First Evaluation of the Federal Elderly Nutrition Program Since 1983

Evaluation Objectives
Key Findings
Program Accomplishments
Ordering Related Publications

The graying of the U.S. population has vaulted the need to design efficient service delivery systems for the older population into the public eye. Many efforts are under way to build networks to provide elders with a continuum of home- and community-based long-term care, so they can avoid premature or unnecessary hospital or nursing home care. Nutrition services, such as those the Elderly Nutrition Program (ENP) offers, must be a part of these networks to ensure that older people achieve and maintain good nutrition.

Title III of the ENP provides 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 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

The evaluation was conducted for the U.S. Department of Health and Human Services. The ENP, created in the 1970s as part of the Older Americans Act, had not been evaluated since 1983.

KEY FINDINGS

Program Outcomes

• People who receive ENP meals have higher daily intakes of key nutrients than similar nonparticipants.
• ENP meals provide approximately 40 to 50 percent of participants' daily intakes of most nutrients.
• Participants have more social contacts per month than similar nonparticipants.
• Most participants are satisfied with the services the ENP provides.

Participant Characteristics

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

Funding

• ENP expenditures are 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 is supplemented by an additional $1.70 from other sources. For Title III-C-2, every dollar spent on home-delivered services is supplemented by an additional $3.35 from other sources.
• The average cost of an ENP meal, including the value of donated labor and supplies, seems 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 are $6.19 and $7.18, respectively.

Program Operations

• The ENP is 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 provides a continuum of nutrition services in addition to meals to participants. This continuum includes nutrition screening, assessment, education, and counseling.
• ENP meals supply well over 33 percent of the Recommended Dietary Allowances (RDAs) for key nutrients. The meals are also "nutrient dense"--they provide high ratios of key nutrients to calories.
• Forty-one percent of Title III ENP service providers have waiting lists for home-delivered meals, suggesting a significant unmet need for these meals.

WHAT HAS THE PROGRAM ACCOMPLISHED?

• The ENP provides an average of 1 million meals per day to older Americans. These meals are 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 increase the dietary intakes of ENP participants.
• The ENP reduces 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 have forged close links with other parts of America's emerging home and community-based long-term care system. Federal dollars are highly leveraged. Despite participants' low income levels, their contributions account for 20 percent of both group and home-delivered meals costs. Local donations and volunteer time, often from program participants, account for 14 percent of costs.

ORDERING RELATED PUBLICATIONS

Copies of the executive summary, "Serving Elders at Risk, The Older Americans Act Nutrition Programs, National Evaluation of the Elderly Nutrition Program, 1993-1995," are available through the Administration on Aging at (202) 619-0011. In addition, the text of the executive summary and full report is available at http://www.aoa.dhhs.gov/prof/aoaprog/nutrition/program%5Feval/eval%5Freport.asp

Public use data on CD-ROM are available. Further information about obtaining the data may be obtained from the National Aging Information Center, 7830 Old Georgetown Road, Suite 100, Bethesda, MD 20814-2434, (301) 907-6743.

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