Nutrition Services

Section 230.255  Nutrition Services a)         Congregate Meals and Home Delivered Meals are the two types of nutrition services that may be funded by the Department or the AAA under Title III-C of the Older Americans Act. All AAAs are required to fund both types of nutrition services. Nutrition services and the units of service are defined and determined by the U.S. Department of Health and Human Services, Administration for Community Living. 1)         Congregate Meals A)        A congregate meal is defined as a meal provided by a qualified nutrition services provider to a qualified individual in a congregate or group setting. The meal is served in a program that is administered by the Department or an AAA and meets all the requirements of the Older Americans Act and State and local laws and ordinances. Meals provided to an individual through means-tested programs may be included. B)        Under the Congregate Meal Program, an AAA may provide grab go meals and/or food boxes as determined by local community needs. Grab and go meals and/or food boxes are intended to serve as a complement to the AAAs congregate meal program and cannot exceed 25% of the funds expended by the AAA under Title III part C-1 of the Older Americans Act. The Department and the AAAs must request approval for the provision of grab and go meals and/or food boxes when submitting the State Plan and area plan for approval. i)          Grab and go meals are served in a program that is administered by the Department or an AAA and meets all the requirements of the Older Americans Act, State and local laws and ordinances. Meals provided to an individual through means' tested programs may be included. ii)         Food boxes will be funded using State GRF Home Delivered Meal monies and/or federal funds. C)        Units of Services i)          For congregate meals including grab and go meal, one unit of service is equal to one meal. ii)         For food boxes, the number of ingredients contained in the box per dietitian evaluation and the recipes provided equals the number of meals. 2)         Home-Delivered Meals A)        A home-delivered meal is defined as a meal provided to a qualified individual in their place of residence. The meal is served in a program that is administered by the Department or an Area Agency on Aging and meets all the requirements of the Older Americans Act and State and local laws and ordinances. Meals provided to an individual through means-tested programs may be included. B)        One unit of service is equal to one meal. 3)         Nutrition Counseling A)        Nutrition counseling is a standardized service as defined by the Academy of Nutrition & Dietetics 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 their caregivers. Counseling is provided one-on-one by a Registered Dietitian Nutritionist licensed under the Dietitian Nutritionist Practice Act [225 ILCS 30] and addresses the options and methods for improving nutrition status with a measurable goal. B)        One unit of service is equal to one hour of nutrition counseling. A partial hour may be reported to two decimal places, e.g., 0.25 hours. b)         The AAA may award funds to provide nutrition services to older individuals. 1)         The AAA shall assess the level of need for congregate, home-delivered, grab and go meals, and food boxes within the planning and service area. Additionally, the AAA shall assess the diversity of its planning and service area to ensure its contracted providers have the capacity to provide culturally appropriate meals based on the population. 2)         The AAA shall give primary consideration to congregate meal. However, the AAA may award funds to an organization that provides home-delivered meals. 3)         When awarding funds to provide home-delivered meals, consideration shall be given, where feasible, to organizations that have demonstrated an ability to provide home-delivered meals efficiently, have provided assurances of efforts to solicit voluntary support, and will not use funds made available under Title III-C of the Older Americans Act to supplant funds from non-federal sources. 4)         When awarding funds, the nutrition services provider shall meet the requirements of this Section and demonstrate it has carried out its nutrition services activities with effectiveness. 5)         Except as provided in 45 CFR 75, Subpart D (2020) and 2 CFR 200, Subpart D (2020), the AAA shall not discontinue funding to a nutrition services provider unless the nutrition services provider has been given an opportunity for an appeal to the AAA and/or Department, in accordance with the provisions in Subpart E of this Title. c)         Requirements for Participant Eligibility 1)         The following individuals are eligible to participate in a congregate-meal program: A)        An individual who is age 60 or older; and B)        The spouse, regardless of age, of an individual who is age 60 or older participating in a congregate-meal program; and C)        An individual who is not 60 or older, but has a disability as defined in the Older Americans Act, 42 U.S.C. 3002 (2020) and: i)          resides in a housing facility primarily occupied by the older individuals at which congregate meals are provided; or ii)         resides at home with an older individual who is eligible to participate in a congregate meal program. 2)         The following individuals are eligible to participate in a home-delivered meal program: A)        An individual who is age 60 or older. Consideration shall be given to the individual's ability to leave home unassisted, ability to shop for and prepare nutritious meals, degree of disability, or other relevant factors pertaining to the individual's need for the service, including social and economic need; and B)        The spouse of an individual participating in the home-delivered meal program, regardless of age or condition, may receive a home-delivered meal if, according to criteria determined by the Area Agency on Aging, receipt of the meal is in the best interest of the frail and/or homebound older individual. d)         Requirements for All Nutrition Services Providers 1)         A nutrition services provider shall have procedures for obtaining participants' opinions regarding the services they receive and for involving participants in the planning of nutrition services and other programs provided for their benefit. 2)         A nutrition services provider shall utilize the expertise of a licensed dietitian nutritionist licensed under the Dietitian Nutritionist Practice Act [225 ILCS 30]. A licensed dietitian nutritionist shall certify and sign that each meal meets the State and local requirements and the requirements of the Older Americans Act for congregate and home-delivered meals. 3)         A nutrition services provider shall have available for use upon request appropriate food containers and utensils for persons with disabilities. 4)         A nutrition services provider shall assist participants in applying for benefits available to them under the Illinois Link (SNAP) food program. A nutrition services provider shall coordinate its activities with entities responsible for administering the Illinois Link (SNAP) program to facilitate participation of eligible older individuals in the program. 5)         A nutrition services provider or other entity shall conduct a nutrition screening for each participant on at least an annual basis or sooner if a participant is screened at high nutritional risk. A)        The nutrition screening shall be on a form provided by the Department, which shall include the "DETERMINE Your Nutritional Health" questions developed by the Nutrition Screening Initiative. B)        If a screening indicates the participant is at high nutritional risk, a nutrition services provider should identify an action to take and document the action taken. C)        At minimum, the nutrition services provider or other entity should: i)          Inform the participant of the high nutritional risk; ii)         Recommend the participant contact a physician or other appropriate professional; and iii)        Document that these steps were taken by checking the appropriate box(es) on the registration or intake form. D)        Some other examples of actions to take include, but are not limited to: i)          Making a referral or recommendation, based on the need identified, to meet with a licensed dietitian nutritionist, physician, or social services professional; ii)         Providing the participant with nutrition education; and/or iii)        Providing a list of appropriate resources that are available to help reduce the participant's nutritional risk, including information on the SNAP program. 6)         A nutrition services provider shall provide nutrition education on at least a semiannual basis to participants. If feasible, the Department recommends that nutrition education be provided quarterly or more frequently. A)        Nutrition education activities are designed to: i)          Assist older individuals in obtaining the best nutritional services available within their resources; ii)         Aide older individuals in making sound food choices consistent with the most recent Dietary Guidelines for Americans, and in obtaining the best food to meet their nutritional needs; iii)        Increase awareness of community-sponsored health programs that encourage and promote sound nutritional habits and good health; iv)        Assist older individuals, where feasible, in the area of therapeutic diets as required by health or social condition; and v)         Provide available medical information approved by health care professionals, such as informational brochures and information on how to get vaccines, including vaccines for influenza, pneumonia, and shingles, in the individuals' communities. B)        The Department recommends nutrition services providers coordinate with community resources in the provision of nutrition education services. e)         Requirements for Nutrition Services Providers of Congregate Meals 1)         A nutrition services provider shall serve hot or other appropriate meals (e.g., cold meals) in a congregate setting at least once a day, five or more days a week (except in a rural area where such frequency is not feasible, and a lesser frequency is approved by the Department). 2)         A nutrition services provider shall locate congregate meal nutrition services as close as possible, where feasible and appropriate, within walking distance of the majority of eligible older persons. 3)         A nutrition services provider shall establish outreach activities that assure the maximum number of eligible individuals have an opportunity to participate. 4)         A nutrition services provider shall coordinate with other appropriate services in the community. 5)         If operated by special interest groups (e.g., churches, social organizations, homes for the elderly, senior housing developments, etc.), a nutrition services provider shall not limit participation to their own membership or otherwise show preferential treatment for such membership. f)         Requirements for Nutrition Services Providers of Home-Delivered Meals 1)         A nutrition services provider shall assess the need for home-delivered meals in their assigned geographic area. 2)         A nutrition services provider shall deliver home-delivered meals at least once a day, five or more days a week (except in a rural area where such frequency is not feasible, and a lesser frequency is approved by the Department). Home-delivered meals may be hot, cold, frozen, dried, canned or supplemental foods with a satisfactory storage life. 3)         With the consent of the participant, or their representative, a nutrition services provider shall bring to the attention of appropriate entities for follow-up, conditions or circumstances that place the participant or the household in imminent danger. 4)         Where feasible and appropriate, a nutrition services provider shall arrange for the availability of meals to older persons in weather-related emergencies. 5)         A nutrition services provider or other entity must complete an assessment of each person requesting home-delivered meals to determine the individual's need for service. A)        The assessment shall be on a form provided by the Department, which shall include the "DETERMINE Your Nutritional Health" questions developed by the Nutrition Screening Initiative. B)        A nutrition services provider shall complete a periodic reassessment of each participant at least annually or sooner if circumstances change. C)        A nutrition services provider shall assess all participants receiving cold and frozen meals to ensure they have the proper equipment (e.g., freezer, oven, microwave, and refrigerator) and physical and cognitive skills to store and re-heat the meals. i)          A person eligible to receive home-delivered meals should not be denied services based on the individual's inability to safely store and prepare a frozen meal. ii)         In rural areas or when the nutrition services provider only has the capacity to provide frozen meals, and the individual is unable to safely store and prepare frozen meals, the nutrition services provider shall make a referral to the Care Coordination Unit, Managed Care Organization, or other community services as appropriate to receive assistance with meals (e.g., in-home services or adult day services). g)         Requirements for Meals 1)         Meals provided through the nutrition program shall comply with the most recent Dietary Guidelines for Americans and provide each participant a percentage of the Dietary Reference Intakes (DRI) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. 2)         If the participant is offered one meal per day, the meal shall provide a minimum of 33⅓ % of the DRI. 3)         If the participant is offered two meals per day, the meals shall provide a minimum of 66⅔ % of the DRI. 4)         If the participant is offered three meals per day, the meals shall provide 100% of the DRI. h)         Requirements for Meal Planning, Food Purchasing, and Meal Preparation 1)         A nutrition services provider shall ensure that menus are approved and signed by a licensed dietitian nutritionist. A)        Menus may be approved by completing a nutritional analysis or by using the meal pattern developed by the Dietary Guidelines for Americans. B)        If a nutritional analysis is used, a copy of the nutrition breakdown of analysis must be maintained with the menu and the nutritional analysis menu approval sheet signed by the licensed dietitian nutritionist. C)        If the meal pattern is used, portion sizes that align with the meal-pattern menu approval sheet signed by the licensed dietitian nutritionist shall be documented on the menu. 2)         A nutrition services provider shall follow appropriate procedures to preserve the nutritional value and safety of the food that is purchased, prepared, and provided to participants. 3)         A nutrition services provider shall comply with all State and local health laws and ordinances concerning preparation, handling, and serving of food. Site managers shall have certified food safety manager certification. Food service workers and volunteers shall have food handler training. 4)         If feasible, a nutrition services provider shall develop special menus to meet the particular dietary needs arising from the health requirements, religious requirements, or ethnic backgrounds of participants. If not feasible for the nutrition services provider to accommodate a client's particular dietary needs, the nutrition services provider shall make a referral to the Care Coordination Unit, Managed Care Organization, or other community services as appropriate to receive assistance with meals (e.g., in-home services or adult day services). 5)         A nutrition services provider shall keep on file, for at least three years, menus and the menu-approval sheets signed by the licensed dietitian nutritionist. Any changes shall be noted in writing. 6)         If feasible, a nutrition services provider shall offer more than one meal option at least once per week, which allows participants choice in meeting their dietary needs and food preferences. 7)         A nutrition services provider shall inquire into the reasons why a participant is declining menu items or consistently refusing menu items. 8)         A nutrition services provider shall assist participants to assure that adequate nutrition intake is maintained (e.g., providing smaller serving portions, substitutions when feasible, or serving the participant first). i)          Requirements for Food Service 1)         If a nutrition services provider receives a complaint or report of symptoms of food borne illness, the nutrition services provider shall notify the local health department immediately to initiate an investigation and notify the Area Agency on Aging within 24 hours of the start of the investigation. 2)         In the event of a reported food borne illness, the Area Agency on Aging shall notify the Department on Aging within three working days. 3)         A nutrition services provider shall train new food service staff in fire and safety regulations during the orientation, and at a minimum, once a year thereafter. 4)         A nutrition services provider shall conduct in-service food safety training for all paid food service staff on an annual basis. Staff shall complete training recommended by the Department. 5)         A nutrition services provider shall document in writing the daily temperature records of hot and cold foods and keep the documentation on file at the site where the food was prepared. A nutrition services provider shall make the documentation available for review by a consulting licensed dietitian nutritionist or staff from the Department or Area Agency on Aging. 6)         For congregate meals, a nutrition services provider shall check and document the temperature of the food daily at the time the food leaves the production areas, upon arrival if the food is prepared off site, and at the time of service. 7)         For home-delivered meals, a nutrition services provider shall check and document the temperature of the food daily, both at the end of production and at the time of packaging. At least twice a month, the temperature shall be checked and documented at the end of the delivery route requiring the longest delivery time. 8)         A nutrition services provider is prohibited from reusing leftovers from hot, cold, or frozen home-delivered meals that are unused (e.g., a participant was not home to receive the meal and it was brought back to the site) as a future frozen home-delivered meal. Such meals shall be discarded. This prohibition does not apply to meals that have been kept in a temperature-controlled environment. 9)         A nutrition services provider shall advise participants receiving home-delivered meals that hot meals should be consumed immediately after delivery or ensure that instructions for proper heating, storage, and handling of meals are given to the participant. 10)       A nutrition services provider shall give instructions to participants when utilizing frozen meals regarding safe meal storage and preparation. These instructions shall be provided at the time of the participant's assessment, reassessment, and periodically as appropriate. 11)       A nutrition services provider shall not leave a meal at a participant's home when there is no one available to receive the meal. A nutrition services provider shall have guidelines for home-delivered meal drivers to notify staff when someone is not home. These guidelines enable the nutrition services provider to follow up with these participants. 12)       A nutrition services provider shall inspect delivery vehicles weekly. If necessary, the vehicles shall be cleaned or sanitized (e.g., spilled milk or food) to ensure that the interiors of the vehicles are clean and maintained for sanitary purposes. j)          Requirements for Emergency and Disaster Plans 1)         A nutrition services provider shall have written plans that address pandemics, emergencies, and disasters. Such plans may be developed in collaboration with an AAA. Such plans shall provide for three emergency shelf-stable meals to both congregate and home-delivered meal participants. 2)         A nutrition services provider shall ensure staff and volunteers are familiar with the plans. 3)         The plans shall address the following: A)        Medical emergencies; B)        Pandemic protocols, including the provision of personal protective equipment; C)        Site evacuation in case of a fire or other disaster; D)        Inclement weather plans; E)        Site closure procedures that include communication processes; F)         Alternative sites for providing meals; G)        Storage of and coordination with meal providers for providing shelf-stable meals; H)        Volunteer resources and contacts; and I)         Emergency contacts. 4)         Congregate meal participants should be encouraged to keep an emergency supply of food and water at home for circumstances, such as inclement weather or a pandemic, which prevent travel to the congregate site. 5)         A nutrition services provider shall have written plans and supplies to ensure home-delivered meal participants receive meals during emergencies, weather-related conditions, pandemics, and natural disasters. These plans may be in collaboration with an AAA. For example, a nutrition services provider may plan for and maintain emergency shelf-stable meal packages, have arrangements with other community resources, or four-wheel drive vehicles. 6)         Emergency shelf-stable meals shall be planned for a minimum of three days, (preferably five days). If feasible, meals shall meet the Dietary Guidelines for Americans and provide ⅓ of the Dietary Reference Intakes, and menus shall be approved and signed by a licensed dietitian nutritionist as meeting the Dietary Guidelines for Americans. If feasible, meals shall meet specialized diet requirements. 7)         Emergency shelf-stable meal packages shall include menus with instructions on how to combine the foods to meet the meal requirements. 8)         Emergency shelf-stable meal packages shall be labeled with a use by or expiration date. k)         Nutrition Services Incentive Program (NSIP) 1)         Nutrition services providers are eligible to receive cash assistance from the Administration on Aging in the form of a funding allocation for meals served through NSIP for seniors. 2)         Allocated funding may be claimed for meals that meet the most recent Dietary Guidelines for Americans, are: A)        served to eligible participants; B)        served by a nutrition services provider that has received a grant under Title III-C of the Older Americans Act; and C)        provided with no set fee charged to the recipients. 3)         A nutrition services provider shall spend NSIP funds only to purchase food or United States Department of Agriculture approved food commodities. 4)         NSIP funds shall not be used to off-set program costs or as non-federal matching funds for any other program.