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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.