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 OLDER
AMERICANS ACT NUTRITION PROGRAMS
TRAINING AND BEST PRACTICES
Administration
on Aging
National Nutrition Advisory Council Meeting
September 12 and 13, 1995
Doubletree Hotel, Arlington, Virginia
Drafted by JoAnn Pegues, M.P.A., R.D.
Region VIII Nutritionist
Administration on Aging
ISSUE: The issue facing the Administration
on Aging (AoA) is how does the AoA, and the National Nutrition Advisory
Council (Council) prepare the aging network to maximize resources, change
our paradigm of service provision and customer service by developing agreed-upon
training and best practices for a Federally-funded, State and Tribe-administered
Elderly Nutrition Program (ENP) that is diverse, multi-funded and changing
in nature.
BACKGROUND:
Nutrition services as funded under Title III, Parts C-1 and C-2 and Title
VI of the Older Americans Act (OAA) and collectively called the Elderly
Nutrition Program (ENP) are essential services that assist older individuals
in remaining independent and at home in the community. The AoA, which
administers these programs, is faced with a shrinking budget and a need
to provide national leadership, vision, direction and training to a network
of State Units on Aging (SUAs), Tribes, area agencies on aging (AAAs),
and nutrition service providers (NSP). AoA recognizes that moving the
ENP into the 21st century with limited resources, a growing population
of older persons particularly the 85+, presents both challenges and opportunities.
When
the ENP began in 1973, the AoA exhibited leadership and vision by providing
hands-on training, guidelines, and assistance to assure effective program
operations. By utilizing Title IV dollars a two week hands-on comprehensive
training was provided to project directors and staff. That two week training
provided the framework and knowledge base including data collection and
accounting procedures for every project director to operate a nutrition
program. In addition the administration invested in the development of
a "Guide to Effective Project Operations" (the Green Guide)
which presented in a clear and readable fashion, information essential
for those persons who had major responsibilities for providing nutrition
services under the OAA.
The
operational guide, developed at Oregon State University in cooperation
with other institutions, was prepared for and used by agencies, organizations,
and institutions that received a Title VII (now Title III C) OAA nutrition
project award. It became the single most valuable tool that providers
could utilize to obtain answers to numerous questions concerning federal
regulations and policy; understanding and meeting needs of older people;
guidance for supportive services and community resources; and other practical
information.
The
Title IV funded comprehensive nutrition training for project directors
continued through 1975 at Oregon State University and several other training
centers around the country. By that time most programs were up and running
with some level of efficiency.
During
the mid to late 1970s and 1980s the AoA provided Title IV-A funds to SUAs
to carry out training plans for staff development. The SUAs contracted
with organizations such as the Community Nutrition Institute (CNI) to
conduct topical training for nutrition providers and staff to meet various
needs identified in the state's training plan.
During
the 1980's AoA's leadership and vision for the ENP was minimal. Training
opportunities were limited and SUAs and AAAs sought other sources for
training and direction. Many states developed their own training resources.
CNI
received AoA Title IV funding to develop a number of training programs
and materials to be used for training nutrition program personnel.
In
1975 CNI developed a Training guide for Trainers.
In
1980 CNI developed training manuals on Storage, Purchasing, Menu Planning,
and Quantity Control.
In
1982 additional manuals were developed by CNI for use in the ENP: Volume
I, Program Management; Vol II, Site Management; Vol III, Financial Management;
and Vol IV, Training. These manuals were probably the most comprehensive
since the development of the Guide to Effective Project Operations and
many states still utilize them today as a supplement to the Green Guide.
In
1983 CNI developed the following tools: Auditing the Management of Nutrition
Service Providers; Improving Productivity in Nutrition Service Provision;
Controlling Food Service Costs Using a Systems Approach; and Off Site
Monitoring of Provider Food Service and Cost Control System.
Due
to limited national leadership, other agencies and organizations have
provided leadership and direction in training the ENPs such as the National
Association of Nutrition and Aging Service Programs (NANASP), National
Association of Meals Programs (NAMP), and The American Dietetic Association
(ADA).
In
the early 1990s funds were granted through the Discretionary Fund Program
(DFP) to NANASP and the National Association of State Units of Aging (NASUA)
to carry out a joint project called "Enhancement of Nutrition Services
for Older Americans". Two manuals were produced: (1) Preparing the
Nutrition Program for the Nineties and (2) Collection of Innovative Models.
Each state was provided one copy of the manuals.
In
1991 the Gerontological Nutritionists (GN), a practice group of The American
Dietetic Association, developed "Effective Menu Planning for the
Elderly Nutrition Program", a menu planning manual for the ENP under
Title III (C) of the OAA as amended. The manual addressed the fact that
in 1973 the meals were planned using the "Basic Four" food groups.
However, the OAA began requiring compliance with the Recommended Dietary
Allowances (RDAs) and the U.S. Dietary Guidelines. "Effective Menu
Planning for the Elderly Nutrition Program" sought to bridge the
gap since 1973. The manual was disseminated to all SUAs, Tribal Programs
and AoA Regional offices.
Minimum
Standards for the OAA Nutrition Programs were developed and presented
to the U.S. Senate Special Committee on Aging and the Committee on Agriculture,
Nutrition and Forestry by the ADA, NANASP, and NAMP in February, 1991.
These organizations felt that minimum standards should be developed at
the federal level, adequate funding provided in order to meet the nutritional
needs of older Americans, and reduce end costs of health care and improve
quality of life.
DISCUSSION:
Training, technical assistance and the dissemination of best practice
models are essential for the aging network in order to meet the changing
needs of older people, to accommodate expanding knowledge, to translate
research into practice, to increase skill levels, to stimulate innovation,
to insure good management and operations, to assure quality services,
to accommodate the changes in social and health services, to maximize
resources (financial as well as human resources), to eliminate barriers
and to form new partnerships and collaborative efforts.
In
addition to the reasons for providing training, the OAA requires the provision
of training at all levels of the aging network. The OAA states in Titles
II and IV [Sec. 202(a)(17) and Sec. 411(a)(2)] that the AoA has a responsibility
to provide training for personnel working in the aging network. In addition
the OAA provides that SUAs [Sec. 307(a)(17)] and AAAs [Sec. 306(a)(6)(B)]
also have a responsibility for providing training and technical assistance
to personnel of agencies and programs funded under the Act.
During
a time of national debate regarding the respective roles and responsibilities
of the Federal, Tribe, State and local entities in the provision of services,
the AoA and other levels of the hierarchy need to address the factors
influencing the need for training, what subject areas need to be addressed,
what methods should be used to accomplish training, and who can best address
these needs. At a time of uncertainty, the AoA can provide leadership
and direction and facilitate information exchange and dissemination.
Factors
Influencing Training
Factors influencing training and technical assistance needs and provision
at any level include at least the following: program itself, size, functions,
funding, clientele, level of sophistication; program goals and objectives,
activities, needs, expected outcomes; current knowledge and skill levels
of personnel; access to materials, training, technology;costs, long-term
as well as short-term; location (rural, urban) and place where training
occurs, senior center, nursing home, library, video or computer-assisted)
room, etc. and buy-in from decision-makers as well as rank and file.
Training
and technical assistance needs must be analyzed to determine how to plan,
develop, implement, and evaluate proposed strategies.
Training
and Technical Assistance Needs
Recently the AoA has looked at training needs in the aging network. In
1993, a joint survey of the States by the Office of the Inspector General
and the AoA found that SUAs lacked selected skills needed to carry out
requirements of the OAA in regard to training. Examples of training needs
related to nutrition programs included targeting, cost-sharing and managing
voluntary contributions, recruiting and managing volunteers, and nutrition
program issues.
In
1994, the AoA regional offices identified a broad range of weaknesses
in the ENPs in SUA and Title VI monitoring visits that needed to be addressed
through training and technical assistance. These weaknesses include basic
operational functions such as: sanitation and safety issues; purchasing;
meal cost accounting; data collection; lack of nutrition expertise; policies
and procedures; fiscal and accounting procedures; staff turnover; advisory
board functions and guidelines; volunteers; inadequate staff; coordination
with community resources; transportation problems; lack of nutrition education;
outdated equipment; decline in participants; modified meals; and increased
demand/need for home delivered meals.
Ways
to Provide Training
The methods used to provide training, technical assistance and disseminate
information regarding best practices are varied. Traditional methods remain
acceptable and accessible. However, the technology revolution is now.
The AoA as well as the aging network needs to recognize and use technology
effectively to allow the network to be partners in a learning organization
that strives to meet the needs of its customers.
According
to the 1994 SUA monitoring review data, none of the States who provided
technical assistance or training to address the identified weaknesses
indicated that they used technology as a means of accomplishing the goals.
The
new 60 year olds, 100 year olds, various cultures and ethnic groups bringing
unique value systems, all contribute to the diversity of the population
we now serve. Technology will provide opportunities to understand and
serve this diverse population in new and different ways.
Examples
of technological opportunities currently are available to the aging network
including those with training implications follow:
Interactive communications such as using:
- video-conferencing,
- nutrition
on the internet,
- interactive
kiosk at senior centers
Information
access such as using:
- CD-Rom,
- computer
technology for training, and record-keeping
- internet
access to nutrition research through:National Institute on Aging, or
to disseminate periodic nutrition services information
- the
AoA-funded, National Aging Information Center for client profiles, etc.,
- use
of National Aging Program Information System
- technology
colleges on cable;
Improved
service technology for individuals, services, and programs such as using:
- assistive
devices for impaired elderly
- computerized
inventory and menus
- blast
freezer technology
- laptop
computers for outreach, client
- nutrition
assessment, referral
In
addition to increased use of technology, the aging network needs to collaborate
and coordinate with other organizations and partners to maximize limited
resources, eliminate artificial barriers and expand the range of service
provision. For example, involving other public agencies such as parks
and recreation, law enforcement, and safety, and the private sector such
as food, food service, pharmaceutical companies, foundations, etc. enable
both groups to address their own agendas as well incorporate others. Establishing
and maintaining linkages with research and academic institutions, including
community colleges, allows for multiple learning opportunities as well
as sharing of resources.
At
a time of limited resources (financial as well as human), the aging network
is faced with the need to provide and receive expanded training and technical
assistance. However, the aging network also has the opportunity to develop
new ways to this through technology as well as through expanding collaborations
with new partners.
SUMMARY:
The AoA and the aging network are required by the OAA as well as by good
management practices to provide and receive training and technical assistance
and to disseminate best practice models. At a time of fiscal constraints,
diverse and ever increasing and changing program needs, and increased
technology use and changing ways to provide training, the AoA and the
Council need to assist the aging network in meeting the training challenges
of the uncertain future.
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