Section 230.255 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

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

e 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

t 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

ng 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

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

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

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

he 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)

as 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

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

st. 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

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

very 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

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

unity 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.