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HomeMy WebLinkAboutNutrition Advisory Council - Agenda - 8/21/2024 (715) 373-6144 Phone/TDD • (715) 373-6130 FAX • www.bayfieldcounty.org • baycodhs@bayfieldcounty.org Department of Human Services 117 East Fifth Street P.O. Box 100 Washburn, WI 54891-0100 FROM: Carolyn Novack, Aging Services Coordinator DATE: 08/21/24 RE: Meeting Notice The Bayfield County Department of Human Services Nutrition Advisory Council will meet at 11:00 on Wednesday August 21, 2024, at the Port Wing Congregate Meal Site, First Lutheran Church, 83105 Washington Ave, Port Wing, WI, 54865. Participation via remote access is available by phone by calling +1 715-318-2087 at the start of the meeting and entering participant code, 453 687 237 followed by the # sign. Committee members will receive an invitation via Microsoft Teams. Notice is hereby given, in the event the standing committee does not have a quorum, the County Board Chair or Vice Chair may act as an ex officio member (County ordinance, Chapter 3, section 2-3-1(c)). Any person wishing to attend who, because of a disability, requires special accommodation should contact the Department of Human Services at 715-373-6144, at least 24 hours before the scheduled meeting time so appropriate arrangements can be made. The agenda includes: Call to Order and Introductions; Discussion and Possible Action- Review of the May 16, 2024, Meeting Minutes; Preliminary Discussion about Nutrition Goals for the 2005-2007 Aging Unit Plan; Dining Site Hospitality Reviews – report back from Council members; Program Reports: Congregate Meals, Home Delivered Meals; Other (Informational Items); Future Meeting Dates, Motion to Adjourn. cc: Post (bulletin board and website) E-Mailed: Dennis Pocernich, County Board Chair Mark Abeles-Allison, County Administrator Lynn Divine, County Clerk Human Services Board Elizabeth Skulan, BCDHS Director Management Staff Anne Marie Coy, Health Dept. Director Greater Wisconsin Agency on Aging Resources, Inc. (GWAAR) DCS, Rhinelander Red Cliff-Tribal Chair Daily Press K:\Agends and Minutes\A&D Nutrition Advisory Council \Notices\NAC Meeting Notice-8/21/24 (715) 373-6144 Phone/TDD • (715) 373-6130 FAX • www.bayfieldcounty.org • baycodhs@bayfieldcounty.org Department of Human Services 117 East Fifth Street P.O. Box 100 Washburn, WI 54891-0100 BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES NUTRITION ADVISORY COUNCIL Frances Renn-Malcheski (Chairperson) Sue Aiken (Vice-Chairperson) Fred Strand RE: August 21, 2024, Nutrition Advisory Council Meeting Dear Council Members: The Bayfield County Department of Human Services Nutrition Advisory Council will meet at 11:00 on Wednesday August 21, 2024, at the Port Wing Congregate Meal Site, First Lutheran Church, 83105 Washington Ave, Port Wing, WI, 54865. Participation via remote access is available by phone by calling +1 715-318-2087 at the start of the meeting and entering participant code, 453 687 237 followed by the # sign. Committee members will receive an invitation via Microsoft Teams. Notice is hereby given, in the event the standing committee does not have a quorum, the County Board Chair or Vice Chair may act as an ex officio member (County ordinance, Chapter 3, section 2-3-1 (c)). Any person planning to attend who, because of a disability, requires special accommodation, should contact the Department of Human Services at 715-373-6144, at least 24 hours before the scheduled meeting time, so appropriate arrangements can be made. Microsoft Teams Join the meeting now Meeting ID: 296 931 250 086 Passcode: 7UCHDo Dial in by phone +1 715-318-2087, United States, Eau Claire Phone conference ID: 453 687 237# Department of Human Services 117 East Fifth Street P.O. Box 100 Washburn, WI 54891-0100 The agenda for the meeting is as follows: AGENDA 1. Call to Order and Introductions 2. Discussion and Possible Action-Review of the May 16, 2024, Meeting Minutes 3. Preliminary Discussion about Nutrition Goals for the 2005-2007 Aging Unit Plan 4. Dining Site Hospitality Reviews – report back from Council members 5. Program Reports:  Congregate Meals  Home Delivered Meals 6. Other (Informational Items) 7. Future Meetings:  October 21, 10:45 at the Cable Meal Site 8. Motion to Adjourn Join us for the Senior Lunch afterward at 12:00 p.m. Carolyn Novak, Elder Nutrition Program Supervisor K:\Agendas and Minutes\A&D Nutrition Advisory Council\NAC minutes\2024-05-16-NAC Meeting-CN.doc 1 BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES THE NUTRITION ADVISORY COUNCIL Barnes Meal Site, Barnes Town Hall May 16, 2024, at 11:00 a.m. Committee Members Present: Karen Anderson, Frances Renn-Malcheski, Sue Aiken, Lynette Benzschawel, Fred Strand Others Present: Carolyn Novak, Jim Crandall Call to Order and Introductions Benzschawel called the meeting to order at 11:05 a.m. Discussion and Possible Action-Review of the February 27, 2024, NAC Meeting Minutes Motion by Renn-Malcheski, seconded by Aiken to approve the corrected meeting minutes of February 27, 2024. Motion passed. Membership Updates: County Board Supervisor, Madelaine Rekemeyer, has resigned from the NAC due to other obligations. She is being replaced by Supervisor Fred Strand. Both Karen Anderson and Chairperson Lynette Benzschawel, are going off the NAC because their 2nd terms have expired. This leaves 2 openings for community members. New members will be recruited from outlying areas of the county to provide representation from underserved communities. Carolyn Novak and Carrie Linder will start the recruiting process ASAP. Discussion and Possible Action-Election of Chairperson Benzschawel needs to be replaced as NAC Chairperson because she is leaving the Council. Nominations for the new chair were limited to Renn-Malcheski. She accepted the nomination and was voted in unanimously. Motion by Anderson, seconded by Benzschawel to approve Renn-Malcheski as Chairperson. Motion passed. Discussion and Possible Action-Election of Vice Chairperson Since Renn-Malcheski moved up from Vice Chair to Chair, the Vice Chair position was left vacant. Nominations for the new Vice Chair included Aiken. Aiken was voted in unanimously. Motion by Benzschawel, seconded by Anderson to approve Aiken as Vice Chairperson. Motion passed. ENP goal development for the 2025-2027 Aging Plan A new 3-year aging plan is being developed for approval later this summer. Assessment surveys have been collected and listening sessions are being held around the county. Survey results are currently being tallied. The plan requires at least one goal developed for the nutrition program. Goal ideas will be discussed at the next NAC meeting. Dining Site Hospitality Review Orientation New dining site hospitality review forms were introduced to NAC members. As discussed in previous meetings, it was determined that all NAC members would do at least 1 hospitality review at one of the congregate meal K:\Agendas and Minutes\A&D Nutrition Advisory Council\NAC minutes\2024-05-16-NAC Meeting-CN.doc 2 sites. The review includes how people are welcomed, site features (easy parking, accessible bathrooms), rating of the food and volunteers/site managers. NAC members were asked to choose a site other than one they might go to regularly and to have the review completed by the end of summer. Anderson and Benzschawel volunteered to complete an assessment even though this is their last council meeting. Some NAC members signed up for sites, others are checking their availability and will let Novak know their preferences. Cornucopia – Fran Renn-Malcheski Iron River – Sue Aiken Port Wing – Lynette Benzschawel Time Out – Karen Anderson Program Reports:  Congregate Meals – Chartwells, the main food vendor for Bayfield County and Ashland County Senior Meals, is in negotiations with Northland College administrators about the future of Chartwells at Northland. Chartwells is supposed to provide a 60-day written notice if they are ending their contract with Bayfield County, however, it seems unlikely they will do so. As a backup plan, Bayfield County can move all current Chartwells meal production to the Bayfield County Jail kitchen. Discussions are underway on what that may look like. The new Cable site is open and running well with an average participation number of 40-45 people per meal. Barnes is also doing well – going from 2-3 people last year to about 20 participants per meal. Iron River changed food vendors and will continue to be monitored for participant satisfaction. Time Out, St. Louis and Cornucopia numbers are increasing as people return from winter vacations. Port Wing has increased and is holding steady.  Home Delivered Meals –Bob Marx, meal route driver, recently retired. His position will be re-evaluated before posting. Marx does have a long-term substitute taking his place. Another driver will be taking a summer sabbatical, but his route will be covered by a long-term substitute. Ads have been posted for substitute drivers. Other (Informational Items)  Renn-Malcheski will be trained to implement the “Mind over Matter” bladder and bowel curriculum for older women. The training will be done online. Renn-Malcheski will work with the office to set up classes in Bayfield County.  A&D will have an outreach booth at the South Shore EMS Expo on Saturday, May 18 at the Community Center in Port Wing. Both congregate and home delivered meal information will be promoted at the event, along with other department services.  WEAAD (World Elder Abuse Awareness Day) occurs annually on June 15th. This year, A&D staff will host a Senior Empowerment Day at the Iron River Community Center on Friday, June 14 from 8:30 a.m.- 12:30 p.m. Speakers will be addressing a variety of topics, including financial frauds and scams. Door prizes and lunch will be offered. The event is free! Future Meetings:  August 21, 11:00 at the Port Wing Meal Site  October 21, 10:45 at the Cable Meal Site K:\Agendas and Minutes\A&D Nutrition Advisory Council\NAC minutes\2024-05-16-NAC Meeting-CN.doc 3 Benzschawel adjourned the meeting at 12:00 noon. Minutes respectfully submitted by Carolyn Novak GWAAR Nutrition Team 7-23-24 FINAL Technical Assistance Document: GWAAR Service Area Meal Prioritization/Waitlist Local Considerations & Actions Needed Local programs shall utilize the Right Meal & Services for You Form & Process and the supporting materials provided by GWAAR if implementing a Meal Prioritization and/or Waitlist. This process has been reviewed and approved by BADR and aligns with the requirements in the Nutrition Services Aging Operations Manual. This guide will assist you in adopting this process, as some local decisions need to be made when implementing this process. You can access the required score form, editable templates, training materials, and supporting documents on the GWAAR Partner Resources-External Site in the Nutrition Library- Meal Prioritization Folder. Reference for this document: Nutrition Services Aging Operations Manual P-03062-38 (04/2024) WI Dept of Health Services (pages 8, 19, 25-27, 54). (See Appendix A for full text). If you have any questions, please contact your regional GWAAR Nutrition Team Representative, they will be happy to assist you. The GWAAR Nutrition Team Reasons for adopting this process: If demand appears to, or does exceed capacity, or if you want to avoid a waitlist, or pivot to offering person-centered tailored nutrition options that meet people where they are, i.e. the Right Meal for You. 1. First, Local agencies will ensure that everyone on their HDM program meets the eligibility criteria by completing initial assessments or annual reassessments before a waiting list/meal prioritization process is considered. 2. If it is found that the demand for program resources exceeds funding, staff, volunteers, or other capacity issues a local waiting list or meal prioritization process will be implemented. 3. If you want to begin or continue offering Carryout or Grab-N-Go meals, using this process fulfills the requirements of the Nutrition Services Operations Manual. If you are going to adopt & implement this process locally, you must notify your GWAAR Nutrition Team Representative by completing the Notification Form Local Implementation: Local programs have the flexibility to decide who will complete the Right Meal & Services for You Form (Meal Prioritization/waitlist) and determine what interventions you can offer. Programs can adapt or combine any of the following methods of implementation: 1. Support Staff-Complete HDM Inquiry Form over the phone. o After completing the form over the phone, if they are eligible for Carry Out or HDMs, the support staff can offer to fill out the appropriate registration form with them while on the call. OR ask if they would like to schedule a follow-up call with them or the HDM Assessor to complete the registration form. AND/OR Older Americans Act program area (Select a program area if applicable.) ☐Title III-B Supporve Services ☒Title III-C1 and/or III-C2 Nutrion Program ☐Title III-D Evidence-Based Health Promoon ☐Title III-E Caregiver Supports Aging Network value (Select a value if applicable.) ☒Person centeredness ☒Equity ☐Advocacy Goal statement: 1. Why are we choosing this thing to focus our efforts on? 2. Why do we believe this parcular effort will make things beer? 3. How do we think this leads to people being beer off? 4. How will we know when we’re done with this effort? 5. How will we know whether anyone is beer off because of this effort? Bayfield County has a Meal Priorizaon policy and a Waing List policy. Both need to be updated to reflect new informaon and resources available. Staff reorientaon and orientaon regarding both processes is also necessary. By ulizing the GWAAR Person- Centered Meal Priorizaon Process, we can implement a standardized process to assess individual needs and offer resources to best meet personal goals. Plan or strategy: By 10/01/2025 staff will implement the GWAAR Person-Centered Meal Priorizaon Process to opmize the delivery of meals and related services within the OAA Nutrion Program. This will ensure that individuals with the highest nutrional needs are being served within the means of program resources while also offering person-centered services to those with moderate to low needs that meet the individual where they are to opmize their nutrion status and enhance their quality of life. Nutrion resource opons will be tailored to meet individual needs, providing appropriate nutrion and supporve services that are grounded in person-centered pracces and equitable to all by ensuring transportaon needs and financial burdens are met. DRAFT Preliminary ideas about documenng efforts and tools:  The Meal Priorizaon policy and Waing List policy will be updated between October and December of 2024.  Nutrion resources will be developed between by March 1, 2025  Staff and commiee members will be informed and trained on the updated processes by April 1, 2025.  The new process will be implemented for all new parcipants beginning May 1, 2025.  The new process will be implemented for reassessments when they begin in June 2025. How well it has been done:  Data will be recorded as directed by GWAAR and BADR and analyzed quarterly for service delivery trends by need category, scope of ulizaon, and overrides. o Assess # parcipants who are short term (less than 3 months), High, Moderate and Low need to beer understand the demand. o Addional services and referrals will be offered to 50% of parcipants to demonstrate person-centered planning. Assessing whether anyone is beer off: Processes will be established and implemented to ensure parcipants at each level of need are being monitored and reassessed to prevent decline. In addion, surveys to parcipants and staff will measure their level of sasfacon with the new process.  Within 4 to 12 weeks follow up with the parcipant will occur to see how their plan is working and if referrals have been completed and addional programs/services started.  Provide a Sasfacon Survey to the parcipant. The intent is to see if anyone is beer off and to idenfy strengths and opportunies for improvement. (This should be provided within 4-12 weeks of inial contact). Survey results will be entered via this link The goal is to have 80% return rate.  Bayfield County will provide input about the new process via this link  Staff will provide input by compleng the Right Meal & Services for You process Sasfacon Survey via Staff Sasfacon Survey Link  Time Added to the assessment process: Goal 80% of staff will note no or negligible me addion. GWAAR Nutrition Team 7-23-24 FINAL 2. Assessor-Completed Prioritization and Notification o The HDM Assessor completes the HDM registration form. If the participant is eligible for HDMs, the Assessor also completes the Right Meal & Services for You Form and informs the participant of the number of meals and other interventions they qualify for. We have sample scripts and conversation tips for HDM assessors available. AND/OR 3. Assessor-Completed Prioritization and Deferred Notification o The HDM Assessor completes the registration form and, if the participant is eligible for HDMs, completes Steps 1 and 2 of the Right Meal & Services for You form. The participant is informed that they will be notified within a specified number of days about the number and type of meals and other interventions they qualify for. The Assessor then discusses the case with the local director or designee, who decides on the number of meals and interventions to offer. A process must be in place for communicating this decision to participants (sample letters are available in the Meal Prioritization folder on the Nutrition – EXT SharePoint site). AND/OR 4. Director-Completed Prioritization and Notification o The HDM Assessor completes the registration form and informs the participant that they will be notified within a specified number of days about the meals and other interventions they qualify for. The Assessor then discusses the registration form with the local nutrition director or designee, who completes the Right Meal & Services for You form and determines the number and type of meals and other interventions to offer. A process must be in place for communicating this decision to participants. By implementing these methods, local programs can ensure an efficient and clear process for prioritizing meal services and communicating eligibility and interventions to participants. INTERVENTIONS a. You can use Version 1, or Version 2 of the Right Meal & Services for You Form, the difference is on how the Intervention section is laid out. b. Customize this section of the form to reflect the innovations, programs, services, and referrals you offer. Define the interventions for each need level or adopt a person-centered approach and decide on a case-by-case basis. Consider the following when determining interventions. • Meal Allocation Strategy: o Will you assign a specific number of meals to each need category, or will you adopt a person-centered approach and base it on individual needs or a hybrid of both? • Implementation Scope: o Will you keep all current participants on the program and inform them about the new process during reassessment, or will this new process only apply to new participants? GWAAR Nutrition Team 7-23-24 FINAL Intervene Keep in mind, that we are trying to determine what type of meal service, or combination of meal service and supportive services can best support the nutrition security, socialization, and wellness of the individual to align with the intent of the OAA. In collaboration with the participant, offer interventions that align with their level of need and situation. Refer to the Right Meal & Serviced for You Decision Tree and the If this, then that guide HDM Assessor Conversation Guide to help train HDM Assessors. Both of these documents can be placed on their clipboard as a quick reference. In alignment with the purpose of the OAA, all individuals requesting nutrition services should be provided with additional resources and referrals to other organizations and/or services within your agency that might assist in meeting their needs. Aging units and providers should develop relationships with key stakeholders and partners in their communities to meet the growing and ever-changing needs of older adults. Will You Provide Additional Meals and if so what type? If yes, include them on Step 3-Interventions on the Right Meal and Services for You form. 1. Programs may provide two or three meals per day, seven days per week, to those who need them and/or have no other assistance with their nutritional needs. (High Need Category). 2. When resources permit, additional HDMs may be offered on a voluntary contribution basis. 3. Approval from the program nutritionist is required for providing additional meals. HDM Verbal Consent to Share Information Form If you are going to make referrals outside of your agency, we strongly suggest you obtain verbal consent from the participant to share information. We have a template available however, be sure to discuss with your local corp. counsel and follow their advice and your local policies and procedures. The HDM Assessor would check the Verbal Consent box on the form if verbal consent were given. If no consent is given, inform the participant that only the interventions noted that are offered by your agency will be made since we need their consent to share with entities outside of our office. (I.e., VA officer, Center for Independent Living, etc.). Referrals and Person-Centered Plan • Follow through with the intervention plan. We have a sample 1-page Services and Referral Summary form for consideration. Record in the state database notes as directed by GWAAR. • Review and Update the Right Meal & Services for You Nutrition Plan Tri-fold brochure to include the interventions you can offer locally. Then be sure each person receives a copy of the brochure as it summarizes their nutrition plan. Leave the brochure with the participant for their records. GWAAR Nutrition Team 7-23-24 FINAL • Provide other information as appropriate based on the assessment. I.e., Nutrition, Socialization, Wellness brochure, Emergency Preparedness information and handouts, Social Connectedness, Falls Prevention resources, etc. Supporting materials can be found in our GWAAR Partner Resources-External Site in the Nutrition Library- Meal Prioritization Folder ub the Forms and Supporting Documents and Options Supporting Materials Folders. Holding or Discontinuing Service Define Situations when applicants may remain active on home-delivered meals, while not receiving meals: (for example) • The individual is temporarily a resident of a hospital or nursing home (Less than 2 weeks), OR • The individual has a temporary caregiver who is assisting with meals (less than 2 weeks). Discontinued Service: • An individual shall be discontinued from the HDM program when they no longer meet the eligibility criteria. They will be provided with appropriate referrals and options as noted above. • The date HDMs were discontinued, and the reason shall be documented in the state database. • Senior Dining and/or Carryout meals will be offered as appropriate and available. Data: If you are using the Right Meal for You Tool, please record at this link as well as in the required statewide database. More details forthcoming. • Data will be analyzed quarterly for service delivery trends, client outcomes, scope of utilization, etc. Follow-up & Evaluation • Within 4 to 12 weeks contact participant to see how their plan is working and if referrals have been completed and additional programs/services started. • Provide a Satisfaction Survey to the participant. We have developed a half-page cover sheet with a QR code embedded that can be provided with the 1-page Satisfaction Survey. The intent is to see if anyone is better off and to identify strengths and opportunities for improvement. (This should be provided within 4-12 weeks of the process). Please enter the survey results at this link. • Local programs can provide continuous input about the process at this link. • Staff Satisfaction Survey: We encourage you to have whoever is completing the Right Meal & Services for You process complete this survey so we can obtain valuable input. Staff Satisfaction Survey Link GWAAR Nutrition Team 7-23-24 FINAL • If a participant or family member is dissatisfied with the process and services offered. o Follow your local Appeal/Grievance Process/Complaint policies and procedures. o Provide them with the Advocacy letter template. o See sample letter for inquiries related to the new process. o Templates for the letters noted above are available on GWAAR Partner Resources- External Site in the Nutrition Library- Meal Prioritization Folder in the Forms and Supporting Documents Folder. Caregiver Meals Be familiar with the guidelines related to Caregiver Meals: Receiving a meal for the caregiver as part of their caregiver plan through AFCSP or NFCSP. There is a learning module in the Meal Prioritization Folder and in the Optional Supporting Materials folder on our Nutrition SharePoint location. o Note: NFCSP can only be used for meals to a caregiver who does not already qualify under the C1 or C2 contracts otherwise their meals must be applied to C1 and C2 and not the caregiver program. This also applies to using NFCSP money for nutrition counseling or nutrition education. o 2019 AFCSP Policy Elder Nutrition Services memo Fee For Service/Private Pay Full-Cost Meals: (Full cost should be recovered for meals, do not use OAA funds) From Section 212 of OAA: Agreements may not "result in the displacement of services otherwise available to an older individual with greatest social need, an older individual with greatest economic need, or an older individual who is at risk for institutional placement; or (4) in any other way compromise, undermine, or be inconsistent with the objective of serving the needs of older individuals, as determined by the Assistant Secretary." ❑ Willing to pay full cost for the meal while on the waitlist. OR ❑ If the person is enrolled in Family Care, IRIS, or the Insurance Plan includes HDMs. Since these are a source of revenue and additional support offered through these programs, meals may be provided at the discretion of the local program. Local programs are not required to provide meals for Family Care, IRIS, or other entities. If a person was receiving meals through the MCO and there was a change and the meals are no longer authorized and included in their plan but the participant still wants to receive meals, here is the process to follow: ❑ Refer to their MCO case manager to authorize or understand more about why HDMs at full cost are no longer being offered. ❑ Provide ombudsman contact information as appropriate to the participant. GWAAR Nutrition Team 7-23-24 FINAL ❑ Refer participant/legal guardian to Care Manager for eligibility and authorization. ❑ If you have concerns or issues with MCO meals, please email Sara Koenig DHS SaraS.Koenig@dhs.wisconsin.gov, and cc: your GWAAR Nutrition Team representative. Please include the name of the MCO and any specific instances (individual-related), thank you! ❑ Refer to the insurance company to authorize meals, as applicable. ❑ Keep in mind that OAA is the payer of last resort and should not be funding these services. ❑ According to federal Medicaid guidance, “Medicaid is generally the ‘payer of last resort,’ meaning that Medicaid only pays claims for covered items and services if there are no other liable third party payers for the same items and services.” However, “Medicaid will pay for a service if there is another party that may—but is not legally obligated to—pay for the service. […] Under the OAA, there is a source of funding to cover some services that are also covered by Medicaid. Individuals, however, are not legally entitled to receive services through the OAA, and thus the OAA program has no legal obligation to cover those services. Since the OAA program is not legally liable for the service, the OAA does not fall within the definition of ‘third party.’ Accordingly, Medicaid will pay for a service even if the OAA program would also pay for the service.” Waiting List If the program is operating at capacity (due to financial and/or route availability & capacity) and there is currently a waiting list for Title III-C nutrition services, nutrition programs will offer placement on a waiting list to eligible individuals. The decision to place eligible recipients of a meal on a waiting list, and their position on such a list, is based on the greatest social and economic need. Local programs will utilize the “Right Meal & Services for You” Form to determine the level of need. Process: Adding/Removing an individual to/from the Waitlist. • Assessment: o Advise new individuals a Meal Prioritization and/or Waitlist process is in effect. o First, complete the HDM Registration form for all new individuals requesting home- delivered to determine if they are eligible for HDMs. Note: This can be done over the phone initially to determine if they qualify so meals can begin. o If they are eligible to receive meals, then set up a call to complete the “Right Meal & Services for You” form to determine their Priority Level Nutrition Plan utilizing the tools created by GWAAR. o Document the individual's determined priority level (High, Moderate, or Low) at this link as well as in the required statewide database. (More details forthcoming) and offer appropriate meal options. GWAAR Nutrition Team 7-23-24 FINAL o Complete in-home assessment within 12 weeks to better assess the individual's situation. Adjust priority level and/or services offered as appropriate. • Notification: o Inform individuals if they are eligible for meals or of their placement on the waiting list and their position based on prioritization criteria. o Provide an estimated time limit that they will be on the waitlist. o Provide information on available private-pay options. • Waitlist Management: o Define the process for how often you will check in with individuals on the waitlist and what services you will provide to them. At a minimum, you are required to provide: ▪ Senior Dining Site locations ▪ Participants placed on a waitlist must be provided with Senior Dining locations along with other food/meal options. Here are two Templates for local communities to use. Food Related Resources Template & Additional Meal and Food Support Template o The waitlist will be reviewed at least quarterly to re-evaluate the individual's status. This can be done by trained staff or volunteers via phone or in person to determine if the person’s status or situation has changed. • Removable from the Waitlist. o Eligible persons will be removed from the HDM waitlist and receive meals as there is availability of funding, route space, or route availability. People will be removed from the waitlist based on the established need categories defined earlier, high need served first, followed by moderate need, then low need. If someone is enrolled in Family Care of IRIS, they will receive the lowest priority for services. o A person can request a rescreen of their Priority level placement at any time if there has been a significant change in condition. Compliance: This policy and procedure document ensures that services are prioritized effectively, waiting lists are managed fairly, and private-pay systems are implemented transparently while adhering to the guidelines of the Older Americans Act. GWAAR Nutrition Team 7-23-24 FINAL Appendix A: Reference: Nutrition Services Aging Operations Manual P-03062-38 (04/2024) WI Dept of Health Services ((pages 8, 19, 25-27, 54). Prioritization of services When nutrition program resources are fully committed and the program is unable to provide meals to all eligible individuals on a contribution basis, it may become necessary to determine priorities of service or to create waiting lists for services. As long as the intent of the OAA remains intact, the OAA allows states, AAAs, and/or service providers to create prioritization systems, create waiting lists if necessary, and seek payment for meals by establishing contracts and/or offering private-pay meals for eligible individuals who might otherwise be placed on waiting lists. AAAs may develop prioritization systems for their service area if systems are reviewed by BADR before implementation. Any prioritization systems developed by aging units or providers must be submitted to the AAA for review and approval before implementation. Tools used in prioritization must be user friendly, fair, and reliable and target services to eligible individuals who are in greatest social and economic need, as required by the OAA, with particular attention to older adults who are: • Individuals with low incomes. • People of color. • Residents of rural communities. • Individuals with limited English proficiency. • Individuals at risk of institutional care. In addition to the targeting requirements above, nutrition programs should use factors obtained through screening processes as criteria for prioritization, such as: • Food security and/or geographic access to food. • Malnutrition risk. • Nutrition risk score. • Functional status (limitations in Activities of Daily Living and Instrumental Activities of Daily Living). • Transportation access. • Living situation (whether an individual lives alone or faces housing insecurity). • Availability of other supports and services. GWAAR Nutrition Team 7-23-24 FINAL Waiting lists If the program is operating at capacity and there is currently a waiting list for Title III-C nutrition services, nutrition programs will offer placement on a waiting list to eligible individuals. The decision to place eligible recipients of a meal on a waiting list, and their position on such a list, is based on greatest social and economic need in accordance with the OAA and the prioritization and waiting list procedure established by the nutrition program in consultation with the AAA. Each waiting list procedure established by the nutrition program must be submitted to the AAA for review and approval before implementation so that AAAs can review service resource usage and efficiency, offering technical assistance if necessary. AAAs will communicate status of their aging units’ and/or providers’ waiting lists to BADR at least quarterly. Fee-for-service, private-pay systems Private-pay systems, for which the older adult or their payor agrees to pay to receive services, are separate from programs funded under the OAA. Nutrition programs may develop private-pay systems, but funds provided under the OAA may not be used to support private-pay programs or any other services for which fees are required. Meals served to clients participating in a fee-for-service, private-pay option may not be reported as NSIP meals in the National Aging Program Information System (NAPIS) state program report. Private-pay programs offered by agencies cannot compromise core responsibilities under the OAA. All individuals eligible for OAA services must be offered the opportunity to receive OAA services on a contribution basis. If an OAA nutrition program is at capacity, the nutrition program must give eligible individuals the opportunity to be placed on a waiting list to receive OAA services. After the eligible individual is either placed on the waiting list or declines placement on the waiting list, the individual can be offered available private-pay options. Agencies will ensure that no eligible individual is pushed into a fee-for-service, private-pay option or denied service due to the inability to contribute toward the cost of a meal. Additional meals When sufficient funding and resources are available, programs may offer additional HDMs to participants on a voluntary contribution basis. Provision of such meals requires approval from the program nutritionist. Carryout meals Individuals for which carryout meals might be particularly appropriate include those who meet the eligibility criteria above but who might not require a meal delivered to their residence. Examples include individuals who: GWAAR Nutrition Team 7-23-24 FINAL • Are unable to consume meals at a congregate dining location due to personal health reasons or other reasons that make dining in a congregate setting inappropriate. • Have access to transportation to pick up meals. • Have supports in place to pick up meals on their behalf. a. Carryout meal screening and assessment Section 339 of the OAA requires nutrition programs to conduct nutrition screening and assessment for services. Carryout meal participants may be screened via phone, virtually, or in person to determine the individual's need for nutrition and other services. Because carryout meal participants may be receiving meals intermittently or continuously for personal or programmatic reasons, a home visit is not required. Home visits are recommended for carryout meal participants who are not receiving other nutrition services so that agencies may better assess the level of support a participant needs based on their individual situation and connect participants with education and other resources that will best meet their nutritional and health needs in alignment with the purposes outlined in section 330 of the OAA. b. Determination of continued carryout meal eligibility A reassessment of available nutrition program resources and a participant’s continued need for carryout meals will be done at least annually, depending on the extent of other resources available to the individual. Carryout meals (p. 19-20) Carryout meals are complete meals offered to participants who choose not to dine in a congregate setting and instead take the entire meal from the point of service to be eaten at home or another location. Examples of carryout meals include grab-and-go, pick-up, or drive-through meals. Carryout meals are handled differently than congregate meal leftovers, in which the meal is consumed in a congregate setting and the participant chooses to take home an uneaten portion of it. Because carryout meals are not provided to participants in a congregate setting, they are classified and reported as HDMs. Title III-C2 funds are used to fund carryout meal service. Nutrition programs may also utilize local funds (beyond what is required for match) to fund carryout meals. In alignment with the OAA requirements that services are targeted to older adults who have the greatest economic or social need—paying particular attention to low-income, minority, and rural individuals— nutrition programs should consider their overall capacity and whether providing carryout meals will contribute to a waiting list for HDMs delivered to an individual’s residence. Agencies offering carryout meals will establish a local procedure, reviewed by the AAA, which describes: • When carryout meals will be offered, (for example, on a regular, ongoing basis versus only at times of emergency or staff and/or volunteer shortage). GWAAR Nutrition Team 7-23-24 FINAL • How older adults receiving carryout meals will be served if resources are limited. Carryout meals are subject to the same requirements as congregate and HDMs regarding nutrition education, collection of voluntary contributions, and food safety, unless otherwise specified in this chapter. Nutrition programs offering carryout meals should continuously evaluate utilization of the carryout and congregate dining models to ensure that those most in socioeconomic need are being provided sufficient access to, and adequately served by, both service models. Caregiver support programs Caregivers who do not otherwise meet eligibility criteria for Title III-C nutrition services may be eligible to receive meals, nutrition counseling, or nutrition education as a supplemental service of the National Family Caregiver Support Program (NFCSP) or Alzheimer’s Family Caregiver Support Program (AFCSP). Caregiver support program coordinators will complete a caregiver needs assessment to determine need for nutrition services in coordination with the nutrition program. Per AFCSP policy, completion of DHS form F-02425 is required to purchase home-delivered or congregate meals. The caregiver’s signature ensures that they are aware they are choosing to use their limited AFCSP funds to pay for the full cost of the meal. It is also best practice to use form F-02425 with caregivers enrolled in NFCSP as a way to coordinate among the two programs and the caregiver. For those enrolled in NFCSP, an opportunity to voluntarily contribute towards the meal will be provided in accordance with OAA Title III-E requirements, and program income will be used to expand Title III-E services.