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STATE OF NEVADA
Aging and Disability Services Division 

SERVICE SPECIFICATIONS

NUTRITION SERVICE
(Revised 1/10)

Any exceptions to these Service Specifications must be requested in advance in writing and approved by the Deputy Administrator. 

SERVICE DEFINITION: 

Nutrition services provide meals to congregate and/or home-delivered meal participants.

AoA SERVICE CATEGORIES AND UNIT MEASURES: 

Congregate Meals (1 Meal) - Provision, to an eligible client or other eligible participant, at a nutrition site, senior center or some other congregate setting, a meal which meets the standards established by the Older American’s Act and complies with the Dietary Guidelines for Americans published by the Secretaries of the Department of Health and Human Services and the United States Department of Agriculture. 

Home-Delivered Meals (1 Meal) - Provision, to an eligible client or other eligible participant, at the client’s place of residence, a meal which meets the standards established by the Older American’s Act and complies with the Dietary Guidelines for Americans published by the Secretaries of the Department of Health and Human Services and the United States Department of Agriculture. 

Special Meals (1 Meal) - Special meals are modified both in texture/consistency (chopped or pureed) or modified based on related disease. One unit equals one modified meal, which meets the standards established by the Older American’s Act, and complies with the Dietary Guidelines for Americans published by the Secretaries of the Department of Health and Human Service and the United States Department of Agriculture.

SPECIFICATIONS: 

1.            Nutrition Services: 

1.1             Meals provided to eligible individuals in a congregate setting or delivered to individuals who are homebound due to physical or mental health conditions that prohibit them from eating in a congregate setting. 

1.2             Special meals may be provided, according to the nutrition program’s ability, to clients that have specific dietary needs arising from health conditions, religious requirements or ethnic backgrounds.   

1.2.1      A diabetic diet is not provided unless there is an order written by a physician and the diet is designed by a registered dietitian.  

1.3           Frozen meals, sack lunches, cold meals, and/or shelf-stable meals may be used to provide supplemental meal service to clients who receive home-delivered meals. 

1.4           During each program year, all certified home-delivered meal recipients must receive two shelf-stable meals.  

1.4.1      Clients are to be advised to save the meals for an occasion on which the program cannot deliver a regularly-scheduled meal (e.g. severe weather, emergencies, etc.).  

1.5           Five congregate meals, or five-to-seven home-delivered meals, are to be provided each week, except in situations where such frequency is not feasible and a lesser frequency is approved by the Division. 

1.6           Nutrition education services are to be provided, no less than semi-annually, to congregate and home-delivered meal participants. The goal of nutrition education is to provide older persons with information that will promote improved food selection, eating habits and health-related practices.  

1.6.1      Nutrition education documentation shall include:  date of presentation or distribution of materials, name and title of presenter, a copy of materials distributed to clients or topic discussed (if applicable), and number of persons in attendance. If materials are delivered to homebound participants, documentation shall include date of distribution, copy of distributed material, and number of participants that received the information. 

2.            Nutrition Service Standards:

2.1             Programs must maintain the food safety standards listed in the Food Safety Checklist. 

2.2           The program’s Food Service Establishment Inspection Report must be sent to the Division on an annual basis, or as new inspections occur.

2.3           A quarterly food safety self-assessment, using the Food Safety Checklist and cover sheet, is to be completed by the program director or a member of the board. The program must retain a copy of the completed cover sheet for review. 

2.4           Programs are required to complete a background check on all home-delivered meal drivers and document the results, before drivers provide services. 

2.5             Drivers cannot accept tips, gifts, loans or fees from home-delivered meal participants. Drivers may collect program donations.

2.6             Programs are prohibited from providing eligible congregate clients with “take-out” meals as an alternative to participating in the congregate meal program, which requires meals to be consumed in a group setting. These meals will not be eligible for reimbursement from USDA or Title III-C funding under any circumstances. 

2.7             Programs are required to establish written alternative procedures for the availability of home-delivered meal service during inclement weather. 

2.8             Training shall be provided for all paid and volunteer personnel to assure the safe preparation and delivery of meals. Directors and head cooks must complete ServSafe (or equivalent) training.  Certification is achieved by passing this training’s nationally-recognized examination in food safety. 

Recognized providers of the ServSafe food safety examination and certifications are: 

Or any other ServSafe certified trainer.   

Upon employment, and before working in the kitchen, the director and head cook must have taken and passed the Division’s online food safety tutorial. Additionally, the director is responsible for making sure that he/she and the head cook successfully complete the ServSafe Examination within six (6) months of employment.   

All other paid/volunteer foodservice-related staff must have four (4) hours of training on topics related to their job duties. All staff must complete the training requirement within three (3) months of hiring/volunteering.  The director is responsible for ensuring that all other paid/volunteer kitchen staff is properly trained in food safety. 

2.9             All recipients of home-delivered meals will be visited at their home by provider staff to be certified regarding the need for service. The continued need for service should be periodically reviewed and documented by staff to assure program resources are being appropriately allocated. Documentation must include:

2.9.1      The date service was started;

2.9.2      The physical and/or mental health condition(s) that prevents the individual from attending a congregate meal site, and any documentation concerning the noted condition(s);

2.9.3      A notation whether the client has a working refrigerator, freezer, microwave and stove;

2.9.4      The estimated length of time the individual is expected to receive home-delivered meals. The length of certification must be based on the client’s health condition and cannot exceed 12 months.  Each assessment and reassessment must include a determination of when the next reassessment should take place; 

2.9.5      Documentation regarding the need for weekend or second meals, if provided by the program. The program is responsible for the costs associated with providing a second meal unless the Division’s assigned Resource Development Specialist has approved, in writing, the need to supply additional meals to a client due to extenuating circumstances; and 

2.9.6      The date of certification and signature of certifying staff member. 

2.10         Incorporating services that promote client independence in the community should be part of the home-delivered meal client assessment and certification.
 

2.11        Grantees are required to establish a written home-delivered meal service termination policy, which includes at a minimum:
 

2.11.1   The client’s decision to stop receiving services, or;
 

2.11.2   Reassessment, which determines the client to be ineligible;
 

2.11.3   Improvement in the client’s condition, which eliminates the need for home-delivered meals;
 

2.11.4   An increase in the availability of support from friends and/or family;
 

2.11.5   Institutionalization of the client (in either an acute care or long-term care facility);
 

2.11.6   Death of the client; 

2.11.7   Written documentation of acknowledgement of request to end service or notification of the client termination must include the date service will end or be terminated and any referrals that were made to another provider, if appropriate. 

2.12    A “monthly participant letter” can only be sent to home-delivered meal recipients who are above 185% of the Federal Poverty Level.  The letter must stress that "it is not a bill and service will not be denied because of an inability to donate.”  The participant letter is to only include the number of meals provided to the client for one month and the recommended donation amount.      

2.13       The program is to ask each congregate and home-delivered meal client to fill out the Nutrition Risk Form as part of the annual registration process. The resulting nutritional risk score is to be entered into the client’s file in the Social Assistance Management System (SAMS). 

2.14       Clients determined to be in need of other services shall be assisted with appropriate referrals. 

2.15    Each nutrition program must maintain a perpetual food inventory and conduct a physical verification of the inventory on a monthly basis. (PIN-23)

2.16    Program directors, or a nutrition program representative, are required to attend any and all ADSD-sponsored nutrition conferences and/or trainings. 

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Last Updated: 03/03/10

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