Nutrition Topics

• Childhood Obesity
• Federal Food and Nutrition Programs
• Assessing Dietary
  Quality
• Sharing Expertise
• Clients

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Evaluation of the Federal Elderly Nutrition Program

The graying of the U.S. population vaulted the need to design efficient service delivery systems for the older population into the public eye. Many efforts built networks to provide elders with a continuum of home- and community-based long-term care, so they could avoid premature or unnecessary hospital or nursing home care. Nutrition services, such as those the Elderly Nutrition Program (ENP) offered, ensured that older people achieved and maintained good nutrition.

Title III of the ENP provided daily meals and nutrition services to people age 60 or older in group settings, such as senior centers and churches, or in the home, through "meals on wheels." In fiscal year 1994, federal funding was nearly $470 million. During this period, the program provided 127 million meals to 2.3 million elderly people in group settings. It also delivered 113 million meals to 877,000 homebound elderly people. In addition, 2.8 million meals went to American Indians and Native Hawaiians, under Title VI.

Mathematica's three-year evaluation of the ENP had four major objectives:

• To examine the ENP's effects on participants' nutrition and socialization
• To determine who is using the ENP and how effectively it serves targeted groups (including those with the greatest economic and social needs)
• To assess how efficiently and effectively the ENP is administered and delivers services
• To clarify ENP funding sources and allocation of funds among ENP components

Data Collection Highlights

To collect the required data, we conducted seven separate but linked data collection efforts:

• A telephone survey of the 57 state units on aging (including territories) 
• A telephone survey of a nationally representative sample of 400 area agencies on aging and 110 Indian tribal organizations 
• A telephone survey of a nationally representative sample of 300 nutrition projects
• An in-person survey of a nationally representative sample of 200 meal sites 
• An in-person survey and observation of a nationally representative sample of 300 meal production and handling facilities 
• A computer-assisted personal interviewing (CAPI) survey of nationally representative samples of 1,200 congregate meal program participants and 1,000 home-delivered meal program participants
• A CAPI survey of nationally representative samples of 480 nonparticipants eligible for the Title III congregate meal program and 320 nonparticipants eligible for the Title III home-delivered meal program

The surveys of program participants and nonparticipants included the administration of a 24-hour dietary recall survey, using CAPI.  The surveys also included anthropometric (physical) measures of nutritional status of program participants and nonparticipants. 

Key Findings

Program Outcomes

• People who received ENP meals had higher daily intakes of key nutrients than similar nonparticipants.
• ENP meals provided approximately 40 to 50 percent of participants' daily intakes of most nutrients.
• Participants had more social contacts per month than similar nonparticipants.
• Most participants were satisfied with the services the ENP provided.

Participant Characteristics

• Between 80 and 90 percent of participants had incomes below 200 percent of the poverty level, which was twice the rate for the overall elderly population in the United States.
• More than twice as many Title III participants lived alone, compared with the overall elderly population.
• Approximately, two-thirds of participants were either over- or underweight, placing them at increased risk for nutrition and health problems.
• Title III home-delivered participants had more than twice as many physical impairments, compared with the overall elderly population.

Funding

• ENP expenditures were highly leveraged by state, tribal, local, and other federal funding and services and are also augmented by donations from participants. Typically, a dollar in Title III-C-1 funds spent on group services was supplemented by an additional $1.70 from other sources. For Title III-C-2, every dollar spent on home-delivered services was supplemented by an additional $3.35 from other sources.
• The average cost of an ENP meal, including the value of donated labor and supplies, seemed reasonable when compared to the average per-person cost for lunch in cafeterias or "family-style" restaurants. For Title III, a group meal cost $5.17 and a home-delivered meal cost $5.31. The comparable costs for Title VI were $6.19 and $7.18, respectively.

Program Operations

• The ENP was closely linked to other parts of the nation's emerging home and community-based long-term care system, particularly through cross-referrals and coordination of service delivery within the aging network.
• The ENP provided a continuum of nutrition services to participants—nutrition screening, assessment, education, and counseling.
• ENP meals supplied well over 33 percent of the Recommended Dietary Allowances (RDAs) for key nutrients. The meals were also "nutrient dense"—they provided high ratios of key nutrients to calories.
• Forty-one percent of Title III ENP service providers had waiting lists for home-delivered meals, suggesting a significant unmet need.

Program Accomplishments

• The ENP provided an average of 1 million meals per day to older Americans. These meals were targeted toward highly vulnerable elderly populations, including the very old, people living alone, people below or near the poverty line, minority populations, and individuals with significant health conditions or physical or mental impairments. On average, the meals provided easily meet the RDA requirements and significantly increased the dietary intakes of ENP participants.
• The ENP reduced the social isolation of older Americans in both the group and home-delivered programs and links participants with other needed services.
• Agencies at all levels forged close links with other parts of the home and community-based long-term care system. Federal dollars were highly leveraged. Despite participants' low income levels, their contributions accounted for 20 percent of both group and home-delivered meals costs. Local donations and volunteer time, often from program participants, accounted for 14 percent of costs.

Publications

"Serving Elders at Risk, The Older Americans Act Nutrition Programs, National Evaluation of the Elderly Nutrition Program, 1993-1995, Vols. 1-3" (July 1996)