Current through Register Vol. 49, No. 9, September, 2024
Section 206
Division of Aging and Adult Services Policy and Procedures Manual
206.000
Nutrition
Each Area Agency on Aging (AAA) shall, through a comprehensive
and coordinated system, provide for nutrition services to older Arkansans in
their planning and service area, with particular attention to target groups
identified by the Older Americans Act. Nutrition services must include, but are
not limited to, congregate and home-delivered meals which meet Older Americans
Act and DAAS requirements and which may also include special diets where
feasible, nutrition screening and nutrition education for participants,
in-service training, including food preparation and nutrition, for both paid
and volunteer workers, and outreach. Nutrition assessment and
counseling are also to be provided, when appropriate and feasible. The
AAAs will incorporate the provisions of this policy and accompanying procedures
into their policies and procedures, provide training on these provisions to
nutrition service staff, monitor compliance with the policy and procedures, and
provide appropriate technical assistance to subcontractors in meeting this and
other DAAS, Older Americans Act, and AAA requirements.
To ensure that older Arkansans, particularly those in target
groups identified by the Older Americans Act, have access to low cost,
nutritionally sound meals served in strategically located centers such as
schools, churches, community centers, senior centers, and other public or
private facilities where they can obtain other social and rehabilitative
services. The Nutrition Services Program seeks:
A. To reduce hunger and food
insecurity;
B. To promote
socialization of older individuals; and
C. 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 nutritional health or sedentary
behavior.
206.001
General Authority
The Older Americans Act of 1965, as amended 45 CFR 1321
Social Services Block Grant-CSPP
Rules and Regulations Pertaining to Food Service
Establishments, Arkansas State
Health Department
Arkansas Code Annotated Section
25-10-101 et. seq.
206.002
Definitions
Acceptable Macronutrient Distribution Ranges (AMDR)
- Range of intake for a particular energy source that is associated with
reduced risk of chronic disease while providing intakes of essential nutrients.
If an individual consumes in excess of the AMDR, there is a potential of
increasing the risk of chronic diseases and/or insufficient intakes of
essential nutrients.
Activities of Daily Living (ADLs) - Tasks
performed regularly, daily or multiple times daily, which are necessary for
self care and/or independent living (eating, dressing, bathing, toileting, and
transferring in and out of bed). (See also Instrumental Activities of Daily
Living.)
Adequate Intakes (AI) - A recommended average
daily nutrient intake level based on observed or experimentally determined
approximations or estimates of mean nutrient intake by a group (or groups) of
apparently healthy people. The AI is used when the Estimated Average
Requirement (EAR) cannot be determined.
Assistive Technology - Technology, engineering
methods, or scientific principles appropriate to meet the needs of, and address
barriers confronted by, persons with functional limitations. (Nutrition related
examples: devices that allow such persons to feed themselves or prepare their
own meal, or the devices or processes used to modify food to allow a person to
consume food by mouth.)
Certified Dietary Manager (CDM) - Designation used
by persons who have completed a 12-18 month food service manager's course
approved by the Dietary Managers Association or have an Associates or
Bachelor's degree in a food-related field, and successfully completed a
national registration exam. Course includes sections of training in nutrition
and food service management.
Comprehensive and Coordinated System - An
organized, interactive network for providing all necessary supportive services,
including nutrition services, to older individuals in the service area, in a
manner designed to: facilitate access to, and use of, supportive services and
nutrition services available from public or private agencies or organizations
within the service area; develop and make the most efficient use of such
services and resources, with minimum duplication, in meeting the needs of older
individuals; and encourage and assist public and private entities that have
unrealized potential for meeting the service needs of older individuals to
assist the older individuals on a voluntary basis.
Congregate Meal - A hot or other appropriate meal
served to an eligible person at a congregate meal site. Meals comply with DA
AS, Title III Nutrition Service Standards, and Dietary Guidelines for
Americans, and provide a minimum of 33
1/3% of the Dietary Reference Intakes (DRIs) if one meal is
served, 66 2/3% of the DRIs if two meals are served, and 100% of the DRIs if
three meals are served, with the 2nd and 3rd meals balanced proportionally in
calories and nutrients.
Congregate Meal Site - Generic name of a facility
where meals are served in a group setting and comprehensive supportive
services, including transport to the site, are provided to older adults. The
facility is located as close to residences of the majority of eligible persons
as feasible and may be a multi-purpose senior center, school, church, or other
appropriate community facility.
Dietary Guidelines for Americans (DGs) -
Recommended dietary practices for healthy Americans published jointly every 5
years since 1980 by the Department of Health and Human Services (HHS) and the
Department of Agriculture (USDA). The Guidelines provide authoritative advice
for people two years and older about how good dietary habits can promote health
and reduce risk for major chronic diseases. They serve as the basis for Federal
food and nutrition education programs.
Dietary Reference Intakes (DRIs) - A set of
nutrient-based reference values that expand upon and replace the former
Recommended Dietary Allowances (RDAs). They are actually a set of four
reference values: Estimated Average Requirements (EARs), Recommended Dietary
Allowances (RDAs), Adequate Intakes (AIs), and Tolerable Upper Intake Levels
(ULs).
Disability - A loss of functional capacity due to
physical or mental impairment, or both, resulting in substantial functional
limitations in 1 or more of these areas of major life activity:
(A) self-care,
(B) receptive and expressive
language,
(C) learning,
(D) mobility,
(E) self direction,
(F)
capacity to live independently,
(G)
economic self-sufficiency,
(H)
cognitive functioning, and
(I)
emotional adjustment.
Disease Prevention and Health Promotion Services -
Activities that identify risk for, or presence of, disease or health problems;
encourage behaviors that reduce effects of, or prevent, chronic disabling
conditions (mental or physical) or injuries; or provide information on
preventative health services available. Nutrition related activities in this
service include, but are not limited to, nutrition screening, nutrition
assessment, nutrition counseling, nutrition education, and referral to other
appropriate services.
Education and Training Services - Supportive
services designed to assist older individuals to better cope with their
economic, health, and personal needs through such services as consumer
education, continuing education, pre-retirement education, financial planning,
and other education and training services, which will advance the objectives of
the Older Americans Act.
Estimated Average Requirements (EAR) - the average
daily nutrient intake level estimated to meet the requirement of half the
healthy individuals in a particular life stage and gender group.
Food Service Vendor - A restaurant, hospital,
school or commercial organization that contracts with an AAA Service Provider
to supply prepared meals (usually at a fixed price per meal) to the provider
who contracts with the AAA to provide nutrition and other services.
Frail - With respect to older individuals, one who
is determined to be functionally impaired because the individual:
(A) is unable to perform 2 or more activities
of daily living without substantial human assistance, including verbal
reminder, physical cues, or supervision; or
(B) due to cognitive or other mental
impairment, requires substantial supervision because the individual behaves in
a manner that poses a serious health or safety hazard to him or herself or
another individual.
Greatest Economic Need (poverty) - Need resulting
from an income at or below the poverty line established each year by the Office
of Management and Budget, and adjusted by the Secretary (DHHS) in accordance
with subsection 673 (2) of the Community Services Block Grant Act (42 U.S.C.
9902(2)).
Greatest Social Need - Need caused by non-economic
factors including:
(A) physical and
mental disabilities;
(B) language
barriers; and
(C) cultural, social,
geographical isolation, including isolation caused by racial or ethnic status
which restricts the ability of the person to perform normal daily tasks or
threatens a person's capacity to live independently.
Homebound - Unable to leave the home without
assistance (physical or mental) from another person. For nutrition services,
the person is frail, homebound by reason of illness or incapacitating or
disability or otherwise isolated.
Home-Delivered Meal (HDM) - A hot or other
appropriate meal delivered to the residence of an eligible homebound person.
Meals must follow the Dietary Guidelines for Americans, meet Title III and DAAS
Nutrition Service Standards and contain of 1/3 DRIs if one meal is provided, 66
2/3% if two meals are provided and 100% if three meals are provided. 2nd and
3rd meals are proportionally balanced in calories and nutrients.
Instrumental Activities of Daily Living (IADLs) -
Regularly performed tasks, necessary for independent living (preparing meals,
shopping for personal items, medication management, managing money, using a
telephone, doing heavy housework, doing light house, etc.). (See also
Activities of Daily Living)
Menu Cycle - A pre-planned written sequence of
menus repeated over a specified time frame.
Nutrition Assessment - An in-depth evaluation of
both objective and subjective data related to an individual's food and nutrient
intake, lifestyle, and medical history. Nutrition assessments are performed by
Registered Dietitians to assess and evaluate individual nutritional status. The
assessment leads to nutrition counseling, or other nutrition intervention,
designed to help the individual either maintain the assessed status or attain a
healthier status.
Nutrition Counseling - Individualized guidance to
individuals who are at nutritional risk because of their health or nutrition
history, dietary intake, chronic illnesses, or medications use, or to
caregivers. Counseling is provided one-on-one by a Registered Dietitian, and
addresses the options and methods for improving nutrition status.
Nutrition Education - A service or program that
promotes better health by providing accurate and culturally sensitive
nutrition, physical fitness, or health (as it relates to nutrition) information
and instruction to participants and caregivers in a group or individual setting
overseen by a Registered Dietitian or individual of comparable
expertise.
Nutrition Outreach - An activity designed to seek
out and identify, on an ongoing basis, the maximum number of the hard-to-reach,
isolated, and withdrawn target group of eligible individuals throughout the
program area, and to encourage them to make use of existing services and
benefits.
Nutrition Screening - The process of identifying
individuals with multiple risk factors (easily identified characteristics known
to be linked with increased likelihood of nutritional problems). This serves to
identify individuals at nutritional risk.
Nutrition Services - Must include, but is not
limited to, the provision of congregate and home-delivered meals, nutrition
education, nutrition screening, and nutrition outreach which meet funding
source, DAAS, and other applicable requirements. Services may also include
special diets, nutrition assessment and counseling if appropriate and
feasible.
Nutrition Services Incentive Program (NSIP) - The
Nutrition Services Incentive Program provides supplemental funding for the OAA
Nutrition
Program to States, Territories and eligible Tribal
organizations to purchase domestic food only. This funding may not be used to
pay for other nutrition related services, or state or local administrative
costs. States may choose to receive the grant as cash, commodities from the
United States Department of Agriculture or a combination of cash and
commodities.
Older Individual - An individual aged 60 years or
older.
Project - Defined as a provider of Nutrition Services for
purposes of this policy. The provider may contract with the AAA to provide
services at more than one location.
Recommended Dietary Allowance (RDA) - The dietary
intake level that is sufficient to meet the nutrient requirement of nearly all
(97 to 98 percent) healthy individuals in a particular life stage and gender
group.
Registered Dietitian (RD) - An individual
registered by the Commission on Dietetic Registration (CDR). CDR registration
requires that the dietitian has completed at least a four-year course of study
in a specified curriculum at a college or university accredited by the
Commission on Accreditation for Dietetic Education (CADE), has successfully
completed a CADE-accredited Dietetic Internship and has passed the CDR national
registration exam. Ongoing continuing education is required. In Arkansas,
persons using the title of Dietitian must be licensed (LD).
Severe Disability - A major, chronic loss in
functional capacity due to mental or physical impairment, or both, likely to
continue indefinitely and causing substantial functional limitation in 3 or
more major life activities.
Special Menu - Meal plan that meets the particular
dietary needs arising from health requirements, religious requirements, or
ethnic backgrounds of eligible individuals. (See also Therapeutic Diet)
Subcontractor - A recipient of state or federal
funds by grant, reimbursement, or other means from an Area Agency on Aging in
exchange for services specified by contract. (AAA Service Provider)
Targeted Group - A segment of the population of
the service area toward which services are directed. Nutrition services' target
population is unserved older persons with the greatest economic and social need
(including low-income minority individuals) and frail individuals likely to be
at high nutritional risk.
Therapeutic Diet - A diet designed to treat a
specific health problem. Requires a physician's diet prescription and must be
written under supervision and/or consultation of a Registered Dietitian.
Tolerable Upper Intake Level (UL) - The highest
average daily nutrient intake level likely to pose no risk of adverse health
effects for nearly all individuals in a particular life stage and gender group.
As intake increases above the UL, the potential risk of adverse health effects
increases.
206.003
Responsibilities
Each Area Agency on Aging is responsible for:
A. Determining the nutrition service needs of
older individuals within its planning and service area, with input from
participants, advisory boards, providers and DAAS;
B. Evaluating the effectiveness and use of
existing resources in meeting needs;
C. Developing a comprehensive and coordinated
system that sets out specific objectives to provide needed services, maintain
existing services and plan new services based on results of needs assessment,
including nutrition screening. The system must facilitate access to and use of
services and make the most efficient use of resources, with minimum
duplication;
D. Coordinating with
and assisting other agencies or groups in meeting the service needs of older
individuals in the area;
E.
Entering into agreements with providers of nutrition services; and
F. Reporting activities and outcomes as
required.
206.004
Service Levels
The AAA, and its providers, shall not reduce (from that
approved in the area plan) the level of service, days of service, nor open or
close a site without prior, written DAAS approval, except in weather related
emergencies and natural disasters.
206.005
Awarding Contracts
AAAs will not provide services directly unless specifically
authorized by DAAS to do so. (DAAS Direct Services Policy 201) Nutrition
Services shall be provided through contracts with organizations which, when
possible, have demonstrated an ability to provide meals efficiently and
reasonably, will furnish assurances to the AAA that they will maintain efforts
to solicit voluntary support, and will furnish assurances that Older Americans
Act (OAA) funds will not be used to supplant funds from non-federal sources.
The AAA will develop guidelines and provide technical assistance and training
opportunities to assist subcontractors in meeting requirements. The AAA will
monitor for compliance with OAA and DAAS requirements and take appropriate
action if noncompliance is found.
A.
Each AAA will use a Request for Proposal (RFP) as a guide for advertising and
accepting bids for nutrition services. Contracts will be for one year, with
yearly renewal provisions for up to 3 additional years, unless AAA is operating
under a waiver. Subcontractor will adhere to all assurances as set forth in the
RFP.
1. The subcontractor will not enter into
a subcontract with any caterer or food service operator for the provision of
meals to the nutrition program without an onsite inspection by the AAA and the
written approval of the AAA.
2.
Caterers are subject to the same requirements applicable to the contracted
service and the same schedule of assessments as service providers.
B. Requirements for AAAs,
Home-Delivered Meal Subcontractors and Congregate Meal Subcontractors:
1. Provide adequate facilities and equipment
to safely and effectively deliver quality services; (See Facilities and
Equipment section)
2. Locate
congregate meal sites, if feasible, within walking distance or as close as
possible to the majority of eligible older persons;
3. Provide transportation for congregate
participants to the meal sites;
4.
As specified in the Older Americans Act, establish and administer the project
with the advice of Registered Dietitians, persons competent in the field of
service in which the nutrition project is being provided, older persons who
will participate in the program, and of persons who are knowledgeable with
regard to the needs of older individuals;
5. Maintain adequate staffing to effectively
deliver quality service in a safe and timely manner; (See Staffing
Guidelines)
6. Complete intake
process for all participants to document eligibility and nutritional risk.
Update documentation with congregate participants, and reassess for continued
need with HDM clients as specified in the Intake section of this
policy;
7. Maintain waiting lists
of those who have applied for and were eligible for services, but could not be
served because of lack of resources;
8. Provide home-delivered meals and/or
congregate meals at least once a day, for five or more days a week. (Lesser
frequency must be approved by DAAS, as a part of the AAA Area Plan. Proposals
to provide Home-Delivered Meals less frequently must include what provisions
will be made for meals on days when meals are not delivered.) Each meal must be
approved by a Registered Dietitian and meet nutrition and food handling
standards outlined in these procedures;
9. In regard to HDM, hot meals are preferred,
but cold, frozen, dried, canned or supplemental foods with a satisfactory shelf
life may be used where appropriate and approved by the AAA and DAAS. Persons
who deliver the meals must actually see the participant or caregiver before
leaving the meal; (See Emergency Procedures)
10. Provide special menus, where feasible and
appropriate, to meet the particular dietary needs arising from the health
requirements, religious requirements, or ethnic backgrounds of eligible
persons. (If provided, must meet criteria outlined in Nutrition section)
Provider may contract with AAA to provide other appropriate nutrition
services;
11. Make arrangements for
food availability during weather related emergencies (for example; tornado,
extreme heat or cold, winter storms); (See Emergency section)
12. Comply with Federal Food Code, Health
Department, DAAS (see Section on Compliance with Food Service Requirements) and
any Administration on Aging (AoA) regulations regarding the safe and sanitary
handling of food, equipment, and supplies used in the storage, preparation,
service and delivery of meals;
13.
Conduct nutrition education programs as outlined in Nutrition Education section
of these procedures;
14. Document
and report, in a timely manner, the unduplicated number of persons served,
number of persons on waiting lists, number of meals, contributions, and other
information requested by the AAA and/or DAAS;
15. Solicit, safeguard, and account for
voluntary contributions as described in the Contributions section;
16. Provide matching dollars and solicit
volunteer support as required by the funding sources;
17. Establish ongoing nutrition outreach
activities to assure the maximum numbers of eligible persons have an
opportunity to participate. (See Outreach Section)
206.006
Contributions
A. Eligible persons will
not be denied a meal because they will not or cannot contribute to the cost of
this service.
B. All but Home and
Community-Based Services Medicaid Waiver clients shall be given an opportunity
to voluntarily contribute to the cost of this service.
C. Subcontractors shall develop a suggested
contribution schedule for participants, taking into account income ranges of
eligible individuals in the community.
D. The provider shall establish a guest meal
charge. The charge must be at least the total cost of providing the
meal.
E. The suggested contribution
schedule and guest meal charge shall be posted in a conspicuous
place.
F. Procedures must be
established by subcontractors to protect each participant's privacy with
respect to their contribution. HDM participants shall be provided with a blank
or an agency addressed envelope that does not identify the
participant.
G. AAAs shall consult
with service providers and older individuals about the best method for
accepting contributions.
H.
Procedures must be established by subcontractors for collecting, handling,
safeguarding, depositing and accounting for contributions. Contributions are to
be counted and recorded daily by at least two people, one of whom is a program
participant. Contributions shall be reported by the AAA to DAAS.
I. Nutrition program contributions shall be
used to increase the number of meals (program expansion).
206.007
Outreach
A. AAAs shall conduct and assist providers
with outreach efforts which will identify unserved individuals eligible for
assistance, with emphasis on older individuals:
1. Residing in rural areas;
2. With the greatest economic and social need
(particularly minority individuals);
3. With severe disabilities;
4. With limited English speaking ability;
or
5. With neurological and organic
brain dysfunction.
B.
Projects shall establish a variety of outreach activities that ensure that the
maximum number of eligible persons have an opportunity to
participate.
C. Outreach efforts
shall comply with DAAS Outreach Policy.
206.100
Assessments
A. The AAA shall conduct assessments of each
subcontractor meal site at least once a year in accordance with DAAS 207.000,
AAA Subcontractor Assessments Policy and Procedures. The AAA shall take
appropriate action and follow-up to be sure corrections are made when
noncompliance is found. A summary of findings and corrective actions must be
sent to the provider within 4 weeks. (Risks to health & safety of
participants must be immediately addressed when found.) The providers must
reply within 4 weeks. The AAA must follow-up to assure that corrections were
made. Documentation of assessments and follow-up must be available for DAAS
review.
B. The DAAS annual
assessment of the AAA shall include, but will not be limited to, a review of
program records, random on-site review of client records, observation of meal
service, and inspection of subcontractor facilities and/or senior centers.
Participant interviews for both home-delivered and congregate programs may also
be conducted.
206.200
Congregate Meals Eligibility
The primary target group of the congregate meal program is
eligible persons with the greatest economic or social needs, particularly
low-income minority elderly and those who cannot afford to eat adequately or
lack knowledge, skills, mobility or motivation to obtain adequate food, or are
otherwise at increased nutritional risk.
A means test may not be used to determine eligibility for OAA
Nutrition Program; however, a means test may be applied to individuals who
receive meals funded by sources which require a means test such as the Social
Services Block Grant. Individuals will be eligible to participate in congregate
meal services in one of the following two categories:
A. Any individual determined to be eligible
and who will benefit nutritionally from a congregate meal, and is:
1. A person 60 or more years of age;
or
2. The spouse of a 60+ program
participant; or
3. An individual
with a disability or disabilities, not yet aged 60, who resides in the home
with and accompanies older persons eligible under the Older Americans Act, when
the care and maintenance of the person with disabilities would otherwise
prevent participation of the older person (See SSBG if SSBG client), and if
participation of the person with disabilities will not prevent participation of
older persons and their spouses; or
4. (With AAA approval) A person with a
disability or disabilities, not yet aged 60, living in a housing facility
designated as elderly housing which provides congregate nutrition services, if
participation by the person with disabilities will not prevent the
participation of older persons and their spouses; or
5. Persons age 60 or more who meet Social
Services Block Grant (SSBG) income, residence, and need for service criteria,
if served by SSBG funds.
6.
Individuals not yet age 60, who provide meal related volunteer services during
meal hours, when participation does not prevent an older person and their
spouse from participating.
B. Persons eligible to participate, but who
must pay the full cost of the meal (and may not be included in the number of
meals reported for payment/reimbursement):
1.
Staff members under age 60 may consume a meal only when it will not deprive an
eligible older person of an opportunity to receive a meal. (Provider may choose
to provide staff meals at no cost or at reduced cost as a fringe
benefit);
2. Guests under age 60 if
it will not deprive older persons and their spouses of a meal; and
3. Older persons under the care of an
agency/organization which is receiving reimbursement for their meal (e.g.,
nursing homes, adult day care programs, residential care facilities), providing
that the agency/organization pays the center the full cost of the meal, makes
any required reservations, and provides attendant assistance, as needed.
(Contributions may not be solicited and OAA reimbursement cannot be
claimed.)
206.201
Home-Delivered Meals
Eligibility
Receipt of home-delivered meal service is based on a
determination of need/continued need. The primary target group of the
home-delivered meal program is homebound eligible persons with the greatest
economic or social needs (which may increase nutritional risk). Special
attention is given to low-income, minority elderly, and others who do not eat
adequate and nutritious meals because they are incapacitated due to accident,
illness, or frailty; unable to prepare meals due to their limited mobility,
psychological or mental impairment, inability to safely prepare meals, and/or
lack of knowledge to select and prepare nourishing and well-balanced meals; and
without adequate resources such as family, friends or other community services
to provide them with meals.
A means test may not be used to determine eligibility for OAA
Nutrition Program; however, a means test may be applied to individuals who
receive meals funded by sources which require a means test such as the Social
Services Block Grant.
Persons who have been determined to be eligible through
assessment of need, will benefit nutritionally from receiving a meal, and
are:
A. 60 years and older, homebound
(unable to leave the home without the assistance of another person), and have
no one available to prepare the meal they will receive; or
B. A person who is frail, homebound by reason
of illness or incapacitating or disability or otherwise isolated; or
C. The spouse of a 60+ homebound participant,
if by criteria developed by the AAA or subcontractor, providing a meal is in
the best interest of the homebound participant; or
D. A person with disabilities, under age 60,
who resides with an eligible participant, is unable to prepare nutritious meals
and is in the home during the hours of meal service, with AAA approval;
or
E. 60 years or older and who
meets SSBG income, service need, and residence requirements, if served with
SSBG funds.
206.202
Congregate Meals Participant Intake Process
The following process must be completed for each
participant:
A. The participant or
caregiver must be interviewed by the outreach worker, case manager, or site
director (or trained designee). The interview must include an explanation of
all aspects of the program participation, including the opportunity to
contribute to the cost of the meal, emergency procedures, and availability of
other services, if needed.
B. A
client intake form or consumer registration form must be completed.
C. Nutrition screening must be completed.
(May use "Determine Your Nutritional Health" Checklist).
D. The intake information must be reviewed
and updated annually.
206.203
Home-Delivered Meals
Participant Intake Process
Receipt of home-delivered meal service is based on a
determination of need or continued need. For each participant, prior to billing
for the service, an outreach worker, case manager, or site director shall make
a home visit in order to:
A. Complete
and place in participant's file: client intake forms, including a HDM needs
assessment, which contains:
1. A
determination of why the service is needed, nature and degree of illness,
disability, isolation or nutrition risk, with a statement that the client is
homebound (unable to leave the home without the assistance of another
person);
2. Nutrition Screening
(May use "Determine Your Nutritional Health" Checklist);
3. A description of special needs;
4. A summary of any hearing, chewing,
swallowing, vision, and/or mobility problems;
5. A description of other support available
to the participant (such as SNAP benefits);
6. Emergency contact information;
7. The estimated length of time service will
be needed;
8. Whether other
services may be needed; and
9. Date
of the next reassessment of need for the service.
B. Discuss program participation, including:
1. The opportunity to contribute to the cost
of the meal (Contributions cannot be solicited or accepted from Home and
Community-Based Services Medicaid Waiver clients.);
2. Eligibility requirements and limited
funding may permit serving only those in greatest need;
3. How to safely handle the meals after
delivery; and
4. Emergency meal
procedures.
C. Perform a
reassessment home visit and interview to document continued need at least
annually, more often if participant's needs may be short-term. The goal is for
the participant to attend the congregate site, if able, to benefit from
socialization and physical activity.
206.300
Physical
Facilities/Equipment
Each meal provider must secure and maintain adequate facilities
and equipment for safe, sanitary, and efficient preparation, service, and
delivery of meals. They must meet at least the following applicable
requirements related to physical facilities and equipment:
A. Locate facility, if feasible, within
walking distance or as close as possible to the majority of eligible
persons;
B. Make the facility
available for the hours and days specified in the DAAS approved Area
Plan;
C. Provide a facility
adequate in size to comfortably accommodate meal service and activities for the
usual number of persons served, and to allow safe and sanitary preparation,
service and storage of food; (See local fire code and Health Department
regulations)
D. Provide buildings
that have adequate heating, ventilation and cooling systems, screened (if
applicable) doors and windows, adequate lighting, and well-marked, accessible
exits with easy to open doors; (See Americans with Disabilities Act (ADA) and
Section 504.)
E. Provide facilities
that meet all federal, state and local fire, building accessibility, sanitation
and safety codes. Subcontractor shall arrange for all applicable health, fire,
safety and sanitation inspections and post permits;
F. Provide accessible restrooms, with
adequate number of toilets and sinks for the usual number served, hot and cold
running water, soap dispenser, disposable towels and covered waste
can;
G. Provide the appropriate
facility and equipment to prepare menus as written, transport meals, and
maintain proper food temperatures and sanitation during transport and holding.
Equipment used for transport must be compatible with the packaging materials
used in order to maintain nutritional quality, palatability and food
safety;
H. Provide adequate
equipment and space for cleaning, sanitizing and storing dishes, flatware, and
pans;
I. Provide adequate hand
washing facilities, storage space for food, and adequate janitorial facilities,
separate if possible; (See Health Department Regulations)
J. Provide adequate number and sizes of
serving utensils to ensure uniform servings that meet the required 1/3 DRI as
indicated on approved menus;
K.
Provide adequate tables and chairs to comfortably accommodate participants,
including aisle space to allow for walkers and wheelchairs;
L. Provide adequate tableware and flatware,
in good condition, to serve all participants;
M. Make special provisions, as appropriate,
for the service of meals to persons with disabilities and persons with limited
mobility, including appropriate food containers and/or utensils; and
N. Provide a bulletin board, placed in a
conspicuous location, on which the following are posted:
1. Notice of the right of eligible persons to
equal access to services;
2. The
full cost of the meal to be paid by guests under age 60;
3. Suggested contribution for eligible
participants;
4. Sign with
information on how to apply for SNAP benefits (formerly food stamps);
5. Menu for at least one week;
6. Emergency Evacuation Plan;
7. Grievance procedure for
participants;
8. Toll-free
information and assistance number;
9. Health Department permit; and
10. Other notices required by law.
206.400
Volunteers
The use of volunteers is encouraged whenever possible. The
Older Americans Act requires that projects solicit the expertise of a dietitian
or other individual with equivalent education in nutrition science, or if such
an individual is not available, an individual with comparable expertise in the
planning of nutritional services.
A.
The AAA shall employ, at least part time, a designated Nutrition Program
Coordinator whose responsibilities include technical assistance to providers,
oversight of compliance to programmatic components of contract, DAAS and
Federal requirements, and day-to-day programmatic functions. It is suggested
that the Program Coordinator have management and supervisory experience. A
background in foods, nutrition, and food service management is
recommended.
B. The service
provider must employ an adequate number of qualified personnel to ensure the
satisfactory operation of the program. Project staffing must include:
1. A qualified Program Director who has the
ability and the responsibility to do the following in a professional manner:
a. Perform daily management and
administrative functions of the nutrition program and related support services,
including: reporting; supervision; coordination with community groups,
providers of services to participants, and the AAA; managing program
expenditures and income; and advocating for older persons.
b. Coordinate, develop and implement the
nutrition program planning process.
c. Ensure services are provided in accordance
with AAA, DAAS, OAA provisions, and state and local codes.
d. Conduct orientation and training for
staff, volunteers, Advisory Council, and/or Board appropriate to their
functions.
2. Trained
food preparation staff responsible for the actual cooking and/or serving of
meals and associated cleaning tasks. The number of foodservice personnel and
work hours will depend on the number and type of meals produced, extent of use
of convenience products, and available equipment.
3. Lead Cook or Kitchen Manager (person
overseeing the food preparation and service) must be a qualified person with a
current ServSafe Food Managers Certification, an equivalent certification, or
obtain certification within one year of employment.
4. Other staff as required for serving and
transporting food, and performing necessary cleaning tasks.
C. Orientation and Training to be
provided by the Service Provider:
1.
Foodservice workers, both paid and volunteer, must complete an orientation
prior to providing nutrition services. The orientation should be organized,
documented, appropriate to the job, and must cover at least the following
applicable areas:
a. Personal
Hygiene;
b. Food storage,
preparation, and service;
c.
Sanitation procedures;
d. Portion
control;
e. Quality control of food
flavor, consistency, texture, temperature, and appearance;
f. Policies and procedures;
g. Job duties; and h. Program
information.
2.
Foodservice workers, paid and volunteer, must receive at least quarterly
in-service training designed to enhance knowledge and job performance.
a. Training should consist of topics in food
production and service, sanitation, safety, portion control, food storage,
nutrition, and other related, pertinent topics. The AAA Nutrition Program
Coordinator must review lesson plans and each meeting must be
documented.
b. The lesson
documentation must include: topic, presenter, evaluation, date, time,
signatures of attendees, and other staff who were provided the in-service
information.
c. AAA, DAAS, or other
specific job related training may be used.
3. Foodservice workers shall complete
training and updates, as DAAS and the AAA make them available. All foodservice
workers are strongly encouraged to obtain ServSafe Food Managers
Certification.
206.500
Menu Planning
Title III of The Older Americans Act requires nutrition project
to provide meals that:
A. Comply with
the most recent Dietary Guidelines for Americans (DGs), published by the
Secretary of Health and Human Services and the Secretary of Agriculture;
and
B. Provide to each
participating older individual a minimum of 33 1/3 percent of the Dietary
Reference Intakes (DRIs) established by the Food and Nutrition Board of the
National Academy of Sciences, if the project provides one meal per day.
1. A minimum of 66 2/3 percent of the DRIs if
the project provides two meals per day; and
2. 100 percent of the DRIs if the project
provides three meals per day.
206.501
Guidelines and
Procedures
To ensure meals meet the Federal requirements, the Meal Pattern
must be used in conjunction with Nutrient Analysis.
A. The Standard Meal Pattern must be used. A
meal pattern is a menu-planning tool used to develop balanced meals that
include foods from each group. The Standard Meal Pattern below is based on the
Dietary Guidelines for Americans 2005.
Standard Meal Plan
|
Food Group |
Servings Per Meal |
Serving Sizes |
Recommendations |
|
Grain |
1-2 servings |
1 serving is:
* 1 slice bread
* 1 small roll
* 1 cup dry cereal
* Vi cup cooked rice, pasta,
cereal |
Whole grains. |
|
Vegetable |
1-2 servings: may serve an additional vegetable instead
of a fruit |
1 serving is:
* Vi cup raw or cooked
* 1 cup raw leafy vegetable
* Vi to % cup 100% vegetable
juice |
A variety of deeply colored vegetables are recommended,
such as dark green and orange. |
|
Fruit |
1 serving: may serve an additional fruit instead of a
vegetable |
1 serving is:
* Vi cup fresh, frozen, or canned
fruit
* 1 med fruit
* Va cup dried fruit . Vi
cup 100%
fruit juice |
A variety of brightly colored fruit is
recommended. |
|
Milk, Milk Alternate, or calcium equivalent |
1 serving: 1 cup or equivalent measure |
1 serving is:
* 1 cup low-fat/fat free milk or yogurt
* 1/4 oz of natural cheese
* 2 oz processed cheese
* 1 cup Vitamin D and Calcium fortified
drink |
Low-fat dairy products are recommended. |
|
Meat or Meat Alternate |
1 serving |
1 serving is:
* 2-3 oz. cooked meat, poultry, fish
* % cup cottage cheese
* 3 eggs or equivalent egg substitute
* 1/4 cup cooked beans, peas, lentils |
Lean meats and low-fat meat alternates are
recommended. |
|
Dessert |
1 serving |
Varies |
Using fruit and milk-based desserts is recommended when
possible. |
* For more detail on Nutrition Program Menus,
see Appendix.
B.
Nutrient levels must be calculated and documented using recognized nutrient
analysis computer software. This allows the menu planner to easily adjust
portion sizes and food components to ensure meals meet 1/3 of DRIs. The
Nutrient Requirements and Values for Analysis supersede the Meal Pattern. If
the Nutrient Requirements are met, that is sufficient, as long as no more than
one item from the Meal Pattern is excluded from the meal. The table below
presents the current minimum level of acceptable DRIs for one meal.
Nutrient Requirements and Values for
Analysis
|
Nutrient |
Required Value |
Conditions |
|
Calories |
[GREATER THAN]600 |
Preferred Range 700-800 |
|
Fat (% of total calories) |
[LESS THAN] 35% |
Each Day |
|
Protein (% of total calories) |
[GREATER THAN]15% |
Each Day |
|
Fiber |
7g |
Averaged over one week |
|
Vitamin A |
1,000 IU |
Averaged over one week |
|
Vitamin C |
30 mg |
Averaged over one week |
|
Calcium |
400mg |
Averaged over one week |
|
Sodium |
1200mg or less
(500-600mg recommended) |
Averaged over one week |
C. A Registered
Dietitian must approve menus.
D.
Any planned second meal provided for the same day must be a menu different from
the lunch meal.
E. When choices are
offered, combinations offered contain 1/3 of DRIs.
F. Nutrition providers should stay in touch
with their participants in order to provide meals acceptable to the majority.
An annual meal survey should be done to solicit suggestions and assess client
satisfaction.
G. The USDA MyPlate
(
www.choosemyplate.gov) is an
excellent source of information on specific food groups, and should be used to
guide menu planning for a more healthful menu. In general, it is recommended to
choose food that are higher in fiber and lower in fats and sugars.
H. Resources developed specifically for the
OAA Nutrition Program can be found on the website of the National Resource
Center on Nutrition, Physical Activity and Aging:
http://nutritionandaging.fiu.edu/.
I. Menus shall provide a variety of food
items and preparation methods, including a mixture of colors, textures, shapes,
sizes and flavors.
J. Using locally
grown, fresh fruits and vegetables in season is encouraged, as they will cost
less, be more flavorful and have higher nutritional value.
K. Potassium blunts the effects of sodium.
Serving more vegetables and fruits with higher potassium content is strongly
encouraged.
L. Special dietary
needs of older adults should be considered in menu planning, food selection,
preparation and service.
M. When
feasible, menus should reflect ethnic, cultural, religious or regional dietary
requirements or preferences of the majority of participants.
N. Menus will be written using a four-week
cycle. AAAs may allow providers to shorten the cycle to 3 weeks or lengthen to
6 weeks. Menus should be rotated, at minimum, 3 times a year.
O. Menus must be dated with the date used.
Menus, with production and serving guides, must be posted in the food
preparation and serving areas. A menu must be posted for participants'
viewing.
P. Substitutions for foods
on approved menus should be minimal and approved by the AAA Nutrition Program
Coordinator. Substitutions must be of similar nutrient content.
Q. One holiday meal per month may be served.
The sodium and the fat restriction will not be required for the holiday
meal.
R. Vitamin or mineral
supplements are not provided.
S.
Therapeutic diet for individual specific diagnoses may be served only under the
following conditions:
1. A written therapeutic
diet order, signed and periodically reviewed by the physician, is on file for
each person receiving a diet;
2.
Therapeutic diet menus are written by a Registered Dietitian (RD);
3. Therapeutic meal preparation and service
are to be supervised by a qualified Dietary Manager and monitored by an
RD;
4. Assessment of the
participant by a RD at least every six months validates the continued need for
the diet;
5. The participant
follows the diet for all meals, not just those supplied by the service
provider;
6. There is an adequate
number of individuals who require diets to make the service practical;
and
7. The service provider has or
can obtain at a reasonable cost the necessary food and skills to prepare
therapeutic meals.
T.
AAAs whose services include provision of nutritional supplements (Ensure,
Boost, etc.) must comply with the following;
1. Nutritional supplements may not replace a
meal, except by doctor's order stating that supplements are the only
intake.
2. Nutritional supplements
may be used as a part of the meal with a doctor's order and nutrition
assessment with follow-up of the participant by a RD. Nutritional supplements
sent as a part of a meal may not be counted as a second meal and are not NSIP
reimbursable as a second meal.
206.600
Food Service Operations
All stages of food service operations must comply with federal,
state and local fire, health, sanitation, safety and building codes,
regulations, and licensing requirements.
A. Required Permits and Records
1. A current Food Service Permit must be
posted in each site as required by the Arkansas Department of Health. To be
current, the permit date may not exceed one year elapsed. Without a current
Food Service permit, the facility cannot be used (or contracted with) in the
nutrition program.
2. Copies of a
Food Service Establishment Inspection Report and Fire and Safety Report, dated
within a year, must be maintained for each site or caterer. Corrective actions
recommended by sanitarians or fire officials must be promptly carried
out.
3. Copies of menus, with
notation of any variations in food served, must be maintained for one year.
Copies of temperature records for congregate and home-delivered meals will also
be maintained for one year.
4.
Copies of food invoices, sign-in logs, contribution reports, service logs shall
be kept on file for three years.
5.
Copies of client files and other client records shall be kept on file for seven
years.
B. Requirements
for Food Procurement
1. All foods used in
nutrition programs must be from an approved source, be in compliance with
applicable state and local laws and regulations; and be clean, wholesome, free
of spoilage, adulteration or mislabeling, and safe for human
consumption.
2. No home canned food
may be used.
3. Contributed foods
must meet the same standards of quality, sanitation and safety as purchased
foods.
4. Fresh or frozen meat and
poultry must be USDA inspected. Wild game can be used only if it is secured
from an approved source.
5. Potluck
meals may not be counted on the Title III Program Performance Report and are
not eligible for AoA reimbursement. Because no federal program funds may be
used for staff salaries, utilities, equipment, material, and/or services for
potluck meals, the meal is not subject to federal program
requirements.
C.
Requirements for Receiving Food and Food Storage
1. Incoming shipments must be checked. Goods
must be rejected if they are damaged or show evidence that temperatures were
not properly maintained.
2. Items
must be immediately placed in the proper storage area.
3. Items must be stored in a manner that
allows air circulation around the containers.
4. Items must be stored in a manner that
allows the oldest goods to be used first (FIFO: First In, First Out).
5. Shelving must be smooth and easily
cleaned, at least 6 inches above the floor to allow cleaning under the
shelves.
6. Food may not be stored
with cleaning supplies, mops, buckets, or items that might contaminate
food.
7. Storage area must be well
ventilated, controlled in temperature and humidity; 50-70°F is
suggested.
8. Packages that have
been opened must be tightly covered or closed, labeled and dated.
D. Required Standards for Food
Preparation and Service
1. Food must be
prepared, served, and transported with the least possible manual contact, with
suitable equipment and utensils, on surfaces that, prior to use have been
cleaned and sanitized to prevent cross contamination.
2. Food preparation staff will be supervised
by a trained, ServSafe Certified person (see Staffing) who assures the use of
hygienic practices in food handling, preparation and service.
3. All food preparation staff, paid and
volunteer, must have received orientation and instruction (see Staffing,
Orientation) prior to beginning work.
4. Food preparation staff shall strictly
adhere to safe and sanitary personal habits and food handling practices,
including:
a. Staff wears approved hair
coverings, clean clothes and apron;
b. Staff washes hands thoroughly each time
before handling food, food contact surfaces or serving food;
c. Workers do not go from "dirty" (washing
dirty dishes) to "clean" tasks (handling clean dishes, serving food). If this
is unavoidable, hands are washed; gloves and apron are changed before beginning
the "clean" task.
5.
Adequate hand washing facilities shall be provided and located to encourage
frequent hand washing.
6. Food
preparation staff that is ill (illness that can be transmitted through air,
food, utensils, or contact) shall not be allowed to work.
7. Food production shall be planned and
managed through the consistent use of standardized recipes, adjusted to yield
the number of servings needed. This will help ensure quality and documented
nutrient content of food served, as well as tracking food cost.
8. Food preparation staff shall be familiar
with standardized recipes, understand why they are needed, and be given
necessary equipment to prepare them.
9. There shall be adequate equipment and
space to allow accurate, safe, and sanitary preparation of the menu as written.
Equipment shall be in good repair and easily cleaned. Employees shall be
familiar with the correct usage, safe operation and cleaning methods for the
equipment.
10. Foods shall be
prepared and handled in a manner that preserves optimum flavor, appearance, and
nutrients, as well as food safety. This requires the shortest cooking and
holding times possible.
11. Opened
packages of food, refrigerated, frozen and dry, shall be dated, labeled, and
tightly closed to prevent contamination.
12. Frozen foods shall be thawed in the
refrigerator, under cool running water, or as part of the cooking
process.
13. Foods cooked for later
use shall be cooled immediately and appropriately, not allowed to cool on
counters. Appropriate cooling techniques include: dividing food into smaller
and/or more shallow containers, using an ice-water bath, stirring with an ice
paddle, or in some cases, adding clean ice (such as to soup), stirring until
cooled, then placing in refrigerator. Any combination of these cooling
techniques is acceptable.
14.
Effective procedures and schedules for cleaning and sanitizing dishes,
equipment and work areas must be written and followed consistently.
15. Food service workers must understand the
need for, and use, standardized portions. Providers must supply the necessary
equipment and utensils to serve standardized portions.
16. Food shall be portioned according to a
meal service guide, which shall list which utensil to use and the size of each
serving.
17. Equipment for holding
and serving food must maintain the temperature of the food at either below
41°F or above 135°F.
18.
The holding time between food preparation and meal consumption shall be minimal
to reduce opportunities for bacterial growth and maintain food
quality.
19. Temperatures for meals
served at the center must be checked and recorded each day at the beginning of
meal service. If the temperature is between 41°F and 135°F, corrective
action must be taken.
20. Dish
handling and storage practices must comply with Health Department and ServSafe
requirements and ensure sanitary food contact surfaces. These include:
a. Where possible, there is a physical
separation between dirty and clean dish areas, with a hand washing sink located
near the entrance to the clean dish area.
b. Dirty dishes do not pass through the area
where food is being prepared or served.
c. Foodservice employees shall not handle
silverware by the food contact end, nor handle glasses by the rim.
d. Dishes are allowed to air dry.
e. Wash methods and temperatures meet Health
Department regulations and ServSafe recommendations.
21. Congregate meals are to be consumed at
the meal site. Congregate meals shall not be sent home with participants as a
second meal, nor as a sack lunch for days when the center is closed. (Does not
include shelf stable emergency meals.)
22. At the discretion of the Area Agency on
Aging, participants may carry home leftovers from their own plate. Clients
taking home leftovers must sign a liability waiver holding the food program
harmless concerning food-borne pathogens once the food leaves the dining room.
All clients who take home leftovers must provide their own containers. The food
program is required to include proper food handling in the quarterly
education.
23. If participants are
allowed to take potentially hazardous leftovers, they should be informed of
proper food handling to prevent spoilage and risks of improper leftover
handling, written instructions are recommended. The instructions should include
the date the meal was prepared, the discard date (two days following),
refrigeration instructions, a statement about proper hand washing, instructions
to reheat to 165°F, and a disclaimer that states: For your safety: food
removed from this site must be kept hot or refrigerated promptly. We are not
responsible for illness or problems caused by improperly handled
food.
24. Staff who are not
eligible participants may not take leftovers home.
25. Cooks shall not intentionally prepare
excess amounts of food to ensure that there are leftovers. This increases food
cost and waste.
26. Amounts
prepared need to be carefully considered to prevent leftovers. Unserved food
remaining at the end of the meal:
a. May not
be used for frozen home-delivered meals if the food has remained on a steam
table longer than 30 minutes. Home-delivered meals should be plated at the
beginning of meal service.
b. May
be offered as second helpings to participants.
c. If prepared food is prepared on site and
has been properly handled, leftovers may be refrigerated or frozen for later
use at the center.
i. Leftover food must be
refrigerated or frozen immediately.
ii. Refrigerated food must be used within 3
days.
iii. All leftovers must be
re-heated to an internal temperature ofatleastl65°F.
iv. Leftovers may not be used a second
time.
27. If
food was not prepared on site (was transported), leftovers must be offered as a
second helping or discarded.
E. Requirements for Bulk Food Transport
1. Prepared food must be transported in
approved carriers that maintain food temperatures at or above 135°F or at
or below 41°F (out of the temperature danger zone) from preparation site to
serving site.
a. Carriers must be insulated
and equipped with supplemental heat or cold source, if needed to maintain
proper temperatures.
b. Carriers
must be completely enclosed, with a tight fitting lid.
c. Carrier size shall be such that there is
little "dead space" when the carrier is packed.
d. Carriers must be in good condition, easily
cleaned, and be sanitized after each use.
2. Food temperatures shall be recorded as the
food leaves the preparation area and upon arrival at the service site.
Appropriate corrective actions should be taken and documented if food is in the
temperature danger zone (41°F to 135°F). Temperature records must be
kept on file for review.
3. Drivers
and food handlers must receive orientation and training on sanitation and food
handling.
4. Food transport
vehicles must be clean and sanitary.
5. Length of time between preparation of bulk
food and service of the last meal from it should be minimal, and it must be
demonstrated that safe temperatures are held from preparation to the last meal
served.
F. Required
Standards for Home-Delivered Meals
1.
Home-delivered meals must be packaged at the beginning of the meal, in a
container with a tight fitting lid, and transported immediately.
2. Transport equipment, packaging materials,
and procedures used to deliver meals must be compatible, and must maintain food
temperatures at or above 135°F or at or below 41°F from packing to
delivery.
a. Carriers must be insulated and
equipped with supplemental heat or cold source if needed to maintain proper
temperatures.
b. Carriers must be
completely enclosed, with a tight fitting lid.
c. Carrier size shall be such that there is
little "dead space" when the carrier is packed.
d. Carriers must be in good condition, easily
cleaned, and be sanitized after each use.
3. Routes cannot exceed VA
hours from the center to the last delivery and may not leave the
center before 10:00 a.m. Exception: It can be demonstrated that temperature and
quality can be maintained for slightly longer routes, as with vehicles with
specially designed heated and cooled compartments.
4. Carriers should be opened as little as
possible during deliveries.
5.
Temperatures of the last meal delivered on each route must be taken and
recorded at least weekly. For short, volunteer delivered routes, temperature
checks may be rotated, but must be checked at least monthly. Corrective action
must be taken when temperatures are within the temperature danger zone (between
41°F and 135°F). Temperature records must be kept on file for
review.
6. Delivery personnel must
actually see the participant, or their caregiver, when the meal is delivered.
Meals may never be left at the door or with a neighbor unless specific
arrangements have been made with program staff, and the arrangements are
documented for each occurrence.
7.
Delivery persons must receive an orientation which includes food safety,
emergency procedures, and procedures for handling contributions.
8. More than one meal per day, or meals for
more than one day, may be delivered if proper storage and heating facilities
are available in the home. The participant must be able to re-heat and consume
the second meal by him or herself or with available assistance.
9. Meals requiring heating must be packed in
oven safe containers, with instructions attached.
G. Frozen Home-Delivered Meal Requirements
1. Not more than 2 weeks' worth (10-14) of
frozen meals will be delivered at once.
2. Meals shall be frozen on the day of
preparation, before beginning regular meal service. Food returned from another
site may not be used for frozen meals.
3. Each meal shall be labeled, listing each
item it contains, the date, and items to be added to complete the meal.
Participant and/or caregiver should receive instructions on the use of the meal
when beginning the service, and a reminder at the time of
reassessment.
4. Meals shall be
frozen in containers that will protect food from freezer burn or contamination
and can be heated in the oven.
5.
Meals shall be frozen in a freezer that will lower the temperature of the meal
to 0°F or below within 3 hours. When freezing, meals must be placed in the
freezer in a manner that allows air to circulate freely around each
meal.
6. To meet requirements,
other meal components, such as milk, fruit, bread, etc., must be added to the
frozen portion of the meal as listed on the menu.
7. Food substitutions must be comparable
nutritive value and must be documented.
8. Transportation equipment must maintain
food in a frozen state and ensure sanitary handling.
9. Length of delivery routes and carriers
shall be such that participants receive meals in a completely frozen
state.
10. Frozen meals shall be
rotated out of the freezer and used on a first in, first out (FIFO) basis
within 30 days.
11. A method shall
be developed to assure that the participant:
a. Has adequate freezer space to handle
meals;
b. Has the facilities to
adequately heat the food;
c.
Understands that meals are to be used promptly, especially the milk, bread,
fruit, etc. that accompany the meal; and d. Is physically and mentally able to
heat the meal and understands how to do so, or arrangements have been made to
heat meals for him or her.
206.601
Emergency Procedures
The AAAs and providers shall develop a written plan for a
variety of possible emergency situations, such as participant illness, injury
or choking; and weather related emergencies, such as tornado, ice, snow,
extreme heat, flood, etc. The plan shall include:
A. A procedure for notifying participants
when the center must be closed.
B.
A procedure for notifying HDM participants that meals cannot be delivered and
that they should use an emergency meal.
C. A procedure that delivery personnel are to
follow when no one answers the door for meal delivery, or when an emergency
situation is encountered.
D. A
procedure that center staff should follow in medical emergency, fire or sudden
weather related emergency.
E. A
procedure for supplying emergency meals. (See below)
1. Center and meal delivery staff and
volunteers shall receive instruction in those emergency procedures that apply
to them.
2. Center participants
shall receive information on what to do in the event of an emergency while at
the center (ex: fire, tornado) and while at home. A list of suggested emergency
supplies should be provided to participants. Information should include how the
center will notify them when closing.
3. HDM participants will be supplied with at
least 2 emergency meals. The meals will:
a.
Contain 1/3 DRIs;
b. Be labeled
"Emergency Meal" in large print, with instructions on use of the
meal;
c. Be used within the limits
of their shelf life, usually within 6 months;
d. Be billed when delivered to the
participant; and e. Be replaced after the center has instructed the participant
to use it.
206.700
Education
Nutrition Education activities should be conducted on an
ongoing basis, at least semiannually.
A. Information and instruction should be
given to participants and caregivers in a group or individual setting overseen
by a dietitian or other individual with equivalent education in nutrition
science.
B. Written documentation,
including date, topic, source, presenter, and a list of participants or the
number in attendance must be maintained. Copies of the programs and a brief
evaluation of the program's effectiveness will be kept on file at each senior
center or subcontractor's office for three years. Nutrition Education
Activities may include:
1. Formal
presentations;
2. Learning
activities, such as nutrition bingo, cooking demonstrations or classes,
sampling new or differently prepared foods; and
3. Individual sessions with a participant or
caregiver.
C. Material
that may be used to supplement nutrition education:
1. Large font, easy to understand nutrition
handouts developed by a Registered Dietitian;
2. Bulletin board displays; and
3. Table tents or placemats containing valid
nutrition information.
D. The HDM nutrition education can include
learning activities offered as an individual session with the older adult
and/or caregiver through telephone contact or through a home visit such as
during the initial assessment, follow-up visit, reassessment or as a separate
visit. Print materials such as simple pamphlets, handouts, bookmarks and
placemats are appropriate supplemental material.
E. The Nutrition Education program
development and documentation requirements for congregate meals apply to
HDMs.
206.900
NSIP
AoA administers NSIP in compliance with the requirements of
Section 311 of the Older Americans Act. State Units on Aging (SUAs), such as
DAAS, funded through Title III of the OAA and Indian Tribal Organizations
(ITOs) who have an approved application through Title VI of the OAA may receive
grants of cash from the AoA and/or commodities from the USDA.
A. Meals counted for purposes of NSIP
reporting are those that satisfy the requirements of Title III-C of the OAA.
Meals served in accordance to OAA requirements include meals served:
1. To an individual who is qualified to
receive services under the OAA as defined in Title III or Title VI;
2. To an individual who is not means-tested
for participation;
3. In compliance
with the nutrition requirements of the OAA;
4. By an eligible agency (has a grant or
contract with DAAS or AAA) or a Title VI provider; and
5. To an individual who is given an
opportunity to contribute to the cost of service.
B. Recipients of grants or contracts from
DAAS or AAAs may use NSIP cash to purchase United States (U.S.) agricultural
commodities and other foods of U.S. origin for their nutrition
projects.
C. Medicaid waiver meals
and meals for staff and guests under 60 may not be reported for NSIP
assistance.
D. Grants or contracts
from DAAS to AAAs, or from AAAs to providers may not be reduced when NSIP
reimbursement levels increase.
E. A
reliable reporting system must be in place to assure accurate reporting of NSIP
eligible meals.
F. The
subcontractor must document NSIP eligible meals served and submit a monthly
count to the AAA.
G. Each AAA must
submit a written NSIP Meal Count Report to DAAS by the
18th of each month (or date specified by current
DAAS policy) for eligible meals served the prior month.
H. Election to receive cash in lieu of
commodities is made as a state. AAAs indicate at the beginning of the Area Plan
cycle if they wish to receive commodities or cash. DAAS informs AoA of the
election yearly.
I. Information and
assistance to encourage eligible individuals to apply for Supplemental
Nutrition Assistance Program (SNAP) benefits (formerly food stamps) should be
provided at the time of intake. Information on SNAP eligibility and the
application process should also be posted or available as brochures at the
site.
