GAO: Food Assistance, SDOH Programs See Little Nutrition Oversight – PatientEngagementHIT.com

By | January 3, 2020

By Sara Heath

– Federal food assistance programs aimed at addressing population health issues in older adult patients could benefit from better oversight and regulation, according to a recent report from the Government Accountability Office (GAO).

The report, which focused on six federally sponsored food assistance programs targeting older adults over age 65, revealed that although these programs have nutrition standards, there is little oversight for regulating those standards. Future guidelines for these programs, set to be published for 2025, should take that oversight into account.

This report comes as the medical industry contends with a growing senior population, GAO acknowledged. By 2030, the US Census Bureau predicts about one in five Americans will be over the age of 65, and with that the nation will see a unique set of health challenges.

HHS and other federal agencies have begun to address those health challenges, including by targeting key social determinants of health like food security. Food security is an especially pronounced issue for older populations, who disproportionately experience chronic conditions that require special diets, like diabetes or heart disease.

Older adults also sometimes experience personal barriers, like loss of appetite, that keep them from sticking to a healthy diet.

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HHS and USDA have developed a handful of food assistance programs aimed to help to keep senior patients healthy, including:

  • Home-delivery and congregate food programs, which improve access to prepared meals
  • The Child and Adult Care Food Program (CACFP), which gives children and older adults access to food in daycare settings
  • Commodity supplemental food programs (CSFPs), which include SNAP and Senior Farmers’ Market Nutrition Program, and give seniors resources to purchase their own foods
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Specifically, the agency reviewed the programs for federal nutrition requirements, oversight of those requirements, and the challenges that program providers face in meeting older adults’ needs.

GAO also visited 60 food assistance sites in Arizona, Louisiana, Michigan, and Vermont, as well as conducted interviews with HHS, USDA, states, national organizations, and local providers.

GAO found that some, but not all, of the food assistance programs have certain nutritional requirements. For example, home-delivery and congregate programs through HHS require certain proportions of fruits, vegetables, grains, and proteins to be included in each basket. These programs also require portion sizes to be consistent with national nutrition standards.

These programs also include flexibility to design meals that appeal to older adults.

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Meals and snacks provided as part of CACFP are likewise subject to certain nutritional regulations. These regulations call for a certain proportion of fruits and vegetables, as well as other food groups. Meals and snacks provided through this program also need to allow for certain dietary needs, such as for individuals with diabetes or heart disease.

Programs that fall under CSFP do not have nutritional requirements attached to them.

GAO also reported on certain programs that drive patient education to empower older adults to make better food and nutritional choices.

“Three of the four selected nutrition assistance programs serving older adults that have nutrition requirements also require nutrition education to support efforts to meet older adults’ nutritional needs,” the GAO report authors said. “These programs are HHS’s congregate and home-delivered meal programs and USDA’s CSFP, which provides monthly food packages.”

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These types of educational sessions are a requirement for congregate or meal-delivery services, although HHS confirmed there are no regulations for the frequency or content of these educational programs.

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There are also some patient education requirements included in CSFP programs, and in many locations, they offered resources in multiple languages and with other accommodations to meet the needs of specific cultures.

All of these programs include screening and access requirements, GAO reported.

Despite these regulations, GAO found that HHS has limited oversight of the programs.

For home-delivery and congregate programs, state health and human services departments have been tasked with reviewing regional food assistance program rollout, and regional HHS offices oversee the states. In that exchange, HHS yields very little information about statewide compliance with nutritional regulations, including limited access to program menus.

CACFP and CSFP services also saw limited oversight.

And there were other issues to manage, too, GAO added. For congregate and home-delivery meal kits, GAO’s own assessment revealed high levels of sodium and saturated fats. While these meal kits included the requisite levels of key vitamins and minerals, they also included higher levels of certain negative nutritional components.

Clinicians treating older patients who might benefit from food assistance programs also reported some issues, GAO said. Specifically, providers reported limited financial resources in light of the influx of older adult patients seeking food assistance. Additionally, providers reported issues addressing specific diet accommodations for patients.

GAO said HHS and USDA should account for these shortcomings in its 2025-2030 Dietary Guidelines.

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“A plan to incorporate the varied needs of older adults into the dietary guidelines could assist older adults with making their own dietary decisions and help providers of nutrition assistance programs better meet older adults’ nutritional needs,” the agency wrote.

Specifically, the guidelines should require state offices to conduct more stringent oversight about nutritional compliance, better monitoring of CACFP nutritional guidelines, centralization of nutritional information, and strengthening of the knowledge-base to deliver food plans that better meet nutritional needs for older adults.

HHS and USDA generally concurred with GAO’s recommendations.


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