Nutrition Assistance
Additional Efficiencies Could Improve Services to Older Adults Gao ID: GAO-11-782T June 21, 2011This 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.
GAO-11-782T, Nutrition Assistance: Additional Efficiencies Could Improve Services to Older Adults
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United States Government Accountability Office:
GAO:
Testimony:
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:
GAO-11-782T:
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
services.
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
conclusions.
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
foods.
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
Reports.
[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.
Conclusion:
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 BrownKE@gao.gov.
[End of section]
Appendix I: Selected Federal Food and Nutrition Assistance Programs,
by Agency:
USDA:
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,
CSREES, USDA.
[End of table]
[End of section]
Footnotes:
[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,
http://www.gao.gov/products/GAO-10-346], (Washington, D.C.: April 15,
2010).
[3] GAO, Older Americas Act: More Should Be Done to Measure the Extent
of Unmet Need for Services, [hyperlink,
http://www.gao.gov/products/GAO-11-237], (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,
http://www.gao.gov/products/GAO-11-318SP], (Washington, D.C.: March 1,
2011).
[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,
http://www.gao.gov/products/GAO-10-346], (Washington, D.C.: April 15,
2010).
[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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