C-1010 Overview

Revision 21-0; Effective January 15, 2021

Administration of Older Americans Act (OAA) services includes serving as the focal point for aging services, providing advocacy for older people in their service area, developing and implementing an area plan based on OAA requirements, procurement of services funded with federal and state funds, contract management, reporting, reimbursement, accounting, auditing, monitoring and quality assurance. Documents that are important to successfully administer programs include:

• agreements or contracts and amendments;
• area plans;
• budgets, including adequate proportion, categorical transfers, and minimum expenditures;
• bulletins;
• notifications of funding available;
• performance measure projections;
• State Plan on Aging; and
• State Program Report required data.

C-1020 Targeting

Revision 25-1; Effective January 31, 2025

Services must target people 60 or older. The OAA gives priority to older people with the greatest economic and social need. The OAA federal regulation requires giving priority to people 60 or over who are frail, homebound due to illness or incapacitating disability, or otherwise isolated when delivering in home services. Use the Consumer Needs Evaluation (CNE) form to decide if a person is frail, homebound or otherwise isolated.

The OAA defines someone as homebound if they cannot leave their home without the help of another person.

The OAA defines frail as being functionally impaired because the person:

• cannot perform at least two activities of daily living without considerable human help, including verbal reminding, physical cueing or supervision; or
• needs considerable supervision because the person behaves in a manner that poses a serious health or safety hazard to themselves or another person due to a cognitive or other mental impairment.

AAAs and their subrecipients must consider targeting requirements in their objectives and strategies to meet the needs of the target populations.

AAAs and their subrecipients must write policy to ensure they meet targeting requirements. These written policies should identify older people who:

• cannot always afford basic needs such as food or medicine;
• lack the skills or knowledge to prepare well-balanced meals or appropriately manage medicine;
• cannot access transportation to destinations such as medical appointments;
• live in a rural area;
• lack English language skills;
• have a disabling illness or physical condition;
• have limited mobility that impairs their ability to leave the home;
• have Alzheimer’s disease and related disorders with neurological and organic brain dysfunction;
• are socially isolated; or
• screened as a high nutritional risk.

The service provider must also specify in its agreement with the AAA how it will meet the service needs of these people.

AAAs must monitor their own and their subrecipients’ progress, to meet targeting requirements.

C-1030 Interest Lists

Revision 25-1; Effective January 31, 2025

Consider targeting requirements for interest lists when resources are insufficient to meet the demand for services. An interest list includes people who may be eligible for but are not receiving the service, regardless of the funding source.

AAAs and subrecipients must have written policies and procedures that consider targeting requirements for prioritizing people on interest lists. The policy must show the provider’s method to ensure they meet targeting requirements of interest lists. They must also screen people requesting services who they place on an interest list for other services and refer them as needed.

AAA and subrecipient interest list policy helps ensure compliance with OAA requirements when sudden or unexpected changes in demand or resources occur. Consistent and streamlined approaches for serving people in greatest need allow AAAs and subrecipients to respond effectively to both short-term and long-term impacts of change.

Policy for prioritizing services must ensure the use of socioeconomic issues as factors for higher priority does not result in means testing. The OAA does not allow means testing.

The following are examples of indicators used for written policy to find eligible people with a high probability of service need:

• functional impairment or disability resulting in limited mobility;
• inadequate housing and environment;
• homebound;
• living alone;
• limited English;
• isolation and lack of access to social and recreational activities;
• caregiver burn out found or no caregiver is available;
• high-risk nutritional status;
• the lack of skills or knowledge to select and prepare nourishing and well-balanced meals;
• disabling illness or chronic health condition; and
• recent illness, injury or hospitalization.

AAAs and subrecipients must keep interest lists to give a correct count of people waiting for services to HHSC when asked.

AAAs and subrecipients must be able to list the reasons people are on an interest list such as:

• lack of funds;
• the provider cannot produce more meals with its current staffing, building or kitchen;
• type of meal is not available; or
• provider requested is not available.

Related Policy

Targeting, C-1020

C-1040 Voluntary Contributions

Revision 21-0; Effective January 15, 2021

Voluntary contributions are a way for service recipients of Title III services to share in the cost of services. Voluntary contributions expand services and provide a way for AAAs and subrecipients to expand their programs to serve more people.

Inform all people receiving OAA services that they can make a voluntary contribution to the program. Encourage people whose self-declared income is at or above 185 percent of the poverty line to make a cash contribution to support and expand the nutrition program.

AAAs and subrecipients must set moderate and high-income levels to aid in setting sliding scales for voluntary contributions. AAAs and subrecipients may develop suggested contribution schedules for services provided. In developing the contribution schedule, consider the income ranges of older people in the region or community and the other resources available to the AAA or subrecipient.

AAAs and subrecipients may not consider income or resources (“means testing”) as a condition for eligibility for any service provided with OAA funds.

AAAs must have a process in place to let people know how to make a voluntary contribution to the program. The process must protect the privacy and confidentiality of any person who chooses to contribute or not contribute. AAAs and subrecipients must have written policy and procedures to safeguard and account for all voluntary cash contributions per the OAA and other laws related to cash management:

• encourage people at or above 185 percent of the poverty level to make a voluntary contribution;
• inform people receiving a service they can contribute;
• inform people receiving a service the contribution is voluntary;
• explain how they protect the privacy of a person contributing;
• explain the method used to ensure a contribution is private; and
• inform people the service that they receive will not be denied if a person cannot or does not wish to contribute.

In addition, include procedure in written policy to manage cash contributions that:

• establishes controls for managing the receipt of cash contributions;
• ensures voluntary contributions only expand the programs in which the contributions were generated;
• ensures voluntary contributions do not supplant federal funds;
• accounts for all cash contributions;
• safeguards all cash contributions;
• ensures contributions are not used for match purposes; and
• requires the AAA to report all cash contributions received to HHSC using the Quarterly Performance Report.

Documentation

Documentation must include the name of the AAA or subrecipient, the date the eligible person received the policy and the name of the eligible person.

C-1050 Match

Revision 21-0; Effective January 15, 2021

Each AAA and their subrecipients must secure the required 10 percent non-federal match for supportive and nutrition services and the required 25 percent non-federal match for caregiver services and administration. The match may be cash or in-kind and may attribute fair market value to services and facilities from non-federal sources.

In-kind match is a non-cash contribution of value provided by non-federal or non-state third parties. In-kind match is typically the calculated value of personnel, goods, and services, including direct and indirect costs.

• Count in-kind matches such as donated goods and services.
• Do not count routine activities of partners that would occur regardless if the program existed as in-kind match.

Cash match, such as a cash contribution, can come from the AAA or subrecipient’s own funds (general revenue), cash donations from non-federal or non-state third parties (such as partner organizations), or from non-federal grants. Only apply a cash match contribution to the match requirement after it is spent on a budgeted cost or activity. All match contributions must be spent for goods and services necessary for and specifically identifiable in the approved AAA’s area plan.

Countable cash match examples include:

• cash donations;
• non-federal income from products or services;
• local government grants or appropriations;
• state grants or appropriations;
• foundation grants; and
• corporate contributions.

C-1060 Service Recipient Complaints

Revision 21-0; Effective January 15, 2021

Recipients of OAA services may make complaints orally or in writing to the AAA or directly to HHSC. Complaints may cover:

• specific actions or activities that affect their personal participation in OAA programs; or
• the conduct of the program as it relates to all people who receive services generally or at a specific site or location.

C-1070 Responsibilities on Abuse, Neglect and Exploitation

Revision 21-0; Effective January 15, 2021

Any person 18 years or older, who suspects an adult in Texas with a disability, or a person 65 or older, is in a state of abuse, neglect, or exploitation must immediately report the information to Adult Protective Services of the Texas Department of Protective Services (DFPS) by calling 800-252-5400 or by following the instructions at www.txabusehotline.org.

Under Texas law (Texas Human Resources Code, Section 48.052), a person who does not report suspected abuse can be held liable for a misdemeanor or a felony.

AAAs and its subrecipients must:

• instruct all staff and representatives, other than a representative of the Office of the Ombudsman, to report allegations of abuse, neglect, or exploitation of a program participant to DFPS;
• take proper corrective action if DFPS confirms abuse, neglect, or exploitation by meal provider staff of a person receiving OAA services; and
• instruct all staff to call 911 or another local emergency hotline for fire-fighting, police, medical, or other emergency services, as needed, if an emergency involving a person receiving OAA services occurs.

C-1080 Training

Revision 21-0; Effective January 15, 2021

AAAs must train their staff and volunteers.  AAAs must ensure subrecipients train their staff and volunteers to be sure they deliver safe and quality services.

C-1081 Alzheimer’s Disease and Dementia Certification

Revision 25-2; Effective Sept. 1, 2025

AAAs must:

• comply with House Bill 3428, passed by the 86th Texas Legislature, Regular Session, 2019; and
• ensure all employees and volunteers providing services directly to an elderly person, or the person’s family members or caregivers, have training on Alzheimer’s disease and dementia.

All new and rehired employees and volunteers must receive the training within 30 days of their start date.

Criteria

The training must be evidence-based or evidence-informed and focus on:

• recognizing the signs and symptoms of cognitive impairments caused by Alzheimer’s disease or dementia; and
• understanding how the cognitive impairments may affect the screening of and service planning for a person 60 or older.

Evidence-based is training that was tested through randomized controlled trials as defined by the Administration for Community Living (ACL). It is:

• effective at improving, maintaining, or slowing the decline in the health or functional status of older people or family caregivers;
• suitable for deployment through community-based human services organizations and involves non-clinical workers and volunteers in the delivery of the training;
• researched with results published in a peer-reviewed scientific journal; and
• training that is translated into practice and is ready for distribution through community-based human services organizations.

Evidence-informed uses the unique preferences and circumstances of people with dementia together with the best scientific evidence to inform decisions of care, as defined in the Senate Research Center’s bill analysis. It is less restrictive than evidence-based.

Training Costs

AAAs may allocate any costs related to ensuring employees and volunteers receive the required training to one of the following:

• AAA administration; or
• the primary cost category where the employee or volunteer provides direct services to an eligible person, such as:
  • information, referral and assistance;
  • care coordination; or
  • benefits counseling.

Verification of Training Completion

AAAs must maintain verification that all employees and volunteers have successfully completed the required training.

Acceptable verification of training completion may include system-generated training certificates, screenshots showing training completion, or a written statement issued by the trainer. The verification must be available to HHSC for review on request and must include the following:

• employee’s or volunteer’s name;
• name of the training;
• date of completion; and
• the employee’s or volunteer’s signature.

Notice of Compliance

Each AAA director must submit a notice of compliance letter to HHSC annually by July 15. The letter certifies that all AAA employees and volunteers who provide services directly to people 60 or older or their family members or caregivers have successfully completed the Alzheimer’s disease and dementia training. The AAA director must sign the annual notice of compliance letter and send it to the AAA Qualtrics.

• The annual notice of compliance letter must include:
• the names of each employee and volunteer who successfully completed the training during the annual period;
• the name of the selected training; and
• the dates of successful training completion for each employee and volunteer during the annual period. 

C-1082 Nutrition Services Training Requirements

Revision 25-2; Effective Sept. 1, 2025

Meal providers must recruit, hire and train qualified staff and volunteers and must:

• establish and maintain written policies and procedures on training for all paid staff and volunteers.
• document the training per the meal provider’s written policy.
• adhere to all training requirements for certified food protection managers and food handlers per the Texas Department of State Health Services (DSHS) rules for:
  • retail food, management and personnel (25 Texas Administrative Code, Chapter 228, Subchapter B); and
  • food and drug, Texas food establishments (25 Texas Administrative Code, Chapter 229, Subchapter K).

A qualified dietitian, or a certified food protection manager under the direction of the dietitian, must conduct prevention of foodborne illness training. Train all staff and volunteers who handle food before assuming food service assignments. Handling food includes shopping, storing, cooling, freezing, thawing, preparing, cooking, serving, cleaning, handling leftovers or any other activity when that activity involves direct contact with food.

All staff and volunteers involved in the administration or provision of nutrition services must complete one hour of training on the following topics before assuming duties:

• confidentiality of information about people served;
• managing emergency situations about a person served;
• the meal provider’s role in emergencies and disasters;
• safe and sanitary methods used in serving meals;
• requirements for delivering meals for quality and safety;
• general knowledge and basic techniques to work with people 60 years of or older and people with disabilities; and
• personal hygiene.

All staff and volunteers supporting advanced administrative functions must complete an added one hour of training on the following topics before assuming duties:

• meal provider forms and procedures;
• HHSC forms and requirements;
• nutrition services rules; and
• policies of the meal provider and HHSC related to nutrition services.

The food protection manager and all food handlers must complete an added two hours of training on the following topics before assuming duties:

• procedures for food storage, preparation and service;
• prevention of food-borne illness;
• equipment cleaning before, during, and after meal service;
• choice of proper utensils and equipment for transporting and serving foods;
• automatic and manual dishwashing procedures; and
• accident prevention.

The food protection manager must complete an added six hours of training on the following topics within 30 days of employment to ensure they meet Texas dietary requirements:

• procedures for food preparation, storage and serving;
• OAA nutrition requirements for meals including nutritional needs and meal pattern requirements for people served;
• approved menus;
• use of standardized recipes;
• portion control of food; and
• quality control of flavor, consistency, texture, temperature, and appearance including the use of garnishes.

AAAs and subrecipients must ensure an adequate number of certified staff are available during the time congregate meals are served. Certified staff must include:

• first aid;
• cardiopulmonary resuscitation; and
• operating an automatic external defibrillator, if one is available.

Documentation

The meal provider must keep documentation of training for food service staff per the meal provider’s written policy with DSHS rules (25 Texas Administrative Code, Chapters 228 and 229).

Documentation of training provided by the meal provider must include the following:

• name of the meal provider;
• date completed;
• name of the person trained;
• name of the trainer;
• topics covered; and
• date, time, and length of the training.

C-1090 Records Maintenance

Revision 21-0; Effective January 15, 2021

AAAs and their subrecipients must keep all records related to services according to the AAA’s written policies and provider contracts.

AAAs, subrecipients and contractors must keep records of people receiving services in a locked facility when not in use by authorized staff. They must also limit access to records kept in computer information systems through acceptable computer security practices, including password protection.

AAAs, subrecipients and contractors must give access to all program records and reports to representatives of the AAA, HHSC, state of Texas or federal agencies for audit, assessment or evaluation unless specifically prohibited by law. They must retain records for the period stated in the provider contracts.

C-1110 Overview

Revision 21-0; Effective January 15, 2021

AAAs must monitor providers on a regular and systematic basis through desk reviews, on-site reviews, and quality assurance reviews. All phases of monitoring must occur in compliance with the AAA’s written policy and HHSC rules and policies.

C-1120 Subrecipient Monitoring

Revision 21-0; Effective January 15, 2021

AAAs must monitor all subrecipient providers on-site annually. Complete follow-up visits as needed for corrective action or quality improvements, unless the AAA conducts an annual risk assessment. The AAA may monitor subrecipient providers less often based on the results of the risk assessment. If a provider has an agreement with another organization for a portion of its program, it is the responsibility of the AAA to ensure that the provider monitors those organizations.

AAAs must issue a written corrective action plan to the provider for any high priority or significant findings resulting from subrecipient monitoring. The AAA must continue to issue written reports to the provider until they remedy all identified issues.

C-1121 Subrecipient Monitoring for Nutrition Services

Revision 21-0; Effective January 15, 2021

AAA staff who conduct monitoring for nutrition services must have demonstrated knowledge of sanitation, food handling, food preparation, and food storage principles. AAA staff conducting monitoring should be a Certified Food Protection Manager.

Monitoring of the nutrition service provider must ensure compliance with DSHS food safety and food sanitation requirements, and the service standards in this handbook.

Meal provider monitoring may include, but is not limited to:

• review of all local and state level health department inspections;
• meal and menu-related invoices;
• client intakes and assessments;
• food staff certifications;
• staff training documentation;
• use of standardized recipes to monitor for nutrient compliance;
• approval of recipes and menus by dietitian; and
• observation of kitchen personnel during meal preparation and serving.

AAAs must ensure DSHS or the local health authority, as applicable, monitors a food preparation site for food safety and sanitation compliance at least once every 12 months. The meal provider must send a written report of such monitoring to the AAA.

Related Policy

Intake, D-1020
Caregiver Intake, D-1030

C-1130 Contractor Monitoring

Revision 21-0; Effective January 15, 2021

The AAA must monitor the quality of services through follow-up activities with the person receiving the service. They may use monthly reports from contractors to decide whether the service criteria established in its contract with the AAA are met.

Through a reassessment, customer satisfaction survey, or other follow-up activities with people receiving services, the AAA must conduct a quality assurance review to confirm the satisfaction with the services provided by contractors.

The AAA may:

• develop a standard risk assessment process to decide how often services a person received from each contractor are reviewed for quality assurance;
• use a standardized sampling method of all active contractors each month; or
• include all people from all contractors each month in the quality assurance review.

AAAs must conduct an annual satisfaction survey of people receiving OAA services.

C-1131 Contractor Monitoring for Nutrition Services

Revision 21-0; Effective January 15, 2021

The criteria for monitoring nutrition services for quality assurance include the:

• contractor provides the type and frequency of meals as authorized for the eligible person by the AAA;
• contractor has a valid permit, license, or certificate issued by the appropriate regulatory authority, including requirements for certified food protection managers and food handlers;
• contractor follows all federal, state, and local laws, ordinances, and codes for establishments that are preparing, handling, and serving food as evidenced through current sanitation inspection reports submitted timely to the AAA;
• eligible person receiving meals indicates the services are satisfactory; and
• meals meet or exceed the Texas nutrient requirements.

An annual random sampling of menus as served must show compliance with Texas nutrient requirements as evidenced by computer nutrient analysis or the Texas Model for Menu Planning and approval by a dietitian.

AAAs must keep documentation and menu approval by a dietitian for compliance with Texas nutrient requirements for all meals authorized by a AAA case manager for direct delivery to an eligible person.

Related Policy

Target Nutrient Requirements Computer Analysis of Nutrients, Appendix III
Texas Model for Menu Planning, Appendix IV

C-1210 Overview

Revision 21-0; Effective January 15, 2021

AAAs must develop long-range emergency preparedness plans and coordinate disaster activities with local and state emergency response agencies, relief organizations and local and state governments. AAAs must detail coordination activities in area plans and provide information to HHSC as requested during a disaster.

C-1211 Emergency Conditions, Inclement Weather, Disasters and Holidays for Nutrition Services

Revision 21-0; Effective January 15, 2021

The meal provider must ensure there are sanitary and safe conditions for storing, thawing and reheating meals when the provider distributes chilled, frozen, or other meals for emergency conditions, inclement weather, disasters or holidays. The meal provider must also ensure the person can physically manage the meals.

The meal must be labeled and provide the expiration date in large print with instructions for storing, thawing, and reheating, as appropriate.

Meal providers must develop and keep written procedures to address congregate meal site closures and suspension of HDMs for emergency conditions, inclement weather, disasters, and holidays. AAA’s meal provider contract must address the provision of congregate and HDM services during meal site closures. AAAs, subrecipients, and their meal providers must define emergency conditions, inclement weather, disasters, and holidays and include those terms in the contract for OAA meals.

Meal providers must ensure people receiving meals are aware of the date, or approximate date, the meal service will resume when they stop meals due to an emergency, inclement weather, disaster or holiday.
AAAs must ensure meal providers:

• keep food, facilities, and equipment available for emergencies and disasters according to a plan developed by the meal provider, who gives priority to program participants 60 years or older; and
• adopt written procedures ensuring the availability of food for eligible people during emergencies, inclement weather, disasters, and holidays.

C-1212 Congregate Meal Site Closure

Revision 22-1; Effective March 1, 2022

The decision to close a meal facility or change meal service is the responsibility of a meal provider’s executive management. HHSC does not have the authority to insist a nutrition provider remain open or close due to a health emergency or natural weather situation.

When a congregate site must temporarily close, the site must activate its emergency preparedness plan or business continuity plan. Meal providers must detail how they will provide meals for people at high nutritional risk in their plans. A score of six or higher shows a high nutritional risk on the DETERMINE Your Nutritional Risk Checklist.

Meal providers may provide chilled, frozen or shelf-stable meals to people who participate in the program for consumption at home during the site closure. The meal consumed at home rather than at the congregate site is reimbursed as a HDM.

The congregate meal provider’s executive management must notify the AAA of the closure. If the temporary site closure exceeds the length of time outlined in the site’s plans, the AAA and the meal provider must work together to decide how they will continue to serve people.

Promotion of socialization is one of the purposes of the nutrition program so meal providers may not set up a regular take out meal service. AAAs must ensure they, and their subrecipients, resume regular congregate meal services upon conclusion of the emergency or other situation.

Related Policy

Nutritional Risk Assessment, D-1060