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United States Government Accountability Office: 


Before the Subcommittee on Primary Health and Aging, Committee on 
Health, Education, Labor, and Pensions U.S. Senate: 

For Release on Delivery: 
Expected at 10:00 a.m. EDT:
Tuesday, June 21, 2011: 

Nutrition Assistance: 

Additional Efficiencies Could Improve Services to Older Adults: 

Statement of Kay E. Brown, Director: 
Education, Workforce, and Income Security Issues: 


Mr. Chairman, Ranking Member Paul, and Members of the Subcommittee: 

We appreciate the opportunity to discuss 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).[Footnote 1] 
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. 

My testimony today is based on two recent reports, our April 2010 
report on domestic food assistance[Footnote 2] and our February 2011 
report on the unmet need for services under the OAA.[Footnote 3] My 
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 

To address the objectives, we drew upon our April 2010 report and our 
February 2011 report. In this work, we employed an array of 
methodologies including analysis of administrative data on program 
expenditures and participation and national self-reported data on food 
security status; a nationally representative survey of local agencies 
that administer nutrition assistance programs funded by OAA;[Footnote 
4] an analysis of studies on program effectiveness; a review of 
relevant federal laws and regulations and agency documents; and 
interviews with relevant experts, federal officials, and staff of 
local agencies. We conducted our work in accordance with generally 
accepted government auditing standards. Those standards require that 
we plan and perform the audit to obtain sufficient, appropriate 
evidence to provide a reasonable basis for our findings and 
conclusions based on our audit objectives. We believe that the 
evidence we obtained provides a reasonable basis for our findings and 

On March 1, 2011, we issued a report outlining opportunities to reduce 
duplication across a wide range of federal programs raising attention 
to these issues.[Footnote 5] That report was prepared in response to a 
new statutory requirement that GAO identify and report annually on 
federal programs, agencies, offices, and initiatives--either within 
departments or governmentwide--that have duplicative goals and 
activities.[Footnote 6] In that work, we also considered fragmentation 
and overlap among government programs or activities as these can be 
harbingers of unnecessary duplication. Fragmentation of programs 
exists when programs serve the same broad area of need but are 
administered across different federal agencies or offices. Program 
overlap exists when multiple agencies or programs share similar goals, 
engage in similar activities or strategies to achieve them, or target 
similar beneficiaries. Unnecessary duplication of program services can 
occur when two or more programs are engaged in the same activities or 
provide the same services to the same beneficiaries, and this can in 
turn result in inefficient service delivery and unnecessary program 
costs. Reducing or eliminating duplication, overlap, or fragmentation 
could potentially save billions of tax dollars annually and help 
agencies provide more efficient and effective services. These actions, 
however, will require some difficult decisions and sustained attention 
by the Administration and Congress. 

In Recent Years Nearly a Fifth of Low-Income Older Adults Were Food 
Insecure and Most Did Not Receive Assistance from Meals Programs 
Despite Increased Demand: 

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. (See Figure 1.) 

Figure 1: Food insecurity among all households, low-income households, 
and elderly households (60 and older), 2009: 

[Refer to PDF for image: stacked horizontal bar graph] 

Percent of food insecurity: 

All households: 
Low food security: 9.0%; 
Very low food security: 5.7%; 
Total: 14.7%. 

All households less than 185 percent of poverty: 
Low food security: 20.4%; 
Very low food security: 14.4%; 
Total: 34.8%. 

All households less than 100 percent of poverty: 
Low food security: 24.4%; 
Very low food security: 18.5%; 
Total: 42.9%. 

Elderly households (60 and older): 
Low food security: 5.3%; 
Very low food security: 3.3%; 
Total: 8.6%. 

Elderly households less than 185 percent of poverty: 
Low food security: 11.6%; 
Very low food security: 7.7%; 
Total: 19.3%. 

Elderly households less than 100 percent of poverty: 
Low food security: 16.9%; 
Very low food security: 14.5%; 
Total: 31.4%. 

Source: GAO analysis of December 2009 Current Population Survey Food 
Security Supplement. 

[End of figure] 

Older adults can and do access a number of resources to help alleviate 
food insecurity; however, many low-income older adults likely to need 
assistance from meals programs did not receive it, according to 2008 
data. Through our analysis of information from the CPS, we found that 
in 2008 approximately 9 percent of an estimated 17.6 million low-
income older adults[Footnote 7] received home-delivered or congregate 
meals services including those provided by the OAA Elderly Nutrition 
Program: Home-Delivered and Congregate Meals Services (Elderly 
Nutrition Program)[Footnote 8] and other organizations such as 
churches or nonprofits.[Footnote 9] However, many more older adults 
did not receive these meals services, but likely needed them due to 
food insecurity, difficulties with daily activities, and/or limited 
social interaction, as shown in table 1.[Footnote 10] 

Table 1: Percentages of Low-Income Older Adults with Each 
Characteristic of Likely Need and Percentages Who Did and Did Not 
Receive Meals Services: 

Characteristics of likely need: Food security: Food secure; 
Have each characteristic: 81.4%; 
Received home-delivered meals: 3.3%; 
Did not receive home-delivered meals: 96.7%; 
Received congregate meals: 5.7%; 
Did not receive congregate meals: 94.3%; 
Received either type of meal: 8.3%; 
Received neither type of meal: 91.7%. 

Characteristics of likely need: Food security: Food insecure; 
Have each characteristic: 18.6%; 
Received home-delivered meals: 7.4%; 
Did not receive home-delivered meals: 92.6%; 
Received congregate meals: 4.9%; 
Did not receive congregate meals: 95.1%; 
Received either type of meal: 11.1%; 
Received neither type of meal: 88.9%. 

Characteristics of likely need: Numbers of impairments[A]: None; 
Have each characteristic: 65.2%; 
Received home-delivered meals: 2.3%; 
Did not receive home-delivered meals: 97.7%; 
Received congregate meals: 5.1%; 
Did not receive congregate meals: 94.9%; 
Received either type of meal: 6.9%; 
Received neither type of meal: 93.1%. 

Characteristics of likely need: Numbers of impairments[A]: One; 
Have each characteristic: 18.0%; 
Received home-delivered meals: 3.6%; 
Did not receive home-delivered meals: 96.4%; 
Received congregate meals: 6.3%; 
Did not receive congregate meals: 93.7%; 
Received either type of meal: 8.8%; 
Received neither type of meal: 91.2%. 

Characteristics of likely need: Numbers of impairments[A]: Two or more; 
Have each characteristic: 16.8%; 
Received home-delivered meals: 11.5%; 
Did not receive home-delivered meals: 88.5%; 
Received congregate meals: 6.4%; 
Did not receive congregate meals: 93.6%; 
Received either type of meal: 16.7%; 
Received neither type of meal: 83.3%. 

Characteristics of likely need: Social isolation[B]: Less isolated; 
Have each characteristic: 31.8%; 
Received home-delivered meals: 2.5%; 
Did not receive home-delivered meals: 97.5%; 
Received congregate meals: 6.1%; 
Did not receive congregate meals: 93.9%; 
Received either type of meal: 7.9%; 
Received neither type of meal: 92.1%. 

Characteristics of likely need: Social isolation[B]: More isolated; 
Have each characteristic: 41.4%; 
Received home-delivered meals: 5.0%; 
Did not receive home-delivered meals: 95.0%; 
Received congregate meals: 5.0%; 
Did not receive congregate meals: 95.0%; 
Received either type of meal: 9.0%; 
Received neither type of meal: 91.0%. 

Characteristics of likely need: Social isolation[B]: Missing[C]; 
Have each characteristic: 26.8%; 
Received home-delivered meals: 4.5%; 
Did not receive home-delivered meals: 95.5%; 
Received congregate meals: 5.8%; 
Did not receive congregate meals: 94.2%; 
Received either type of meal: 9.7%; 
Received neither type of meal: 90.3%. 

Source: GAO analysis of 2008 CPS data. 

[A] To identify older adults likely to need meals programs based on 
potential difficulties preparing or obtaining food, we used four CPS 
questions that identified functional impairments, such as difficulty 
doing errands alone, serious difficulty walking or climbing stairs, or 
difficult dressing or bathing. 

[B] We defined likely need for more social interaction as answering 
"no" to all of the questions in the CPS civic engagement supplement 
that asked about the older adult's participation in social activities. 
However, such survey data do not capture more qualitative aspects of 
an individual older adults' likely need for social interaction such as 
personality and individual preference. The data also do not allow us 
to identify individuals who may interact socially outside of organized 
groups and activities. 

[C] CPS questions related to social isolation were asked at a 
different time in the survey cycle than questions about receipt of 
meals services. Therefore, approximately 27 percent of the older 
adults with low incomes in our sample provided information about 
participation in meals programs, but not about participation in social 
groups. As a result, we could not measure whether they were more or 
less socially isolated. 

[End of table] 

It should be noted that there are many reasons why older adults may 
not receive nutrition assistance through the Elderly Nutrition 
Program. They may not know about the available services, may not have 
access to services due to limited supply in their area, may receive 
informal assistance from family or neighbors, or may choose to remain 
self-sufficient rather than request government benefits. In addition, 
some older adults may choose to participate in a separate program 
instead, such as the Supplemental Nutrition Assistance Program (SNAP), 
formerly known as Food Stamps, where they can purchase their preferred 

Requests for Elderly Nutrition Program services have increased and 
demand will likely continue to grow. Through our survey of area 
agencies on aging (local agencies) conducted during the summer of 
2010, we found that an estimated 79 percent of agencies had seen 
increased requests for home-delivered meals, and 47 percent had seen 
increased requests for congregate meals since the start of the 
economic downturn. Further, requests for OAA services are increasing 
as more seniors stay in their homes longer rather than move to 
assisted living facilities or nursing homes, according to agency 
officials. According to U.S. Census data, more than 9 million more 
Americans were 60 years and older in 2009 than in 2000, and the Census 
Bureau projects that population group will continue to grow. 

Further, demand for Elderly Nutrition Program home-delivered meals is 
growing compared to congregate meals. In our 2010 survey, an estimated 
22 percent of agencies reported they were generally or very unable to 
serve all clients who request home-delivered meals, compared to an 
estimated 5 percent of agencies who were generally or very unable to 
serve all clients who requested congregate meals. To adjust to these 
changes in requests for services, most state and some local agencies 
utilized the flexibility provided by the law to transfer OAA funds 
among Title III programs.[Footnote 11] Agencies most commonly 
transferred funds from congregate meals to home-delivered meals or 
other Title III services. Nationally, from fiscal year 2000 through 
fiscal year 2008, states collectively transferred an average of $67 
million out of the congregate meal program each year (see Figure 2). 

Figure 2: Average Yearly Fund Transfers among Title III Programs, 
Fiscal Years 2000 through 2008: 

[Refer to PDF for image: illustration] 

Congregate meals to Home delivered meals: $34.4 million; 
Home delivered meals to Congregate meals: $87,000. 

Congregate meals to Support Services: $32.6 million; 
Support Services to Congregate meals: $139,000. 

Home delivered meals to Support Services: $3.5 million; 
Support Services to Home delivered meals: $983,000. 

Source: GAO analysis of AoA Fiscal Year 2000-2008 State Program 

[End of figure] 

Actions Needed to Reduce Administrative Overlap among Domestic Food 
Assistance Programs: 

In part because food insecurity is a national problem that affects not 
only older adults but also many other vulnerable groups, the federal 
government spent more than $90 billion on domestic food assistance 
programs in 2010. This represents an increase of approximately 44 
percent over 2008 spending, driven largely by increased spending on 
the SNAP. We identified 18 different federal programs that provide 
nutrition assistance, programs that emerged piecemeal over the past 
several decades to address a variety of needs. Agency officials and 
local providers have indicated that the multiple food assistance 
programs work together and provide various points of entry to the 
system to help increase access to food for vulnerable or target 
populations at high risk of malnutrition or hunger. Those officials 
and providers told us that, since no one program alone is intended to 
meet a household's full nutritional needs, the variety of food 
assistance programs can help households fill gaps and address the 
specific needs of individual members. However, we have previously 
reported signs of overlap and inefficient use of resources in the 
delivery of benefits through these programs. In addition to the 
Departments of Agriculture (USDA), Health and Human Services (HHS), 
and Homeland Security (DHS) multiple state and local government and 
nonprofit organizations work together to administer a complex network 
of programs and providers. 

We have found that some of these 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, SNAP. In fact, a recent AoA report conducted by 
Mathematica[Footnote 12] 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.[Footnote 13] 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. 

Moreover, not enough is known about the effectiveness of many of these 
programs. Research suggests that participation in 7 of the 18 
programs--including the Elderly Nutrition Program and SNAP--is 
associated with positive health and nutrition outcomes consistent with 
programs' goals.[Footnote 14] For example, studies on the Elderly 
Nutrition Program found that the program increases socialization and 
may have a positive effect on food security. In addition, research 
suggests the program improves participants' dietary and nutrient 
intake--an outcome related to the program's goal of promoting the 
health and wellbeing of older individuals by assisting such 
individuals to gain access to nutrition and other disease prevention 
and health promotion services to delay the onset of adverse health 
conditions resulting from poor nutritional health or sedentary 
behavior. However, little is known about the effectiveness of the 
remaining 11 programs because they have not been well studied. 

Agencies do regularly collect performance and other data on nutrition 
assistance programs but these data are not sufficient to determine 
program effectiveness and do not always provide all the information 
needed to effectively and efficiently manage their programs. Agency 
data show that the 11 less-studied programs provide food and nutrition 
assistance to millions of individuals and households each year--an 
outcome related to their goals--however, this alone does not 
demonstrate the overall effectiveness of these programs. Other data-- 
such as on need and unmet need for services--could help agencies 
better target limited resources and more efficiently serve their 
target populations but agencies often do not have this information. 
For example, while the OAA requires AoA to design and implement 
uniform data collection procedures for states to assess the receipt, 
need, and unmet need for Title III services,[Footnote 15] AoA does not 
provide standardized definitions or measurement procedures for need 
and unmet need that all states are required to use. Instead, AoA 
provides states with non-binding guidance on these issues and an 
assortment of tools and resources that they can use to evaluate need 
and limited information about measuring unmet need. States use a 
variety of approaches to measure need and measure unmet need to 
varying extents, but no agencies that we spoke with fully estimate the 
number of older adults with need and unmet need in their service area. 
Such information could help providers make informed decisions about 
serving those most in need as the number of older adults increases and 
resource constraints are likely to continue. 

In April 2010, we recommended that USDA, as the principal 
administrator of the federal government's food assistance programs, 
identify and develop methods for addressing potential inefficiencies 
among food assistance programs and reducing unnecessary overlap among 
its smaller food assistance programs while ensuring that those who are 
eligible receive the assistance they need. These methods could include 
conducting a study as a first step; convening a group of experts; 
identifying which of the lesser-studied programs need further research 
and taking steps to fill the research gap; or identifying and piloting 
proposed changes. 

Further, in February 2011 we recommended that, to help ensure that 
agencies have adequate and consistent information about older adults' 
needs and the extent to which they are met, the Secretary of Health 
and Human Services partner with other government agencies that provide 
services to older adults and, as appropriate, convene a panel or work 
group of researchers, agency officials, and others to develop 
consistent definitions of need and unmet need and to propose interim 
and long-term uniform data collection procedures for obtaining 
information on older adults with unmet needs for services provided 
from sources like Title III. 

In addition to our specific recommendations to USDA and HHS, we have 
also noted in prior work that agencies can reduce program 
inefficiencies by broadening their efforts to simplify, streamline, or 
better align eligibility procedures and criteria across programs to 
the extent that it is permitted by law. Consolidating or eliminating 
overlapping programs also have the potential to reduce administrative 
costs but may not reduce spending on benefits unless fewer individuals 
are served as a result. More broadly, essential to all these efforts 
is collaboration among many entities. Achieving meaningful results in 
many policy and program areas, including food and nutrition services, 
requires some combination of coordinated efforts among various actors 
across federal agencies with other governments at state and local 
levels and nongovernmental organizations. 


In conclusion, as I have outlined in my testimony, opportunities exist 
to streamline and more efficiently carry out these important domestic 
food assistance programs. Specifically, addressing duplication, 
overlap, and fragmentation could help to minimize the administrative 
burdens faced by those entities--including states and localities as 
well as nonprofit organizations--that are delivering these programs' 
services. Such administrative burdens range from eligibility 
requirements and the application process to costs associated with 
carrying out the program and reporting requirements. Improving 
consistency among these various requirements and processes as well as 
considering how multiple agencies could better coordinate their 
delivery of programs could result in benefits both for those providing 
and those receiving the services. In addition, collection of adequate 
and consistent information about older adults' needs and the extent to 
which they are met could help providers make informed decisions about 
serving those most in need. It is particularly important to use 
resources efficiently given that the need for meals programs among low-
income older adults will likely continue to outpace available services 
given the growing older population and continued economic constraints. 

Careful, thoughtful actions will be needed to address issues involving 
potential duplication, overlap, and fragmentation among federal 
programs and activities. These are difficult issues to address because 
they may require agencies and Congress to re-examine within and across 
various mission areas the fundamental structure, operation, funding, 
and performance of a number of long-standing federal programs or 
activities. Continued oversight will be critical to ensuring that 
unnecessary duplication, overlap, and fragmentation are addressed. 

Thank you, Mr. Chairman, Ranking Member Paul, and Members of the 
Subcommittee. This concludes my prepared statement. I would be pleased 
to answer any questions you may have. 

For further information on this testimony, please contact Kay Brown, 
Director, Education, Workforce, and Income Security, who may be 
reached at (202) 512-7215, or 

[End of section] 

Appendix I: Selected Federal Food and Nutrition Assistance Programs, 
by Agency: 


Item number: 1. 
Program name: Child and Adult Care Food Program. 

Item number: 2. 
Program name: Commodity Supplemental Food Program. 

Item number: 3. 
Program name: Community Food Projects Competitive Grant Program[A]. 

Item number: 4. 
Program name: Food Distribution Program on Indian Reservations. 

Item number: 5. 
Program name: Fresh Fruit and Vegetable Program. 

Item number: 6. 
Program name: National School Lunch Program. 

Item number: 7. 
Program name: Nutrition Assistance for Puerto Rico. 

Item number: 8. 
Program name: School Breakfast Program. 

Item number: 9. 
Program name: Senior Farmers' Market Nutrition Program. 

Item number: 10. 
Program name: Special Milk Program. 

Item number: 11. 
Program name: Summer Food Service Program. 

Item number: 12. 
Program name: Supplemental Nutrition Assistance Program (SNAP). 

Item number: 13. 
Program name: The Emergency Food Assistance Program. 

Item number: 14. 
Program name: WIC. 

Item number: 15. 
Program name: WIC Farmers' Market Nutrition Program. 

DHS Federal Emergency Management Agency: 

Item number: 16. 
Program name: Emergency Food and Shelter National Board Program. 

HHS Administration on Aging: 

Item number: 17. 
Program name: Elderly Nutrition Program: Home-Delivered and Congregate 
Nutrition Services. 

Item number: 18. 
Program name: Grants to American Indian, Alaska Native, and Native 
Hawaiian Organizations for Nutrition and Supportive Services. 

Source: GAO, Domestic Food Assistance: Complex System Benefits 
Millions, but Additional Efforts Could Address Potential Inefficiency 
and Overlap among Smaller Programs, GAO-10-346 (Washington, D.C.: Apr. 
15, 2010). 

[A] The Community Food Projects Competitive Grants Program is 
administered by the National Institute of Food and Agriculture 
(formerly the Cooperative State Research, Education, and Extension 
Service, CSREES) of USDA. All other USDA programs listed above are 
administered by the Food and Nutrition Service. Community Food 
Projects Competitive Grants Program participation information is from 
CSREES Update: September 17, 2009, Office of the Administrator, 

[End of table] 

[End of section] 


[1] Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42 U.S.C. 
§§ 3001-3058ff). 

[2] GAO, Domestic Food Assistance: Complex System Benefits Millions, 
but Additional Efforts Could Address Potential Inefficiency and 
Overlap among Smaller Programs, [hyperlink,], (Washington, D.C.: April 15, 

[3] GAO, Older Americas Act: More Should Be Done to Measure the Extent 
of Unmet Need for Services, [hyperlink,], (Washington, D.C.: February 
28, 2011). 

[4] We conducted a survey of 125 local agencies, with 99 agencies (79 
percent) responding, The percentages cited from this survey are 
subject to margins of error no more than plus or minus 12 percentage 
points at the 95 percent confidence level. 

[5] GAO, Opportunities to Reduce Potential Duplication in Government 
Programs, Save Tax Dollars, and Enhance Revenue, [hyperlink,], (Washington, D.C.: March 1, 

[6] Statutory Pay-As-You-Go Act of 2010, Pub. L. No. 111-139, § 21, 
124 Stat. 8, 29-30 (codified at 31 U.S.C. § 712 note). 

[7] Our analysis of meal program recipients and non-recipients was 
limited to those living in households below 185 percent of the poverty 
threshold because the CPS did not collect generalizable information 
for individuals with higher incomes. In addition to people age 60 and 
over, younger spouses living with people age 60 and over and people 
with disabilities of all ages in housing facilities occupied primarily 
by older people where congregate meals are served or who live with 
someone age 60 and over are also eligible for meals services through 
Title III. 42 U.S.C § 3030g-21(2)(I). Our estimates of older adults 
who are likely to need meals services also include these additional 
individuals. An estimated 31 percent of people age 60 and over were 
below 185 percent of the poverty threshold. 

[8] 42 U.S.C. §§ 3030e and 3030f. Nutrition services authorized under 
Title III Part C of the OAA are designed to provide balanced and 
nutritious meals at home or in a congregate setting. Home-delivered 
meals, commonly referred to as "Meals on Wheels," are typically 
provided to individuals who have health difficulties that limit their 
ability to obtain or prepare food. Congregate meals are served at a 
variety of sites, such as schools and adult day care centers, and 
serve older adults' social interaction needs, in addition to nutrition. 

[9] The CPS asked seniors whether they received home-delivered or 
congregate meals, but did not specify the source of the meals. 

[10] We aligned our definition of likely need with two of the three 
key purposes of the Elderly Nutrition Program as described in the OAA: 
(1) reducing hunger and food insecurity and (2) promoting 
socialization. 42 U.S.C. § 3030d-21. Given available data, we could 
not estimate the number of older adults likely to need services based 
on the third purpose of promoting health and well-being. Unless 
otherwise noted, our estimates of low-income older adults likely to 
need or receive meals services have a maximum confidence interval of 
+/-3.2 percentage points of the estimate. 

[11] OAA Title III authorizes a supportive services and senior centers 
program that covers, for example, health, transportation, ombudsman, 
nutrition, and education services, as well as home-delivered and 
congregate meals programs. 42 U.S.C. § 3030d. The OAA provides states 
with some authority to transfer federal funding allocations among 
programs. A state may transfer up to 40 percent of allocated funds for 
the home-delivered meals programs to the congregate meals program, or 
vice versa, and the Assistant Secretary of Aging can grant a waiver 
for a state to transfer an additional 10 percent.42 U.S.C. § 
3028(b)(4). In addition, a state may transfer up to 30 percent of 
allotted funds for Part B support services (such as transportation and 
home-based care) to the meal programs and vice versa, and the 
Assistant Secretary may grant a waiver of the 30 percent limit. 42 
U.S.C. § § 3028(b)(5) and 3030c-3(b)(4). 

[12] Allison Barrett and Jody Schimmel, Mathematica Policy Research, 
"Multiple Service Use Among OAA Title III Program Participants," 
September 2010 (Research Brief). 

[13] GAO, Domestic Food Assistance: Complex System Benefits Millions, 
but Additional Efforts Could Address Potential Inefficiency and 
Overlap Among Smaller Programs, [hyperlink,], (Washington, D.C.: April 15, 

[14] The other programs that show outcomes consistent with many of 
their program goals include: WIC, the National School Lunch Program, 
the School Breakfast Program, Nutrition Assistance for Puerto Rico, 
and the Special Milk Program. 

[15] 42 U.S.C. § 3012(a)(26). 

[End of section] 

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