1. Nutrition Leadership Planning Initiative
February 15, 2007

2. Senior Nutrition Program

3. Older Americans Act 1965: Signed into law by
President Lyndon B. Johnson
Medicare and Medicaid was established as part of the Social Security Act.
1972: Title VII is created authorizing funds for a national nutrition program for the elderly.

4. Senior Nutrition Program
Title VII was established to address problems of dietary inadequacy and social isolation among older persons.
Only the Congregate Program was funded.

5. 2004 Senior Nutrition Program
“If the Older Americans Act Nutrition Program was a restaurant, the sign out front would say, ‘Six billion served’. For 30 years, this program not only has provided nutritious, healthy meals to older Americans, but also has touched their lives by linking them to community services that allow them to remain independent.”
-HHSA Secretary Tommy G. Thompson

6. THE PAST Who were we?

7. Nutrition Programs in San Diego
First program established in late 1973.

8. Nutrition Programs in San Diego
First program established in late 1973.
Cedar Community Center, now known as
Senior Community Centers of San Diego

9. Nutrition Programs in San Diego
Between 1973 – 1974
Salvation Army – Mid City & El Cajon
Lemon Grove/Spring Valley
City of Vista
Ramona
St. Charles – Imperial Beach
St. Judes
Santa Ysabel Nutrition Center

10. Senior Nutrition Program
In 1978, Title VII was consolidated into Title III of the OAA.
Home Delivered Meals (Title III C2) began in 1980.

11. Senior Nutrition Program
# Meals Served
1978/1979 C1: 829,741 C2: 0

12. THE PRESENT Who Are We Now?

13. 2005 American Community Survey
U.S. Census Bureau Data
2005 American Community Survey
San Diego County total population (estimate) – 2,824,259
65 years and over – 310,836
11% of the general population

14. Who Are We Now? 23 Nutrition Contractors
Alpine Community Center
Borrego Springs Seniors
City of Carlsbad
Catholic Charities
CFSC-Live Well
City of National City
City of Escondido
City of Encinitas
Fallbrook Senior Citizens
Jacumba Highland Seniors
Mountain Health & Community Services
Jewish Family Services
Neighborhood House Association
Oceanside Senior Citizens
Pacific Ed. – Ramona
Pilipino American Senior Citizens
Poway Valley Senior Citizens
St. Jude’s
Salvation Army
City of San Marcos
Senior Community Centers
Union of Pan Asian Communities
City of Vista

15. Where We Are

16. Who Are We Now? Senior Nutrition Program
59 Congregate Nutrition Sites
18 Programs providing Home Meals.
15 Central Kitchens & On Site Prep Kitchens
6 Private Catering Companies providing meals.
4 Congregate programs serving breakfast & lunch.

17. Number of Meals Served 00/01 – -21% -16% FY C1 % Change C2 00/01
877,756
---
570,735
01/02
840,451
-4%
602,690 6%
02/03
810,348
573,943
-5%
03/04
776,152
505,126
-12%
04/05
731,466
-6%
489,408
-3%
05/06
706,568
479,069
-2%
00/01 –
-21%
-16%

18. Local Participant Data
The number of participants enrolled in the programs increases as the total number utilizing the services decreases.
43%
57%

19. Reported Vehicle Maintenance Cost
Contractor
FY 04-05
FY 05-06
Grand Total 1
$29,293.00
$32,981.00
$62,274.00 2
$10,493.21
$5,771.77
$16,264.98 3
$4,325.08
$18,498.61
$22,823.69 4
$31,837.00
$31,689.00 5
$461.52
$923.04 6
$861.55
$1,416.26
$2,277.81 7
$1,595.79
$1,303.58
$2,899.37 8
$16,525.00
$5,012.00
$21,537.00 9
$52,428.25
$44,677.30
$97,105.55 10
$24,647.12
$26,053.90
$50,701.02 11
$22,905.00
$26,412.00
$49,317.00 12
$4,495.42
$5,278.74
$9,774.16 13
$57,631.00
$56,928.50
$114,559.50 14
$16,500.00
$33,000.00 15
$601.32
$1,202.64
$274,600.26
$273,585.50
$548,185.76

20. Funding – 5 Year Analysis

21. Nutrition Results from the 2004 National Survey of Older Americans Act Clients
Beth Rabinovich, PhD
Suzanne McNutt, MS, RD
WESTAT

22. 2004 National Survey of Older Americans Act Participants - Methodology
Two-stage sample design
Representative sample of Area Agencies on Aging (AAA; large AAAs chosen with certainty)
Clients sampled within AAAs by service
Questionnaires administered by Westat’s Telephone Research Center (TRC)

23. Methodology Continued
Questionnaire
Two questionnaires one for HDM clients and the other for CM clients
Questionnaires covered the following topics:
Demographics
Physical functioning (HDM clients only)
Daily dietary intake
Contribution of program to total daily food intake
Consumer assessment of the program
Emotional well being and social functioning

24. Results Weighted Sample Sizes Home Delivered Meals Clients = 1,000,662
Congregate Meals Clients = 1,905,416
11/16/2018

25. Targeting Variable HDM CM 1 or more ADL limitations 69%
Not asked
3 or more ADL limitations
29%
75 years of age and older
73%
62%
Household income of $20,000 or less
85%
57%
Household income of $10,000 or less
46%
26%

26. National Health Interview Survey*
Self-reported Health
Self-reported Health
HDM CM
National Health Interview Survey*
Excellent 4% 6% 9%
Very Good
14%
25%
21%
Good
28%
40%
35%
Fair
23%
24%
Poor
29%
12%
*NHIS 2003: age 65+, annual income < $20,000

27. Frequency of Participation in the Meals Program
HDM CM
Less than once a week 7%
26%
1 t 2 times a week
12%
29%
3 to 4 times a week 8%
23%
5 or more times a week
72%
21%

28. Proportion of Food that Meals Represent on the Days at the Program
Frequency
Home Delivered Meals
Congregate Meals
“1/3 or less”
34%
43%
“1/2 to 2/3”
44%
47%
“More than 2/3”
22% 9%

29. Contribution of the Home Delivered Meals Program to Daily Intake
Food Group
Percent of HDM clients who only eat one serving a day and it’s from the meals program
Percent of CM clients who only eat one serving a day and it’s from the meals program
Fruit
38%
Vegetables
32%
34%
Dairy
37%
39%
Grain (1 to 2 servings)
61%
67%
Meat
49%
51%
Beans
36%

30. Dietary Intake Food Group Serving Size HDM CM 1999-2000 NHANES*
Number of Meals Per Day 2+
94%
91% -
Fruit
49%
58%
45%
Vegetables 3+
18%
27%
13%
Dairy
19%
23%
10%
Grain 6+ 5% 3% 2%
Meat/Bean
64%
65%
56%
Water 5+
52%
66%
*60+ and income < $20,000

31. Dietary Adequacy

32. Consumer Assessment of the Nutrition Program
Overall Rating of the Meal Program
HDM CM
Excellent
32%
21%
Very Good
37%
39%
Good
25%
31%
Fair 5% 7%
Poor
< 1% 2%

33. Results – Self Reported Outcomes
HDM
(Yes, definitely + yes, I think so) CM
(Yes, definitely + yes, I think so)
Eat more balanced meals
86%
78%
Easier to keep special diet
60%
54%
Better able to avoid sodium/fat
80%
76%
Able to maintain weight
83%
77%
Have something to look forward to
88%
82%
Can continue to live in own home
90%
72%
Would recommend program to others
95%
96%

34. Results – Social Functioning
Feelings about level of present social activities
HDM CM
About enough
53%
68%
Too Much 1% 3%
Would like to be doing more
45%
29%

35. Social Functioning Percent reporting an increase in social activities
as a result of program participation

36. Summary and Conclusions
Targeting
The HDM and CM program meet the OAA’s objectives of serving those in most economic and social need (e.g., low income).
The majority of the clients are among the “old” and “oldest-old.”
A majority of the home delivered meal clients have functional limitations.
The nutrition programs appear to make a large contribution to the dietary status of its program participants.

37. Summary and Conclusions – Consumer Assessment of the Nutrition Programs
The majority of participants are satisfied with the nutrition program
The majority of participants report that the program helps them maintain a healthier diet.
The majority of participants report that the program helps them remain at home.
The survey data are good for monitoring program quality.

38. WHAT’S THE FUTURE?

39. Future
Federal funding for nutrition programs will NOT grow in relationship to population.
Cost of program operations will continue to increase. Staff salaries, energy costs, equipment/vehicle maintenance, food costs.
Population in need of services will grow.

40. Nationwide Client Demographics
Average client is female, years of age.
60+ population in 2004 was 434,147. Predicted for 2010, 60+ population will be 524,319. A 20% increase!
2010: y.o. = 79,592
2020: “ 135,593 ( approx. 70%↑)
2030: “ 184,900

41. Future
Increase competition for the consumers’ eat out meal $$$$s. The average per person expenditure for food away from home was $ in 2004!
Restaurants anticipate that their take-out operations will expand in
Grocery stores are expanding their ready-to-eat and meal replacement offerings.

42. National Successes Mather’s – More Than a Café
- Partnership between Mather’s and the Illinois Senior Center to offer congregate meals in a public café setting.
Centralina AAA (Lincoln County)
– Restaurant Voucher Program
Participants attend programs on healthy living and receive a meal voucher to use at local restaurants at the time of their choice.

43. Statewide Discussion Ideas
Consolidating sites.
Opening new sites in areas with growing senior populations.
Serving an early dinner vs. noon meal.
Expanding Home Meals to provide 2 meals/day, i.e. breakfast & lunch or lunch & dinner.

44. Statewide Discussions
Delivering hot Home Meals 1/2/3 times per week instead of daily, using a combination of hot and frozen meals.
Planning Special Occasion meals in the evenings or Saturdays to attract a different client.
Having 2nd meals available for Congregate clients.
Restaurant Vouchers

45. Local Successes
Utilization of volunteers to deliver Home Delivered Meals.
Use of alternatives for traditional transportation for senior nutrition program:
Volunteer drivers
Provide bus passes
Provide taxi vouchers

46. Local Successes
Receipt of grant funding to replace Home Delivered Meals vehicles.
‘Food for Thought’ program – lunch in a Library – partnership with City of Vista and San Diego County Library.

47. Food for
Thought