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Adult Day Services Requirements for Nutrition Services ACUU, June 3, 2014 Erin Anne Purcell, Adult Day Services Requirements for Nutrition Services ACUU, 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 of Aging Network Operations, New York State for the Aging Lynn Hart, MS, RD, CDN, Aging Services Nutrition Consultant, Division of Aging Network Operations, New York State Office for the Aging Monica Seeber, RD, Public Health Nutritionist, CACFP, State of New York, Department of Health

Nutrition Services in Adult Day Services Learning Objectives: Participate in a discussion on menu Nutrition Services in Adult Day Services 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.

NYSOFA Social Adult Day Care Regulations OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF NYSOFA Social Adult Day Care Regulations 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 INHOME 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

Participant Eligibility Functional Impairment- needing the assistance of another person in at least one Participant Eligibility 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

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

Service Plan Each participant shall receive services only in accordance with an individualized written Service Plan 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)

Core Services Socialization, Supervision and Monitoring Personal Care: hands on assistance with toileting, mobility, Core Services 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

Nutrition Services Providing meals at normal meal times, and snacks and beverages at appropriate Nutrition Services 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

Lunchtime Lunchtime

Services Delivery Policies and Procedures Programs shall establish, follow and have on file for Services Delivery Policies and Procedures Programs shall establish, follow and have on file for review written policies and procedures consistent with SADS regulations, including: Services Delivery q. Socialization q. Supervision and Monitoring q. Personal Care q. Nutrition q. Optional Services

Services Delivery Policy and Procedures Identifies which nutritional standards will be met: NYSOFA requirements Services Delivery Policy and Procedures 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

Services Delivery Policy and Procedures Identifies therapeutic, religious and ethnic options that will be Services Delivery Policy and Procedures 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

Assessment Considerations NYSOFA MINIMUM DATA SET (April 2014) Data Elements To Be Collected For Assessment Considerations 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?

Nutritional Risk Status (NSI) Yes or No 1. Client has illness/condition that changes kind/amount Nutritional Risk Status (NSI) Yes or No 1. 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

Chronic Health Conditions Smelling impairment, Taste impairment Speech problems, Stroke (pockets food on one Chronic Health Conditions 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

Service Delivery Policy and Procedure Personal care assistance with eating Determined from participant assessments Service Delivery Policy and Procedure 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

Best Practices Dining is a social experience, make it enjoyable! Background music, real dishes Best Practices 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

Offer water every hour and make it available at all times Offer water every hour and make it available at all times

Best Practices Arrange for a Registered Dietitian to train staff on the importance of Best Practices 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

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

Questions? ? ? Questions? ? ?

Contact info Erin Anne Purcell Division of Policy, Planning, Programs and Outcomes New York Contact info Erin Anne Purcell Division of Policy, Planning, Programs and Outcomes New York State Office for the Aging 2 Empire State Plaza, Albany NY 12333 518 -474 -5478 Erin. [email protected] ny. gov

Required Nutrition Services in Social Adult Day Care The “A” in the Child and Required Nutrition Services in Social Adult Day Care The “A” in the Child and Adult Care Food Program (CACFP)

Type of adult care programs eligible for CACFP reimbursement Eligible programs must provide nonresidential Type of adult care programs eligible for CACFP reimbursement 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.

Examples of programs (eligible and ineligible) Eligible – day treatment programs or day habilitation Examples of programs (eligible and ineligible) 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.

Criteria for Organizations to Participate Must have federal, state, or local government approval to Criteria for Organizations to Participate 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

Eligibility Criteria for Individual Participation Living in the community or residing with family or Eligibility Criteria for Individual Participation 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)

How is the reimbursement rate determined? $$$$$$$$$ Amount of reimbursement is based on…… Number How is the reimbursement rate determined? $$$$$$$$$ Amount of reimbursement is based on…… Number of eligible meals served The type of meals served The income level of participants

Meal Service in a nutshell: Serve meals that meet the CACFP HEALTHY MEAL PATTERN Meal Service in a nutshell: Serve meals that meet the CACFP HEALTHY MEAL PATTERN requirements for Adults. Reimbursement is based on the service of a complete meal.

BREAKFAST REQUIREMENTS SERVE: THREE REQUIRED FOOD COMPONENTS (GROUPS) 1. Fluid Milk 2. Fruit or BREAKFAST REQUIREMENTS SERVE: THREE REQUIRED FOOD COMPONENTS (GROUPS) 1. Fluid Milk 2. Fruit or Vegetable or Juice 3. Grains or Breads

LUNCH AND SUPPER REQUIREMENTS SERVE: FOUR REQUIRED FOOD COMPONENTS (GROUPS) 1. 2. 3. 4. LUNCH AND SUPPER REQUIREMENTS SERVE: FOUR REQUIRED FOOD COMPONENTS (GROUPS) 1. 2. 3. 4. Fluid Milk Vegetables and/or Fruits - 2 different Grains or Breads Meat or Meat Alternates *Note: Must serve 5 different food items at this meal

SNACK REQUIREMENTS SERVE: TWO DIFFERENT FOOD COMPONENTS (GROUPS) SNACK REQUIREMENTS SERVE: TWO DIFFERENT FOOD COMPONENTS (GROUPS)

Are these foods creditable? What about: “Common” snack foods like: pudding, Jell-O, popcorn, and Are these foods creditable? What about: “Common” snack foods like: pudding, Jell-O, popcorn, and ice cream? Cranberry Juice Fruit pie

Menu Makeover-Monday Old Breakfast Lunch Snack 2% Milk Orange Juice Honey Comb Cereal 2% Menu Makeover-Monday Old Breakfast Lunch Snack 2% Milk Orange Juice Honey Comb Cereal 2% Milk Meatloaf w/gravy Mashed potatoes Canned Peaches White Bread Coffee or Tea New

CACFP Objectives Improve menus by: Serving fresh fruits/vegetables at every meal Increasing whole grains CACFP Objectives 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

Which cereals are whole grain? a) b) c) d) e) Total Product 19 Special Which cereals are whole grain? a) b) c) d) e) Total Product 19 Special K Shredded wheat Cream of wheat

Specific Nutritional Concerns of Aging Adequate amounts of: Calcium Vitamin D Vitamin B 12 Specific Nutritional Concerns of Aging Adequate amounts of: Calcium Vitamin D Vitamin B 12 Fluids

Think about…. . Calcium – adding extra low-fat milk and dairy products to meals Think about…. . 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.

CACFP Contact Information NYS DOH CACFP 150 Broadway 6 th Floor West Albany, NY CACFP Contact Information NYS DOH CACFP 150 Broadway 6 th Floor West Albany, NY 12204 -2719 518 -402 -7400 1 -800 -942 -3858, option #4 http: //www. health. ny. go v/cacfp

Required Nutrition Services in Social Adult Day Services New York State Office for the Required Nutrition Services in Social Adult Day Services New York State Office for the Aging (NYSOFA) Nutrition Program Standards

NYSOFA 59 local offices for the aging in NYS (AAA Area Agency’s on Aging) NYSOFA 59 local offices for the aging in NYS (AAA Area Agency’s on Aging)

Nutrition Standard Requirements The Dietary Guidelines for Americans Nutrition Standard Requirements The Dietary Guidelines for Americans

Nutrition Standard Requirements Dietary (DRI’S) Reference Intake Nutrition Standard Requirements Dietary (DRI’S) Reference Intake

Hand outs * * DRI’s – Nutrient Values for Meal Planning Dietary Guidelines for Hand outs * * 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

Resources The Older Americans Act Nutrition Toolkit http: //nutritionandaging. fiu. edu/OANP_Toolkit/ The National Resource Resources The Older Americans Act Nutrition Toolkit http: //nutritionandaging. fiu. edu/OANP_Toolkit/ The National Resource Center on Nutrition and Aging http: //nutritionandaging. org/component/docman/cat_view/2 2 -library/8 -nutrition-foodhealth? Itemid=51&orderby=dmdate_published&ascdesc=D ESC NYS Office for the Aging http: //www. aging. ny. gov/index. cfm

How can Social Adult Daycare meet NYSOFA Nutrition Standards? How can Social Adult Daycare meet NYSOFA Nutrition Standards?