Process Evaluation of Older Americans Act Title III-C Nutrition Services Program

The Title III-C Nutrition Services Program (NSP), administered by the Administration on Aging (AoA) within the Administration for Community Living of the U.S. Department of Health and Human Services (DHHS) under the Older Americans Act (OAA), represents a key component of America’s strategy for ensuring that the health and social needs of older adults are adequately met. By promoting access to nutritious meals, facilitating social contact, supporting family caregivers, and helping older adults maintain their dignity in their homes and communities, the NSP fits squarely within the strategic goals of the AoA to rebalance long-term care provision away from institutionalization and toward home- and community-based services.

Nutrition services are an important component of any overall package of home- and community-based services for older adults. Adequate nutrition is critical to health, functioning, and quality of life for people of all ages. For older adults, nutrition can be especially important, because of their vulnerability to health problems and physical and cognitive impairments. The NSP’s key nutrition services include nutritious meals, as well as nutrition screening, assessment, education, and counseling, to promote the health and wellbeing of older adults. For participants in congregate meals, Title III-C meals also provide an opportunity to socialize with peers. Furthermore, many other services, such as health promotion, social/recreational activities, and medical screening, are often are provided at senior centers and other Title III-C sites, allowing older adults participating in congregate meals to connect to these services as well. For many home-delivered meal recipients, the person delivering the meal (often a volunteer) may be the recipient’s only human contact of the day. Together, these meals and services help congregate meal and home-delivered meal participants meet their health and nutrition needs.

An important aspect of the NSP, and critical in understanding how it functions, is the way in which it has developed mechanisms to mobilize several levels of constituencies to serve older adults. Although AoA’s central and regional offices provide federal coordination, the State Units on Aging (SUAs) and the Area Agencies on Aging (AAAs) support key aspects of program operations. In turn, usually the Local Service Providers (LSPs) provide the nutritional services directly. In addition, many other governmental agencies and nonprofit groups are involved in serving older adults under the NSP. Together, these organizations make up the National Aging Network, one of the nation’s largest provider networks of home- and community-based services for older people and their caregivers.

The mission of the AoA, now a part of DHHS’s Administration for Community Living, is to develop a comprehensive, coordinated, and cost-effective system of long-term care that helps older adults maintain their dignity in their homes and communities. As part of its ongoing efforts to support program planning, improve program efficiency, and strengthen program effectiveness, AoA contracted with Mathematica Policy Research to conduct the Title III-C NSP Evaluation. The three-part evaluation consists of (1) a process evaluation of program administration and service delivery, (2) an analysis of program costs, and (3) an evaluation of the impact of the program on client outcomes. This report summarizes the findings of the process evaluation, using data collected from SUAs, AAAs, and LSPs, to assess the ways in which the program operates to serve older adults.