Transcript Slide 1

Food and Nutrition Services for
Persons Living with HIV/AIDS
AIDS Institute
NYS Department of Health
Bureau of Community Support
Services
Intent of Initiative
To fund supplementary nutrition interventions
that will improve, maintain and/or delay the
decline of PLWH/A health status, and assist
them to remain in their communities.
The goal is to have clients graduate from the
program, no later than 18 months after
enrollment, with increased knowledge and skills
necessary to purchase and prepare nutritious
foods.
Description of Program
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Food and Meal Components
Home Delivered Meals
Congregate Meals
Groceries/Pantry Bags
Food Vouchers
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AI Continuum of Nutrition Services
Nutritional Screenings
Nutritional Assessments/Reassessments
Nutritional Counseling
Group Nutrition Education
General Eligibility
Persons living with HIV/AIDS who can
provide proof of status as established by
the Ryan White CARE Act Guidance for
Contractors.
Dependent children under the age of 21.
Clients who meet the criteria for selected
meal components.
Food and Meal Components
Home Delivered Meals
Congregate Meals
Groceries/food pantry bags
Food vouchers
Meal Content Recommendations
It is recommended that each meal or the average of one week of meals contain the following:
Calories
Approximately 800 per meal
Protein
15 - 20% of calories (30 - 40 grams)
Carbohydrates
50 - 55% of calories (100 – 110 grams)
Fat
up to 30% of calories (26 grams)
Sodium
 800 milligrams per meal
Cholesterol
 100 milligrams per meal
Dietary Fiber
9 grams
Each meal should contain three servings of fruits and vegetables (preferably fresh).
Each meal should be reasonably priced and culturally/ethnically appropriate.
Children’s meals should contain fewer calories and protein.
Meals must be stored and/or prepared in accordance with local/state food sanitation codes.
Food must be maintained at proper temperature during meal service.
The recommendations for Meal Content were adapted from the Association of Nutrition Services Agencies’ Nutrition Guidelines for
Agencies Providing Food to People Living with HIV Disease, Second Edition, September 2002, Model II – General Nutrient
Recommendations for HIV/AIDS, Energy Expenditure and Macronutrient Breakdown. The amounts of fat, cholesterol and sodium were
based on the American Heart Association Healthy Heart Guidelines
Home Delivered Meals
Eligibility
Clients must be unable to shop or prepare meals
for themselves due to physical or mental
challenges.
Clients must lack a network of family or friends
to provide this support.
Agency must establish and document the criteria
and process for determining eligibility (e.g. a
letter of need from the health care provider, ADL
needs assessments, etc.)
Can be provided to dependent children under
age 21
Home Delivered Meals cont.
Agency must provide not less than 5 and not more than
14 meals per week.
Agency must document how nutrition needs are being
met if a client receives less than 5 meals per week.
Program must include an option for the delivery of a
grocery/pantry bag.
All menus must be reviewed by a nutrition professional
to ensure that they meet the recommendations for meal
content.
Agencies that deliver frozen meals must ensure that: a
person is available to heat up the client’s meal; there is
room in the freezer to accommodate the meals; and,
there is a microwave or oven where the meal can be
heated.
Congregate Meals
Eligibility
Clients must be unable to purchase
nutritious foods due to limited financial
resources and/or,
Clients must have inadequate cooking
facilities to prepare meals.
Dependent children under age 21
Congregate Meal cont.
Must offer client five hot meals per week at the
congregate site or one hot meal and a
grocery/pantry bag that provides four additional
meals.
Clients can not receive more than 14 meals per
week.
All menus must be reviewed by a nutrition
professional to ensure that they meet the
recommendations for meal content.
A nutrition professional must be on-site during
the meal service to answer questions and
provide basic nutrition education.
Grocery/Pantry Bags
Eligibility
Client must be unable
to purchase nutritious
food due to limited
financial resources.
Dependent children
under age 21.
Grocery/Pantry Bag cont.
Bags must contain a variety of foods and provide enough
food for the number of individuals and meals intended.
Bags must contain a minimum of 5, and no more than 14
meals.
A nutrition professional must review the bags to ensure
that the food distributed in the grocery/pantry bags
complies with the nutrient standards for recommended
meal content.
Fruits and vegetables must be included in the bags.
Food must be stored and packaged in accordance with
local and/or state food sanitation codes.
Bags can be picked up or delivered (except by COBRA
staff).
Food Vouchers
Eligibility
Clients must be unable to
purchase nutritious food
due to limited financial
resources, but be able to
shop for and prepare their
own meals.
Amounts may be
increased to include
funds to provide meals to
dependent children under
age 21.
Food Vouchers cont.
Amount of the voucher should allow client to purchase a minimum of
5, and not more than 14 meals that meet the AI Food and Meal
Content standard.
A nutrition professional or trained staff person must review grocery
store receipts before another voucher can be issued.
Programs must develop a system that ensures that only authorized
clients redeem vouchers and purchase allowable food items.
Food Voucher guidelines cont.
Allowable ItemsMilk and Milk
Products (cheese, yogurt, butter);
100% Fruit or Vegetable Juice;
Fresh or Canned Fruit and
Vegetables; Cereals; Bread;
Pasta; Grain Products; Poultry;
Meat; Fish; Eggs; Nuts; Peanut
Butter; Tomato Sauce; Beans
(canned or dry); Margarine;
Mayonnaise; Mustard; Ketchup;
Salad Dressings; Flour; Sugar;
Baking Powder; Baking Soda;
Salt; Oils; Cooking Herbs and
Spices.
Non-Allowable ItemsCarbonated
Beverages including Soda or
Flavored Beverages such as KoolAid; Alcoholic Beverages; Coffee;
Tea; Cigarettes; Paper Goods;
Gum or Candy; Cakes including
Doughnuts, Pies and Brownies;
Laundry detergent; Soap;
Disposable Diapers; Baby Food or
Formula; Pickles; Pretzels;
Popcorn or Chips; Nutritional
Supplements (e.g. vitamin/mineral
pills and or liquid nutritional
supplements such as Ensure);
Frozen sweets such as Ice Cream
and Popsicles; Dessert Sauces;
Syrups and Toppings; or Any NonFood Item
Guidelines for Food Voucher
Programs
Supermarkets and grocery stores from
which vouchers are purchased must be
inspected annually for:
 Quality of food
 Variety of food
 Price
 Facility
 Accessibility
AI Continuum of Nutrition Services
Initial Nutritional Screenings
Nutritional Assessments/Reassessments*
Nutritional Counseling*
Nutrition Group Education*
Meal Orientation
*Must be provided by a nutrition professional, and
are only available for PLWH/A
(not dependent children)
Nutrition Professionals
Registered Dieticians
(RD)
New York State
Certified DieticianNutritionists (CDN)
Registered DieticianEligible (RDE)
Nutrition students
supervised by a RD
or CDN
Nutritional Screening
All clients must be screened to determine the level of
nutritional risk*
The screening is not a substitute for the intake process
(URS/AIRS), but may be conducted at the same time.
Program eligibility must be determined before conducting
the screening.
Best practice is to conduct the screening annually for
clients not receiving regular
assessments/reassessments.
Required elements include information required for care
coordination.
*See Required Information for Initial Nutritional Screening of Clients
Nutrition Assessment &
Reassessment*
Required for all of the following:
 Clients found to be a nutritional
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risk during the screening
process
Clients receiving home
delivered meals
HIV+ children
Adolescents
Pregnant women
*See Required Information for Nutrition
Assessments/Reassessments
Nutrition
Assessment/Reassessment cont.
Assessments are to be completed within
two weeks of enrollment, and
reassessments approximately every six
months thereafter.
May be done by telephone, but face to
face is preferable.
Nutritional Counseling
A nutrition professional must be available to provide nutritional counseling
between assessments and reassessments.
Purpose of nutritional counseling is to:
 Follow-up on the care plan
 Reinforce nutrition and food safety education
 Answer clients’ general nutrition questions
Nutrition Group Education
Congregate meal programs must offer a nutritional
education activity at least once a month.
Clients who receive pantry bags or vouchers must attend
at least 2 workshops per year.
Nutritional assessments must be conducted every 6
months for clients who are unable to attend scheduled
workshops.
Pantry bags must include nutrition education materials
and recipes relevant to the foods in the bag.
Voucher programs must have nutrition education
materials, including sample recipes that can be prepared
on a limited budget, available to clients.
Meal Orientation
 Clients’ rights and
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responsibilities
Agency’s responsibilities
to the client
The hours of meal and
food distribution
Nutrition service
requirements
Signed contract outlining
the above
Expected Outcomes
Improvement in clients’ health, and tolerance
and adherence to their medications.
Increase in clients’ awareness of the importance
of nutrition therapy and eating well-balanced
meals and snacks.
Increase in the clients’ ability to plan, purchase,
and prepare nutritious foods.
Increase in the food security and independence
of clients at graduation from the program.
Outcomes are accomplished by:
Offering PLWH/A the opportunity to transition to and from the four
food and meal components of the AI continuum of nutrition services
that are most appropriate for their stage of illness, physical and
mental abilities.
Conducting nutritional screenings on all clients and performing
nutritional assessments on those who are at nutritional risk or homerestricted.
Providing intensive education and skill development in: nutrition as a
co-therapy in the management of HIV disease; symptom
management and adherence to HIV medications; making healthful
food choices on a budget; and the preparation of nutritious, simple
and economical meals.
Directing PLWH/A to utilize food resources within their communities.
Challenges
Developing systems for measuring and
documenting nutrition program outcomes
Documenting linkages to primary care and other
supportive services
Developing transition criteria for movement
through a nutrition continuum
Graduating clients in 18 months
Questions