to, and use of, supportive services and nutrition services available from public or private agencies or organizations within the service area; develop and make the most efficient use of such services and resources, with minimum duplication, in meeting the needs of older individuals; and encourage and assist public and private entities that have unrealized potential for meeting the service needs of older individuals to assist the older individuals on a voluntary basis.
Congregate Meal - A hot or other appropriate meal served to an eligible person at a congregate meal site. Meals comply with DA AS, Title III Nutrition Service Standards, and Dietary Guidelines for Americans, and provide a minimum of 33
1/3% of the Dietary Reference Intakes (DRIs) if one meal is served, 66 2/3% of the DRIs if two meals are served, and 100% of the DRIs if three meals are served, with the 2nd and 3rd meals balanced proportionally in calories and nutrients.
Congregate Meal Site - Generic name of a facility where meals are served in a group setting and comprehensive supportive services, including transport to the site, are provided to older adults. The facility is located as close to residences of the majority of eligible persons as feasible and may be a multi-purpose senior center, school, church, or other appropriate community facility.
Dietary Guidelines for Americans (DGs) - Recommended dietary practices for healthy Americans published jointly every 5 years since 1980 by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases. They serve as the basis for Federal food and nutrition education programs.
Dietary Reference Intakes (DRIs) - A set of nutrient-based reference values that expand upon and replace the former Recommended Dietary Allowances (RDAs). They are actually a set of four reference values: Estimated Average Requirements (EARs), Recommended Dietary Allowances (RDAs), Adequate Intakes (AIs), and Tolerable Upper Intake Levels (ULs).
Disability - A loss of functional capacity due to physical or mental impairment, or both, resulting in substantial functional limitations in 1 or more of these areas of major life activity:
Disease Prevention and Health Promotion Services - Activities that identify risk for, or presence of, disease or health problems; encourage behaviors that reduce effects of, or prevent, chronic disabling conditions (mental or physical) or injuries; or provide information on preventative health services available. Nutrition related activities in this service include, but are not limited to, nutrition screening, nutrition assessment, nutrition counseling, nutrition education, and referral to other appropriate services.
Education and Training Services - Supportive services designed to assist older individuals to better cope with their economic, health, and personal needs through such services as consumer education, continuing education, pre-retirement education, financial planning, and other education and training services, which will advance the objectives of the Older Americans Act.
Estimated Average Requirements (EAR) - the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group.
Food Service Vendor - A restaurant, hospital, school or commercial organization that contracts with an AAA Service Provider to supply prepared meals (usually at a fixed price per meal) to the provider who contracts with the AAA to provide nutrition and other services.
Frail - With respect to older individuals, one who is determined to be functionally impaired because the individual:
Greatest Economic Need (poverty) - Need resulting from an income at or below the poverty line established each year by the Office of Management and Budget, and adjusted by the Secretary (DHHS) in accordance with subsection 673 (2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)).
Greatest Social Need - Need caused by non-economic factors including:
Homebound - Unable to leave the home without assistance (physical or mental) from another person. For nutrition services, the person is frail, homebound by reason of illness or incapacitating or disability or otherwise isolated.
Home-Delivered Meal (HDM) - A hot or other appropriate meal delivered to the residence of an eligible homebound person. Meals must follow the Dietary Guidelines for Americans, meet Title III and DAAS Nutrition Service Standards and contain of 1/3 DRIs if one meal is provided, 66 2/3% if two meals are provided and 100% if three meals are provided. 2nd and 3rd meals are proportionally balanced in calories and nutrients.
Instrumental Activities of Daily Living (IADLs) - Regularly performed tasks, necessary for independent living (preparing meals, shopping for personal items, medication management, managing money, using a telephone, doing heavy housework, doing light house, etc.). (See also Activities of Daily Living)
Menu Cycle - A pre-planned written sequence of menus repeated over a specified time frame.
Nutrition Assessment - An in-depth evaluation of both objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history. Nutrition assessments are performed by Registered Dietitians to assess and evaluate individual nutritional status. The assessment leads to nutrition counseling, or other nutrition intervention, designed to help the individual either maintain the assessed status or attain a healthier status.
Nutrition Counseling - Individualized guidance to individuals who are at nutritional risk because of their health or nutrition history, dietary intake, chronic illnesses, or medications use, or to caregivers. Counseling is provided one-on-one by a Registered Dietitian, and addresses the options and methods for improving nutrition status.
Nutrition Education - A service or program that promotes better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants and caregivers in a group or individual setting overseen by a Registered Dietitian or individual of comparable expertise.
Nutrition Outreach - An activity designed to seek out and identify, on an ongoing basis, the maximum number of the hard-to-reach, isolated, and withdrawn target group of eligible individuals throughout the program area, and to encourage them to make use of existing services and benefits.
Nutrition Screening - The process of identifying individuals with multiple risk factors (easily identified characteristics known to be linked with increased likelihood of nutritional problems). This serves to identify individuals at nutritional risk.
Nutrition Services - Must include, but is not limited to, the provision of congregate and home-delivered meals, nutrition education, nutrition screening, and nutrition outreach which meet funding source, DAAS, and other applicable requirements. Services may also include special diets, nutrition assessment and counseling if appropriate and feasible.
Nutrition Services Incentive Program (NSIP) - The Nutrition Services Incentive Program provides supplemental funding for the OAA Nutrition
Program to States, Territories and eligible Tribal organizations to purchase domestic food only. This funding may not be used to pay for other nutrition related services, or state or local administrative costs. States may choose to receive the grant as cash, commodities from the United States Department of Agriculture or a combination of cash and commodities.
Older Individual - An individual aged 60 years or older.
Project - Defined as a provider of Nutrition Services for purposes of this policy. The provider may contract with the AAA to provide services at more than one location.
Recommended Dietary Allowance (RDA) - The dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group.
Registered Dietitian (RD) - An individual registered by the Commission on Dietetic Registration (CDR). CDR registration requires that the dietitian has completed at least a four-year course of study in a specified curriculum at a college or university accredited by the Commission on Accreditation for Dietetic Education (CADE), has successfully completed a CADE-accredited Dietetic Internship and has passed the CDR national registration exam. Ongoing continuing education is required. In Arkansas, persons using the title of Dietitian must be licensed (LD).
Severe Disability - A major, chronic loss in functional capacity due to mental or physical impairment, or both, likely to continue indefinitely and causing substantial functional limitation in 3 or more major life activities.
Special Menu - Meal plan that meets the particular dietary needs arising from health requirements, religious requirements, or ethnic backgrounds of eligible individuals. (See also Therapeutic Diet)
Subcontractor - A recipient of state or federal funds by grant, reimbursement, or other means from an Area Agency on Aging in exchange for services specified by contract. (AAA Service Provider)
Targeted Group - A segment of the population of the service area toward which services are directed. Nutrition services' target population is unserved older persons with the greatest economic and social need (including low-income minority individuals) and frail individuals likely to be at high nutritional risk.
Therapeutic Diet - A diet designed to treat a specific health problem. Requires a physician's diet prescription and must be written under supervision and/or consultation of a Registered Dietitian.
Tolerable Upper Intake Level (UL) - The highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all individuals in a particular life stage and gender group. As intake increases above the UL, the potential risk of adverse health effects increases.
Each Area Agency on Aging is responsible for:
The AAA, and its providers, shall not reduce (from that approved in the area plan) the level of service, days of service, nor open or close a site without prior, written DAAS approval, except in weather related emergencies and natural disasters.
AAAs will not provide services directly unless specifically authorized by DAAS to do so. (DAAS Direct Services Policy 201) Nutrition Services shall be provided through contracts with organizations which, when possible, have demonstrated an ability to provide meals efficiently and reasonably, will furnish assurances to the AAA that they will maintain efforts to solicit voluntary support, and will furnish assurances that Older Americans Act (OAA) funds will not be used to supplant funds from non-federal sources. The AAA will develop guidelines and provide technical assistance and training opportunities to assist subcontractors in meeting requirements. The AAA will monitor for compliance with OAA and DAAS requirements and take appropriate action if noncompliance is found.
The primary target group of the congregate meal program is eligible persons with the greatest economic or social needs, particularly low-income minority elderly and those who cannot afford to eat adequately or lack knowledge, skills, mobility or motivation to obtain adequate food, or are otherwise at increased nutritional risk.
A means test may not be used to determine eligibility for OAA Nutrition Program; however, a means test may be applied to individuals who receive meals funded by sources which require a means test such as the Social Services Block Grant. Individuals will be eligible to participate in congregate meal services in one of the following two categories:
Receipt of home-delivered meal service is based on a determination of need/continued need. The primary target group of the home-delivered meal program is homebound eligible persons with the greatest economic or social needs (which may increase nutritional risk). Special attention is given to low-income, minority elderly, and others who do not eat adequate and nutritious meals because they are incapacitated due to accident, illness, or frailty; unable to prepare meals due to their limited mobility, psychological or mental impairment, inability to safely prepare meals, and/or lack of knowledge to select and prepare nourishing and well-balanced meals; and without adequate resources such as family, friends or other community services to provide them with meals.
A means test may not be used to determine eligibility for OAA Nutrition Program; however, a means test may be applied to individuals who receive meals funded by sources which require a means test such as the Social Services Block Grant.
Persons who have been determined to be eligible through assessment of need, will benefit nutritionally from receiving a meal, and are:
The following process must be completed for each participant:
Receipt of home-delivered meal service is based on a determination of need or continued need. For each participant, prior to billing for the service, an outreach worker, case manager, or site director shall make a home visit in order to:
Each meal provider must secure and maintain adequate facilities and equipment for safe, sanitary, and efficient preparation, service, and delivery of meals. They must meet at least the following applicable requirements related to physical facilities and equipment:
The use of volunteers is encouraged whenever possible. The Older Americans Act requires that projects solicit the expertise of a dietitian or other individual with equivalent education in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutritional services.
Title III of The Older Americans Act requires nutrition project to provide meals that:
To ensure meals meet the Federal requirements, the Meal Pattern must be used in conjunction with Nutrient Analysis.
Standard Meal Plan
Food Group | Servings Per Meal | Serving Sizes | Recommendations |
Grain | 1-2 servings | 1 serving is: * 1 slice bread * 1 small roll * 1 cup dry cereal * Vi cup cooked rice, pasta, cereal | Whole grains. |
Vegetable | 1-2 servings: may serve an additional vegetable instead of a fruit | 1 serving is: * Vi cup raw or cooked * 1 cup raw leafy vegetable * Vi to % cup 100% vegetable juice | A variety of deeply colored vegetables are recommended, such as dark green and orange. |
Fruit | 1 serving: may serve an additional fruit instead of a vegetable | 1 serving is: * Vi cup fresh, frozen, or canned fruit * 1 med fruit * Va cup dried fruit . Vi cup 100% fruit juice | A variety of brightly colored fruit is recommended. |
Milk, Milk Alternate, or calcium equivalent | 1 serving: 1 cup or equivalent measure | 1 serving is: * 1 cup low-fat/fat free milk or yogurt * 1/4 oz of natural cheese * 2 oz processed cheese * 1 cup Vitamin D and Calcium fortified drink | Low-fat dairy products are recommended. |
Meat or Meat Alternate | 1 serving | 1 serving is: * 2-3 oz. cooked meat, poultry, fish * % cup cottage cheese * 3 eggs or equivalent egg substitute * 1/4 cup cooked beans, peas, lentils | Lean meats and low-fat meat alternates are recommended. |
Dessert | 1 serving | Varies | Using fruit and milk-based desserts is recommended when possible. |
* For more detail on Nutrition Program Menus, see Appendix.
Nutrient Requirements and Values for Analysis
Nutrient | Required Value | Conditions |
Calories | [GREATER THAN]600 | Preferred Range 700-800 |
Fat (% of total calories) | [LESS THAN] 35% | Each Day |
Protein (% of total calories) | [GREATER THAN]15% | Each Day |
Fiber | 7g | Averaged over one week |
Vitamin A | 1,000 IU | Averaged over one week |
Vitamin C | 30 mg | Averaged over one week |
Calcium | 400mg | Averaged over one week |
Sodium | 1200mg or less (500-600mg recommended) | Averaged over one week |
All stages of food service operations must comply with federal, state and local fire, health, sanitation, safety and building codes, regulations, and licensing requirements.
The AAAs and providers shall develop a written plan for a variety of possible emergency situations, such as participant illness, injury or choking; and weather related emergencies, such as tornado, ice, snow, extreme heat, flood, etc. The plan shall include:
Nutrition Education activities should be conducted on an ongoing basis, at least semiannually.
AoA administers NSIP in compliance with the requirements of Section 311 of the Older Americans Act. State Units on Aging (SUAs), such as DAAS, funded through Title III of the OAA and Indian Tribal Organizations (ITOs) who have an approved application through Title VI of the OAA may receive grants of cash from the AoA and/or commodities from the USDA.
016.19.16 Ark. Code R. 001