Additional Efficiencies Could Improve Services to Older Adults
GAO-11-782T: Published: Jun 21, 2011. Publicly Released: Jun 21, 2011.
This testimony discusses our recent work on food insecurity among older adults and the nutrition assistance programs available to assist them, including nutrition assistance programs authorized under the Older Americans Act of 1965 (OAA). This work can help inform government policymakers as they address the needs of one of our nation's most vulnerable populations while ensuring the efficiency and effectiveness of federal programs given rapidly building fiscal pressures facing our national government. While the economy is still recovering and in need of careful attention, widespread agreement exists on the need to look not only at the near term but also at steps that begin to change the long-term fiscal path as soon as possible without slowing the recovery. Our recent work can help with this by identifying potential inefficiency and overlap among programs. At the same time, there is recognition that the services provided by the OAA can play an important role in helping older adults remain in their homes and communities. As the Congress takes steps to address the fiscal challenge, it will be important that these steps are balanced with efforts to ensure the health and well-being of older adults. This testimony today is based on two recent reports, our April 2010 report on domestic food assistance and our February 2011 report on the unmet need for services under the OAA. This testimony highlights key findings from each of these reports related to (1) the prevalence of food insecurity and the receipt of nutrition services among older adults; and (2) the extent to which nutrition assistance programs show signs of inefficiency or overlap. This statement will discuss some of the challenges related to ensuring the most efficient provision of services, and suggest how better information could help policymakers address overlap and duplication among programs while ensuring those most in need have access to services..
Analysis of data from the Current Population Survey's (CPS) Food Security Supplement shows that in 2009, about 19 percent of households with adults ages 60 and over with low incomes--under 185 percent of the poverty line--were food insecure. These adults were uncertain of having or unable to acquire enough food because they lacked resources. In comparison, slightly less than 15 percent of all households were food insecure. A small but significant portion of households with older adults had very low food security in 2009--about 8 percent of those with households under 185 percent of poverty and about 14.5 percent of those with incomes under the poverty line. In these households, one or more household members' eating patterns were disrupted and their food intake reduced, at least some time during the year because they could not afford enough food. We have found that some of the domestic food assistance programs, including those serving older adults, provide comparable benefits to similar or overlapping populations. For example, the Elderly Nutrition Program administered by the Administration on Aging (AoA), provides home-delivered and congregate meals primarily to individuals 60 years and older. Separately, other programs administered by USDA, including the Commodity Supplemental Food Program, targets a similar population, providing food to older adults, as well as women, infants and children who are also served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. In addition, individuals eligible for groceries through the Commodity Supplemental Food Program or services through the Elderly Nutrition Program may also be eligible for groceries through the Emergency Food Assistance Program and for targeted benefits that are redeemed in authorized stores through the largest program, the Supplemental Nutrition Assistance Program (SNAP). In fact, a recent AoA report conducted by Mathematica found that seven percent of congregate meal recipients and 16 percent of home-delivered meal recipients were also receiving SNAP benefits. The availability of multiple programs with similar benefits helps ensure that those in need have access to nutritious food, but can also increase administrative costs, which account for approximately a tenth to more than a quarter of total costs among the largest of these programs. In addition, our previous work has shown that overlap among programs can lead to inefficient use of federal funds, duplication of effort, and confusion among those seeking services. We have found in previous work that despite the potential benefits of varied points of entry, program rules related to determining eligibility often require the collection of similar information by multiple entities. For example, an older adult might apply for congregate meals through the Elderly Nutrition Program at their local area agency on aging, electronic benefits through SNAP at the Health and Human Services office, and vouchers for fresh fruit and vegetables through the Senior Farmers' Market Nutrition Program at a local food bank. Most of the 18 programs have specific and often complex administrative procedures that federal, state, and local organizations follow to help manage each program's resources. According to our previous work and state and local officials, rules that govern these and other nutrition assistance programs often require applicants who seek assistance from multiple programs to submit separate applications for each program and provide similar information verifying, for example, household income. This can create unnecessary work for both providers and applicants and may result in the use of more administrative resources than needed.