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SECTION XIV

NUTRITION PROGRAM

Section XIV Nutrition Program

INTRODUCTION

The mission of the Lake Cumberland Nutrition Program for the Elderly is to:

Promote health

Provide nutritious meals

Reduce social isolation

Link to other social & rehabilitative services

Lake Cumberland Area Agency on Aging and Independent Living uses grants from the Administration on Aging, State funds and other resources to provide meals.

The Older Americans Act established the Nutrition Program for the Elderly in 1965. Title III of the Act addresses a number of problems faced by the nation's older population, such as dietary inadequacy, declining health status, social isolation, and limited access to social and health services. Among certain subpopulations of the elderly-the poor, ethnic minorities, the isolated, and handicapped-these problems may be more acute. Services are designed to emphasize these priority groups through outreach efforts to encourage their participation and by locating meal sites where they will be accessible to older persons in greatest need.

The major activities of the Nutrition Program are to provide one nutritionally balanced meal per day to the older adults either in a congregate dining setting or through the provision of a home delivered meal, nutrition screening, nutrition education, and nutrition assessment and counseling if appropriate. Participants are encouraged to contribute to the cost of their meals and other services, whether congregate or home delivered.

Nutrition Program policy is applicable to Title III C-1 and C-2 of the Older Americans Act, Kentucky’s Homecare Program, Adult Day Care Program, Adult Day Health Care Program, Alzheimer's Respite Program and any other nutrition program for the elderly which is under the jurisdiction, control, management and audit authority of the Department of Aging and Independent Living and Lake Cumberland Area Development District

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DEFINITIONS

1) Congregate Meal – A unit is one (1) meal. Served to an eligible client or other eligible participant, at an approved congregate site and consisting of a meal which: (1) complies with the Dietary Guidelines for Americans (HHS and USDA) and (2) provides a minimum of of the daily Recommended Dietary Allowances (RDA) published by the Food and Nutrition Board of the National Academy of Sciences.

2) Congregate Meal Site - The selection of a site shall be based on information about older people in its service area and on the advice of public and voluntary agencies serving the elderly. In choosing a site, consideration should be given to demographics, accessibility to the maximum number of people who are socially or economically deprived, proximity to other services or facilities, convenience to public transportation or within comfortable walking distance, free of structural barriers or difficult terrain, and safety and security of participants and staff. Congregate meal sites exist within Focal Points, Senior Centers, or Nutrition Sites. Specifications for each are defined in 910 KAR 1:220. Each nutrition site shall have an individual (volunteer or paid) responsible for administration of the site and present during hours of operation. Services available through the nutrition site include nutrition education, outreach, and information and referral. The total number of participants to be served shall be adequate to justify the cost of operating the site.

3) Home Delivered Meal – A unit is one (1) meal: Served to an eligible client or other eligible participant, at the client’s place of residence and consisting of a meal which (1) complies with the Dietary Guidelines for Americans (HHS and USDA) and (2) provides a minimum of of the daily Recommended Dietary Allowances (RDA) published by the Food and Nutrition Board of the National Academy of Sciences.

4) In-Home Assessment: This activity is intended to confirm, correct, and document information already collected about the potential Title III C program client. Additional information, including but not limited to cooking and storing facilities are also collected and documented. This activity is conducted in the clients’ residence.

5) Intake: Collection of additional demographic information about a potential client to confirm Title III C program eligibility. Information collected is (1) required for NAPIS reporting, (2) ADL, IADL, and NRA. This activity may be conducted over the telephone along with screening.

6) Meal Costs Ready-To-Serve (RTS): (Meal Preparer/Caterer Costs) Costs incurred by the meal caterer. Specify one unit cost for all types of meals, congregate, home-delivered, and emergency meals for the contract period.

7) Meal Service Costs: All other costs incurred for serving foods at congregate sites. Does not include caterer costs.

8) Meal Service and Meal Delivery Costs: All other costs incurred for the delivery of meals to home bound clients. Does not include caterer costs.

9) Nutrition Counseling – A unit is one (1) session. A one-on-one advice and guidance to individuals, who are at nutritional risk because of the nutritional history, current dietary intake, medication use or chronic illnesses, about options and methods for improving their nutritional status, provided by a registered or licensed dietitian or other health professional functioning within their legal scope of practice.

10) Nutrition Education – A unit is one (1) session. A service or a program to promote better health by

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Section XIV Nutrition Program

providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition)

information and instruction to participants and caregivers in a group or individual setting overseen by a dietitian or individual of comparable expertise.

11) Nutrition Services and Incentive Program (NSIP) is administered by the U.S. Department of Health and Human Services and receives financial support from the USDA Food and Nutrition Service (FNS).

12) Registered Dietitian/Licensed Dietitian (RD/LD) means one who has successfully completed a standard competency test administered by the American Dietetic Association and has completed license requirements of a state licensing agency.

13) Screening: Collection of preliminary information about a potential client to determine Title III C program eligibility. Information collected is (1) client name, (2) client date of birth, (3) client address, and (4) client telephone number. This activity is usually conducted over the telephone.

14) Wait List: Compilation of potential clients waiting to be served, persons who are waiting for additional services and persons waiting to be assessed and placed on the waitlist.

15) Nutritionist: A health care professional practicing nutrition and certified pursuant to KRS 310.031

16) Chilled Food System: Any system of food production which results in the partial or complete cooking of a prepared product which is then chilled, maintained at refrigeration temperatures and reheated either at a finish kitchen or at the site or service. Potentially hazardous foods (protein foods) shall not be partially cooked and finished later. These foods shall be cooked to heat all parts of the product to an internal temperature of at least 140 degrees F.; minimum internal temperature shall be 165 degrees F. for poultry, 160 degrees F. for pork and ground meats, 145 degrees F for fish and 160 degrees for egg dishes.

17) Dietitian: A health care professional practicing dietetics and licensed pursuant to KRS 310.021

18) District Nutrition Program : The district nutrition program approved by the Department for Aging and Independent Living and administered in each of the fifteen planning and service areas in ·Kentucky by the Area Development Districts or other contract agencies. The district program shall include but not be limited to meals or nutrition services funded by Title III of the OAA, Homecare, USDA, Adult Day Care, Adult Day Health Care, Alzheimer's Respite or other funds designated in the approved plan.

19) Meal : A portion of food consisting of a minimum of five dissimilar components, the volume of which shall be a minimum of three cups total and which shall provide the equivalent of one-third of the dietary reference intakes as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and comply with the most recent Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture.

20) Nutrition Service Provider: Is an entity that is awarded a contract under the area plan to provide nutrition services covered under policies governing the Nutrition Program for the Elderly.

21) Standardized Recipe : A written formula for producing food items of a consistent quality and quantity that includes the name of the food item, the total quantity prepared, the number and size of portions, the ingredients by weight and/or measure and sometimes by count, the procedures and times for combining ingredients, the cooking temperatures and times, and the panning or portioning information.

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RESPONSIBILITIES OF NUTRITION SERVICE PROVIDERS

The service provider contracting to provide meals and services shall:

(1) Provide meals in accordance with the requirements of this section;

(2) Provide Lake Cumberland Area Agency on Aging and Independent Living with statistical and other information necessary for state reporting requirements;

(3) Provide recipients with an opportunity to voluntarily contribute to the cost of the service; Voluntary contributions shall be allowed and solicited, if the method of solicitation is non-coercive, and encouraged for an individual whose self-declared income is at or above 185 percent of the federal poverty level at contribution levels based on the actual cost of the service in accordance with 42 U.S.C. 3030c-2(b)

(4) Assure that an older person is not denied service because the older person will not or cannot contribute to the cost of the service;

(5) Protect the privacy of each older person with respect to contributions;

(6) Use all meals contributions to increase the number of meals served, and to facilitate access to such meals;

(7) Report to appropriate officials for follow up, conditions or circumstances which place the older person or the household of the older person in imminent danger;

(8) Where feasible and appropriate, make arrangements for services to older persons in weather-related emergencies;

(9) Assist participants in taking advantage of benefits under other programs;

(10) Employ adequate numbers of qualified staff to ensure satisfactory conduct of the service;

(11) Have a site director on a paid or volunteer basis responsible for activities at the site. Where Title III-C funds are utilized, the maximum paid hours per day shall be five; Title III-B or other funds may be used to pay for additional hours;

(12) Permit staff of the Lake Cumberland Area Agency on Aging and Independent Living or the Cabinet for Health and Family Services and federal representatives to monitor and inspect the operation;

(13) Attend meetings scheduled by the Lake Cumberland Area Agency on Aging and Independent Living and the Department for Aging and Independent Living.

(14) Monitor quality of meals and services delivered to clients.

(15) Conduct an annual satisfaction survey to clients and submit the completed surveys to LCAAAIL annually.

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RESPONSIBILITIES OF NUTRITION SERVICE PROVIDERS CONTRACTING FORMEALSONLY

The service provider contracting to provide meals only shall:

(1) Provide meals in accordance with the requirements of Nutrition Program Policy;

(2) Provide the contracting agency with statistical and other information which the contracting agency requires;

(3) Permit staff of Lake Cumberland Area Agency on Aging and Independent Living, the Cabinet for Health and Family Services and federal representatives to monitor and inspect the operation;

(4) Employ adequate numbers of qualified staff to ensure satisfactory conduct of the service;

(5) Attend meetings scheduled by the Area Agency on Aging and Independent Living and the Department for Aging and Independent Living.

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RESPONSIBILITIES OF LAKE CUMBERLAND AREA AGENCY ONAGING AND INDEPENDENT LIVING

A. Assess the level for congregate and home delivered meals within the planning and service area.

B. Coordinate with other appropriate services in the community and assure that these services do not constitute unnecessary duplication of services;

C. Establish procedures, subject to the approval of the Department for Aging and Independent Living, for prioritizing participants to receive home delivered meals. This prioritization shall include both Home care and Title III-C2 eligible individuals.

D. Lake Cumberland AAAIL shall provide assessments to Home Care home delivered meal consumers annually, and to Title III-C2 every 6 months, to determine eligibility and need.

E. Monitor the food service operation a minimum of twelve (12) times per year to evaluate compliance with nutrition program policies.

F. Provide congregate and home delivered meal program participants with an opportunity to evaluate meals and services, by survey, at least annually.

G. Coordinate with agencies responsible for administering the food stamp program.

H. Assure that the nutrition service provider provides:

a. At least one (1) meal per day in a congregate nutrition site or provide home delivered meals based upon a determination of a participant’s needs:

b. That the maximum number of eligible older individuals with emphasis on the frail, those with greatest social and economic need and the isolated, have the opportunity to participate;

c. Nutrition screening and counseling and nutrition education services to address a participants assessed needs and ensure that nutrition funds are used to provide those services;

d. Nutrition services are provided to keep older persons healthy, reduce the older adult’s risk of chronic disease and disability and help the older adult to manage chronic diseases and conditions;

e. An emergency plan for back up food preparation sites, nutrition sites and meal delivery; and

f. A plan for furnishing emergency meals during such emergencies as: i. Inclement weather conditions

ii. Power failure

iii. A disaster that may cause isolation; or

iv. A medical emergency;

I. Ensure that direct service providers are using meal contributions to increase the number of meals served, and to facilitate access to these meals;

J. See General Administration Sections for additional LCADD/AAAIL duties/responsibilities

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CLIENT PROVISION OFMENUS

Approved hot home delivered meal and frozen meal menus are provided to each senior center director to be distributed to clients and/or posted in the local newspaper.

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CONGREGATEMEAL

Policy:

Congregate meals shall be provided by Nutrition Service Providers who, five or more days a week within each county, provide at least one hot or nontraditional meal per day. Each meal shall furnish a minimum of one-third of the dietary reference intakes as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and comply with the most recent Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture and shall be consumed in a congregate setting.

Procedures:

A. Congregate meals are served after home delivered meals have been packaged. Foods are kept at appropriate temperatures during all phases of food service.

B. Milk and other cold food items are not preset on tables prior to meal service; tables may be preset with individually wrapped eating or drinking utensils.

C. Food items left over from meals may be offered as seconds to participants after all have been served;

D. Participants shall be allowed to carry out leftover food items from their own meal;

E. Left over foods that are carried out shall comply with 910 KAR 1:190

F. The United States Department of Agriculture Food Safety and Inspection Service Food Safety Information handout titled "Leftovers and Food Safety" shall be provided to participants and posted in a visible location near the food service area.

G. Only complete meals can be claimed for payment. The omission of any of the required meal components causes that meal to be incomplete and ineligible for payment and for NSIP reimbursement. Refusal by a participant of specific meal components will not make a meal incomplete. This "offered vs. served" provision applies to meal service at congregate sites but does not apply to the portioning of home delivered meals.

H. An ongoing nutrition education program will be planned and offered; a minimum of one (1) session each month at each nutrition site. The program should use a wide range of teaching techniques for a variety of topics including health promotion and disease prevention and food fads and diets.

I. Participants scoring 6 or more points on the Nutritional Risk Assessment are referred to a registered or licensed dietitian for nutrition counseling.

J. An older person cannot be denied service because he/she does not or cannot contribute to the cost of the service;

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ELIGIBILITY FORCONGREGATEMEALS

A person age 60 or older and the spouse of that person, regardless of age, are eligible to participate in congregate nutrition services. Congregate meals shall be provided on the same basis that meals are provided to participating older individuals, to individuals providing volunteer services during the meal hours, and to individuals with disabilities who are not older individuals but who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided, and to disabled individuals who reside in non-institutional households with and accompany persons eligible for congregate meals. Clients in Adult Day Care, Adult Day Health Care, and Alzheimer's Respite shall be eligible to receive meals.

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PRIORITIZATION OF TITLE III C-1CONGREGATEMEALS

Policy:

In the event that funding is not available to meet all the nutritional needs of eligible older adults needing congregate meal services in the LCADD, a waiting list will be maintained at each senior center.

Procedure:

The use of both the NAPIS form and the Nutrition Assessment will assist in determining those most in need. The eligible individual with the greatest number of points will be put on meals first when they become available.

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HOME DELIVEREDMEALS

Policy:

Home delivered meals shall be provided by Nutrition Service Providers which, five or more days a week, provide at least one home delivered hot, cold, frozen, dried, or shelf stable meal per day.

Procedure:

Each menu is prepared by a registered dietician and comply with the dietary guidelines for Americans. Each meal served provides a minimum of 33 and 1/3 percent of the current Recommended Dietary Allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences.

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ELIGIBILITY FOR HOME DELIVEREDMEALS

Policy:

Eligibility for Home Delivered meals shall be based on the following Criteria and determined by LCADD Case Managers who will conduct Assessments and Reassessments annually or as needed:

(a) A person age sixty (60) or older and the spouse of that person

(b) The person must be by reason of illness or incapacity be unable to attend a congregate site and has no one in the home able to prepare a nutritious meal on a regular basis; or

(c) A non-elderly person who is a member of a non-institutional household with an elderly person.

(d) Eligibility for the Homecare Program home-delivered meals shall be in accordance with 910 KAR 1:180.

Procedure:

LCADD Case Mangers will implement the Nutrition Screening Initiative – Level One by identifying client’s nutritional risk on the Nutritional Risk Assessment Form.

Eligible individuals with the greatest economic and social needs will be served. Using the LCADD nutritional assessment identifies the need for home delivered meals even further. This includes all of the risk factors on the NAPIS form plus additional questions that will assist in determining the client’s needs that might extend beyond nutritional needs. Such needs might include referrals to their doctor or specialist, a dietician for individual counseling, heating assistance, Homecare Services, and or transportation.

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PRIORITIZATION OF TITLE III C-2 HOME DELIVEREDMEALS

Policy:

In the event that funding is not available to meet all the nutritional needs of eligible older adults needing Title III C-2 Home Delivered meal services in the LCADD, Lake Cumberland Case Managers will maintain a waiting list.

Procedure:

The use of both the NAPIS form and the Nutrition Assessment will assist in determining those most in need. The eligible individual with the greatest number of points will be put on meals first when they become available.

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MEAL PLANNING

Nutrient dense meals shall be planned using preparation and delivery methods that preserve the nutritional value of foods. The use of saturated fats, trans fats, salt and sugar shall be restricted to maintain good health.

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MENUREQUIREMENTS

Menus shall be:

(1) Planned with suggestions from participants in the form of comment cards, satisfaction surveys or verbal comments;

(2) Planned for a minimum of one month in advance;

a. Repetition of entrees shall be kept to a minimum;

b. If a cycle menu is utilized, there shall be provisions to include seasonal foods

c. A cycle menu must be at least five weeks long. Dietary preferences of a majority of the participants shall be reflected.

(3) Certified in writing by the local LC/CN as meeting the current Dietary Reference Intakes (DRI) based on the nutrient analysis and current Dietary Guidelines.

(4) Adhered to with minimal substitution. However, it is known that menus are subject to change when food items are not available.

a. Lake Cumberland AAAIL should be notified immediately whenever any menu substitution is made.

b. All changes must also be submitted to the local LC/CN within one week for review and subsequent approval

c. If indicated by excessive and/or inappropriate substitutions additional training on menu substitution shall be provided.

d. The appropriateness of the menu changes should be noted by the LD/CN and the menus should then be forwarded to the AAAIL.

(5) Retained in the Area Agency on Aging and Independent Living; One copy of the menu, as served, shall be retained for a three-year period.

(6) Posted in a conspicuous location, including each congregate meal site and each preparation site. Notification of the meals to be served shall, be provided to participants receiving home delivered meals.

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THERAPEUTICDIETS

Since nutrition program meals comply with the Dietary Guidelines and provide 1/3 of the Dietary Reference Intakes, they are suitable for most persons with diabetes, heart disease and hypertension. As a result, they meet participant dietary needs such as low sugar, low salt, low fat, or low cholesterol requirements without further modification.

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ADDITIONAL FOODS

Additional foods may be added to the meal to provide personal satisfaction and additional nutrition but shall not be considered art of the reimbursable program meal. These foods may include fresh produce, baked items, and donated canned items. Home – canned foods shall not be used. The additional foods may not take the place of the foods provided by the approved menu.

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POTLUCK MEALS

When a potluck meal is served at a particular site, no congregate meal shall be served at that site. Home delivered meals shall be provided on the same basis as if the potluck meal had not been scheduled.

The promotion of healthy potlucks is encouraged. Some ideas for implementation include: (1 ) Identify and promote healthier food

(2) Lessons regarding how the keep food safe

(3) Lead by example

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SUPPLEMENTS

Vitamins and mineral supplements shall not be provided with nutrition program funds; however, citrus juice or drinks fortified with vitamin C are recommended. Only full strength juices shall be used as one of the required meal components.

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MEAL PATTERN

Congregate, home delivered and emergency menus shall certify that each meal served contains the equivalent of one-third of the dietary reference intakes as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and comply with the most recent Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture. The nutrient content of therapeutic meals shall be in accordance with the requirements of the prescribed diet and whenever possible provide one-third of the dietary reference intakes as stated above.

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MENU PLANNING FOR FROZENMEALS

Menus for frozen meals are to be provided by a registered dietitian. All menus must provide to each participating individual a minimum of 33 1/3 percent of the daily-recommended dietary allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences.

The registered dietitian preparing the frozen meal menus shall utilize a computer assisted nutrient analysis program to plan and prepare menus to ensure the nutrient adequacy of meals. All menus shall be signed by a Registered Dietitian or Certified Nutritionist and submitted to the contract provider agency along with recipes and nutrient analysis. A menu approval sheet shall also accompany the monthly menus.

If substitutions are necessary, then they shall come from the approved substitution list provided by the dietitian. All menus shall be submitted to the AAAIL for approval one month in advance of scheduled service.

Menu planning shall also include input from participants as a best practice through suggestion boxes, satisfaction surveys or verbal comments. Suggestions may also come from food production staff, site managers, home delivered meal drivers and or the AAAIL.

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MEAL PLANNINGNUTRIENT REQUIREMENTS

Meals are pre - planned and meet the required nutritional analysis as verified through the computer assisted nutrient analysis.

Legal Authority

Older Americans Act of 1965 as amended

10 KAR 1:190

Procedure

Menus shall be documented as meeting the nutritional requirements through computer assisted nutrient analysis and must provide the following when one meal is served per day. The menus must be approved using the following, Nutrient, Amount Required, Notes

Calories, Average for week between 675 and 735 calories per meal, No one meal may be less than 625 calories

Protein, 15 – 25% of calories

Carbohydrate, 93 Grams (acceptable range is 85 grams – 105 grams), This requirement is in keeping with the high incidence of diabetes in Kentucky

Fat, Within a one week period the

daily average should be 30% calories, No one meal may be more than 35% fat. Lard may not be used. Limit trans fats

Fiber, Within a one week period the daily average should be 8 g/meal

Calcium, 400 mg per meal averaged over one week, No one meal may be less than 360 mg

Magnesium, 140 mg per meal averaged over one week, No one meal may be less than 126 mg

Zinc, 3.7 mg per meal average over one week, No one meal may be less than 3.33 mg

Vitamin A, 300 mcg (RE), averaged over one week,

Vitamin B6, .6 mg per meal averaged over one week, No one meal may be less than .54

Vitamin B12, .8 mcg per meal averaged over one week, No one meal may be less than .72

Vitamin C, 30 mg per meal average over one week, No one meal may be less than 27 mg

Sodium, 1000 mg per meal averaged over one week when one meal is served per day, No more than 1200 mg per meal.

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Menu Approval Sheet

for use with

Nutritional Analysis for the Kentucky Senior Nutrition Program

Nutrient 1 Meal per Day

Energy No Less than 625; Average 675-735 for the week

Protein 15 – 25%of calories

Carbohydrate 93 grams (acceptable range – 85-105 grams)

Fat Weekly average should be ≤30% calories (never more than 35%)

Fiber 8 grams average over one week

Calcium No meal may be less than 126 mg 140 mg per meal averaged over one week

Zinc No meal less than 3.33 mg 3.7 mg per meal averaged over one week

Vitamin A 300 mcg (RE) averaged over one week

Vitamin B6 No meal less than .54 mg .6 mcg per meal averaged over one week

Vitamin B12 No meal less than .72 mcg .8mcg per meal averaged over one week

Vitamin C No meal less than 27 mg 30 mg per meal averaged over one week

Sodium No one meal more than 1200 mg ≤1000 mg averaged over one week

I certify that, to the best of my knowledge, each meal in the attached menus provides one-third of the current Recommended Dietary Allowances of the National Academy of Sciences and conforms to the Dietary Guidelines for Americans

Signature Date:

Licensed Dietitian / Certified Nutritionist

MENUAPPROVAL SHEET

All menus must be approved by the licensed dietitian or certified nutritionist. The approval sheet can be used for the entire menu cycle.

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CONDIMENTS ANDPRODUCT SUBSTITUTES

Policy

Condiments and additives to allow individuals to prepare their meals to their own taste shall be provided when meal appropriate, and shall not be counted as fulfilling any part of the nutritive requirements.

Legal Authority

Older Americans Act of 1965 as amended

910 KAR 1:190

Procedure

(1) The meal service provider shall provide meal appropriate condiments to include: (a) sugar substitutes;

(b) pepper;

(c) herbal seasonings such as Mrs. Dash;

(d) lemon;

(e) vinegar;

(f) non-dairy coffee creamer;

(g) salt;

(h) sugar;

(i) mayonnaise,

(j) catsup;

(k) mustard;

(l) fat-free butter flavoring;

(m)any other condiments that are meal appropriate

(2) Butter or margarine shall be provided as appropriate and will count as part of the nutritive value of the meal.

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FOODPROCUREMENT

All foods purchased for use in the Nutrition Program shall be of good quality and shall be obtained from sources which conform to federal, state, and local regulatory standards for quality, sanitation, and safety. The following requirements apply to food procurement.

All foods used in the nutrition program must be:

(1) From approved sources;

(2) Be in compliance with applicable state and local laws, ordinances and regulations;

(3) And be clean, wholesome, free from spoilage, free from adulteration and mislabeling, and safe for human consumption.

Hermetically sealed food, which has been processed in an approved commercial food processing establishment, may be used. Home-canned foods may not be used.

All foods contributed to the nutrition program must meet the same standards of quality, sanitation and safety that apply to foods processed commercially and purchased by the nutrition program.

Fresh or frozen meat and poultry used in the meals provided byt the service provider must be USDA and or state inspected.

The service provider assumes responsibility for determining the condition, quality and safety of fresh produce used in its food service.

Purchasing procedures should assure availability of food, supplies and equipment in the quantity and quality consistent with established standards and at the most favorable prices consistent with set standards.

Service providers are encouraged to use locally produced foods whenever possible, and collaborate with local food producers and other food assistance programs to maximize access to and use the high quality, nutritious, affordable foods.

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FOODPREPARATIONRECIPES

Standardized recipes shall be used in food preparation and yield shall be indicated. Recipes shall specify the yield and portion size adjusted for the requirements of the Nutrition Program for the older persons.

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QUALITYCONTROL

The following standards shall be established for quality control:

(1) Food production for hot foods shall take place within the eight hours preceding service unless otherwise directed in the recipe. Protein foods shall be cooked completely once the cooking cycle has begun. Foods to be served cold (e.g., congealed salads, puddings, potato salad) and neutral temperature foods (e.g., cookies, cakes) may be prepared earlier than the preceding eight hours if so directed in the recipe. All solid and semi-solid cooked foods stored under refrigeration shall be placed in containers that are no more than 4" in depth.

(2) A chilled food system shall not be served without prior review of the Department for Aging and Independent Living Dietitian. A chilled food system for bulk food shall not be used because of the danger of microbial growth in foods that remain too long in the temperature danger zone while being chilled and because of the compromised quality which may result in foods that are heated, chilled, reheated, and held hot prior to being served. A chilled food system using individually portioned meals may be considered for approval provided that the cumulative hot-holding time for these meals is less than two hours.

(3) Packing of hot foods into insulated chests shall be accomplished as rapidly as possible to prevent heat loss. Hot foods shall be packed at temperatures 160 degrees Fahrenheit or higher; temperatures shall not be so hot that the quality of menu items is compromised. Temperature records shall be maintained

(4) To maintain quality in prepared foods, holding times shall be kept to an absolute minimum. Because long periods of hot holding diminish the nutrient content and the palatability of foods, the holding time for hot food shall not exceed three (4) hours after preparation. Exception to this requirement may be granted by the Department for Aging and Independent Living provided that meal quality is not compromised with extended hot holding and that appropriate temperatures are maintained. The request for this exception must be submitted with a plan to remedy the holding time issue.

The internal temperatures of hot foods to be transported shall be 135 degrees Fahrenheit or above and cold foods 41 degrees Fahrenheit or below at all times during transportation and service.

(5) Optimal temperatures for hot and cold foods shall be maintained to inhibit spoilage and enhance palatability. Hot foods shall be maintained at or above 135 degrees Fahrenheit; cold foods shall not exceed 41 degrees Fahrenheit. Thermometers used to check food temperatures shall be of metal stem-type construction, numerically scaled, and accurate to plus or minus three (3) degrees Fahrenheit. Periodic checks shall be made to insure that each thermometer is registering accurately. Temperature logs shall be maintained.

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INSPECTION OF FACILITIES

Food preparation facilities shall be in compliance with state and local fire, health, sanitation and safety regulations which apply to food service operations. State and local health officials and the Department for Aging and Independent Living Dietitian shall inspect food preparation and service kitchens periodically. Lake Cumberland Area Agency on Aging and Independent Living is responsible for monitoring each food preparation kitchen at least one time per year.

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FOODPREPARATIONGUIDELINES

Policy

The preparation of food for the nutrition program for older adults shall be in accordance with the nutritional guidelines to meet the 1/3 daily nutritional allowance and shall be made pleasing to the taste by utilizing appropriate seasonings that do not alter the nutritional analysis.

Legal Authority

Older Americans Act of 1965 as amended

910 KAR 1:190

Food Preparation Guidelines

(1) Prepare foods without adding salt unless salt is specified in the recipe and has been calculated in the nutritional analysis.

(2) Flavor foods by using herbs, spices, salt-free seasoning, lemon juice, limejuice, vinegar, etc

(3) When using high sodium condiments such as ketchup, barbeque and teriyaki sauce, prepared mustard, seasoned salts, bouillon, pickles and olives, balance the menu with low sodium choices. Light soy sauce should be used to replace regular soy sauce and used infrequently. Low sodium condiments are strongly encouraged. The sodium content of the condiments should be considered in menu planning.

(4) Monosodium glutamate, MSG, shall not be used in food preparation.

(5) Use low fat cooking methods such as baking, broiling or steaming. Minimize the addition of fat to vegetables.

(6) Use all types of fish, lean cuts of meat, and poultry without skin.

(7) Select low sodium versions of canned soups, tomatoes, vegetables, and salad dressings in place of regular canned/bottled items.

(8) Offer fruit desserts: fruit cup, fruit crisp, fruit cobbler, fruited gelatin

(9) Select low fat, low sodium cheese when feasible.

(10) Make sauces and gravies without fat. Add starch to cold liquid, instead of blending starch with fat, before cooking to thicken.

(11) Substitute vegetable oils (ex. canola oil) for shortening, margarine for butter. The amount of trans and saturated fats should be limited. Lard should not be used.

(12) Expand the use of fresh and frozen vegetables and fruits, which contain no added salt

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DIETARYGUIDELINES

Policy:

Special consideration shall be given to the nutritional needs of the elderly, including fewer refined sugars, limited salt, and lower levels of cholesterol and saturated fat are required to maintain good health.

Procedure:

Procedures required in meeting these nutritional needs are as follows:

(1) Reduction in the amount of animal or saturated fats used during preparation and for seasoning; use of vegetable oils, corn oil, safflower oil.

(2) Controlled use of rich desserts containing high levels of fats and sugar (cakes and pies).

(3) Limited use of salt during preparation as well as infrequent use of those foods naturally high in salt or sodium (ham, luncheon meats, and salt cured meats).

(4) Expanded use of fresh and frozen vegetables and fruits which contain no added salt; Restricted use of canned foods containing high levels of salt; Increased use of salt replacements such as herbs and spices.

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FOOD SAFETY AND PERSONAL HYGIENE

The handling and preparing of food shall be conducted in safe and hygienic conditions to ensure the safety of the food service workers and participants of the nutrition program.

Legal Authority

Older Americans Act of 1965 as amended 910 KAR 1:190

Procedure:

Standards for food handling and personal hygiene shall be in accordance with the State Food Service Code (902 KAR 45:005).

(2) These standards include but are not limited to the following: (a) Hairnets, hats or scarves shall be required for all persons preparing food. Persons serving food shall wear appropriate hair restraints to prevent the contamination of food, equipment and utensils. All staff and volunteers shall wear protective clothing such as aprons or smocks. Disposable gloves shall be used to serve those foods, which are not served with utensils.

(b) All staff and volunteers shall be free of contagious disease and transmittable infections while preparing and serving food.

(c) Hands shall be washed before starting work and as often as necessary to keep them clean particularly alter smoking, eating, drinking, or using the toilet. Hand sinks shall be accessible.

(d) Food handlers' certificates shall be up-to-date and posted, when required by the local regulatory agency.

(e) All vehicles used to transport food shall be kept clean and sanitary.

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STATE FOOD SERVICE CODE

Policy:

Standards for food handling and personal hygiene shall be in accordance with the State Food Service Code (902 KAR 45:005).

Procedure:

(1) Hairnets, hats or scarves shall be required for all persons preparing food. Persons serving food shall wear appropriate hair restraints to prevent the contamination of food, equipment and utensils. All staff and volunteers shall wear protective clothing such as aprons or smocks. Disposable gloves shall be used to serve those foods, which are, not served with utensils.

(2) All staff and volunteers shall be free of contagious disease and transmittable infections while preparing and serving food.

(3) Hands shall be washed before starting work and as often as necessary to keep them clean particularly alter smoking, eating, drinking, or using the toilet. Hand sinks shall be accessible.

(4) Food handlers' certificates shall be up-to-date and posted, where issued.

(5) All vehicles used to transport food shall be kept clean and sanitary.

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TEMPERATURECONTROL

Policy:

Optimal temperatures for hot and cold foods shall be maintained to inhibit spoilage and enhance palatability.

Procedure:

Hot foods shall be maintained at or above 135 degrees Fahrenheit; cold foods shall not exceed 41 degrees Fahrenheit. Thermometers used to check food temperatures shall be of metal stem-type construction, numerically scaled, and accurate to plus or minus three (3) degrees Fahrenheit. Periodic checks shall be made to insure that each thermometer is registering accurately. Temperature logs shall be maintained.

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TRANSPORTATION OFMEALS

The following requirements shall apply to the transportation of meals to congregate sites:

(1) Insulated containers shall be used for bulk food.

(2) Bulk foods shall be transported in stainless steel pans or aluminum disposable pans in an insulated container. Use of plastic shall be restricted to cold items only.

(3) Hot items (maintained over 135 degrees F.) shall be transported in bulk containers separate from cold products (maintained under 41 degrees F.). Containers shall be preheated or pre-chilled before being loaded.

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CONFORMANCE TOMENU

Policy:

Food items served in the Lake Cumberland District shall correspond to the published menu;

Procedure:

The Lake Cumberland Food Service Provider shall plan and prepare meals on the approved menu. Any discrepancies in quantity or quality shall be documented and reported. All menu substitutions must be approved by the dietitian. If there is a pattern of substitutions or the substitutions are not appropriate, then additional training must be provided.

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ORDER OF SERVICE

The following order of service shall be followed:

(1) Congregate meals shall be served after packaging the home delivered meals. Foods shall be maintained at appropriate temperatures during all phases of food service.

(2) Any method of serving food may be used so long as it does not result in menu items being held at inappropriate temperatures either on the tables or on the serving line. Milk and other cold food items shall not be preset on tables prior to meal service; tables shall not be preset with eating and drinking utensils for more than four hours prior to meal service unless each item is individually wrapped.

(3) After all participants have been served, volunteers and other staff may be served. Units for volunteers shall be recorded.

(4) Food items left over from any meal may be offered as seconds to congregate meal participants after all have been served, and taking left overs home is acceptable. No meals are allowed to be a carry out instead vs. eating at the center.

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PAYMENT FORMEALS

Only complete meals shall be claimed for payment. The omission of any of the required meal components shall cause that meal to be incomplete and therefore ineligible for payment and USDA Reimbursement.

Refusal by a participant of specific meal components shall not render that meal incomplete.

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FOODTEMPERATURES

Food temperatures for both hot and cold food items shall be checked daily, and recorded both at the kitchen and nutrition site. Specific items for which temperature control is critical are those potentially hazardous foods which support rapid growth of microorganisms - meat, milk, eggs, poultry, fish and those items containing any of the potentially hazardous foods (e.g., sauces,. gravies, puddings, etc.). To preserve optimal temperature control, containers shall not be opened until immediately prior to meal service unless the hot bulk food is to be placed on a commercial hot food table or in ovens and the cold food is to be refrigerated. Temperature checks shall be made when the food arrives and as often as necessary to assure the maintenance of hot food temperatures above 135 degrees Fahrenheit and cold food temperatures below 41 degrees Fahrenheit. If the appropriate temperatures are not maintained then the food should be discarded and shelf stable meals shall be distributed. Discarded foods are not eligible for reimbursement.

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NUTRITIONPROGRAM PARTICIPANT EVALUATION

Menu planning for Congregate, Home Delivered Traditional, Frozen, and Shelf Stable shall include input from participants through annual satisfaction surveys distributed by the Lake Cumberland AAAIL Nutrition Service Providers. Suggestions may also come from food production staff, site managers, home delivered meal drivers, call centers and or the AAAIL.

Case Managers inform Home Delivered Meal clients that input toward the meals and or meal program can be sent directly to Lake Cumberland Area Agency on Aging and Independent Living or discussed during Case Management visits

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HOME DELIVEREDMEAL SERVICE

Meals produced according to the regular menu shall be used in the Home Delivered Meals Program. Home delivered meals shall be provided 1-5 days per week. Provisions may be made for weekend meals for those individuals unable to obtain meals from another source.

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DELIVERYMETHODS

Providers of home delivered meals may use any method of delivery that will prevent outside contamination and hold food at appropriate temperatures. Portioning, sealing, and packing into insulated containers shall be accomplished as rapidly as possible; the most rapid heat loss in home delivered meals takes place between portioning and loading into delivery containers.

Participants in the Congregate Meal Program shall not deliver meals unless all local driver-training requirements are met.

Nutrition site personnel shall check and record temperatures of meals at least weekly toward the end of each meal delivery route. If the temperatures are not consistent with the requirements of 910 KAR 1:190, the nutrition site personnel shall check and record the meal temperatures daily until the temperatures are consistent with those requirements.

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FOODTEMPERATURES

Individual trays shall be transported in insulated containers, which maintain temperatures not less than 135 degrees F. for hot foods, and not more than 41 degrees F. for cold food. Delivery routes shall be kept as short as possible to minimize nutrient loss and to facilitate temperature retention. All meals shall be delivered within three hours from the end of preparation to the final destination. The Department for Aging and Independent Living may grant exception to this requirement provided that meal quality is not compromised with extended hot holding and that appropriate temperatures are maintained.

Nutrition site personnel shall check and record temperature of home delivered meals at least weekly toward the end of the longest delivery route. If temperature retention problems are found, daily checks of temperatures shall be made until the problem is corrected. Meals that do not comply with temperature requirements should not be delivered. These meals are not eligible for reimbursement.

If the temperature of a meal has fallen below of risen above the approved temperatures, the meal shall be discarded and the home delivered meal participant shall be provided with a shelf stable meal.

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PACKAGINGREQUIREMENTS

The following requirements shall apply to the packaging of meals:

(1) Home delivered meals packaged at the center shall be portioned and packaged first, and delivered immediately. Portioning and delivery of all home delivered meals shall be accomplished in such a manner as to insure that hot foods are held hot and cold foods are held cold. The temperature of hot food to be packaged shall be 160 degrees F. or above in order to maintain safe temperatures during transportation and delivery. This requirement does not apply to meals carried in heated secondary containers, provided hot food temperatures never drop below 135° F.

(2) For optimal temperature retention, the space within the delivery containers shall be filled as completely as possible. Foods cannot hold temperatures as efficiently in partially filled delivery containers as in smaller containers, which are completely filled.

(3) The use of heated delivery equipment is encouraged. If heated delivery equipment is not available, other means to hold temperatures shall be used. The use of hot wax bottles, heated ceramic tiles, or hot water bottles may be used to maintain temperatures within the hot food boxes. These shall be placed under hot food in order to maximize heat retention. The source of heat shall be hotter than the temperature of the food itself; if the source is cooler than the food, the temperature of the food will drop to equalize the temperature of the internal chamber. Also hot food items will lose heat to the air inside the container and to adjacent food items, which have lower portioning temperatures. Cold food shall not be over 41°F during the delivery process.

(4) Eutectic plates or artificial ice shall be placed over the cold foods within the food boxes. Ice may be used if the food containers are constructed to prevent water seepage into the food.

(5) Neutral temperature foods shall be packaged and delivered in such a way as to prevent outside contamination.

(6) Frozen meals shall be maintained in a frozen state during delivery. If the meal has thawed to the extent that ice crystals are not contained in the meal, then the meal shall not be refrozen for later use. A meal, which has begun to thaw, may be held for a brief period at 41 degrees F. or below or it may be heated and consumed immediately.

(7) Participants receiving any type of home delivered meals that are prepared in a kitchen within the LCAAAIL should be notified of proper storage procedures if the meal is not consumed immediately and the use by or discard date for each meal received. All Home delivered meals (hot or frozen) that are prepared in a kitchen within the LCAAAIL should be labeled to indicate that the meal should be consumed immediately or refrigerated, with the date prepared, and a use-by or discard date.

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FROZENMEALS

Frozen Meals will only be utilized in the following circumstances:

•The participant has expressed a preference for frozen; or

•The participant lives off an established route, and

•Proper storage and heating facilities are available in the home; and

•The participant is able to prepare and consume the meal alone or with available assistance.

The Case Management and Assessment Team will assess clients for the frozen requirements. Documentation of the assessment will be every six months for Title III, and annually for Homecare clients and more often if needed.

Frozen meals will only be utilized for those clients who live in outlying areas, which make regular delivery difficult due to temperature and time restraints as well as a financial burden to the Home Delivered Meal Program. Participants receiving Frozen Meals shall receive a hot meal on the days of delivery, or all frozen for the week.

Frozen meals will be maintained in a frozen state during delivery. All policies for handling frozen meals will be followed as stated in the KAR 1:190 Nutrition Program for the Elderly Section 9, (2).

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DAILYCONTACT

Policy: Contact, either face-to-face or by phone, will be made with each recipient of frozen meals everyday that the elderly nutrition program is in operation based on the participant’s assessed need. This contact is either made by the driver delivering the meals or by a designated individual; either employee, volunteer or family member. The contact will promote socialization and provide a wellness check.

Procedure:

1. The case management staff or senior center staff will make arrangements for a daily or weekly contact when the alternative meal recipient is enrolled in the elderly nutrition program.

2. The case manager will identify the frequency of the contact and the type of contact. A description of the arrangements will be recorded in the participant’s care plan and will be updated each time an assessment or reassessment is completed.

3. Community resources will be utilized to assure that all frozen meal recipients are contacted either daily or weekly. Such resources include but are not limited to: a. Family members

b. Neighbors

c. Church members

d. Volunteers from the senior centers

e. Homemakers

f. Homecare aides

4. The purpose of the contact shall be a. Daily wellness check

b. Socialization

c. Identification of any changes that would interfere with participant’s ability to prepare and consume their frozen meal

5. The person making the daily contact will notify the person responsible for assessing an alternative meal recipient, either the case manager or senior center director, immediately when a significant need or change in a participant’s status is suspected as a result of the daily contact. a. When the case manager/senior center director is notified of a possible concern, an updated assessment will be initiated and the participant will be evaluated to determine their ability to continue as a participant in the alternative meal program.

6. The person making the contact should identify any changes in the participant’s support system, possible changes in ADL/IADLs, change in nutritional risk and change in fall risk. Identified changes shall be noted in the participant’s record and forwarded to the person responsible for completing re-assessment.

Daily contact: Frail, isolated participants without a support system and have a history of falls or a high risk of falls, deficiency of three (3) or more ADL/IADLs, and be at high nutritional risk;

Weekly contact: All Home Delivered Meal Participants must be contacted at least weekly.

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PREPARATION INSTRUCTIONS FORALTERNATIVEMEALS

Frozen Meals

Home Delivered Meals are dated with the date of preparation. Meal Delivery drivers record the day of delivery of each meal on the Meal Delivery Sheet.

New Home Delivered Meal Participants receive information regarding storage and preparation instructions as follows:

Notice the packaged date on the frozen meals. Freeze immediately upon receiving meals. It is recommended that meals be used within two weeks of the package date.

If you would like to thaw the frozen meal before cooking, thaw the frozen meal in the refrigerator.

To heat in the oven, remove cardboard cover and heat thawed meals at 325 degrees for 25 to 30 minutes (ovens will vary in temperature). Cooking time should be doubled if the meal is still frozen

To heat in a microwave, remove cardboard and cover with a paper towel or place frozen meal on a microwave safe plate and cover with paper towel. Heat on high for 8 to 10 minutes. If meal is thawed before heating, cook time will only be between 3 –5 minutes (microwaves will vary in temperature).

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REQUIREMENTS FOR EMERGENCYMEALS

Menus for emergency shall provide the equivalent of one-third of the dietary reference intakes as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and comply with the most recent Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture.

Menus shall be signed and approved by the local dietitian. The menus will be reviewed by the Department for Aging and Independent dietitian during the annual monitoring.

Menus shall be planned for a minimum of three days and shall be submitted on the official menu form. Frozen meals shall be used only if the participant is able to store, prepare and consume the meal alone or with available assistance and if the delivery system is arranged so that storage time after delivery is minimal. Preparation instructions and used by / expiration dates shall be included

Each meal shall contain all the components of the regular meal as described in the Meal Pattern policy, with the exception that butter or margarine may be optional. Water shall be provided if necessary.

Shelf stable meals may be made available for emergency meals. The shelf stable meal should be monitored so the expiration date does not pass. The nutrient content of the shelf stable meals in the package may be averaged to meet requirements.

Shelf Stable Packaging requirements:

(1) The page shall include menus to instruct the clients how to combine the foods to meet the meal requirements.

(2) Cans are to be easy to open, with pull-tabs whenever possible.

(3) The box must be labeled with the use by/expiration date.

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EMERGENCYMEALS

Policy:

Emergency Meals are available during inclement weather conditions, power failure, or any disaster that may cause isolation or create a special need.

Procedures:

1.) Menus are planned for a minimum of three (3) days;

2.) Menus are certified in writing by the LD/CN as meeting the current Dietary Reference Intakes (DRI) based on the meal pattern or nutrient analysis.

3.) The menu includes foods, which require no cooking prior to consumption;

4.) Emergency meal packages are distributed to homebound clients with home delivered meals and may be used for congregate participants when centers are closed;

5.) For reporting purposes, meals are counted during the month in which they were distributed.

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COMPOSITION OF EMERGENCY MEALS

The menu plan shall include some foods which require no cooking prior to consumption. Participants shall be advised that canned foods may be heated in hot tap water if a stove is not available. Hot tap water may also be used to make instant soup, cereals, coffee, tea or cocoa. One dish meals may be used--stews, casseroles- provided that both the protein requirement and one of the vegetable requirements are contained in the single serving. Foods which may be contained in emergency meals are as follows:

(1) Meats and Meat Alternates:

(a) Canned meat, poultry, or fish.

(b) Canned mixtures of meat, poultry or fish with vegetables, rice, macaroni, spaghetti, or dried beans.

(2) Fruits and Vegetables:

(a) Canned fruits, vegetables, and soups.

(b) Dried fruits.

(c) Canned fruit juices

(3) Breads and Cereals:

(a) Packaged crackers and cookies.

(b) Canned breads, canned spaghetti dishes.

(c) Instant cereals, ready-to-eat cereals.

(4) Milk and Milk Products:

(a) Canned milk, dried milk, instant milk products.

(b) Canned or packaged puddings.

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NUTRITIONEDUCATION

Policy

An ongoing Nutrition Education Program shall be implemented that provides education for all participants of the nutrition program for the elderly.

Legal Authority

Older Americans Act of 1965 as amended 910 KAR 1:190

Procedure

(1) An annual nutrition education plan shall be developed by the Area Agency on Aging and Independent Living and the nutrition service providers.

(2) The plan shall include a minimum of one session each month at each nutrition site.

(3) The plan shall include a variety of topics using a wide range of teaching techniques.

(4) The plan shall include how educational materials shall be provided to home delivered meal clients at least monthly.

(5) The DAIL Senior Health and Wellness Newsletter may be utilized to meet the nutrition education requirements monthly.

(6) Nutrition Education topics shall include at least the following: (a) Nutrition and its relevance to health promotion and disease prevention;

(b) Consumer approaches to food safety and food purchasing;

(c) Food fads and diets;

(d) Physical activity; and

(e) Activities to modify behavior and improve health literacy, including providing information and optimal nutrients

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NUTRITION EDUCATION FOR THE HOME DELIVEREDMEAL CLIENT

Case managers for Home Delivered Meal Clients will assess the clients need for nutrition education and indicate the need for education services on the Nutrition Risk Assessment as well as on the clients care plan.

Clients deemed as needing or requesting nutrition education will be referred to Lake Cumberland Area Agency on Aging’s nutrition and health promotion providers for education. Nutrition Education Information is always made available to home delivered meal clients and delivered with meals. Follow up phone calls are made to check on the clients’ status and if necessary, referrals are made to the local health department, extension office and or doctors’ offices for additional education or support.

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NUTRITIONCOUNSELING/CONSULTATION

Policy:

Individual diet counseling with participants shall only be provided by a dietitian.

Procedure:

Congregate Meals:

LCADD Congregate meal site directors shall conduct nutritional risk assessments on all congregate meal clients. Clients with moderate nutritional risk will be referred to their local doctor, health department and a dietitian. Clients who are at a high nutritional risk will be referred to their physician and/or dietitian.

Home Delivered Meals:

LCADD Case Mangers will implement the Nutrition Screening Initiative – Level One by identifying client’s nutritional risk on the NAPIS form.

Eligible individuals with the greatest economic and social needs will be served. Using the LCADD nutritional assessment identifies the need for home delivered meals even further. This includes all of the risk factors on the NAPIS form plus additional questions that will assist in determining the client’s needs that might extend beyond nutritional needs. Such needs might include referrals to their doctor or specialist, a dietician for individual counseling, heating assistance, Homecare Services, and or transportation

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NUTRITION SERVICES AND INCENTIVE PROGRAM (NSIP)

Policy: The NSIP is based on a performance incentive model. LCADD/AAAIL receives funding based on the number of meals actually served in the LCADD region in relationship to the total number of meals actually served in the state in the previous year.

Procedures:

A. LCADD may disburse NSIP monies to nutrition service providers based upon each provider's proportion of the total number of eligible meals served in the region for the previous fiscal year. 1. Disbursements of cash are made quarterly, upon receipt of funds from DAIL.

2. The provider shall expend NSIP monies within one (1) year from the time payment is received.

3. NSIP funds shall be used to expand the total number of meals provided and shall not be used to reduce funds from any other grant or contract which the provider may be given.

B. The meal provider maintains records to show the amount of cash received and to demonstrate how NSIP funds are used to expand LCADD funded nutrition services program;

C. The meal provider uses cash to purchase foods for the nutrition program; 1. Purchase meals provided the cost of the meal is quoted as a unit cost, which includes both food and labor.

2. Only meals and actually consumed by eligible participants may be claimed;

3. Meals claimed for reimbursement cannot be claimed under other USDA reimbursement programs;

D. Financial records maintained by the provider will show: 1. NSIP funds are used as a revenue source for expansion of meals served in the region;

2. The unit cost of a meal is not reduced in anticipation of future NSIP reimbursement but is stated as a true cost in both bidding and reporting procedures; and

3. Monthly financial reports reflect NSIP expenditures.

E. NSIP Funds shall not be used for the following:

a. To reduce funds from any other grant or contract which the provider may be given

b. To fund meals served to individuals, guest, or staff less than sixty (60) years of age;

c. To fund meals served to a person who is paying a set fee for the meal;

d. To fund meals served to consumer that meet income eligibility criteria under other programs;

e. To fund alcoholic beverages and vitamin supplements not allowed under the nutrition program guidelines;

f. To fund sponsored meals if a set fee or charge is involved; or

g. To fund meals served to individuals in nursing homes, adult day care, or assisted living facilities where the meal is part of the per diem.

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FINANCIALRECORDS

The following requirements apply to accounting for NSIP:

(1) Meals provided in the Nutrition Program for the Elderly shall be bid without regard to NSIP reimbursement.

(2) NSIP funds shall be used as a revenue source for expansion of numbers of meals served in Lake Cumberland Area Agency on Aging and Independent Living.

(3) The unit cost of a meal shall not be reduced in anticipation NSIP funds but shall be stated as a true cost in both bidding and reporting procedures.

(4) Monthly financial reports shall reflect NSIP expenditures and meals provided.

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NUTRITION PROGRAM COSTS

Legal Authority

Older Americans Act of 1965 as amended 910 KAR 1:190

A standardized single method for computing actual meal costs shall be used. This computation shall be referred to as the ready-to-serve meal cost and the food service and delivery cost. The ready-to-serve cost provides a mechanism for comparing costs among differing programs and providers.

(1) Ready to Serve Meal Cost

(a) Food Costs: Include the cost of raw food (food normally purchased by a food service operation, which prepares its own food, and convenience foods, which may require very little preparation). This also includes food purchased with NSIP funds.

(b) Non-Food Costs: Include the costs of serving supplies, disposables, cleaning materials, and all non-capital items used ·in the preparation of food. (Paper goods, disposables, eating and serving utensils, detergents and other cleaning supplies and equipment.)

(c) Labor Costs - Food Preparation: Include the costs of labor for food preparation; cooking, and portioning bulk foods; and delivery of food to the site of service. Labor cost shall include:

1. Wages paid to all persons who prepare food.

2. Wages for persons who prepare and maintain the sanitary condition of the kitchen and storage areas.

3. Wages paid for time spent in food and supplies inventorying, storing and receiving and in direct supervision of kitchen employees.

4. Fringe benefits are also included;

(d) Equipment Costs: Include the costs of such capital items as ranges, dishwashers, trucks and vans, steam tables, freezers, etc.

(e) Utility Costs: Include the costs of space and related utility costs incurred for food preparation, including equipment operation costs and costs for maintenance and repair.

(f) Other Costs: Include the non-labor costs of transporting food, food storage, insurance, and general liability.

(2) Food Service and Delivery Cost

(Use cash outlay and value of resources used for minimum required match)

(a) Portioning Costs: Include the costs of labor for serving foods and labor for home delivery of meals to participants.

1. Wages paid to all persons who portion food;

2. Wages for persons who maintain the sanitary condition of the service kitchen and dining areas; and

3. Wages paid to persons who supervise these activities.

4. Fringe benefits are also included

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Section XIV Nutrition Program

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(b) Delivery Costs: Include the costs of labor for delivering meals to homes of participants and mileage and maintenance of vehicles used for this purpose.

(c) Other Nutrition Service Costs: Include costs incurred for nutrition education and nutrition outreach services needed to meet the needs of participants. These costs include personnel, equipment and supplies, etc., which can be properly allocated to the nutrition program. Include the cost, if any, for rental and maintenance of facilities used for nutrition services.

(d) Project Management Costs: Exclude expenses .incurred for nutrition education and nutrition outreach services.

1. Personnel Costs: Include expenses incurred for the program director and related administrative staff, such as bookkeepers, clerical staff, nutritionists, registered dietitians, etc.

2. Equipment and Supply Costs: Include equipment and supplies related to overall program administration, such as typewriters, computers, software for menu analysis, office supplies, office furniture, cleaning supplies, disposable paper supplies and janitorial supplies.

3. Other General Expenses: Include costs related to overall program management, such as insurance, bonding, licenses, membership fees paid to professional organizations, utilities, repair and maintenance of equipment in centers, pest control, office and site rental, office supplies, insurance and other miscellaneous costs.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

LCADD Contact Info

Lake Cumberland Area Development District
P.O. Box 1570
(mailing address)
2384 Lakeway Dr.
(street address)
Russell Springs, KY 42642
Phone: 270-866-4200
Toll Free: 800-264-7093
TDD: 800-648-6056
Fax: 270-866-2044
info@lcadd.org

LCADD Calendar

September 2017
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