As we consider centralized kitchens for multigenerational populations, it is important to understand how these two funding programs are structured and the requirements associated with each in order to anticipate points of efficiency and points of conflict that may occur as the programs are integrated. The federal government provides subsidies for both older adults and early childcare meals. These funding programs come with nutritional and safety requirements for the meals, and policies for tracking meals and applying for reimbursements. While the majority of funding for older adult meals comes through a block grant, both programs rely on
reimbursement subsidies from the USDA to fund their meal program. The regulations for the early childcare meals reimbursement program, however, comes with many more requirements and stipulations. This section will describe the major funding programs for senior meals and ECE meals, in an effort to develop a thorough understanding of the policy and financial environment for integration of these meal programs.
Senior Meal Programs – Congregate Meal and Home-Delivery Meal Programs
Under Title III-C of the Older American Act, the Administration on Aging (AoA) within the U.S Department of Health and Human Services Administration for Community Living (ACL) is authorized as the administrator the Nutrition Services Program for older adults. Nutrition services include the Congregate Meal Program and the Home-Delivered Meals program for individuals age 60 and older. The congregate meal program programs provide a meal in a group setting for individuals 60, while the home-delivered meal program is intended for individuals who are physically or mentally unable to obtain food, or who are unable to
participate in the congregate nutrition program. Both programs must adhere the current dietary guidelines for Americans, provide a minimum of one-third of the daily dietary reference intakes, meet state and local food safety and sanitations rules, and be appealing to older adults (Anon 2018a) The ACL provides grants to each state to support their nutrition services for older adults. These services are intended to promote the general health and well-being of older adults,
specifically through “reducing hunger and food insecurity, promoting socialization, and delaying the onset of adverse health conditions” (Anon 2018a). These services specifically target low- income adults, minority older adults, older adults in rural community and older adults with limited English proficiency.
In North Carolina, funding from the Older Americans Act is managed by 16 regional Area Agencies on Aging (AAAs) that distribute the Home and Community Care Block Grant (HCCBG) funds to each county in their AAA region using a formula based on population
estimates. HCCBG provides funds for 18 services for older adults, including the congregate meal program and the home-delivered meal program. While the AAA provides recommended
percentages for how to use the funds (for example, a recommended 33% spent on nutrition services), the HCCBG funding is an agreement with the county and county commissioners have the final say in how the funds are allocated. Ideally a citizen advisory group will recommend which leading agencies receive the funding, and the commissioners will approve it. The
distribution of funding for services looks different in each county, with some counties having a more centralized service structure coordinated by a single agency, whereas others have services distributed among multiple local agencies (Pollan 2018c).
In addition to the HCCBG funds, the USDA Nutrition Services Incentive Program (NSIP) provides reimbursement incentives to serve supplemental meals. The supplement is
intended to promote the use of U.S. grown agricultural products in various nutrition programs. Reimbursement grantees can choose to receive the reimbursement grant as cash, commodities (food), or a combination of cash and commodities. Like HCCCBG, NSIP funds are disbursed the AAA to further subsidize Title 3-C nutrition programs. Reimbursement of funds is based on the number of meals delivered by the provider agencies to older adults and reported to the AAA. Currently, the reimbursement rate is $0.75 per meal (Anon 2018b). Many agencies use NSIP funding to stretch their block grant funds to be able to serve a greater number of older adults (Pollan 2018c).
According to Mary Warren, the Director of the Triangle J AAA, the Title III-C funding for nutrition services has been quite successful in protecting its current level of funding, much in part to the strong public support for these programs and strong advocacy efforts of Meals on Wheels. Nutrition Services is also one of the least costly services, meaning that a small increase in funding can benefit many people. Thus, in terms of funding, the program is considered to be stable and relatively well-supported (Pollan 2018c).
Early Childhood Meals – Child and Adult Care Food Program (CACFP)
The Child and Adult Care Food Program (CACFP) is a broad, federally funded program administered and funded by the USDA’s Food and Nutrition Services. CACFP provides financial support for nutritious meals served to low-income children in ECE centers. The federal
government sets income-based eligibility criteria for CACFP participation (Zaltz et al. 2018). Participating ECE centers are required to meet specific nutritional standards for fruits and vegetables, milk, whole grains, meats, and added sugars for the one or more meal types they serve, including breakfast, lunch and/or snack. Meals served to children are reimbursed at rates based upon a child’s eligibility for free and/or reduced price meals. In North Carolina in 2018,
the set CACFP reimbursement rates are as follows: $1.79 for breakfast, $3.31 for lunch, and $0.90 for snack. Centers utilizing CACFP must submit accurate monthly claims for
reimbursement to their state administering agencies through the assistance of CACFP sponsors at the local level. Reimbursements are based on the number days the center is operating and the number of children being served per a meal on each of those days. Based on these totals, the center can see its potential reimbursement from USDA (Pollan 2018d).
CACFP allows for the participation of selected adult day care facilities, an expansion of the program initiated by the Older Americans Act. CACFP is not, however, an additional source of funding for general use on older adult meals. In fact, meals served to older adults which are claimed for reimbursement under Title III-C of the Older Americans Act cannot be claimed under CACFP (Anon 2014).
According to ECE nutrition services practitioners, CACFP reimbursement rates have stayed relatively stable because it is a federally funded programs. However, they commented what has changed is the nutritional guidelines for the program, including the inclusion of a daily whole grain, additional fresh fruits and vegetables, and minimizing of processed foods. These changes result in a higher cost of food, and therefore, even as the reimbursement rate remains stable, the funding has become more stringent to compensate for these new nutritional changes (Pollan 2018d).
Bibliography
Accius, J. 2008. NUTRITION ASSISTANCE FOR OLDER AMERICANS: Fact Sheet. AARP Public Policy Institute.
Administration for Community Living 2016. Profile of State OAA Programs: North Carolina - Part F: Program Income Earned [Online]. Available at: https://agid.acl.gov/StateProfiles/Profile/ Pre/?id=35&topic=10&years=2016 [Accessed: 11 December 2018].
Anon 2014. Child and Adult Care Food Program (CACFP): Why CACFP Is Important [Online]. Available at: https://www.fns.usda.gov/cacfp/why-cacfp-important [Accessed: 11 December 2018].
Anon 2015. Equitable Development Toolkit: Local Food Procurement. PolicyLink. Anon 2016. Food Runners Collaborative [Online]. Available at: http://foodrunnersnc.org/ [Accessed: 18 February 2019].
Anon 2010. Institutional Food Purchasing. Michigan Good Food.
Anon 2018a. Nutrition Services [Online]. Available at: https://acl.gov/programs/health-wellness/ nutrition-services [Accessed: 11 December 2018].
Anon 2018b. Special Programs for the Aging - Title III-C Nutrition Services and Nutrition Services Incentive Program (NSIP). N.C. Department of Health and Human Services: Division of Aging and Adult Services.
Anon 2018c. Trend: Food Insecurity - Seniors, North Carolina, United States [Online]. Available at: https://www.americashealthrankings.org/explore/senior/measure/food_insecurity_sr/state/NC [Accessed: 11 December 2018].
Anon WealthWorks value chain defining characteristics [Online]. Available at:
https://www.wealthworks.org/basics/construct-wealthworks-value-chain/wealthworks-value- chain-defining-characteristics [Accessed: 11 December 2018].
Center for Disease Control and Prevention 2017. Nutrition, Physical Activity, and Obesity: Data, Trends and Maps - North Carolina [Online]. Available at:
https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?
rdReport=DNPAO_DTM.ExploreByLocation&rdRequestForwarding=Form [Accessed: 31 March 2019].
Child care Services Association 2018. About Us [Online]. Available at: https://childcareservices.org/au/about-us/ [Accessed: 1 April 2019].
Feenstra, G., Allen, P., Hardesty, S., Ohmart, J. and Perez, J. 2011. Using a Supply Chain Analysis To Assess the Sustainability of Farm-to-Institution Programs. Journal of Agriculture, Food Systems, and Community Development 1(4), pp. 1–16.
Fitch, C. and Santo, R. 2016. Instituting Change: An Overview of Institutional Food
Procurement and Recommendations for Improvement. The Johns Hopkins Center for a Livable Future.
Harris, D., Lott, M., Lakins, V., Bowden, B. and Kimmons, J. 2012. Farm to institution: creating access to healthy local and regional foods. Advances in nutrition (Bethesda, Md.) 3(3), pp. 343– 349.
Health Care Without Harm Healthy Food in Health Care [Online]. Available at: https://noharm- uscanada.org/healthyfoodinhealthcare [Accessed: 18 March 2019].
Hodgson, K. 2011. Multigenerational Planning: Using smart growth and universal design to link the needs of children and the aging population. American Planning Association.
Johnson, J. and Parnell, A. 2017. : The Challenges and Opportunities of the American Demographic Shift. Journal of the American Society on Aging 40(4), pp. 9–15.
Miller, D. 2018. Where Are Retirees Moving – 2018 Edition [Online]. Available at:
https://smartasset.com/retirement/where-are-retirees-moving-2018-edition [Accessed: 26 March 2019].
Olinger, J., Reece, J. and Usher, K. 2015. Anchoring Equitable Development: Anchor Institute- Led Models of Housing & Community Development to Strengthen Institutions and Communities.
The Kirwan Institute For The Study Of Race & Ethnicity: The Ohio State University.
Pollan, H. 2019a. Conversation with Dennis Streets, Executive Director of the Chatham County Council on Aging.
Pollan, H. 2018a. Interview with Brownie Doss, Director of Older Adult Services at WAGNES NC.
Pollan, H. 2019b. Interview with Kevin Underwood, Director of Operations and Christina Ogden, Executive Director, of Food Runners Collaborative.
Pollan, H. 2018b. Interview with Lisa Menna, Kitchen Manager of Child Care Services Association.
Pollan, H. 2018c. Interview with Mary Warren, Director of Triangle J Area Agency on Aging. Pollan, H. 2019c. Interview with Orange County Department on Aging.
Pollan, H. 2018d. Interview with Wanda Becton, WAGES NC Health Services Manager. Richman, N.J., Allison, P.H. and Leighton, H.R. 2019. Farm to institution new England: mobilizing the power of a region’s institutions to transform a region’s food system. In:
Institutions as conscious food consumers. Elsevier, pp. 175–194.
Warner, M. and Greenhouse, E. 2010. Multi-generational community planning: Linking the needs of children and older adults. Department of City and Regional Planning, Cornell University.
Working Landscapes 2018. Growing Opportunities: Building Farm-to-Fork Connections in Northeastern North Carolina.
Zaltz, D.A., Pate, R.R., O’Neill, J.R., Neelon, B. and Benjamin-Neelon, S.E. 2018. Barriers and Facilitators to Compliance with a State Healthy Eating Policy in Early Care and Education Centers. Childhood obesity (Print) 14(6), pp. 349–357.