Applicants will be expected to demonstrate extensive knowledge and present a proven track record of expertise concerning the nature of nutrition for older individuals and the business of nutrition program administration within the aging network. Individuals, foreign entities and sole proprietorship organizations are not eligible to compete for, or receive, awards made under this announcement.
The OAA provides funding to States and Tribal Organizations to support a broad array of services that support an older adult’s ability to continue to reside within their homes and communities for as long as possible. The statutory purposes of the OAA Titles III-C nutrition program is to reduce hunger and food insecurity, promote socialization and promote health and well-being through providing a nutritious meal. These purposes are accomplished through the provision of not only a healthy meal, but also providing access to a range of services (nutrition screening, education, and counseling), opportunities for social engagement, and information on healthy aging. The OAA Nutrition Services Program (NSP) meal often acts as the initial service or gateway for other home-and community-based services such as homemaker and home-health aide services, transportation, physical activity and chronic disease self-management programs, and home repair and modification. OAA programming is person centered, in an effort to provide the correct mix of services, which contribute to an older individual’s overall well-being and play a vital role in ensuring older adult’s ability to maintain their independence.
Several studies have validated the benefits of the NSP effect on helping participants remain healthy in an effort to continue to reside within their home. For example, research indicates that food insecure older adults have worse health outcomes when compared to food secure seniors.  The 2018 outcome evaluation showed that the Titles III-C and VI nutrition programs are decreasing participant’s food insecurity, especially for low-income older adults, the report found that lower-income congregate NSP participants were significantly less food insecure than low-income nonparticipants.
Furthermore, the prevalence of chronic conditions, such as diabetes, heart disease, cancer, and depression, increases as one ages. According to the Centers for Disease Control and Prevention, approximately 85 percent of older adults have at least one chronic health condition, and 60 percent have at least two conditions. Chronic diseases have significant economic costs (i.e., healthcare spending), as well as human costs (i.e., loss of independence). And, chronic conditions are also a leading cause of disability in later age. The Morbidity and Mortality Weekly Report (MMWR) published in 2018 by the Center for Disease Control found that approximately 2 in 5 adults in this age group have a disability.  Advanced chronic conditions and/or disability can often result in increased hospitalizations and needing long-term care and supports. The 2018 outcome evaluation found that congregate meal program participants utilized less Medicare-funded healthcare.  They were less likely to have hospital admissions, less likely to have emergency department visits that led to a hospital admission, and less likely to have a nursing home admission.
Additional research has demonstrated that states that invest in the home delivered meal program have fewer institutionalized older adults.  Additional research is needed to test new approaches for enhancing the efficacy of the NSP. This could be the development of innovations, further testing of promising practices or evidence-based approaches, and additional evaluations to further clarify previous research findings (i.e., examining program impact in a way that takes into account local program variation). [6,7,8]
Purpose and Goals
The purpose of this funding opportunity is to support systematic testing and documentation of innovative and promising practices that enhance the quality, effectiveness, and other proven outcomes of nutrition services programs within the aging services network. It is critical that ACL work with the aging services network (i.e., State Units on Aging, Area Agencies on Aging (AAA), and local partners) to modernize these services to ensure that the NSP is achieving its intended outcomes, and that every dollar is spent effectively to ensure the sustainability of these services.
Within the OAA programs, ACL has historically used innovation dollars provided under Title IV of the Act as a means of testing new approaches to service delivery and developing replicable models that could then be embedded into the core delivery programs authorized under Titles III, VI, and VII. One example of how this approach has been used effectively is the Title III-D Preventive Health Services Program. Starting in 2003, ACL used dollars provided under the Title IV Program Innovations budget to begin testing evidence-based models for delivering health services in community-based settings across a variety of areas, including Chronic Disease Self-Management, Falls Prevention, Enhanced Fitness, and Medication Management. As these models proved more successful than traditional approaches, States increasingly shifted their funding to provide greater support to evidence-based approaches. Additionally, building and strengthening the business acumen of nutrition providers is of critical importance to ensure that the capacity of the network keeps pace with demand, in spite of limited federal resources.
The goal of this funding opportunity is to enhance the quality, effectiveness and proven outcomes of nutrition services programs within the aging services network. Translating previously generated knowledge into evidence-based models for delivering nutrition program services and programs at the community level is essential to ensuring the continued efficacy of these programs while improving their efficiency.
Projects proposed under this funding opportunity must have the potential for broad implementation throughout the aging services network and have demonstrated value, i.e., improvements in participant well-being, cost savings, etc. Applicants must explain how they see this proposal as innovative/promising, explain its potential impact on the aging services network, and explain how broad implementation and scaling of this innovation/promising practice can be achieved (should the project prove successful). Innovations must target services to underserved older adults with greatest social and economic need, and individuals at risk for institutional placement, to permit such individuals to remain in home and community-based settings as indicated in the OAA.
Applicants’ proposals must focus on at least one of the following areas:
Creating partnerships between Universities, Tribal Colleges and Universities (TCUs), and/or other research organizations in collaboration with aging services network organizations to develop or test innovative evidence-based programs or practices for senior nutrition - examples could include, but are not limited to:
Testing or piloting nutrition programs with the potential of meeting Title III-D standards, developing nutrition related promising practices that extend the time people can safely remain in their home, and efforts that focus on enhancing the quality and effectiveness of older adult nutrition programs services.
Modernizing the congregate and/or home delivered meal program infrastructure, delivery mechanisms, and/or marketing and outreach that can be used by the aging services network - examples could include, but are not limited to:
Decreasing food waste, increasing meals served and consumed, decreasing overhead cost, increasing revenues, developing new approaches for volunteer recruitment and retention, increasing person-centered practice models that address food preferences of participants, incorporating traditional activities such as dancing, intergenerational food practices and demonstrations for healthy eating to enhance cultural continuity, holistic communities, eco-friendly delivery mechanisms, incorporating traditional foods and food practices (such as foraging, hunting and fishing donations) in Title VI programs to decrease program costs and enhance cultural practices , and/or similar strategies.
Enhancing partnerships with health care partners, Indian Health clinics, and community partnerships to further demonstrate the network's value in solving local and national problems, and/or increasing business acumen opportunities - examples could include, but are not limited to:
Decreasing social isolation, food insecurity, and developing effective suicide prevention strategies, promoting the bidirectional relationship between diet/nutrition and oral health in older adults, services that complement medical services, decreasing fall risk by increasing meal delivery, and targeting people with specific health condition(s) in an effort to decrease overall health care utilization of that population.
Advancing the use technology within the aging services network - examples could include, but are not limited to:
Investigating sustainable telehealth applicability for the network, developing web-based ordering systems, improving business practices, improving participants health, and establishing feedback procedures in the aging services network.
An innovation must be a product, service, or process that is new (or a significant enhancement) and can be replicated by the aging services network using OAA funding. Applicants should ask themselves the question, "is this truly innovative" when conceptualizing ideas.
 Gundersen, C. & Ziliak, J. (2017). The Health Consequences of Senior Hunger in the United States: Evidence from the 1999-2014 NHANES. Report submitted to Feeding America.
Mabli, J et al (2017): Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet Quality
 Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:882–887. DOI: http://dx.doi.org/10.15585/mmwr.mm6732a3
 Mabli, J et al (2018) Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization
Thomas K. and V. Mor. The Relationship Between Older Americans Act Title III State Expenditures And Prevalence Of Low-Care Nursing Home Residents, Health Serv Res. 2013; 48 (3): 1215–26
 Wright, L., Vance L., Sudduth C. & Epps J. (2015). The Impact of a Home-Delivered Meal Program on Nutritional Risk, Dietary Intake, Food Security, Loneliness, and Social Well-Being, Journal of Nutrition in Gerontology and Geriatrics, 34:2, 218-227, DOI: 10.1080/21551197.2015.1022681
 Mabli, J et al (2017):Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet Quality
 Malbi, J. et al (2018) Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization