Nutrition Program Standards 2009

Oregon Congregate and Home-Delivered

Nutrition Program Standards

Older Americans Act and Oregon Project Independence

Oregon Department of Human Services

Aging and People with Disabilities

500 Summer St NE

Salem, Oregon 97301

September 2022

1 September 2022

Table of Contents

I. Program Overview and Purpose ...................................................................3

II. Nutrition Program Services and Eligibility ..................................................4

A. Congregate Meals ..............................................................................................4

B. Home-Delivered Meals ......................................................................................4

C. Nutrition Education ............................................................................................5

D. Nutrition Counseling ..........................................................................................6

III. Program Administration ................................................................................7

A. Provision of Nutrition Services by AAAs .........................................................7

B. Frequency of Meals............................................................................................7

C. Required Policies and Procedures ......................................................................8

D. Congregate Meal Location and Site Management .............................................9

E. Nutrition Program Reporting Requirements ...................................................10

F. Home-Delivered Meal Assessments ................................................................12

G. NSIP and NSIP Reporting ...............................................................................13

H. Staff and Volunteer Training ...........................................................................14

I. Criminal Background Checks .........................................................................14

J. Adult Protective Services Mandatory Reporting .............................................15

K. Outreach ..........................................................................................................15

L. Participant Input ...............................................................................................15

M. Role of Advisory Councils...............................................................................16

N. Guidelines on Prayer at Meal Sites .................................................................16

O. Waitlists ...........................................................................................................16

P. Emergency Plans .............................................................................................17

Q. Process for Altering Services or Closing a Meal Site ......................................17

R. Participant Donations .......................................................................................18

S. Use of Program Income ...................................................................................19

IV. Menu Planning and Dietary Guidelines ...................................................... 20

A. Nutrition Guidelines ........................................................................................20

B. Menu Planning .................................................................................................21

C. Menu Considerations for Diverse Populations ................................................22

D. Use of Donated Foods .....................................................................................23

E. Leftovers and Carryout Meals ........................................................................24

F. Meal Preparation Safety and Sanitation ...........................................................24

G. Home-Delivered Meal Safety and Delivery Requirements .............................25

H. Frozen Home-Delivered Meals ........................................................................26

2 September 2022

V. Appendices .................................................................................................. 28

A. DRI and Dietary Guidelines: Key Nutrients for Older Adults ........................28

B. Menu Component Form and Guidelines ..........................................................29

C. Specific Nutrient Sources ................................................................................31

D. Restaurant or Voucher Guidelines ..................................................................33

E. OAA Nutrition Risk Screening ........................................................................35

F. NAPIS Definitions ..........................................................................................36

G. Sources of Potential Funding for Nutrition Services .......................................38

3 September 2022

I. Program Overview and Purpose

The purpose of the Older Americans Act (OAA) Nutrition program is:

1) To reduce hunger and food insecurity

2) To promote socialization of older individuals; and

3) To promote the health and well-being 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 nutrition health or sedentary

behavior. (OAA Sec. 330)

The objectives of the OAA nutrition program are to provide an opportunity for older individuals to

live their years in dignity by providing healthy, appealing meals; promoting health and preventing

disease; reducing malnutrition risk and improving nutritional status; reducing social isolation and

increasing social interaction; linking older adults to community-based services; and providing an

opportunity for meaningful community involvement.

The Oregon older adult nutrition program is designed to support independent living of older

Oregonians. Oregon Department of Human Services Aging and People with Disabilities (APD)

receives OAA funding from the federal Administration for Community Living. These OAA funds

are distributed to Oregon’s Area Agencies on Aging (AAA) using a funding formula that is based on

the older adult population, as well as the minority and low-income older adult population, in each

area.

Nutrition services are not intended to reach every eligible individual in the community. Services

should be targeted to those in greatest social and economic need with particular attention to:

• Low income individuals,

• Minority individuals,

• Older individuals in rural communities,

• Older individuals with limited English proficiency, and

• Older individuals at risk of institutional care.

OAA Sec. 306(a)(1))

OAA nutrition services do not allow for means-testing, and the OAA has no citizenship or residency

requirements.

4 September 2022

II. Nutrition Program Services and Eligibility

A. Congregate Meals (Title III, Subpart CI)

Congregate meals can be offered in a variety of settings, including nutrition sites, senior

centers/community centers, churches, schools, adult care facilities, multigenerational meal sites,

or some other congregate setting under the supervision of a nutrition project. The OAA allows

meals to be served other than at lunch; AAAs have flexibility in offering breakfast or an evening

meal. (ACL guidance)

The congregate setting is designed to provide a welcoming and pleasant atmosphere where

people age 60 and older, and their spouses, can gather for a meal. Older adults can enjoy meeting

new people, form friendships, and gain support by coming together for meals on a regular basis.

The balanced meal and the social contact provide a positive motivation for self-care for seniors

who often eat poorly on their own and can become lonely and depressed in isolation. Congregate

sites offer nutrition education and access to other aging services and information. The nutrition

program is more than just a meal—its purpose is to nourish the whole person.

Eligibility for Congregate Meals:

1. Individuals who are 60 years of age or older, and their spouses, regardless of age.

2. Individuals with disabilities regardless of age who reside with and accompany older

individuals who are eligible under the OAA.

3. Congregate meals may also be made available to disabled persons under 60 years of age who

reside in housing facilities where congregate meals are served, and which are primarily

occupied by persons age 60 and older. (OAA Sec. 339(2)(I))

4. In addition, AAAs have the authority to establish procedures that allow the option to offer a

meal, on the same basis as meals provided to participating older individuals, to volunteers,

regardless of age, who provide volunteer services during meal hours. (OAA Sec 339(2)(H))

B. Home-Delivered Meals (Title III, Subpart CII)

Meals that are delivered to homebound clients are critical to maintaining independence and

allowing clients to remain in their own homes. Home-delivered meals are often the first in-home

service that an older adult receives, and the program is a primary access point for other home and

community-based services. (ACL website)

Individuals who receive home-delivered meals tend to have more health problems than

congregate participants do, and may have become homebound because of increasing age or

short- or long-term health problems. Programs can provide nutritional support through the

delivery of one or more meals per day. The regular in-person contact through delivery of meals,

nutrition education, and connections to other AAA and community services can provide added

care and support to high-risk individuals.

5 September 2022

Eligibility for Home-Delivered Meals:

1. Individuals who are 60 years of age or older and homebound

by reason of injury, illness, or

an incapacitating disability or be otherwise isolated, or

2. The spouse or disabled dependent child of any age who resides with a senior who is eligible

under this criteria, if it is in the best interest of the homebound client (45CFR 1321.69), or

3. Individuals who are 60 years of age or older, and

a. Physically or mentally predominately unable to shop for or safely prepare meals to

meet minimal nutrition requirements, or

b. Have an inadequate support system for food shopping or meal preparation, or

c. Are unable to tolerate a group situation due to physical or mental disability or

substance abuse.

4. AAAs may also choose to make home-delivered meals available to individuals with

disabilities under 60 years of age who reside in housing facilities occupied primarily by older

individuals at which congregate nutrition services are provided. (OAA Sec. 339 (I))

In addition, home-delivered meal participants must meet the following criteria:

5. Willing to eat the meal within a reasonable time, such as within 30 minutes of delivery, or

refrigerated on arrival and eaten within 48 hours or discarded after 48 hours of refrigeration;

and

6. Approved for eligibility by the AAA or the OPI service provider (see Part III F. Home-

Delivered Meal Assessments below); and

7. Live within the service area boundaries designated by the AAA or OPI service provider; or

8. Live outside the service area boundaries and can make arrangements to have a meal picked

up and delivered to the eligible client’s home.

C. Nutrition Education

The Older Americans Act requires that states ensure nutrition programs “provide for nutrition

screening and nutrition education, and nutrition assessment and counseling if appropriate.”

(OAA Sec. 339(2)(J) Nutrition education is intended to “promote better health by providing

accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition)

information and instruction to participants, caregivers, or participants and caregivers in a group

or individual setting, overseen by a dietitian or individual of comparable experience.” (NAPIS

Reporting Requirements)

____________________________

Homebound means that leaving home is a major effect, leaving home unassisted is not normally possible, and when

leaving home, it must be to get medical care, or for infrequent non-medical reasons such as trip to get a haircut, or to

attend religious service or adult day care http://www.aspe.hhs.gov/daltcp/reports/OASISfr.htm;

6 September 2022

Nutrition education must be provided regularly to all OAA Nutrition Program participants.

• Each congregate meal nutrition site shall provide nutrition education at least quarterly.

• Home delivered meals shall provide nutrition education a minimum of one time per year.

Nutrition education is required at the first nutrition risk assessment. Subsequent yearly

nutrition education topics may be determined by local nutrition service providers.

Nutrition education has to go beyond providing information alone. Distributing newsletters or

brochures that contain nutrition information from a trusted source does not constitute nutrition

education unless the information is accompanied by some form of instruction to a group or

individual. Instruction is defined as imparting knowledge or information.

• In a congregate setting, this may include reviewing main concepts of nutrition education

materials prior to the meal.

• In a home setting, this may include reviewing educational materials that relate to the annual

nutrition risk assessment or other relevant nutrition education topics.

Nutrition education topics will be based on the needs of the participants and should be culturally

appropriate. Teaching methods and instructional materials must accommodate the older adult

learners, i.e. large print handouts, interactive demonstrations. Examples of nutrition education

activities include presentations, cooking classes or food preparation demonstrations, food tasting

sessions, gardening, physical activity programs, or discussion of community resources that can

support participants’ health and nutrition.

The Community Services & Supports Nutrition webpage has materials approved for use by

nutrition programs. Approved materials for nutrition education can also be obtained from federal

agencies including the Administration for Community Living, Centers for Disease Control and

Prevention, National Institute on Aging, and US Department of Agriculture; or from Oregon

State University Extension Service.

D. Nutrition Counseling

Nutrition counseling is service which AAAs may provide, as appropriate, and based on the needs

of meal recipients. (OAA Sec. 331 (3))

Nutrition counseling is the provision of “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 their caregivers.” (NAPIS Reporting Requirements)

Nutrition counseling is performed by a Registered Dietitian or other health professional in

accordance with state law and policy. It is an important component of a nutritional care

program in which a Registered Dietitian gives professional guidance to an individual, working

with the individual’s medical provider as appropriate. The service includes:

1. Assessing current food habits, eating practices, and nutrition status;

2. Developing a written plan for appropriate nutrition intervention;

3. Reviewing and assisting the individual to implement the plan;

4. Planning follow-up care and evaluating progress toward nutrition goals.

7 September 2022

III. Program Administration

A. Provision of Nutrition Services by AAAs

Per OAR 411-011-0000 and the Older Americans Act, no nutrition services will be directly

provided by the State agency or an Area Agency on Aging, except where, in the judgment of the

State agency, provision of such services by the State agency or an AAA is necessary to assure an

adequate supply of such services, or where such services are directly related to such State agency

or AAA administrative functions, or where such services can be provided more economically

and with comparable quality, by such State agency or AAA. (OAA Sec. 307(a)(8)(A))

AAAs should have a system in place to periodically review options and request proposals to

identify potential nutrition services providers that could meet the OAA and state requirements in

providing nutrition services that best meet the needs of their service area.

Direct provision of nutrition services by the designated AAA must be approved by ODHS Aging

& People with Disabilities’ Community Services & Supports Unit.

B. Frequency of Meals

Nutrition programs should provide meals 5 or more days per week in each county. (OAA Sec.

331(1))

• For congregate meals, this means providing at least one hot meal or other appropriate meal in

a congregate setting at least once a day, five or more days per week.

• For home-delivered meals, this means offering delivery of at least one meal a day, five or

more days per week. Regular (non-emergency) home-delivered meals may be hot, cold, or

frozen. If the nutrition provider chooses, it is acceptable to provide a combination of two or

three meals, including breakfast, lunch, and/or dinner, to participants receiving home-

delivered meals. Nutrition providers are also encouraged to offer weekend meals, which

could be hot, cold or frozen meals.

In rural

areas where the frequency of serving or delivery of meals five or more days per week is

not feasible, AAAs must request approval from the State agency of a lesser frequency of meal

service. (OAA Sec. 331(1))

This written request should be included in the Area Plan. When requests are submitted as part of

the Area Plan or as part of an Area Plan Amendment, approval of the Area Plan will constitute

approval of the request. However, a AAA can also submit the request when a nutrition program

decides to change meal service frequency from five days a week to a lesser frequency in any

given county, using the Nutrition Approval – Request to Provide Reduced Meals form on the

APD website.

Rural is defined by the Administration on Aging as “any area that is not defined as urban. Urban areas comprise (1)

urbanized areas (a central place and its adjacent densely settled territories with a combined minimum population of

50,000) and (2) an incorporated place or a census designated place with 20,000 or more inhabitants.”

8 September 2022

C. Required Policies and Procedures

The OAA requires assurance of fiscal control and fund accounting procedures to ensure proper

disbursement of, and accounting for, federal funds paid to contract or grant recipients. (OAA Sec.

307(a)(7)(A))

1. AAA should have a process for monitoring the program budget and making adjustments, as

needed;

2. AAA should have a procedure for reconciling meal counts and sub-contractor invoices to

ensure accuracy; and

3. AAA or nutrition provider should have a system in place that reduces the risk of fraud or

mishandling of contribution/donations.

Nutrition programs must develop, implement, and annually update an operating policy manual

containing, at minimum, the following information:

1. Fiscal management

2. Food service management

3. Safety and sanitation

4. Staff responsibilities

5. Emergency/disaster plan

AAAs that contract with community partners to provide nutrition services should develop a

written agreement or contract with each outside agency or organization which addresses issues

including:

1. Responsibilities and obligations of each party, including compliance with nutrition program

and reporting standards,

2. Costs and payments, if any, to be paid or incurred by either party,

3. Days and hours the congregate nutrition site will operate, or days meals will be delivered for

HDMs.

AAAs are required to participate in monitoring by APD, and are encouraged to develop systems

for regular monitoring of their nutrition program. Monitoring and quality assurance may include

ensuring that Nutrition program standards are being met, and review of program data and

nutrition risk information to assess whether nutrition services are reaching targeted populations

as determined by the AAA.

9 September 2022

D. Congregate Meal Location and Site Management

Site Location

The location for the congregate meal program is vital to its success. In order to create a

gathering place that offers opportunities for good nutritious meals and social interaction, an ideal

facility will:

• Be conveniently located to the target population. The OAA calls for meals to be provided in

settings in as close proximity to the majority of eligible older individuals’ residences as

feasible. (OAA Sec. 339(1)(D))

• Have convenient, accessible and affordable transportation.

• Be in a safe, well-lit, well-maintained location.

• Be easily visible and open to the public.

• Have adequate space to support programming.

• Have clear, inviting and culturally appropriate exterior and interior signage.

The meal site should create an atmosphere that is pleasant and inviting, as well as conducive to

the needs of the older population. This environment should include:

• A welcoming ambience that plays down institutionalization.

• Adequate lighting.

• Acoustics that support individual and group conversations.

• Accessible restroom locations.

• Kitchens that support high quality and safe meal service.

• Furnishings that are functional, comfortable, safe and appropriate.

ADA Requirements

Each congregate meal site must meet the requirements of the Americans with Disabilities Act for

accessibility to public programs. (DHS Policy DHS-010-005) Nutrition sites are encouraged to

use an ADA checklist to assess for accessibility (copy on APD website), and should ensure that

sites:

• Are free from structural barriers that limit the participation of people with disabilities,

• Have equipment, including tables and chairs that are sturdy and appropriate for older

persons, and adequate aisle space to easily accommodate movement by persons with canes,

walkers, and wheelchairs.

• Make special provisions as necessary for the service of meals to persons with disabilities.

Site Management

Site management is important to the success of a comprehensive, safe and vital meal program.

Guidelines for a successful program should include:

1. Staffing: Knowledgeable of the aging network system and services, sensitive to aging issues

and competent in food service management.

10 September 2022

2. Nutrition and meal services: Provide safe and appetizing meals that meet OAA

requirements; meals that adapt to the client satisfaction; opportunities for nutrition education.

3. Programming: Provide interactions that meet client interests and needs.

4. Services referral: Help clients become familiar with community resources.

5. Outreach to the community: Create public awareness of program and services.

6. Volunteer opportunities: Provide a volunteer program that cultivates purposeful and

responsible involvement.

7. Administrative: Provide consistent and accurate required reporting, monitoring of budget

and fund raising activities, and other duties as needed.

E. Nutrition Program Reporting Requirements

As the federally designated State Unit on Aging, APD’s Community Services & Supports Unit is

required to submit aggregate OAA client information annually to the National Aging Program

Information System (NAPIS) in the federal State Program Performance Report (SPR). Nutrition

programs must collect and report the information required by APD and the Older Americans Act

in GetCare.

1. NAPIS information must be collected and updated annually for each congregate and home-

delivered meal participant. For home-delivered meal participants, the Activities of Daily

Living (ADL) and Instrumental Activities of Daily Living (IADL) information must also be

collected initially and updated annually. NAPIS data for new nutrition participants should be

reported to the Area Agency on Aging on a monthly basis for data entry to GetCare, unless

there is another agreement between the AAA and nutrition provider to submit this

information using an alternative method. The NAPIS intake form can be obtained from the

first link on the AAA page of the APD web site (http://www.oregon.gov/DHS/SENIORS-

DISABILITIES/SUA/Pages/Area-Agency-Aging.aspx).

2. The OAA Nutrition Risk screening must be completed at the time of intake and at annual

update for each congregate and home-delivered meal participant. AAAs should develop

appropriate policies or procedures for review of the nutrition-screening checklist and for

making appropriate referrals if participants score at a high nutrition risk. The Nutrition Risk

screening form can be found online at http://www.oregon.gov/DHS/SENIORS-

DISABILITIES/SUA/Documents/Nutrition%20Screening%20Checklist.pdf, and in

Appendix A.

While clients who decline to provide NAPIS or nutrition risk screening information may not be

denied service, nutrition providers should make every effort to obtain the required NAPIS and

Nutrition Risk data from each congregate and home-delivered meal participant. In order to

reduce potential barriers for new participants at congregate sites, nutrition programs may allow

new congregate participants to eat 1-2 meals as a guest, but should request that participants

complete the NAPIS and risk screening information no later than their 3

visit.

Nutrition programs should work with staff and volunteers on ways to effectively explain and

encourage completion of requested information, consider providing posted or written

information, clearly explain why and how the information is used, and develop systems to

facilitate annual updating of information by participants.

11 September 2022

Service Units for NAPIS reporting in GetCare

While OPI and Medicaid HDMs will continue to be recorded in Oregon ACCESS, OAA-funded

nutrition services must be reported in GetCare. The following list includes service reporting

units and service definitions related to nutrition programs developed by the Administration for

Community Living. (SPR: Appendix A: Data Element Definitions; 7/2/20)

1. Congregate meal. Service unit is one meal. (Registered service)

A meal provided by a qualified nutrition project provider to a qualified individual in a

congregate or group setting. The meal is served in a program that is administered by SUAs

and/or AAAs and meets all the requirements of the Older Americans Act and State/Local

laws. Meals provided to individual through means-tested programs may be included.

2. Home-delivered meal – Service unit is one meal. (Registered service)

A meal provided to a qualified individual in his/her place of residence. The meal is served in

a program that is administered by SUAs and/or AAAs and meets all the requirements of the

Older Americans Act and State/Local laws. Meals provided to individual through means-

tested programs may be included.

3. Nutrition Education - Service unit is a Session, typically 15 minutes to 1 hour. (Non-

registered service for group sessions)

A targeted program to promote better health by providing accurate and culturally sensitive

nutrition, physical fitness, or health (as it relates to nutrition) information that is consistent

with the current Dietary Guidelines for Americans and instruction to participants, caregivers,

or participants and caregivers in a group or individual setting overseen by a dietitian or

individual of comparable expertise.

4. Nutrition Counseling – Service unit is an hour; a partial hour may be reported to two

decimal places, e.g. 0.25 hours. (Registered service)

A standardized service as defined by the Academy of Nutrition & Dietetics and that provides

individualized guidance to individuals who are at nutritional risk because of their health or

nutrition history, dietary intake, chronic illness, or medication use, or to caregivers.

Counseling is provided one-on-one by a registered dietitian, and addresses the options and

methods for improving nutrition status with a measurable goal.

5. Health Promotion: Non-Evidence-Based – Service unit is one session.

Initial home-delivered meal assessments and reassessments, including nutrition risk

screening, should be reported as a Health Promotion: Non-Evidence-Based service. ACL’s

definition of this service includes the following: (A) health risk assessments; (B) routine

health screening; (C) nutritional counseling and educational services for individuals and their

primary caregivers.

Narration to document services provided

Any conversation or contact beyond regular service delivery or assessment should be narrated in

GetCare to substantiate nutrition services provided. For further information on narration in

12 September 2022

GetCare, see the Community Services & Supports Unit Narration Standards for GetCare in the

GetCare Help Library.

The following documentation of nutrition education or nutrition counseling (if provided) must be

maintained three years:

• Date of presentation or other allowable nutrition education activity

• Topic discussed

• Number of eligible persons participating in nutrition education activity

For further information on NAPIS reporting, see Oregon’s State Performance Program

Definitions at https://www.oregon.gov/dhs/SENIORS-DISABILITIES/SUA/Pages/Area-

Agency-Aging.aspx, NAPIS definitions in the Appendix, or

https://www.acl.gov/programs/performance-older-americans-act-programs

F. Home-Delivered Meal Assessments

In order to provide meals to a homebound older person, nutrition service providers must

determine eligibility for home-delivered meals and any other appropriate services.

Initial Assessment

1. The initial assessment should be conducted in person. This initial assessment should focus

both on the individual’s strengths and limitations. Other means of realistically obtaining

consistent and adequate meals such as shopping assistance, assistance from friends and

family, attending a congregate site and homemaking services should be explored. Other

assistance, including other AAA or community services, may reduce the need for home-

delivered meals and help determine the level of service priority.

2. The initial assessment/screening, including the required OAA NAPIS data, nutrition risk

assessment, and ADL and IADL needs, shall be completed within the period designated by

the AAA.

3. The nutrition screening checklist is available in Appendix F or on the DHS website at

http://www.oregon.gov/DHS/SENIORS-

DISABILITIES/SUA/Documents/Nutrition%20Screening%20Checklist.pdf. Each participant

should complete this nutrition screening once per year.

4. Program applicants who are determined ineligible to receive home-delivered meals should be

directed to the nearest congregate nutrition site, other appropriate food assistance programs,

and/or other AAA or community services.

5. Conditions or circumstances that place the older person or the household at high risk of

abuse, neglect or exploitation must be brought to the attention of appropriate officials (Adult

Protective Services or law enforcement) for follow-up.

Reassessment

1. The purpose of reassessments is to determine if a participant’s need for home-delivered

meals still exists and at what level.

13 September 2022

2. Participants who originally were determined to need meals for a few weeks, such as those

recovering from surgery or illness, should be reassessed before the end of that service period

to determine if their need for meals still exists. If the participant continues to need home-

delivered meals, services should continue and an appropriate reassessment schedule should

be determined.

3. Participants receiving home-delivered meals that are expected to need the service for long

periods should be reassessed at least every six months to a year, depending on the unique

needs of the person receiving the service. Annual reviews must be performed in-person. Six-

month reviews may be performed over the telephone if it is not feasible to meet the

participant in-person.

4. If a participant is no longer eligible to receive home-delivered meals, the service provider

should direct them to the nearest congregate nutrition site or to other appropriate food

assistance services.

G. NSIP and NSIP Reporting

The Nutrition Services Incentive Program (NSIP) administered by the Administration for

Community Living provides grants to support congregate and home-delivered nutrition programs

based on the number of meals that are served in the prior federal fiscal year. (OAA Sec. 311)

Eligibility for NSIP Funds

1. Meals eligible for NSIP funds must be served by a nutrition service provider that is under the

jurisdiction, control, management and audit authority of the AAA. Any nutrition services

provider receiving NSIP reimbursement must operate in compliance with all federal

requirements, and state operating standards pertaining to the Congregate and Home-

Delivered Meal Program.

2. Meals eligible for NSIP reimbursement are those meals served to eligible persons, as defined

by the Older Americans Act or Oregon Project Independence (OPI), and that meet OAA and

Oregon nutrition program requirements.

3. Meal counts include all OAA and OPI eligible meals, including those served to persons

under age 60 where authorized by the OAA. NSIP Meals also include home-delivered meals

provided as Supplemental Services under the National Family Caregiver Support Program

(Title III-E) to persons aged 60 and over who are either care recipients (as well as their

spouses of any age) or caregivers.

4. Meals paid with Title XIX or private reimbursement programs are not eligible for NSIP

reimbursement.

(NAPIS Reporting Requirements)

Use of NSIP Funds

NSIP funds must be used to expand meal services, and can only be used to purchase

domestically produced foods of United States.

14 September 2022

NSIP reimbursement may not be used to supplant funds previously earmarked for services for

older individuals. NSIP funds cannot be used to cover meal transportation costs, staff salaries,

location costs, etc. (ACL guidance)

Reimbursement of NSIP Funds

The AAA must establish a systematic method for documenting the number of meals served to

qualify for receipt of NSIP reimbursement.

Reimbursement from APD shall be disbursed as requested monthly by the AAA. The service

provider must expend NSIP funds according to state guidelines, before using state or federal

funds or program income.

H. Staff and Volunteer Training

Each nutrition program provider should develop written procedures for all components of meal

services. Personnel and volunteers who assist with the congregate or home-delivered meal

operations should be instructed in:

• Portion control (for congregate meals),

• FDA Food Code practices for sanitary handling of food,

• Agency safety policies and procedures,

• Protecting confidentiality and safeguarding collection of voluntary donations, and

• How to report concerns to appropriate staff for follow-up.

Regular training should be provided to reinforce safe food handling practices.

• Food handler training should be completed by all nutrition program staff, and is

recommended for volunteers. Certification is available in each county, costs $10, and is

valid for three years.

• ServSafe training is recommended for meal site coordinators of nutrition sites where meal

preparation occurs.

See http://www.oregon.gov/oha/ph/HealthyEnvironments/FoodSafety/pages/index.aspx for

information on Oregon’s Food Safety rules and available training. Persons handling food/food

service must comply with the Food Protection Program, which adopted the 1999 FDA Food

Code with Oregon Amendments, and with local public health code regulating food service

establishments. (OAR 333-150 through 333-160, and ORS 624.010 through 624.992)

I. Criminal Background Checks

APD’s contract with each AAA for OAA services, including nutrition services, requires that AAAs

agree to utilize the DHS Criminal Records Information Management System (CRIMS) to meet

provider requirements set forth in OAR 407-007-0200 through 407-007-0370 and ORS 181.a195

through 181a.200 and ORS 443.004. Subject individuals required to complete CRIMS checks are

15 September 2022

employees of the AAA; volunteers of AAA; and employees and volunteers of AAA’s subcontractors

including nutrition programs who are 16 years of age or older.

Unless a new staff/volunteer discloses a criminal history within the past 5 years, an agency can

hire or use the staff/volunteer immediately on a preliminary basis as soon as the background

check has been submitted, as long as the individual is actively supervised (within line of sight

and hearing). (OAR 407-007-0315)

The Background Check Unit has also clarified that volunteers for a special event do not have to

complete a background check, but must be actively supervised:

• Volunteers providing any care or services for a special event lasting no more than two

weeks whose access to clients is no more than three days within the two week period.

These volunteers must always be actively supervised in accordance with OAR 407-007-

0315 and have no unsupervised contact with clients. (OAR 407-007-0210 (Definitions

section) 8(b)(E))

For frozen meals delivered by commercial carriers, all carriers (e.g. United States Postal

Service) must pass criminal background checks sufficient to protect the well-being of the OAA

and OPI clients. Each provider must ensure that all individuals who deliver meals have passed

an acceptable background check as defined in OAR 407-007-0275.

J. Adult Protective Services Mandatory Reporting

Nutrition programs have direct contact with older adults, and provide a critical role in helping to

identify and report suspected abuse. Nutrition programs should ensure that all staff are trained in

mandatory reporting requirements, and that both staff and volunteers have clear guidance on how

to report concerns and suspected abuse. (ORS 124.050 through 124.095 and OAR Chapter 411,

Division 20).

K. Outreach

As part of their Area Plan, AAAs identify community needs and develop goals for OAA services

including nutrition, ensuring that services are targeted to those in greatest social and economic

need.

Nutrition outreach is designed to ensure that the maximum number of eligible individuals in the

program area have the opportunity to participate in nutrition services, with a focus on reaching

older adults that the AAA has identified as being in greatest need. As the older adult population

becomes more diverse, AAAs are encouraged to identify ways to adapt outreach and services to

meet the needs and nutrition preferences of the older adults within the AAA service area.

16 September 2022

L. Participant Input

Each service provider should establish a means of soliciting participant input on appropriate

matters relating to Congregate and Home-Delivered Nutrition Program services. Input should be

used to assess service quality and satisfaction, and to identify any needed changes or

improvements. Information may be obtained through approaches such as focus groups, advisory

councils, suggestion boxes, and surveys. Suggestions may also come from food production staff,

site managers, home-delivered meal drivers, and other individuals knowledgeable with regard to

the needs of older individuals. (OAA Sec. 339(2)(G))

M. Role of Advisory Councils

While not required, AAAs are encouraged to establish a nutrition advisory council. The nutrition

advisory council may be a sub-committee of an existing advisory council. The nutrition program

may also set up a separate advisory council for home-delivered meals representation.

Suggested advisory council roles and responsibilities:

1. Make recommendations to the nutrition director regarding the food preference of

participants;

2. Make recommendations to the nutrition director and AAA regarding days and hours of meal

site operations and site locations;

3. Make recommendations to the nutrition director regarding ways to make nutrition services

more welcoming, inclusive, and accessible to diverse populations, including older adults at

greatest economic and social need;

4. Conduct at a minimum, annual on-site review of each meal site to ensure program

compliance;

5. Advise and make recommendations to the nutrition director and AAA regarding supportive

social services to be conducted at meal sites;

6. Provide support and assistance to the ongoing development of the nutrition program;

7. Represent and speak on behalf of nutrition participants and program; and

8. As a liaison group, act as a communication clearinghouse between the nutrition program and

the public.

N. Guidelines on Prayer at Meal Sites

The Older Americans Act does not forbid older adults from praying before a meal at a senior

center or some other location that provides a meal with funding from the OAA. Where prayer is

used at meal sites, nutrition programs should adopt policies that ensure that each individual

participant has a free choice whether to pray either silently or audibly, and that the prayer is not

17 September 2022

sponsored, led or organized by persons administering the nutrition program or the meal site.

(https://www.acl.gov/about-acl/authorizing-statutes/older-americans-act)

O. Waitlists

If funding is not adequate to serve all those requesting meals, AAAs should have a policy or

procedure in place to address use of a waitlist for home-delivered and/or congregate nutrition

services. The AAA should have a defined system to prioritize individuals on a waitlist, taking

into consideration nutrition risk screening score, length of time on the waitlist, or other factors

determined by the AAA.

P. Emergency Plans

Nutrition programs must have written plans to address emergencies and disasters. Plans may be

part of the AAA emergency plan, or developed separately for each site. However, staff and

volunteers must be familiar with the plan, and plans should at least address the following:

• Medical emergencies

• Site evacuation in case of fire or other disaster

• Inclement weather plans

• Emergency/unanticipated site closure procedures, including communication plans and back-

up options for providing meals if a site must be closed for some period of time

• Emergency contacts

Congregate meal participants should be advised to keep an emergency food shelf at home, in

case of inclement weather that prevents travel to the congregate site or other such emergencies.

A resource for additional information is the OSU Extension’s Family and Community

Development website at: http://extension.oregonstate.edu/fch/.

For home-delivered meals, nutrition service providers should have a plan to ensure clients will

receive meals during emergencies, weather-related conditions and natural disasters. Plans may

include annual providing of “Blizzard meals” or shelf-stable emergency meal packages, use of

four-wheel drive vehicles, and/or volunteer arrangements with other community resources.

Q. Process for Altering Services or Closing a Meal Site

Nutrition providers must notify APD of any prolonged changes in the meal production and

delivery system. This might include a change from a hot to a frozen home delivered meal, or

changing from a central kitchen to onsite cooking. This notification may be included in the Area

Plan; however, it must be submitted when a nutrition project decides to change the meal delivery

system.

18 September 2022

When a meal site or home-delivered meal service supported by OAA funds is to be closed, the

following procedure must be followed:

1. The AAA must identify ways to minimize the impact of the closure, with particular focus on

those at greatest social and economic need, including low income and minority individuals,

older individuals in rural communities, those with limited English proficiency, and those at

risk of institutional care.

2. The AAA must notify APD in writing of the intent to close the meal site or home-delivered

meal service in advance of notifying participants; providing a rationale for closing the

service, and steps the AAA is taking to minimize the impact on populations at greatest social

and economic need.

3. The program must notify participants at the meal site or home-delivered meal service to be

closed of the intent to close the site at least 30 days prior to the last day of meal service.

R. Participant Donations

Voluntary contributions shall be allowed and may be solicited if the method of solicitation is

noncoercive. (OAA Section 315(b)(1)) AAAs should ensure that each nutrition provider:

• Provides participants with an opportunity to voluntarily contribute to the cost of the service;

• Clearly informs each participant that there is no obligation to contribute and that the

contribution is purely voluntary;

• Protects the privacy and confidentiality of each participant with respect to their contribution

or lack of contribution; and

• Establishes appropriate procedures to safeguard and account for all contributions. (OAA

Sect. 315(b)(4)(A-D))

The AAA and service providers shall not deny services to any individual who does not

contribute to the cost of the service, nor conduct means testing to determine eligibility. (OAA

Section 315(b)(3))

Donations for Congregate Programs

• A clearly visible and easy-to-read sign may be posted near the entrance and/or the sign-in

area stating the actual cost of the meal, suggested donation, and statement that meal

recipients under 60 must pay the full cost of the meal.

• Volunteers offered the option of a meal on the same basis as meals provided to participating

older individuals, should be encouraged to donate towards the cost of their meal.

Donations for Home-Delivered Programs

• Nutrition programs should have procedures in place to ensure that drivers receiving

contributions from meal recipients bring all donations back to the meal site.

19 September 2022

S. Use of Program Income

Program income includes all participant donations for meals. Programs funded completely or in

part by Older Americans Act receive program income in the form of donations.

1. Nutrition program must have appropriate procedures to safeguard and account for all

contributions.

2. All collected contributions shall be used to expand the service for which the contributions

were given. (OAA Sec. 315(b)(4)(E))

1. All program income shall be used within the program year in which it is received and shall

be used before federal, state or local funds are used.

2. Program income shall be documented in the service provider’s financial records in the same

manner as all other federal, state or local funds. Program income shall be reported on the

monthly financial reports to APD as required.

20 September 2022

IV. Menu Planning and Dietary Guidelines

A. Nutrition Guidelines

Oregon APD encourages every effort to include key nutrients and current nutrition

recommendations that influence chronic disease and the health of older Oregonians when

developing menus for the senior nutrition programs. Menu standards are developed to sustain

and improve client’s health through the provision of safe and nutritious meals using specific

guidelines. AAAs are encouraged to incorporate these standards into all requests for proposals,

contracts, and open solicitations for meal provision using Older Americans Act funding.

1. The Older Americans Act:

• Provides flexibility to nutrition providers in designing meals that are appealing to

program participants (OAA Sec. 339 (2)(B)

• Encourages providers to enter into contracts that limit the amount of time meals must

spend in transit before they are consumed. (OAA Sec. 339(2)(C)

• Where feasible, encourages joint arrangements with schools and other facilities serving

meals to children in order to promote intergenerational meal programs (OAA Sec. 339

(2)(D)

• Where feasible, encourages the use of locally grown foods in meal programs, and

identifies potential partnerships and contracts with local producers and providers of

locally grown foods. (OAA Sec. 339(2)(L))

2. Congregate and Home Delivered meals supported with Older Americans Act funding must

comply with the most recent Dietary Guidelines for Americans, and each meal must provide

a minimum of 33⅓% of the current daily Dietary Reference Intakes as established by the

Food and Nutrition Board of the National Research Council of the National Academy of

Sciences and the current Dietary Guidelines for Americans (published by the Secretaries of

the Department of Health and Human Services and USDA). (OAA Sec. 339(2)(A))

3. Current Dietary Reference Intakes and Dietary Guidelines for Americans target values for

nutrients of concern for older adults are included in Appendix C to assist AAAs and RDs

working with nutrition programs to adopt menus that meet OAA guidelines. As noted on the

attached chart, nutrient requirements may be averaged over one week to allow more

flexibility in menu planning.

4. To address the nutritional needs of older adults, menu planning should be designed to:

a. Include a variety of foods, especially fruits, vegetables and whole grains.

a. Include foods with adequate complex carbohydrates and fiber.

a. Encourage nutrient dense foods.

b. Avoid too much total fat, saturated fat, trans fat and cholesterol. Encourage mono and

poly unsaturated fats.

b. Avoid too much refined carbohydrates.

c. Avoid added sugars.

21 September 2022

d. Avoid too much sodium by using salt free herbs and spices, cooking from scratch, and

utilizing less processed and manufactured foods.

e. Provide an appropriate number of calories to help maintain ideal body weight.

5. Water should always be offered with meals. Beverages such as milk and calcium fortified

soymilk may contribute to nutrient intake and are encouraged. All beverage consumption

enhances fluid intake of participants.

6. Sugary beverage consumption is strongly discouraged, especially on special occasions when

high calorie, fat and sugar items are offered. Sugary beverages include any beverage with

added caloric sweetener; most commonly fruit-flavored drinks such as fruit punch or

lemonade, sodas and sports drinks. Frequent sugary beverage consumption is linked to

obesity and many health problems, including diabetes, coronary heart disease, and high blood

pressure. Providing sugary beverages in a congregate meal site makes it more difficult for

seniors to self-manage their chronic diseases.

7. The Older Americans Act specifies that nutrition programs should “to the maximum extent

practicable, adjust meals to meet any special dietary needs of program participants.” (OAA

Sec. 339(2)(A)(iii)) This may include providing meals individually modified for health

reasons (e.g. low-sodium or diabetic meals), ethnic and religious preference, and developing

meal sites specifically targeted to address meal preferences of specific populations.

8. The OAA allows Title III funds to be used to purchase liquid supplements at the discretion of

the AAA; however a liquid supplement by itself cannot be counted as a meal for OAA or

NSIP reporting. (ACL guidance) Supplements should not replace a meal except by a

physician’s order or emergency/disaster situation if a meal cannot be provided. Supplements

are to be used only in extenuating circumstances, and regular follow-up is required by a

Registered Dietitian or Registered Nurse.

B. Menu Planning

An Registered Dietitian (RD) or individual with comparable expertise must certify and sign that

each meal meets the OAA and state requirements for congregate and home-delivered meals, and

provide consultation on food quality and safety. A person with comparable expertise is defined

as a person who has a Master’s or other advanced degree in home economics, family and

consumer sciences, public health nutrition, health education or human sciences with an emphasis

in nutrition and dietetics. AAAs are encouraged to work with schools, public health

departments, or other AAAs to identify an RD to review and approve menus, provide guidance

on nutrition education, and be available to consult with the AAA on nutrition needs as needed.

Nutritional analysis is the best practice for menu planning. Computer analysis will provide

better information about menus than a meal pattern, helps ensure that meals are fully meeting

OAA requirements, and may decrease food costs. For meals where nutritional analysis is used,

nutrition programs are encouraged to share nutrition analysis for meals provided with

participants, enabling participants the ability to know more about the food they are eating.

22 September 2022

A menu component approach may be used if a nutrition program is unable to obtain nutritional

analysis of meals (e.g. in the case of meals provided by restaurants or individual kitchens). A

menu component format is provided in Appendix B.

Key issues for nutrition programs using a menu component approach:

1. An RD or individual with comparable expertise must review and approve component menus,

working with meal providers to adjust and/or substitute meal options to meet nutrition

guidelines.

2. Menus should be planned and written for a minimum of four weeks.

3. Food substitutions should be infrequent or similar nutritional value, not reduce or radically

alter the nutritional content, and made in consultation and approval by an RD or individual

with comparable expertise.

4. Nutrition programs that use menus approved by RDs from other sites should use the same

recipes as the original site, or work with an RD or individual with comparable nutrition

expertise to ensure that replicated menus still meet dietary guidelines.

C. Menu Considerations for Diverse Populations

The Older Americans Act encourages flexibility in designing meals that are appealing to

program participants, while still complying with overall requirements. (OAA Sec. 339 (2)(B)

Strategies that AAAs are using to address the changing and diverse preferences of older adults

include:

1. Offer more than one meal option. Offering more than one option allows participants

choice in meeting dietary needs and food preferences. Healthy foods that meet dietary

guidelines should be offered, but participants should have the option to choose what they

are served and what they wish to eat. AAAs may also consider offering meals other than

lunch – e.g. breakfast or dinner – that may better meet community needs and preferences.

2. Contract with restaurants or food service providers that prepare culturally

appropriate meals. See App. E on Restaurant or Voucher Guidelines.

3. Use salad bars. The OAA allows salad bars to be counted as a full meal as long as they

meet the nutritional and other requirements in the OAA. Nutrition service providers have

successfully used a variety of methods to help older adults select ingredients in healthy

portion sizes from a salad bar to meet the nutritional requirements of the OAA. (ACL

guidance)

4. Include meal participants and Advisory Councils in testing and providing feedback

on new menu items.

5. Engage RDs together with nutrition program participants and local community

partners to identify food options that meet local preference while still addressing

dietary guidelines. Cultural foods, food preferences, and use of traditional foods are

options that can be included in nutrition programs with help from an RD that can determine

23 September 2022

if foods meet dietary guidelines, need to be adapted, or can be included infrequently – eg

for specific celebrations – due to dietary guideline requirements.

D. Use of Donated Foods

The Older Americans Act encourages the use of locally grown foods in meal programs, and the

development of partnerships and contracts with local producers and providers of locally grown

foods. (OAA Sec. 339(2)(L)) While home-prepared foods are prohibited, garden produce and

fresh fruits and vegetables can be used in meal preparation or provided to meal participants.

Use of Food in Prepared Meals.

Nutrition providers should develop policies and procedures for use of donated food items in

their meal programs.

Donations of food items may be prepared and served by nutrition programs if they are safe and

wholesome. Food donations cannot be utilized when deemed adulterated. For definition of

adulterated food, see ORS 616.235. Non-commercial canned or packaged items and homemade

items are not permitted for use in a reimbursable meal. Nutrition quality, health issues and

client perception should also be considered when deciding how to accept and utilize food

donations.

• Game meat donated to senior nutrition programs should be inspected and determined fit for

human consumption by the State of Oregon Department of Agriculture, the State

Department of Fish and Wildlife, or the Department of State Police who have been trained

by the State Department of Agriculture to determine fitness for human consumption. (ORS

ORS 619.095 and 624.165; Poultry Products Inspection Act Sec. 20(a)(5)(A);

• Donations of traditional foods – including wild game meal, fish, seafood, marine mammals,

plants, and berries – to senior meal programs operated by Indian tribes and tribal

organizations that primarily serve Indians is allowed, but must follow the guidelines and

responsibilities relating to ensuring safety of donated foods as outlined in USDA Policy

Memo SP 42-2015, CACFP 19-2015, SFSP 21-2015.

• Meat donated by 4-H or other similar farm programs should be butchered, cut and wrapped

by a locally identified processor that provides similar services for licensed commercial

businesses.

Donated Food Provided Directly to Meal Participants

If nutrition programs accept donated food that is provided directly to meal participants (e.g.

donated food items put out on a table at a congregate site), programs should have policies or

procedures in place on this distribution of food. Food should be safe to share, and support the

health of participants.

24 September 2022

E. Leftovers and Carryout Meals

The OAA allows occasional carry-out meals at congregate sites, but not on a regular basis. One

of the main strengths of the congregate program is that older adults get together to eat as a

community. The congregate meal program is a social in-person program, not a take-out program.

If on occasion, someone is ill or unable to get to their regular congregate site on a particular day,

a carry-out meal may be appropriate. AAAs may make specific exceptions for an individual to

take meals to go when there are clearly identified health, safety, or other barriers to the

individual’s participation in the scheduled group meal program.

Purposely ordering or overproducing food or preparing too many meals simply to allow

participants to take a second meal home is not appropriate. However, if an individual eats at a

congregate meal site, and the site ends up with extra food that they offer to the participant to take

home, the nutrition site can count this as two meals provided, as long as the take-home meal

includes a full meal meeting OAA requirements.

The OAA also allows participants to take leftovers from their plate home, as long as state and

local food safety codes are followed. Following these food safety codes is not only required, but

it is important because older adults are at a higher risk of food borne illnesses than other adults;

proceeding with utmost caution and concern is important. Sites may provide special containers

with instructions on reheating; limit leftovers to foods that are safe at room temperature (like

rolls and fresh fruit); or develop rules to help ensure safety while allowing participants to bring

home food from their plates, so as not to be wasteful. (ACL guidance)

F. Meal Preparation Safety and Sanitation

Meals prepared and provided as part of the OAA nutrition programs must meet the following:

1. Compliance with applicable federal, state and local fire, health, sanitation, safety and

building codes, regulations, licensor requirements, and other provisions relating to the public

health, safety, and welfare of meal patrons is required in all stages of food service operation.

2. Compliance with Oregon Public Health Code and local licensing standards for food

preparation, storage and delivery, as well as preparation and distribution guidelines included

in these program standards. See the Food Safety Training Manual at:

https://public.health.oregon.gov/HealthyEnvironments/FoodSafety/Pages/manual.aspx.

3. Copies of all current inspection reports by health department staff, registered sanitarian or

fire officials should be posted at the meal site.

4. Temperature checks should be taken with a food thermometer daily at the time food leaves

the production area, upon arrival if food is prepared off site, and again at serving time.

Records of these temperatures checks should be kept in the nutrition program files.

5. Each meal site is required by state sanitation laws to limit kitchen access to those who work

in it.

25 September 2022

6. Foods must be prepared, served and transported with the least possible manual contact, with

suitable utensils, and on surfaces that prior to use have been cleaned, rinsed and sanitized to

prevent cross contamination.

7. Effective procedures for sanitizing dishes, equipment and work areas should be written,

posted and followed consistently.

8. In order to retain maximum nutritional value and food quality, foods should be served as

soon as possible after preparation.

G. Home-Delivered Meal Safety and Delivery Requirements

To ensure the safety of meals provided to home-delivered meal participants, nutrition programs

must ensure the following:

1. When home-delivered meals are dispatched from a congregate meal site, they shall be

individually plated, packaged and prepared for transportation prior to the serving of the

congregate meal. Delivery of each meal will be in accordance with procedures for safe food

handling, including standards of food handling safety after removing from temperature

control and dispatch to participants.

2. The meal should be delivered directly to the participant or as otherwise directed by the

participant, ensuring food safety and the intent of the home-delivered meal in providing

regular social and safety contacts with homebound individuals. Meals should not be left

when there is no one available to receive a meal unless otherwise required/requested by the

participant due to medical or physical constraints, and pre-approved by the nutrition site to

ensure safe food handling guidelines are adhered to. Nutrition programs should have

guidelines for home-delivered meal drivers to notify staff when someone is not home,

enabling nutrition programs to follow up with these participants.

3. To ensure the safety of delivered foods, nutrition sites should follow the timing rule which

requires careful attention to temperatures and times:

a. Hot food must be cooked to the recommended temperature, and must be checked to

be at 135F or higher before removing from the oven/heat.

b. Hot food that was prepared the previous day, properly chilled and refrigerated

overnight to be reheated the next day for delivery, must be checked to be at 165F or

higher before removing from the oven/heat.

c. Cold food must be checked to be at 41F or lower before removing from

refrigeration.

d. Hot and cold foods must be delivered within 4 hours, and timing of the 4 hours starts

when food is removed from heat or refrigeration.

e. Sites must ensure record-keeping of temperature and time when pulled from heat or

refrigeration.

f. Hot and cold foods must be transported in thermal/insulated food carrier units.

26 September 2022

g. Sites must have written procedures to ensure food is discarded if not delivered within

the 4 hours.

Nutrition programs should keep in mind that home-delivered meal clients may not

immediately eat a delivered meal; for this reason, it is recommended that food be delivered as

soon as possible, and that participants be provided with periodic information and reminders

on safe eating, storing, and disposal of their delivered meals.

4. The AAA shall develop written procedures for maintaining food safety.

Meal Packaging Supplies and Carriers

1. Meal packaging supplies and carriers should be used that ensure hot foods are packaged and

transported in separate carriers from cold foods.

2. Meal carriers used to transport food should be enclosed and equipped with insulation and

supplemental hot or cold sources as needed to support hot and/or cold food temperatures.

3. Meal carriers should be cleaned and sanitized daily.

H. Frozen Home-Delivered Meals

Frozen home-delivered meals may allow AAAs to broaden the provision of meals, provide an

option that enables clients to set their own meal time, and potentially increase the flexibility to

meet special dietary needs (e.g. ethnic or therapeutic meals). However, frozen meals

require specific preparation considerations to ensure food quality and safety. AAAs that

provide frozen meals are strongly encouraged to work with a meal provider – e.g. hospitals,

Department of Correction, schools, or commercial meal providers – with the capacity to

prepare and safely flash freeze meals that meet OAA requirements.

Safety issues and requirements for frozen meals:

1. Frozen Meal Production. Service providers must demonstrate capability of cooling

meals in a safe and timely manner (from 140°F to 70°F or below within two hours,

and from 70°F to 41°F or less within four more hours). Please note that this process

of “flash-freezing” requires specialized freezers, and cannot be accomplished usi ng

commercial or standard freezers. Frozen meals shall be stored in a

commercial/industrial freezer. Leftovers from congregate or hot home delivered

meals shall not be reused in frozen meal production.

2. Packaging. Packaging shall be heat sealed and manufactured specific to microwave

re-heating. However, the possibility of including dual-oven packaging (able to be

reheated in both microwave ovens and traditional ovens) may be investigated. On all

packaging types, expiration dates must be clearly marked in large print and easily

visible.

3. Transit. Transportation from where the meal was produced to the dispatch location

and from the dispatch location to the client shall comply with temperature controls.

According to the USDA, frozen foods held cooler than 40°F are safe to refreeze or

27 September 2022

cook. Meals that have been warmer than 40°F for more than two hours must be

discarded. Prior to delivery, the service program must confirm that a recipient has

adequate freezer storage available before they are able to receive food.

If temperature is not controlled for in the delivery environment itself (i.e. refrigerated

truck or dry ice cooler), then proper insulation (e.g. ice, ice packs) must be used during

either transportation mechanism to ensure that temperature will remain within the safe

zone. If temperature control is not feasible then frozen meals should not be offered.

Meal time in transit shall be limited as much as possible. During the delivery process, all

frozen meals should be kept at or below 32°F.

4. Reheating. Recipients must be capable of using the stove, oven, or microwave to reheat

food to 165°F or higher and should be instructed about proper thawing methods. Efforts

should be made to ensure that recipients do not allow meals to thaw out on their kitchen

counter or at the drop off locations. Under no circumstances should meals be left for

recipients in a cooler.

5. Delivery standards. Delivery should occur as often as possible with a maximum of

seven days of meals provided at a time. Exceptions shall be evaluated on a case by case

basis by the AAA. Lowering delivery frequency to less than once weekly service would

be harmful due to decreased social interaction. As many of the seniors who partake in

home-delivered meals are isolated from friends or family, the social benefit of human

interaction is integral to program success. Postal deliveries are only acceptable if the provider

has regular contact with the individual to determine any change in conditions or concerns.

6. Contact requirements between deliveries. For program deliveries totaling more than 7

meals at one time, phone calls or check ins should be initiated with participants on a

weekly basis in order to prevent social isolation and ensure proper utilization of home

delivered meals. For example, if a client receives two weeks of meals a phone call or

check in should be scheduled during the week the client didn’t receive the meals.

28 September 2022

Appendix A: Dietary Reference Intakes and Dietary Guidelines:

Key Nutrients for Older Adults

Dietary Reference Intakes and Dietary Guidelines (2020-2025)

Key Nutrients for Older Adults

The following have been identified as nutrients of concern for older adults.

This chart shows the daily level as established by the current Dietary Reference Intake

and Dietary Guidelines for a >70 year male, as well as the target values for each meal.

Nutrient requirements may be averaged over one week to allow more flexibility in menu

planning.

Nutrient

DRI/ Dietary

Guidelines Daily level

Target values for one meal

(1/3 of daily levels)

Calories

2000

700 calories

Protein

56 g

19 g

Total Fat

20-35% calories; no

more than 35% per meal

20-35% calories; no more than 35% per

meal

Saturated Fat

<10% calories

Trans Fat

No trans fat

Fiber

28 gm

>10 gm

Calcium

1200 mg

400 mg

Magnesium

420 mg

140 mg

Zinc

11 mg

3.7 mg

Vitamin B6

1.7 mg

.6 mg

Vitamin B12

2.4 mcg

.8 mcg

Vitamin C

90 mg

30 mg

Sodium

2,300 mg*

767-1,050 mg*

Added Sugar

<10% of calories

<17 grams

Source: 2020-2025 Dietary Guidelines (calories, fat, saturated fat, fiber, sodium, added

sugar) and Dietary Reference Intakes (protein, total fat, trans fat, fiber, calcium, magnesium,

zinc, vitamins B6, B12, C)

*The 2020-2025 Dietary Guidelines recommend limiting sodium to 2,300 mg/day. While

Oregon currently includes a range of 767-1,050 mg as the sodium target value for one meal,

AAAs are encouraged to work on keeping meals at the lower end of this allowable range.

Please note that the Dietary Guidelines indicate that adults with prehypertension and

hypertension would particularly benefit from blood pressure lowering; for these individuals,

further reduction to 1,500 mg/per day can result in even greater blood pressure reduction.

(2020 Dietary Guidelines, Chapter 1)

29 September 2022

Appendix B: Menu Component Form and Guidelines

Word and Excel version of the meal component form are available on the APD Nutrition website at

http://www.oregon.gov/DHS/SENIORS-DISABILITIES/SUA/Pages/Restaurant-Voucher-

Resources.aspx

These pages can be used by programs using the meal pattern option of menu planning for

documenting that the menus conform to the meal pattern. Meal patterns must be reviewed and

approved by an RD prior to use.

Site/Program _________________________ Date: _______________

Food

Group

Servings per meal/portion

size

Meal 1

Meal 2

Proposed

meal

Brief description of proposed meal

and beverages

Bread,

cereal,

rice, pasta

2 servings

1 serving equals 1 slice bread; 1/2

cup cooked pasta, rice or cereal; 1

cup cold cereal. At least 1 serving

should be whole grain products

Vegetable

2 servings

1 serving equals ½ cup; 1 cup leafy;

3/4 cup 100% vegetable juice. An

additional vegetable may be served

in place of a fruit; If corn, peas,

squash, or other starchy vegetable,

count as bread and include another

vegetable. Look for dark green, red,

orange or yellow vegetables.

Fruit

1 serving

1 serving equals one medium whole

fruit; ½ cup chopped, cooked, or

canned; 1/2 cup 100% fruit juice

Milk or

calcium

alternate

1 serving

1 serving equals 1 cup fluid milk; 1

cup yogurt; 1 cup tofu processed

with calcium salt; 1 1/2 oz. natural

cheese. Select low or nonfat

products.

Meat or

meat

alternate

1 serving

1 serving equals 2.5-3 oz meat, fish

poultry; 3/4 cup cooked beans, peas,

or lentils; 7 oz soyburger; 3 Tbsp

peanut butter; 3 eggs; 1 1/2 cups tofu

30 September 2022

Menu Component Form – Food Preparation Guidelines

• Include a variety of foods, especially fruits, vegetables and whole grains.

• Use food servers/scoops to help provide appropriate serving sizes.

• Prepare most foods without adding salt. To flavor foods, use salt-free herbs and spices, salt-free

seasonings, lemon juice, lime juice or vinegar.

• When using high sodium condiments such as ketchup, barbeque and teriyaki sauce, prepared

mustard, seasoned salts, bouillon, pickles and olives, balance the menu with low sodium choices.

• Light soy sauce should be used to replace regular soy sauce and used infrequently. Monosodium

glutamate (MSG) should not be used in food preparation.

• Select low sodium versions of canned soups, tomatoes, vegetables and salad dressings in place of

regular canned/bottled items. If possible, prepare low sodium, low fat soup and gravy stocks

rather than purchase. Make sauces and gravies without fat. Add starch to cold liquid, instead of

blending starch with fat, before cooking for thickeners.

• Use low fat cooking methods such as baking, broiling or steaming. Do not add fat to cooked

meats or vegetables.

• Select low fat, low sodium bread and cheese when feasible.

• Substitute vegetable oils (ex. canola oil) for shortening, soft margarine for butter. Lard should

not be used.

• Use products that indicate zero grams of trans fat per serving on the label and no partially

hydrogenated oils in the ingredient list.

• Use all types of fish, lean cuts of meat, and poultry without skin.

• Substitute beans, peas, and lentils for some meat. For example, modify recipes to include well-

cooked lentils along with meat in pasta sauce or use whole-wheat flour as a thickener or extender

in some dishes.

• Offer water with meals. Avoid offering sugary beverages such as fruit punch, lemonade, sodas

and sports drinks. Sugary beverage consumption is linked to obesity and many health problems,

including diabetes, coronary heart disease, and high blood pressure.

• If dessert is provided, limit grain-based and dairy desserts to no more than once or twice a week,

and offer fruit on other days.

Appendix C. Specific Nutrient Sources

Source: USDA National Nutrient Database for Standard Reference

http://www.nal.usda.gov/fnic/foodcomp/search/

Nutrient content amounts are approximate

Calcium target – 400 mg/meal

Dairy sources

Milk: skim, 1%, 2%, buttermilk, chocolate,

whole ~280 mg/8 oz.

Yogurt: ~275 mg/8 oz.

Cheese: Romano, Swiss, provolone,

mozzarella, cheddar, muenster, bleu, feta

~ 300 mg/1.5 oz.

Processed cheeses: ~300 mg/ 2 oz.

Ricotta cheese ~ 300 mg/ ½ cup

Non-dairy sources

Fortified, ready to eat cereals: varies, check

labeling - 236-1043 mg/1 oz.

Cooked Greens:

Collards 178 mg/ ½ cup

Spinach 146 mg/ ½ cup

Turnip greens 124 mg/ ½ cup

Kale 90 mg/ ½ cup

Beet greens, bok choi 80 mg/ ½ cup

Cooked Beans:

Green soybeans 130 mg/ ½ cup

White beans 96 mg/ ½ cup

Black-eyed peas 106 mg/ ½ cup

Mature soybeans 88 mg/ ½ cup

Magnesium – target 140 ug/meal

Good sources (> 80 ug/ serving)

Halibut

Brazil Nuts

Quinoa

Spinach

All Bran

Fair sources (> 40 ug/ serving)

Fish: pollock, haddock, flounder, tuna,

Beans: white beans, black beans, chickpeas,

navy, lima, pinto

Nuts: peanuts, almonds, cashew

Brown rice

Couscous

Vegetables: okra, baked potato with skin,

artichokes

Raisin Bran

Soy beverage

Zinc – target 3.7 mg/meal

Lean meat

Beef ~ 5 mg/ 3 oz.

Pork ~ 2 mg/ 3 oz.

Poultry ~ 1.3 mg/ 3 oz.

Seafood (especially oysters)

Yogurt 1.68 mg/8 oz.

Split peas, black beans ~ 1.0 mg/ ½ cup

Fortified, ready to eat cereals: varies, check

labeling – up to 15 mg/1 cup

32 September 2022

Vitamin C target - 30 mg/meal

Rich sources (>30 mg in ½ cup)

Kiwi fruit

Raw orange

Strawberries

Brussels sprouts

Cantaloupe

Papaya

Red and green sweet raw or cooked peppers

Orange and grapefruit juice

Tomato and vegetable juice

Kohlrabi

Broccoli

Fair Sources (20-30 mg in ½ cup)

Cauliflower

Beet, mustard, and turnip greens

Kale

Cabbage, coleslaw

Pineapple

Mango

Baked potato with skin

Sweet potato, canned

Vitamin B6 target - 0.6 mg/meal

Fish-cod, haddock, tuna

Chicken, turkey

Beef, pork

Garbanzo beans

Baked potato, with skin

Rice

Ready to eat cereals (fortified)

Prunes, prune juice

Banana

Vitamin B12 target - 0.8 mcg/meal

Lean meat, poultry, fish

Eggs

Milk, cheese, yogurt

Ready to eat cereals (fortified)

Fiber target >10 gm/meal

Very Good Sources: More than 3 grams

fiber/serving

Grains: Barley, bulgur wheat, couscous,

All-Bran, shredded wheat cereals

Vegetables: Mature beans (navy, kidney,

split peas, lentils, black beans, pinto,

lima, white, chickpeas, great northern,

cowpeas, soybeans), baked and sweet

potato with skin, pumpkin, spinach,

cooked greens, artichokes, Brussels

sprouts,

Fruits: Dried prunes, dates, figs (3 each),

frozen raspberries, blackberries, raw

apples and pears with skin

Peanuts (1/4 cup)

Good Sources: 2 to 3 grams fiber

Grains: Brown rice, oatmeal, whole wheat

spaghetti, whole wheat bread,

Cheerios, Raisin Bran

Vegetables: Sweet potatoes, winter squash,

cabbage, broccoli, mixed vegetables

Fruit: Frozen blueberries, strawberries, and

peaches, raw orange, banana, canned

apricots and pears

Nuts, 1 oz. (almonds, brazil, hazelnuts or

filberts, macadamia, mixed, pecans,

peanuts, pistachio

33 September 2022

Appendix D – Restaurant or Voucher Guidelines

AAA nutrition providers may choose to use vouchers for meals to be eaten at a restaurant, café,

or other food service establishment; or may contract with a restaurant to provide meals on-site or

delivered to an existing meal site.

Restaurants or other food establishments may support menu choice (eg culturally-specific

meals), access for older adults (eg in rural communities), or flexibility (eg offering meals on

weekends or different times of day). AAAs should also be aware of potential challenges

including: ensuring that restaurants operating on a business model will meet nutrition

requirements, ensuring meal programs can still provide social support and connection to aging

services, and considering fundraising and additional programs or staff support that is often

provided by traditional meal sites that may not be available in working with other food

establishments.

AAA nutrition programs that use Older Americans Act funding to contract with a restaurant,

café, or other food service establishment must still comply with OAA requirements and the

Oregon Nutrition Standards. The following guidelines are provided to help AAAs and nutrition

programs in their work with contracted restaurants or other food service establishments.

A. Planning

 The restaurant, café, or other food service establishment must agree to provide one or more

meals that meet OAA and Oregon Nutrition Standards for meals and that has been reviewed

and approved by an RD.

 The restaurant or other food service establishment must be licensed, and be inspected

regularly by the local health jurisdiction. The restaurant, café, or other food establishment

must be barrier-free and Americans with Disabilities Act (ADA) compliant.

 Before entering into an agreement with a prospective food service establishment, the

nutrition coordinator should conduct an on-site visit of the restaurant and its kitchen facilities

to determine that nutrition program requirements can be met, and appropriate food safety and

sanitation practices are in place.

 For restaurant dining centers and voucher programs, nutrition providers should consider how

the planned agreement can best encourage and support the OAA goal of reducing social

isolation and increasing social interaction (e.g. having designated meal times, encouraging

participants to attend with others, providing training for restaurant staff in how they interact

with participants, etc.).

B. Written agreements

A written contract or agreement between the nutrition program and the restaurant or other food

establishment should address how the following issues will be addressed:

 How meals and/or food choices will be reviewed and approved by an RD prior to being

offered to participants, ensuring meals meet OAA and Oregon Nutrition standards for meals,

34 September 2022

and addressing procedures for communicating and approving menu changes and

substitutions.

 Cost per meal, and how invoicing and payment will occur.

For restaurant dining centers and/or voucher programs:

 The number of restaurant meals per day, week or month that will be provided; and how, and

how often, the restaurant or food service establishment will track and report meals provided

to the nutrition program.

 For voucher programs, how and where vouchers will be made available, how older adults

qualify to receive vouchers, and any efforts to prioritize distribution to priority populations.

 How NAPIS data will be collected initially and annually; how nutrition education will be

provided to participants; and how participants will have access to other aging services

offered by the AAA.

 Insurance coverage, such as workers compensation and comprehensive and general liability,

for the food service establishment and the nutrition program.

 Rights of the nutrition program staff to monitor on-site, including monitoring of the food

preparation and storage areas of the food service establishment.

 Policy regarding gratuities. Any tips for service staff must be included in the per meal price

that the nutrition program reimburses to the food service establishment for redeemed

vouchers.

 System for obtaining regular participant feedback/satisfaction, and complaint/grievance

policy.

 Policy for addressing misuse of vouchers by either participants or restaurant/food service

establishment.

Other expectations or training that nutrition programs may want to address in agreements:

 Roles and responsibilities regarding outreach, promotion, or registration of participants.

 How menus and/or food choices will be communicated to participants.

 Ensuring that the restaurant and program participants understand that meals may not be

ordered to go, but that voucher holders may take leftovers home, and that they may purchase

additional beverages and food with their own money.

 Responsibilities for on-site donations, if this is planned.

 Training/guidance for food establishment staff on basic understanding Older Americans Act

and ways to communicate effectively with older adults, and/or nutrition issues such as

portion control.

 Policies regarding confidentiality, mandatory report, and systems to refer participants to

other aging and community services.

 System for ensuring timely communication between the AAA nutrition program and

restaurant or other food establishment of concerns or challenges.

35 September 2022

Appendix E: OAA Nutrition Risk Screening

The OAA Nutrition Screening Survey includes the following questions:

For all YES answers that apply to you or someone you know, circle the number at the end of the

question. Total all your circled numbers (YES answers). This is the Total Nutritional Score.

Nutrition Checklist

Questions

YES

I have an illness / condition that made me change the kind and/or amount

of food I eat.

I eat fewer than two meals per day.

I eat few fruits, vegetables or milk products.

I have three or more drinks of beer, liquor or wine almost every day.

I have tooth or mouth problems that make it hard for me to eat.

I do not always have enough money to buy the food I need.

I eat alone most of the time.

I take three or more different prescribed or over-the-counter drugs a day.

Without wanting to, I have lost or gained 10 pounds in the last six months.

I am not always physically able to shop, cook and/or feed myself.

TOTAL =

❖ NOTE: This questionnaire is part of the Nutrition Screening Initiative, a project of the

American Academy of Family Physicians, American Dietetic Association, and National

Council on Aging. It is funded in part by a grant from Ross Products Division, Abbott

Laboratories.

Total your nutritional score. If it is:

• 0-2 − Good! Recheck the nutritional score in six months.

• 3-5 − You are at moderate nutritional risk. See what can be done to improve your eating

habits and lifestyle. Your office on aging, senior nutrition program, senior citizens center, or

health department can help. Recheck the nutritional score in three months.

• 6 or more − You are at high nutritional risk. Bring this checklist the next time you see your

doctor, dietitian or other qualified health, or social service professional. Talk with them about

any problems you may have. Ask for help to improve your nutritional health.

36 September 2022

Appendix F – NAPIS Definitions

The Aging Network, part of the Department of Health and Human Services, Administration on

Aging, has issued several definitions of services that must be reported through NAPIS. The

following definitions relate to the Nutrition Programs (Title III of the Older Americans Act).

1. Minority Status: Minority older persons are defined by the following designations:

OAA Ethnicity:

i. Not-Hispanic or Latino: A person not of Cuban, Mexican, Puerto Rican, or South or

Central American, or other Spanish culture or origin, regardless of race.

ii. Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, or South or Central

American, or other Spanish culture or origin, regardless of race.

iii. Unknown

OAA Race:

i. White: A person having origins in any of the original peoples of Europe, the Middle

East, or North Africa.

ii. Black or African American: A person having origins in any of the black racial groups

of Africa.

iii. American Indian or Alaska Native: A person having origins in any of the original

peoples of North America (including Central America), and who maintains tribal

affiliation or community attachment..

iv. Asian: A person having origins in any of the original peoples of the Far East,

Southeast Asia or the Indian subcontinent including, for example, Cambodia, China,

India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and

Vietnam.

v. Native Hawaiian or Other Pacific Islander: A person having origins in any of the

original peoples of Hawaii, Guam, Samoa or other Pacific Islands.

2. Impairment in Activities of Daily Living: The inability to perform one or more of the

following six activities of daily living without personal assistance, stand-by assistance,

supervision or cues: eating, dressing, bathing, toileting, transferring in and out of bed/chair,

and walking.

3. Impairment in Instrumental Activities of Daily Living: The inability to perform one or more

of the following eight instrumental activities of daily living without personal assistance, or

stand by assistance, supervision or cues: preparing meals, shopping for personal items,

medications management, managing money, using telephone, doing heavy housework, doing

light housework, and transportation ability.

4. Poverty: Persons considered to be in poverty are those whose income is below the official

poverty guideline (as defined 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)). The annual HHS Poverty Guidelines provide

dollar thresholds representing poverty levels for households of various sizes.

5. Home-Delivered Meals: A meal provided to a qualified individual in his/her place of

residence. The meal is served in a program that is administered by SUAs and/or AAAs and

37 September 2022

meets all the requirements of the Older Americans Act and State/Local laws. Meals provided

to individual through means-tested programs may be included.

6. Meals provided to individuals through means-tested programs such as Medicaid Title XIX

waiver meals are excluded from the Nutrition Services Incentive Program (NSIP) meal

reimbursement, but they are included in the total meal counts.

7. Congregate Meals: A meal provided by a qualified nutrition project provider to a qualified

individual in a congregate or group setting. The meal is served in a program that is

administered by SUAs and/or AAAs and meets all the requirements of the Older Americans

Act and State/Local laws. Meals provided to individual through means-tested programs may

be included. Meals provided to individuals through means-tested programs such as Medicaid

Title XIX waiver meals are excluded from the Nutrition Services Incentive Program (NSIP)

meals reimbursement, but they are included in the total meal counts.

8. Nutrition Counseling: A standardized service as defined by the Academy of Nutrition &

Dietetics and that provides individualized guidance to individuals who are at nutritional risk

because of their health or nutrition history, dietary intake, chronic illness, or medication use,

or to caregivers. Counseling is provided one-on-one by a registered dietitian, and addresses

the options and methods for improving nutrition status with a measurable goal.

9. Nutrition Education: A targeted program to promote better health by providing accurate and

culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information

that is consistent with the current Dietary Guidelines for Americans and instruction to

participants, caregivers, or participants and caregivers in a group or individual setting

overseen by a dietitian or individual of comparable expertise.

10. NSIP: A Nutrition Services Incentive Program (NSIP) Meal is a meal served in compliance

with all the requirements of the OAA, which means at a minimum that: 1) it has been served

to a participant who is eligible under the OAA and has NOT been means-tested for

participation; 2) it is compliant with the nutrition requirements; 3) it is served by an eligible

agency; and 4) it is served to an individual who has an opportunity to contribute. Meal counts

include all OAA eligible meals including those served to persons under age 60 where

authorized by the OAA. NSIP Meals also include home delivered meals provided as

Supplemental Services under the National Family Caregiver Support Program (Title III-E) to

persons aged 60 and over who are either care recipients (as well as their spouses of any age)

or caregivers.

38 September 2022

Appendix G. Sources of Potential Funding for Nutrition Services

OAA nutrition services are not intended to serve every eligible older adult, and OAA nutrition

funding was intended to help leverage additional public and private funds to support programs.

However; given the growing older adult population, and level OAA funding, AAAs and nutrition

programs face a constant challenge in funding these programs.

Beyond the OAA and NSIP funds, and participant donations, other potential ways that AAAs

may fund programs include:

• Local government funding. Some AAAs receive funding through city or county budgets to

support local nutrition services.

• Foundation or local business grants, sponsorships, and community fund-raising. AAAs

have obtained grants, developed “sponsorship” programs, developed donor databases and

regular direct mail appeals, required local nutrition sites to develop their own annual fund-

raisers, and other creative approaches to fund-raising.

• OAA funds transferred between program areas. AAAs may use the Funds Transfer

Request form on the APD website to request transfer of no more than 30% of Title IIIB funds

to C1 (congregate) or C2 (home-delivered) nutrition programs each fiscal year. AAAs may

also use this same form to transfer no more than 40% of funds between C1 and C2 programs

each fiscal year.

• Family Caregiver Support Program (OAA Title IIIE). AAAs may decide to allow OAA

family caregiver support program supplemental services funds be used to pay for meals for

caregivers and their care recipients to receive meals. These individuals must meet federal

and state requirements for the family caregiver support program, as well as any policies

developed by the AAA.

• Oregon Project Independence. If a AAA decides to include home-delivered meals as an

OPI service, the AAA must include this in their Area Plan and OPI policies. The cost of the

meal cannot be an expense to the OPI consumer on the OPI sliding fee scale, and meals

supported with OPI funds must meet OAA and OPI standards including meeting 33 1/3

percent of Dietary Reference Intakes and Dietary Guidelines; menus approved by a registered

dietitian; include an in-person initial and at minimum annual assessment; and provide

nutrition education at least one time per year. (OPI rule 411-032-0000(30))

• Sale of meals. Meal providers may provide private catering, rent out their kitchen, contract

with a health plan to provide members with meals, or develop other business plans to prepare

and sell food, as long as these meals are not paid for with OAA funds and are not counted for

OAA or NSIP purposes. (ACL guidance)

• SNAP donations. AAAs have the option of developing systems to enable older adults

participating in SNAP to use those benefits as a voluntary contribution toward the OAA meal

if that is what the older adult wishes to do. Use of SNAP may enable older adults to feel that

they’re making a voluntary contribution in the only way possible for them; on the other hand,

using limited SNAP benefits on a program that doesn’t require a payment may not be in the

best interests of the adult. (ACL guidance)

39 September 2022

• Medicaid Home-Delivered Meals. AAAs can contract with their local APD office to

provide and be reimbursed for meals authorized by APD case managers for Medicaid clients.

Services funded by OAA are exempt from Medicaid third party liability requirements; if an

individual is eligible for Medicaid home-delivered meals, Medicaid should reimburse for this

cost, even if the participant could also be funded under the OAA. (Medicaid Third party

Liability and Older Americans Act Services; NASUAD June 17, 2016).

Medicaid cost of care consumers, however, are still eligible for OAA-funded meals since

they would be expected to pay the full cost of their meals under Medicaid.

See Oregon Medicaid Home Delivered Meal Standards and Responsibilities and OAR 411-

040-0000 for additional information on Medicaid Home-Delivered meal requirements and

reimbursement.