Wa



STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H20-015 – Policy and Procedure

March 16, 2020

|TO: |Area Agency on Aging Directors |

|FROM: |Bea Rector, Director, Home and Community Services Division |

| | |

| |Chanh Ly, Director, Management Services Division |

|SUBJECT: |Older Americans Act Nutrition Program-COVID-19 Response |

|Purpose: |Provide information and interim guidance for Older Americans Act Nutrition Programs effected by COVID-19 and |

| |provide instruction for tracking service impacts and emergency meals |

|Background: |In response to COVID-19 Public Health guidance, an increasing number of Congregate Meal sites are closing. |

| |Continued service impacts are anticipated for both congregate and home delivered meal (HDM) programs. AAA’s, |

| |nutrition providers, tribal communities and ALTSA are collaborating to implement plans to ensure that food |

| |insecure individuals continue to receive nutritious meals. |

|What’s new, changed, or |As conditions rapidly evolve, nutrition providers need prompt access to current public health guidance for |

|Clarified |social distancing precautions to take during meal delivery and on site. |

| | |

| |To assist nutrition providers with determining clients that may be at higher food security risk, report |

| |filters have been created to help providers extract data from GetCare. .The report results include clients |

| |currently enrolled in respective (CNG or HDM) nutrition programs and have units recorded within the current |

| |Federal Fiscal Year). Where data is entered, the reports will also include client address, income range and |

| |FPL status, household composition, race and nutrition risk scores. For Home Delivered Meals ADL and IADL |

| |scores are also included as a result. A quick guide is attached. Use of these reports is optional. |

| | |

| |Nutrition contractors can provide meals to Title III C1 congregate participants through alternative means, |

| |e.g. pick up sack lunches, frozen meals or hot meals at meal sites that have closed and/or provide home |

| |delivered meals (frozen, hot, or shelf stable) to congregate participants. |

| |It is preferred, but not required that alternative meals meet the dietary reference intake (RDI) standards on|

| |page ten of the Senior Nutrition Program Standards. These meals will be recorded in the new Service Set. |

| | |

| |Scope of Work: Emergency Meals |

| |Program: Covid-19 Response |

| |Service Detail: 1 Meal |

| | |

| | |

| |It is possible in the future that current suppliers or delivery methods of HDMs may not be viable and |

| |alternatives could be selected that may not meet RDI requirements. This would be another scenario when you |

| |would count a meal as a COVID-19 emergency meal. |

| | |

| |Program Standard |

| |Congregate Meals |

| |Home Delivered Meals |

| |COVID Emergency Meals |

| | |

| |Socialization |

| |X |

| | |

| | |

| | |

| |Assessment(s) |

| | |

| |X |

| | |

| | |

| |Well Check |

| | |

| |X |

| | |

| | |

| |1/3 RDI nutrition |

| |X |

| |X |

| |Preferred, but not required |

| | |

| | |

| |In addition to tracking service impacts, “alternative delivery” meals will be tracked separately so we can |

| |determine the appropriate funding (OAA, state, special federal or FEMA) and how we may count them for |

| |NAPIS/SPR in the future. |

| | |

| |Tracking meals in this way will allow us to easily respond to inquiries about what we are providing to |

| |support the nutritional needs of senior clients during the crisis.  |

| | |

| |Prior to instituting delivery to congregate participants, if that is the chosen service methodology, screen |

| |those clients to assess their need for meals and prioritize those clients who have limited informal |

| |assistance to shop and prepare meals or those who are low income and may not have access to food. |

| | |

| |Since it is likely that the service change may be of long duration, it is important the seniors know where to|

| |call to sign up for meal delivery if their circumstances change. It may also be helpful for AAAs or service |

| |providers to develop a resource list of grocery stores and pharmacies that deliver in local areas to share |

| |with participants along with advice on how to access them. |

| | |

| |Nutrition providers have emphasized their priority will remain serving those who need to be served. ALTSA |

| |will continue to consult with nutrition providers and AAA’s about future nutrition standard waiver |

| |requirements. |

| | |

| |To date in consultation for following waivers/adjustments have been implemented: |

| | |

| |ALTSA will temporarily waive the state nutrition standard that requires a face-to-face assessment for Home |

| |Delivered Meal (HDM) intake. Under this temporary waiver all assessments will be conducted using |

| |telephonic/other technology based on client request/choice, public health social distancing guidance, or out |

| |of an abundance of caution.  Although it is best practice and advised, related OAA Section 336 language is |

| |not explicit about location of assessment or how it is conducted. |

| | |

| |Use of telephone or other technology for HDM wellness checks when dropping off meals and implementing social |

| |distancing precautions where appropriate will not require a waiver. We continue to advise consultation with |

| |local health jurisdiction with respect to in-person contact. Delivery personnel should be instructed to limit|

| |in-person contact by knocking and waiting until the client comes to the door to get their meals, then leaving|

| |the meal by the door for the client to retrieve. |

| | |

| | |

|ACTION: |AAAs will continue to advise contracted nutrition programs to follow guidance from DOH: |

| |  and consult with their Local Health Jurisdictions to follow |

| |recommended precautions, including social distancing for both congregate and home delivered meal programs. |

| | |

| |ALTSA will continue to consult with AAA’s and nutrition providers about program implementation needs and |

| |waivers. |

| | |

| |ALTSA appreciates AAAs sharing nutrition program response and innovations for alternate (emergency) meals |

| |with ALTSA and other AAAs. |

| | |

| |AAAs will continue to report program service impacts to ALTSA, including: provider/site, closure dates, |

| |number of participants impacted, and if there will be alternative meal provision. |

| | |

| |AAAs will advise contracted nutrition providers to ask congregate participants if they desire alternative |

| |meals so the participant can decide related to food insecurity or ability to prepare if they want the meal |

| |without the socialization. Providers should serve interested participants based on their capacity and |

| |priority list. |

| | |

| |A quick guide to using reporting tools in GetCare to assist providers determining clients who may be at risk |

| |of food insecurity is attached. |

| | |

| |If a provider does not have the ability to provide alternate meals for participants requesting them, AAAs are|

| |encouraged to contract with a meal to home delivery service or other vendor. Some areas may have grocery |

| |delivery as a possible alternative delivery method. It is recommended that AAAs work with service providers |

| |to develop a resource list of grocery stores and pharmacies that can deliver in local areas. |

| | |

| |AAAs will record emergency meals using the new service set in CLC GetCare to track emergency response. |

| |Additional details are attached. |

| | |

| |We are advising AAA’s and nutrition program providers to continue to follow existing emergency preparedness |

| |guidelines, e.g. this can include delivery of additional shelf  stable meals to existing HDM participants: |

| |ACL Emergency Preparedness guidance. ACL posted new FAQ for Senior Nutrition on March 12. |

|Related | |

|REFERENCES: | |

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|ATTACHMENT(S): |[pic] [pic] |

|CONTACT(S): |Rosemary Biggins, Senior Nutrition Program Manager |

| |(360) 725-2466 |

| |Rosemary.Biggins@dshs. |

| | |

| |Andrea Meewes-Sanchez, AAA Unit Manager |

| |(360) 725-2554 |

| |SanchAC@dshs. |

| | |

| |Lisa Livingston, GetCare System Administrator |

| |(360) 725-2572 |

| |Lexie.Bartunek@dshs. |

| | |

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HCS MANAGEMENT BULLETIN

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