Health, Department of

Aging Division

Chapter 4: Older Americans Act Programs

Effective Date: 07/25/1994 to 09/22/1995

Rule Type: Superceded Rules & Regulations

Reference Number: 048.0003.4.07251994

Date Filed 07/25/94

Expr Date

Supr Date

Repeal Date

Document Type RULES

CHAPTER IV

OLDER AMERICANS ACT PROGRAMS

Section 1. General Provisions.

(a) Responsibilities of grantees/contractors include:

(i) administration of grant/contract in accordance with these Rules and Regulations and the Older Americans Act.

(b) Non-eligible participants' fees for services and meals:

(i) non-eligible participants will pay the cost for services as established by the grantee/contractor and approved by the Division.

(A) Failure to make such payment will result in termination of service provision.

(ii) non-eligible participants will pay for meals as follows:

(A) Staff and guests under age sixty (60), (except for spouses of older participants) may consume a meal only when it will not deprive an eligible older person of an opportunity to receive a meal. These individuals are required to pay the full cost of any meal received.

(I) The required fee for the meal will be re-established annually by the Division on Aging.

(B) payment for non-eligible participants will be documented.

(C) failure to make such payment or to be documented by the grantee/contractor for non-eligible participants meals will result in termination of the meal provision.

(iii) Grantee/contractors may offer a meal to individuals providing volunteer services during the meal hours by giving the volunteer an opportunity to donate for the meal. Each grantee/contractor shall define the volunteers eligible for the meal. Criteria shall include the type of work and the number of hours served. If the volunteer is over 60, they shall be counted as an eligible participant. If under the age of 60, donations shall be shown in program income.

(c) Program income generated by a grantee/contractor will go back into the grant fund as prescribed in the Financial Management and Accounting System of the Division.

(i) Such income will be expended first, followed by federal, state and local funds utilizing the match requirements in Chapter V, Section 8, infra.

(d) Intake form:

(i) Each grantee/contractor shall record the following intake information at each site for each elderly individual:

(A) participant's name, address and telephone number;

(B) date of birth, or if not known, estimate of age;

(C) if participant is not sixty (60), that he/she is the spouse of an eligible participant;

(D) physician's name, address and telephone number;

(E) name, address and telephone number of person to contact in the event of an emergency;

(F) handicaps, as defined by 42 U.S.C. 8003 (1978), of which staff should be aware;

(G) potential supportive service needs expressed by the participant and/or identified by project staff;

(H) race;

(I) sex;

(J) special dietary needs;

(K) information that will permit estimates of whether or not the person is of low income (e.g., receiving food, stamps or SSI, etc.);

(ii) the personal record shall be obtained and kept by the following:

(A) participants will be informally interviewed by the appropriate staff person within four weeks (4) after they have begun receiving nutrition or social services;

(B) personal information obtained from the interview shall be kept confidential. If any information is to be released, the participant must consent by signing a release of information form;

(iii) completion of the information is not to be used as a pre-requisite to program participation. If the participant refuses to provide the information, this should be recorded on the in-take form.

(e) Community focal points: At a minimum, for a facility to be designated as a community focal point, it must:

(i) be open five (5) days a week, Monday-Friday;

(ii) have open hours 10:00 A.M. until 2:00 P.M.;

(iii) provide information and referral service;

(iv) primarily provide services for the elderly;

(v) preference for designation will be given to those facilities that serve a meal.

(f) Contributions for meals and services from the elderly:

(i) Each grantee/contractor must:

(A) provide each older person with an opportunity to contribute voluntarily to the cost of the meal or service;

(B) protect the privacy of each older person with respect to his or her contributions;

(C) establish appropriate procedures to safeguard and account for all contributions;

(D) use all supportive services' contributions to expand or improve these services provided under Section 1;

(E) use all nutrition services' contributions only to expand or improve these services under Section 3.

(ii) Each grantee/contractor must develop a suggested contribution schedule for services and meals provided.

(A) Income ranges must be considered in the development of the schedule.

(B) A means test may not be used.

(iii) A grantee/contractor that receives AoA funds shall not deny any older person meals or services because the older person will not or cannot contribute the cost of such meals or service.

Section 2. Supportive Services and Senior Centers.

(a) Supportive services which shall be considered for funding include:

(i) health, education and training, public assistance, information, recreation, homemaker assistance, counseling or referral services;

(ii) transportation services to facilitate access to supportive and/or nutrition services;

(iii) services designed to encourage and assist older individuals to use the facilities and services available to them;

(iv) services designed to:

(A) assist older persons to obtain adequate housing, including residential repair and renovation projects designed to enable older individuals to maintain their home in conformity with minimum housing standards;

(B) adapt home to meet the needs of older individuals suffering from physical disabilities;

(C) prevent unlawful entry into residences of elderly individuals, through the installation of security devices and through structural modifications or alterations of such residences;

(v) services designed to assist older persons in avoiding institutionalization and in returning them to their communities through community based, in-home services.

(vi) services designed in the area of counseling, law, health and insurance assistance.

(vii) services designed to enable older individuals to attain and maintain physical and mental well-being through programs of regular physical activity and exercise;

(viii) services designed to provide pre-retirement and second career counseling for older individuals;

(ix) services designed to provide health screening to detect or prevent illnesses that occur most frequently in older individuals;

(x) services designed to meet the unique needs of older disabled individuals;

(xi) services designed to promote crime prevention and participation in victim assistance programs;

(xii) services designed for the prevention of abuse of older individuals;

(xiii) services designed to enable mentally impaired older individuals to attain and maintain emotional well being and independent living through a coordinated system of support services;

(xiv) in-service training and staff development;

(xv) any other services, if such services meet the standards prescribed by the Division and are necessary for the general welfare of older persons.

(b) Grantees/contractors will prioritize services based on the following criteria:

(i) the service provides basic care for an eligible older person who is 'at risk' of entering a nursing home;

(ii) the service is targeted to meet the needs of the low income elderly;

(iii) the service is targeted to meet the needs of the socially disadvantaged elderly.

Section 3. Nutrition Services.

(a) Menu development. All menus served by grantees/contractors shall meet 1/3 of the Daily Recommended Dietary Allowances (RDA) by the following:

(i) Menus will be monitored to meet the Colorado State University Nutrient Standard Method and, with regard to each item, will follow the established meal pattern below:

3	oz. meat or meat alternative
2	1/2 cup servings of fruit and/or vegetables
1	serving enriched bread or bread alternative
1	tsp. fortified butter or margarine 1 cup fortified milk
1/2	cup serving of dessert

(A) Meat or meat alternative - each menu will contain 3 oz. cooked edible portion of meat, fish or poultry. In addition, the following may be substituted for 1 oz. of cooked lean meat:

1	egg
1	oz. cheese
1/4	cup cottage cheese
1/2	cup cooked dried beans or peas
2	Tbsp. peanut butter

(B) Fruit and/or vegetables - any of the following will satisfy the meal pattern for two (2) servings of fruit; and/or vegetables:

1 serving of fruit and 1 serving of vegetable 2 servings of fruit 2 servings of vegetables

(I) each serving is to be equivalent to 1/2 cup;

(II) fruit served as a dessert may only be counted as a dessert, not as both a fruit and a dessert;

(III) rice, spaghetti, macaroni and noodles are counted as bread alternatives, not as vegetables;

(IV) full strength fruit or vegetable juice may be counted as a serving of fruit or vegetables.

(C) Bread or bread alternative - any of the following will satisfy the meal pattern as one serving of an enriched bread product: one slice of bread; one biscuit; one muffin; one sandwich bun; one piece of cornbread.

(I) Bread alternatives include enriched or whole grain cereals, or cereal products such as spaghetti, macaroni, dumplings, pancakes, waffles, noodles and rice.

(D) Fortified butter or margarine - one teaspoon will be considered one serving.

(E) Milk group - one serving will be one cup of fortified whole, skim or low fat milk. One cup of fortified chocolate milk or buttermilk may also be used as a serving in the milk group. One and one-half inch cube of cheese may be offered participants who do not drink milk.

(F) Dessert group - one serving of fruit, pudding, jello, ice cream and sherbet will consist of 1/2 cup. Cakes, pies, cookies and cobblers are acceptable dessert items. When cakes, cookies or pies are used, these items should be made with enriched or whole grain flour.

(G) All menus must meet this meal pattern as a minimum. Menus may exceed this meal pattern if the nutrient standard monitor will allow additional calories for the particular meal.

(I) Grantee/contractor directors may choose from Division approved menus or hire a local dietician or nutritionist to develop menus that meet the minimum requirements of the Nutrient Standard Monitor. These menus shall be arranged into monthly menus and forwarded to the

Division nutritionist two (2) weeks prior to service to participants.

(II) Division nutritionist shall review the menus and return comments to grantees/contractors prior to service, if menus contain deficiencies. Grantees/contractors shall modify menus in accordance with these comments.

(III) A copy of menus from each grantee/contractor shall be kept by the Division nutritionist for a period of one (1) year.

(IV) A final copy of each month's menu shall be posted prior to service by the grantee/contractor in a conspicuous place at each congregate meal site.

(V) Grantee/contractor directors shall maintain the portion controls that follow the established meal pattern. Buffet style/family style service is not an acceptable means of maintaining portion control.

(VI) Grantees/contractors shall use standardized recipes to assure consistent quality and quantity of the meal served.

(VII) Grantees/contractors shall limit substitutions of foods on the monitored menus to those approved by the Division nutritionist.

(b) Contribution of food to grantee/contractor nutrition projects.

(i) All food contributed to a grantee/contractor for use in meals provided by a project financed under federal or state funds shall be required to meet those standards of quality, sanitation and safety that apply to foods that are purchased commercially by the project by the following:

(A) home canned or preserved foods shall not be accepted;

(B) foods cooked or prepared in an individual's home shall not be accepted as meals providing 1/3 of RDA.

(C) no fresh or fresh-frozen fish donated by sportsmen shall be accepted;

(D) grantee/contractor may accept donated wild game only if:

(I) the game is butchered at a packing plant;

(II) the meat is free from parasites, spoilage or any other abnormality;

(III) the game is cooked to an internal temperature of 150°F or higher;

(IV) documentation is maintained showing that the above steps have been met.

(E) fruits and vegetables grown in a personal garden may be accepted only if:

(I) they have been picked within the previous 24 hours;

(II) they are thoroughly washed to remove pesticides or herbicides that may have been used by the gardener.

(c) Special diets. For participants who have a physician's order, therapeutic diets shall be available, as feasible, by the following:

(i) such participant shall have in his/her file a physician's order for the specified diet. If a written order cannot be obtained, verbal approval from the physician, documented by the grantee/contractor director's signature, will be acceptable;

(ii) such participant receiving a special diet shall be interviewed by the staff member responsible for planning such diet. Reassessment of need shall occur at a minimum of every six (6) months and a current diet prescription shall be on file;

(iii) special diets shall be prepared in accordance with diet manuals approved by the Division nutritionist;

(iv) grantees/contractors shall do everything possible to make the general menu acceptable to most people with dietary limitations. 411 menus shall be:

(A) moderate in sodium, cholesterol, unsaturated fats and carbohydrates;

(B) salt shall be used sparingly in cooking and shall be available at the table, with preference given to common iodized table salt;

(C) alternative foods and/or beverages shall be offered to participants with dietary limitations, when feasible.

(d) Leftovers.

(i) Each grantee/contractor shall reduce the number of leftover meals to be no more than three to five percent of the total number of meals ordered or prepared per day.

(ii) No food shall be taken home by staff. Fresh fruit is the only food that may be taken home by participants.

(e) Food safety. Grantee/contractor nutrition projects shall be required to comply with the standards, as outlined in Wyoming Food Service Regulations, published by the Environmental Health, Division of Health and Medical Services, 1982. In addition:

(i) such grantees/contractors' standards will substitute the words 'hair net' for each reference to 'hair restraints' in the Wyoming Food Service Regulations;

(ii) grantees/contractors shall mail copies of all sanitarian inspection reports to the Division nutritionist.

(f) Food stamps. Grantees/contractors shall assist all participants who desire food stamps to apply for such assistance and provide the opportunity for all participants to use food stamps as their contribution toward the cost of the congregate and home delivered meal as follows:

(i) obtain authorization from the Division to accept food stamps;

(ii) give a presentation on food stamp eligibility and application criteria at each congregate meal site at least twice during the budget period;

(iii) give written information on food stamp eligibility and application criteria to home delivered meal participants at least twice during the budget period;

(g) Nutrition Education. Grantees/contractors shall make available to all meals program participants nutrition education targeted to achieving optimal nutritional status, taking into account ethnic preferences, cultural factors and geographical and environmental limitations by the following:

(i) provide a system of feedback from program participants regarding topics to be included in nutrition education;

(ii) provide, through the Division nutrition notes or through a person having a background in nutrition education, home economics or other related field, one or both of the following:

(A) group nutrition education once per quarter to project participants at a meal site or through a newsletter;

(B) upon request, in-depth, one-to-one diet counseling;

(iii) records of all group presentations, newsletter usage, and of one-to-one counseling will be kept on file by the grantee/contractor.

(h) USDA assistance program. The Division shall administer the USDA commodity/cash-in-lieu program by the following:

(i) the Division shall enter into a written agreement with the USDA designated State Commodity Distribution Agency;

(ii) the above agreement shall be reviewed annually and modified as needed;

(iii) Division personnel shall coordinate with the State Commodity Distribution Agency and grantee/contractor in all matters regarding receipt, distribution and accountability for commodity foods;

(iv) the Division, together with representatives of the grantee/contractor shall determine annually the percentage of commodities versus cash-in-lieu that will be received by the State of Wyoming for distribution to grantees/contractors.

(v) the Division shall administer the USDA commodities and/or cash-in-lieu of commodities program to grantees/contractors who have received a 'notification of grant award' to provide nutrition services to the elderly by:

(A) forwarding annually to nutrition grantees/contractors a listing of commodity foods expected to be available;

(B) having the grantee/contractor returning to the Division yearly estimates of commodity foods that the grantee can use from the list provided;

(C) balancing grantee/contractor orders for commodities against those commodities grantees/contractors have remaining in their inventories. The final order placed with USDA may be reduced for high inventory items;

(D) authorizing amounts to each grantee/contractor which shall be based on a projection of the total number of meals to be served to elderly and spouses during the project period. Grantees receiving cash-in-lieu of commodities must spend the cash by buying food produced and packaged in the United States or by purchasing contracted meals. Cash shall be sent to grantees/contractors upon receipt of notification of cash authorization from USDA;

(vi) grantees/contractors receiving commodity foods shall maintain a current inventory of commodities stored at local storage facilities, and shall submit to the Division a monthly inventory report not later than the 10th of the following month;

(vii) grantees/contractors receiving cash-in-lieu of commodities shall maintain a separate accounting of the cash.

(i) Eligibility and delivery of home delivered meals.

(ii) Grantees/contractors shall be required to provide home delivered meals to persons meeting the following eligibility criteria:

(A) illness of two (2) or more weeks;

(B) homebound by a physical handicap, (e.g. arthritis, blindness, crippling condition, etc.) and who have no other means of assistance;

(C) lacking the physical mobility to provide adequate meals for themselves but are capable of living in their own homes or apartments, thereby being partially disabled; or,

(D) have emotional problems which would prohibit their participation at a congregate site because they:

(I) are actually afraid to leave their homes and are, therefore, homebound;

(II) have recently lost a spouse and temporarily need the support of a friendly visitor and nutritious meals;

(III) feel extreme rejection from others at a congregate site.

(E) they live so far away that it is prohibitive to transport the participant to and from the congregate site and are thereby isolated.

(ii) Project directors will make the eligibility determinations within five (5) working days of the initial request for home delivered meals. Meals will be delivered while determination is being made.

(iii) Project directors or outreach workers will work with the recipient to determine if other services are needed, such as nursing, emergency medical, chore, homemaker, home repair, transportation, escort or counseling.

(A) Project directors shall make eligibility criteria available to all potential referral agencies, physicians and the general public.

(B) Special diets shall be provided in accordance with Section 3.(c).

(iv) Participants denied home delivered meals or who lose eligibility are entitled to a hearing in accordance with Chapter II, Section 5.

(v) Packaging and delivery of home delivered meals. Home delivered meals are required to be packaged and delivered in a manner that will maintain safe food temperatures by the following;

(A) hot foods shall be delivered at 140 F or higher. Cold foods shall be delivered at 45°F or colder. Hot foods and cold foods shall be packaged separately. Temperature logs shall be kept at each project to document that these temperature requirements are being met.

(B) The time period between the end of cooking the food and delivery to the individual recipient shall not exceed two and one-half (2½) hours.

(C) Each grantee/contractor shall establish written procedures on the cleaning and sanitation of all the home delivered meal delivery equipment.

(D) Each grantee/contractor shall provide food safety information to the individual recipient. This may take the form of a handout or may be given verbally and shall include washing hands before the meals, eating the meals immediately upon receipt and refrigerating leftovers.

(E) Each grantee/contractor shall develop and administer a survey to formally assess the recipients satisfaction with food quality and delivery of the home delivered meals. These surveys will be conducted once a year and will be kept on file by the grantee/contractor.

(F) The grantee/contractor shall provide training or a handout for all delivery personnel. The training shall include, at a minimum: temperature controls, menu requirements, importance of confidentiality, eligibility criteria and emergency planning. This training shall be reviewed with delivery personnel on an annual basis.

(G) A delivery route list shall be given to each delivery personnel. This list shall include:

(I) a detailed map of the area;

(II) details for gaining access to the homes (ringing doorbells, etc.);

(III) the grantees/contractors, office

and kitchen telephone numbers.

(IV) special physical or psychological problems of the recipient.

(j) Meals for the handicapped non-elderly. The Division shall administer nutrition programs by making meals available to those handicapped non-elderly who reside in housing facilities occupied primarily by the elderly at which congregate nutrition services are provided by the following:

(i) grantee/contractor shall include in the meal count those meals served the handicapped non-elderly for use in determining the quantity of commodities or cash-in-lieu of commodities to which the grantee/contractor is entitled;

(ii) the grantee/contractor shall record the following intake information for the handicapped non-elderly at each housing facility that is occupied primarily by the elderly at which congregate nutrition services are provided for the elderly:

(A) The handicapped, non-elderly's name, address and telephone number;

(B) date of birth:

(C) handicaps, as defined by 42 U.S.C. 8003 (1978);

(D) special dietary needs;

(E) information that will permit estimates of whether or not the person is of low income (e.g., receiving food stamps or SSI, etc.).

(iii) The personal record shall be obtained and kept by the following:

(A) participants will be informally interviewed by the appropriate staff person within two (2) weeks after they have begun receiving congregate nutrition services;

(B) personal information obtained from the interview shall be kept confidential. If any information is to be released, the participant must consent by signing a release of information form;

(C) completion of the intake information is not to be used as a prerequisite to program participation. If the handicapped non-elderly refuses to provide the intake information, this should be recorded on the intake form.

(iv) Meal standards. Congregate nutrition services provided to the handicapped non-elderly shall meet the dietary, preparation, service and education standards as provided in Section 3.

Section 4. Long Term Care Ombudsman. The Division shall establish a long term care ombudsman program pursuant to W. S. 92-1301 through 9-2-1309 (1977) (1986 cum. supp.)

(a) Responsibilities of the long term care ombudsman include:

(i) investigation and resolution of complaints of residents and the management of long term care facilities with regard to action that may adversely affect residents health, safety, welfare or rights;

(ii) monitoring the development and implementation of federal, state and local laws, regulations and policies with respect to long term care facilities in the state;

(iii) establishment of a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in long term care facilities for the purpose of identifying and resolving significant problems, with provision for submission of such data to the state agency responsible for licensing or certifying long term care facilities in the state and to the Division.

(b) Grants/contracts will be submitted annually based on the instructions from the Division.

Section 5. Legal Assistance. The Division shall establish a legal service network through the Legal Services Developer Program to provide and coordinate legal assistance to and in behalf of the elderly in accordance with the Older Americans Act.

(a) Grants/contracts will be submitted annually based on the instructions from the Division.

Section 6. Employment Services for Older Persons. The Division will establish employment programs for the elderly in accordance with the Older Americans Act.

(a) Eligibility shall be in accordance with the specific guidelines of this program.

(b) Grants/contracts will be submitted annually based on the instructions from the Division.