Requirements for Nutrition ServicesACUU, June 3, 2014

Erin Anne Purcell, Aging Services Program Analyst, Division of Policy, Planning, Programs and Outcomes, New York State Office for the Aging,Jenifer O’Keefe, MS, RD, Aging Services Nutrition Consultant, Division ofAging Network Operations, New York State for the AgingLynn Hart, MS, RD, CDN, Aging Services Nutrition Consultant, Division ofAging Network Operations, New York State Office for the AgingMonica Seeber, RD, Public Health Nutritionist, CACFP, State of New York,Department of Health

Learning Objectives:

Participate in a discussion on menu planning, nutrient content and

therapeutic/religious/ethnic diets as they relate to nutrition services for older adults.

Learn about the requirements in NYSOFA’s nutrition regulations and how to participate in the Child and Adult Care Food Program (CACFP).Take away best practices and sample menus.

OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK, TITLE 9. EXECUTIVE DEPARTMENT SUBTITLE Y. NEW YORK STATE OFFICE FOR THE AGING CHAPTER II. OLDER AMERICANS, COMMUNITY SERVICES, AND EXPANDED IN-HOME SERVICES FOR THE ELDERLY PROGRAMS, PART 6654. SERVICES:

* Section 6654.20.* Social adult day care programs.

Establishes minimum requirements: service and administration standards for the operation of “SADS”

Defines a SADS program as a structured, comprehensive day program in a protective setting for less than a 24-hour period

Provides functionally impaired individuals with core and optional services

Functional Impairment- needing the assistance of another person in at least one of the following ADLs:◦ Toileting (including incontinence care)◦ Mobility and Transfers◦ Eating

Or needing supervision due to cognitive and/or psycho-social impairment

And will benefit from participation in the program

The program shall serve only individuals whose needs can be met and managed by the program

An assessment of functional capacities and impairments must be conducted prior to admission, includes eating

Each participant shall receive services only in accordance with an individualized written service plan developed by the program staff in conjunction with the participant

Based on the assessment and consistent with the needs of the participant

The plan shall be developed in consultation with the participant and or participant’s informal caregiver(s)

Socialization, Supervision and Monitoring Personal Care: hands on assistance with

toileting, mobility, transfers, and eating. Nutrition: providing meals at normal meal

times, and snacks and beverages at appropriate times

Providing meals at normal meal times, and snacks and beverages at appropriate times◦ Meal standards: meet the NYSOFA requirements

for a nutrition program for the elderly OR the program participates in the USDA Child and Adult Care Food Program

Programs shall establish, follow and have on file for review written policies and procedures consistent with SADS regulations, including:

Services Delivery

SocializationSupervision and Monitoring

Personal Care Nutrition

Optional Services

Identifies which nutritional standards will be met:

NYSOFA requirements for a nutrition program for the elderly

OR the program participates in the USDA Child and Adult Care Food Program

Identifies therapeutic, religious and ethnic options that will be made available to participants … THAT MEET THE NUTRITIONAL STANDARDS

Identifies designated staff roles to be responsible for the nutrition services

May include nutrition assessments, nutrition education and nutrition counseling

NYSOFA MINIMUM DATA SET (April 2014) Data Elements To Be Collected For The Following Services: Personal Care Levels 1 & 2, Case Management, Home Health Aide Services, Home Delivered Meals, Consumer Directed In-Home and Social Adult Day Care

Reported Height: Feet /Inches. Reported Weight: Pounds. Body Mass Index:

Refrigerator/freezer and cooking facilities adequate?

Able to open containers/cartons and to cut-up food? Use nutritional supplements? Have a physician diagnosed food allergy? Have a physician prescribed modified/therapeutic

diet?

Yes or No1. Client has illness/condition that changes kind/amount of food eaten, 2. Eats fewer than 2 meals/day, 3. Eats few fruits or vegetables, or milk products, 4. Has 3+ drinks of beer/wine/liquor almost every day, 5. Has tooth/mouth problems making it hard to eat,6. Does not always have enough money to buy food needed, 7. Eats alone most of the time, 8. Takes 3+ prescribed/over-the-counter drugs/day, 9. Lost or gained 10 pounds in last 6 months,10. Not always able to physically shop, cook and/or feed self.

Score by adding the numbers of those factors that were answered Y. A score of 6 or more indicates "High" nutritional risk, 3-5 indicates "Moderate" nutritional risk and 2 or less indicates "Low" nutritional risk

Smelling impairment, Taste impairment Speech problems, Stroke (pockets food on

one side of mouth), Swallowing difficulties Visual, perceptive and spatial impairments Poor teeth, poor fitting dentures and lack of

dental care/ dental hygiene Physical impairment, arthritis, need for

special positioning/adaptive equipment when eating

Dementia and neurological impairments

Personal care assistance with eating Determined from participant assessments

what types of interventions are needed

Adaptive equipment Positioning Physical prompts, verbal cueing Supervision to prevent choking Textures

Dining is a social experience, make it enjoyable! Background music, real dishes and silverware, placemats, tablecloths, flowers, centerpieces… and offer alternate meal choices

Arrange for a speech therapist or occupational therapist to conduct training on eating/feeding

Set up food and beverage items before serving Participants with dementia may benefit from

finger foods or many small servings Scheduled toileting and hand washing Have staff eat with participants

Arrange for a Registered Dietitian to train staff on the importance of good nutrition

Discuss menus with participants using reminiscence to stimulate attention and appetite during meals

Provide a short rest period after a meal Combine food items with activity themes,

cultural and educational programming Get feedback from participants and

caregivers

Adult Day Services must meet the nutrition requirements in the NYSOFA regulations

It is more than providing a lunch Nutrition services support healthy living,

combats chronic diseases and provides sensory stimulation

Staff eating/feeding interventions can help participants to be as independent as possible

Erin Anne PurcellDivision of Policy, Planning, Programs and

OutcomesNew York State Office for the Aging

2 Empire State Plaza, Albany NY 12333518-474-5478

Erin.purcell@aging.ny.gov

The “A” in the Child and Adult Care Food Program

(CACFP)

Eligible programs must provide nonresidential day care services to functionally impaired adults.

Public or private nonprofit and for-profit organizations are eligible if they are approved by a government agency to provide a structured and comprehensive community based day care program.

The program must provide the same meal service to all individuals enrolled in care, regardless of individual CACFP eligibility or funding.

Eligible – day treatment programs or day habilitation programs serving mentally or physically disabled adults, or programs serving people with Alzheimer’s disease.

Not Eligible – sheltered workshops, vocational programs, and substance abuse programs do not meet the CACFP definition of adult day care.

Must have federal, state, or local government approval to serve impaired adults (OMH, OPWDD, NYSOFA, OHSM)

Must maintain a Plan of Care for each individual in care

In the case of a “For-Profit” organization◦ > 25% of adults in care must be directly paid for

by Medicaid

If a program receives Title III of the Older Americans Act funding for meals provided to day care participants, (“Congregate meals”) those meals are NOT eligible for CACFP reimbursement

Living in the community or residing with family or other caregivers who would benefit from the

respite which adult programs provide.

“Living in the Community”

Living in a household – their own, with relatives or foster care setting

A community residence which may be subsidized and house one or more individuals who are primarily responsible for their own care

A group or Adult home An apartment, including an enriched housing

facility

Institutionalized persons (i.e. those in hospital, nursing home, or intermediate care facilities are NOT eligible for participation)

Amount of reimbursement is based on……

Number of eligible meals served

The type of meals served

The income level of participants

Serve meals that meet the CACFP HEALTHY MEAL PATTERN requirements for Adults.

Reimbursement

is based on the service of a complete meal.

SERVE: THREE REQUIRED FOOD COMPONENTS (GROUPS)

1. Fluid Milk

2. Fruit or Vegetable or Juice

3. Grains or Breads

SERVE: FOUR REQUIRED FOOD COMPONENTS (GROUPS)

1. Fluid Milk2. Vegetables and/or Fruits - 2 different 3. Grains or Breads4. Meat or Meat Alternates

*Note: Must serve 5 different food items at this meal

SERVE: TWO DIFFERENT FOOD COMPONENTS (GROUPS)

What about:

“Common” snack foods like: pudding, Jell-O, popcorn, and ice cream?

Cranberry Juice

Fruit pie

Old New

Breakfast 2% Milk

Orange Juice

Honey Comb Cereal

Lunch 2% Milk

Meatloaf w/gravy

Mashed potatoes

Canned Peaches

White Bread

Snack Coffee or Tea

Granola Bar

Improve menus by: Serving fresh

fruits/vegetables at every meal

Increasing whole grains Serving more legumes Choosing lower fat items Serving 1% or skim milk

a)Totalb)Product 19c)Special Kd)Shredded wheate)Cream of wheat

Adequate amounts of:

Calcium Vitamin D Vitamin B12

Fluids

Calcium – adding extra low-fat milk and dairy products to meals and snacks.

Vitamin D – milk, salmon, sardines, tuna, and other fatty fish.

Vitamin B-12 – meats, fish, eggs, dairy and fortified food, including cereals, i.e. raisin bran (a whole grain!)

Fluids – actively offer fluids (especially water) several times a day.

NYS DOH CACFP150 Broadway 6th

Floor WestAlbany, NY 12204-2719

518-402-74001-800-942-3858,

option #4

http://www.health.ny.gov/cacfp

New York State Office for the Aging (NYSOFA)Nutrition Program

Standards

59 local offices for the aging in NYS (AAA Area

Agency’s on Aging)

The Dietary Guidelines for Americans

Dietary Reference Intake (DRI’S)

* DRI’s – Nutrient Values for Meal Planning

* Dietary Guidelines for Americans * Suffolk County Sample 1 week menu

and nutrient analysis * State Sanitary Code Food Service Establishments

The Older Americans Act Nutrition Toolkithttp://nutritionandaging.fiu.edu/OANP_Toolkit/The National Resource Center on Nutrition and Aginghttp://nutritionandaging.org/component/docman/cat_view/22-library/8-nutrition-food-health?Itemid=51&orderby=dmdate_published&ascdesc=DESCNYS Office for the Aginghttp://www.aging.ny.gov/index.cfm