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Nutrition

Evaluations Report

Chapter II. CHARACTERISTICS OF TITLE III NUTRITION PROGRAM PARTICIPANTS

C: THE EFFECTIVENESS OF PROGRAM TARGETING

The original intent of the OAA was to enable all older persons to receive program services, regardless of income, health, residence, or other factors. Thus, neither the congregate nor home-delivered meal components use means tests to determine eligibility for receipt of program services. Over time, however, Congress has recognized that specific subgroups of elderly people have greater needs than others for program services. The program continues to operate without a means test, but subsequent amendments to the OAA have directed the program to target elderly people with the greatest "economic or social need," in particular, low-income elderly and members of racial and ethnic minority groups. A person with an economic need has an income below the poverty threshold specified by the DHHS guidelines (see discussion in Section A). A person with a social need has a need for services that is the result of noneconomic factors, such as physical or mental disabilities, language barriers, or cultural or social isolation.

In this section of the report, we assess the extent to which the two meal program components successfully target program services to these priority subgroups of elderly people. We do so by comparing the distribution of Title III elderly priority target groups in the participant populations with their representation in the contiguous U.S. population, based on Census data. Target groups considered are racial and ethnic, low-income, low-income minority, rural, and disabled elderly. We make the comparisons in two ways. The first examines program targeting, using the approach that makes the participant tabulations representative of the characteristics of persons who are more frequent users of program meal services (Table II.24). The second examines targeting, using the weight variable that makes tabulations representative of all participants (Table II.25). The first approach assesses targeting in terms of those who use the bulk of program resources. The second approach assesses targeting in terms of all persons who participate, regardless of the intensity of service use, and is consistent with program reporting data maintained by AoA and the previous evaluation.

TABLE II.24

PARTICIPATION OF SELECTED TARGET GROUPS, COMPARED WITH

THAT OF CONTIGUOUS UNITED STATES ELDERLY POPULATION

(Percentage of a Cross-Section of Participants Receiving Title III Meals on a Given Day)


All Eligible Elderly


Title III Congregate Meal

Eligible Elderly


Title III Home-Delivered Meal

Eligible Elderly

Elderly Target Group

Program

Participantsa

Elderly

Populationb


Program

Participantsc

Elderly

Populationd


Program

Participantse

Elderly

Populationf

Non-Hispanic Blacks

14.96

8.21


11.65

7.25


18.87

12.81

Non-Hispanic American Indians, Eskimos, or Aleuts

1.73

0.40


2.22

0.36


1.14

0.56

Non-Hispanic Asians or Pacific Islanders

0.69

1.58


1.26

1.56


0.01

1.68

Hispanics

8.40

3.90


11.67

3.68


4.53

4.93

All Racial and Ethnic Minorities

26.15

14.12


27.24

12.88


24.86

20.03

All Low-Income Elderly

40.37

14.58


34.03

12.54


47.84

24.34

Low-Income Racial and Ethnic Minorities

15.49

4.10


14.97

3.36


16.10

7.62

Low-Income Nonminorities

24.88

10.49


19.06

9.18


31.74

16.72

Rural Elderly

22.64

25.36


28.42

25.54


15.86

24.48

Source: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; Census of Population and Housing 1990; U.S. Bureau of the Census 1994.

Note: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

aTitle III congregate and home-delivered participants 60 years of age and older.

bPersons in the contiguous United States 60 years of age and older.

cTitle III congregate participants 60 years of age and older.

dPersons in the contiguous United States 60 years of age and older who do not have a mobility limitation or self-care limitation.

eTitle III home-delivered meal program participants 60 years of age and older.

fPersons in the contiguous United States 60 years of age and older who have either a mobility limitation or a self-care limitation or both.

Regardless of the approach used, the findings show that the Title III meals program is very successful at targeting services to priority groups of elderly people, particularly low-income and minority elderly, when the representation of these groups in the overall U.S. population is used as the benchmark.

1. Targeting Results Based Principally on Characteristics of More Frequent Users of Meals Program

Table II.24 shows the distribution of Title III elderly priority groups in the participant population, using the weighting approach that reflects the population of participants receiving the bulk of program resources, and comparing them with the representation of these groups in the contiguous U.S. population. Both the congregate and home-delivered meals programs have success in targeting the priority subgroups of elderly people, when the proportion of these groups in the overall U.S. population is used as the benchmark. Except for non-Hispanic Asians and Pacific Islanders and, for the home-delivered meal program, rural residents, the proportion of these groups in the participant populations exceeds their representation in the overall elderly population.

The proportion of racial and ethnic minorities is 27 percent of the congregate participant population, compared with 13 percent in the overall elderly population; the percentages for the home-delivered meal program are 25 and 20 percent, respectively. The proportion of low-income persons in the congregate program participant population is nearly three times as large as their proportion in the elderly population eligible for the program overall (34 percent versus 12.5 percent). Similarly, the proportion of low-income elderly home-delivered participants is more than twice as large as their proportion in the home-delivered eligible elderly population overall (48 percent versus 24 percent). Low-income minorities represent 15 percent of congregate participants, compared with 3 percent in the overall elderly population. The proportion of low-income minority elderly home-delivered participants is twice as large as their proportion in the overall elderly eligible population (16 percent versus 8 percent). Title III rural congregate participants exceed their representation in the overall population (28 percent versus 26 percent), but the proportion of home-delivered participants that are rural residents is considerably smaller than their representation in the overall elderly population (16 percent versus 24 percent).

TABLE II.25

PARTICIPATION OF ELDERLY TARGET GROUPS, COMPARED WITH THAT OF CONTIGUOUS UNITED STATES POPULATION

(Percentage of a Cross-Section of Title III Meal Participants Who Ever Receive Meals)


All Eligible Elderly


Title III Congregate Meal

Eligible Elderly


Title III Home-Delivered Meal

Eligible Elderly

Elderly Target Group

Program

Participantsa

Elderly

Populationb


Program

Participantsc

Elderly

Populationd


Program

Participantse

Elderly

Populationf

Non-Hispanic Blacks

15.68

8.21


10.69

7.25


18.72

12.81

Non-Hispanic American Indians, Eskimos, or Aleuts

1.18

0.40


1.22

0.36


1.16

0.56

Non-Hispanic Asians or Pacific Islanders

0.38

1.58


0.99

1.56


0.01

1.68

Hispanics

5.31

3.90


6.70

3.68


4.47

4.93

All Racial and Ethnic Minorities

22.89

14.12


19.92

12.88


24.69

20.03

All Low-Income Elderly

41.16

14.58


33.78

12.54


45.79

24.34

Low-Income Racial and Ethnic Minorities

13.52

4.10


11.05

3.36


15.07

7.62

Low-Income Nonminorities

27.63

10.49


22.68

9.18


30.74

16.72

Rural Elderly

25.51

25.36


39.57

25.54


16.97

24.48

Source: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; Census of Population and Housing 1990; U.S. Bureau of the Census 1994.

Note: Tabulations are weighted to be representative of all participants receiving Title III meals during a one-year period.

aTitle III congregate and home-delivered participants 60 years of age and older.

bPersons in the contiguous United States 60 years of age and older.

cTitle III congregate participants 60 years of age and older.

dPersons in the contiguous United States 60 years of age and older who do not have a mobility limitation or self-care limitation.

eTitle III home-delivered meal program participants 60 years of age and older.

fPersons in the contiguous United States 60 years of age and older who have either a mobility limitation or a self-care limitation or both.

2. Targeting Results Based Principally on Characteristics of All Meal Program Participants

Table II.25 shows the distribution of Title III elderly priority groups in the participant population, using the weighting approach that gives equal weight to all participants who ever attended the program during a one-year period, and comparing them with their representation in the contiguous U.S. population. Both the congregate and home-delivered programs differentially target the program to priority subgroups of elderly people, when the proportion of these groups in the overall population is used as the benchmark. When the data are weighted to reflect the overall participant population who ever attended the program, the estimated percentages of minorities go down somewhat but still remain higher than their proportions in the overall population. For example, 20 percent of congregate participants are members of racial and ethnic minority groups, compared with 13 percent in the overall elderly congregate eligible population. Under the second approach, the percentage of participants that are rural residents increases, particularly for congregate participants. This increase reflects the fact that the program, particularly the congregate program, reaches rural elderly people, but they do not use meal services as frequently as other groups.

3. Use of Program Services by Selected Priority Subgroups of Elderly

Tables II.26 and II.27 show the receipt of public and private nutrition and supportive services by selected subgroups of elderly Title III congregate and home-delivered meal program participants. The priority groups examined are minority, low-income, and low-income minority elderly participants. Relative to all participants, these priority subgroups of elderly people are more frequent users of most, but not all, program services. This relationship is stronger for congregate than for home-delivered participant priority groups.

Minority, low-income, and low-income minority Title III congregate participants are more likely than congregate participants overall to use special transportation between home and the meal site, and to use assisted transportation for shopping or other purposes (Table II.26). These groups are also more likely than all congregate participants to receive nutrition counseling. Minority, low-income, and low-income minority Title III home-delivered meal program participants are also more likely than participants overall to use assisted transportation, nutrition counseling services, and personal care services (Table II.27).

TABLE II.26

USE OF OTHER NUTRITION AND SUPPORTIVE SERVICES BY SELECTED PRIORITY

SUBGROUPS OF CONGREGATE MEAL PARTICIPANTS

(Percentages of a Cross-Section of Participants Receiving Title III Meals on a Given Day)

Service

Minority

Low-Income


Low-Income Minority

All Participants

Use Special Transportation to Get to and from Meal Site

39

36


43

26

Receive Assisted Transportation

18

25


25

16

Receive Nutrition Screening or Assessment

38

35


36

43

Receive Nutrition Education

62

64


61

68

Receive Nutrition Counseling

18

19


22

18

Receive Recreation Services

75

70


74

70

Receive Personal Care Services

4

5


6

3

Receive Homemaker Chore Services

5

12


9

9

Receive Home Health Aide Services

3

3


4

2

Receive Adult Day Care Services

2

2


3

2

Use Information and Referral Services

28

30


27

26

Unweighted Sample Size

460

654


252

1,040

Source:Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

Note:Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day. Services include those offered by formal public or private programs, but not informal support from friends, neighbors, and so forth.

TABLE II.27

USE OF OTHER NUTRITION AND SUPPORTIVE SERVICES BY SELECTED PRIORITY

SUBGROUPS OF HOME-DELIVERED MEAL PARTICIPANTS

(Percentages of a Cross-Section of Participants Receiving Title III Meals on a Given Day)

Service

Minority

Low -Income


Low-Income Minority

All Participants

Receive Assisted Transportation

25

20


27

19

Receive Nutrition Screening or Assessment

40

31


34

36

Receive Nutrition Education

29

29


27

34

Receive Nutrition Counseling

14

11


13

12

Receive Personal Care Services

39

31


34

29

Receive Homemaker Chore Services

40

30


31

35

Receive Home Health Aide Services

17

14


15

14

Receive Adult Day Care Services

4

2


5

2

Use Information and Referral Services

10

13


8

18

Unweighted Sample Size

213

338


135

818

Source:Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

Note:Tabulations are weighted to be representative of a cross-section of all participants receiving Title III meals during a one-year period. Services include those offered by formal public or private programs, but not informal support from friends, neighbors, and so forth.