CHAPTER 7
AREA AGENCY ON AGING SERVICE DELIVERY
[Prior to 5/20/87, see Aging, Commission on the [20] Ch 8]
[Prior to 1/27/10, see Elder Affairs Department[321] Ch 7]
17—7.1(231) Definitions. Words and phrases as used in this chapter are as defined in 17—Chapter 1 unless the context indicates otherwise. The following definitions also apply to this chapter. The appearance of an acronym after a defined term indicates that the definition was taken from that source.
“Legal assistance” means legal advice and representation provided by an attorney to older individuals with economic or social needs and, to the extent feasible, includes counseling or other appropriate assistance by a paralegal or law student under the direct supervision of an attorney and counseling or representation by a nonlawyer where permitted by law.
“Multipurpose senior center” (OAA) means a community facility for the organization and provision of a broad spectrum of services, which shall include, but not be limited to, provision of health (including mental health), social, nutritional, and educational services and the provision of facilities for recreational activities for older individuals.
“Nutrition Services Incentive Program” or “NSIP” means the Nutrition Services Incentive Program established under the OAA.
“Site” means a facility designated for provision of congregate meals or other nutrition-related services.
“Therapeutic menu” means a soft, low-fat, low-sodium, or controlled calorie menu.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.2(231) Service delivery. If the requirements of 17—Chapter 6 are met, each AAA may contract for service delivery or provide services directly. All applicable terms, procedures and specifications of the department shall be followed contingent upon the source of funding under the Act. At a minimum, the contract for nutrition services shall include nutrient requirements for meals; food safety, including time limits for transporting food; use of project income; length of contract; cost per unit; participant evaluation surveys as available; and performance requirements to ensure accountability and monitoring.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.3(231) Outreach for greatest need. Each AAA shall conduct outreach efforts to identify the older individuals with greatest economic or social needs and to inform the older individuals of the availability of services. The outreach efforts shall place special emphasis on rural, low-income, minority and American Indian older individuals.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.4(231) Delivery of service.
	7.4(1) Facility and focal points. Each AAA shall designate a focal point for a comprehensive and coordinated system of services in each served community, giving special consideration to the designation of multipurpose senior centers that currently or potentially can accommodate the collocation of services, where feasible.
	7.4(2) Focal points. The area profile submitted by the AAA as required in 17—Chapter 6 shall specify the communities and facilities which are designated as focal points.
	7.4(3) In the designation of focal points, the AAA shall consider:
	a. 	Communities with the greatest incidence of older individuals with the characteristics as given in 17—7.3(231) and the efforts of voluntary organizations in the community;
	b. 	The needs of participants and the delivery pattern of services funded under the Act and from other sources;
	c. 	The location of current multipurpose senior centers and congregate nutrition sites;
	d. 	The geographic boundaries of communities and natural neighborhoods; and
	e. 	The location of facilities suitable for designation.
	7.4(4) Developing collocation of services at the focal point. The AAA shall:
	a. 	Encourage service providers to coordinate and collocate their services;
	b. 	Coordinate with public and private agencies, institutions and elected officials in the community to achieve maximum collocation, coordination, and access to other services or opportunities for the elderly;
	c. 	Ensure that information and referral and emergency service programs are provided;
	d. 	Ensure that services funded under the Act will be based at, linked to, or coordinated with focal points; and
	e. 	Establish guidelines for operating schedules which are convenient for older individuals in the community.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.5(231) Funding for services and program facilities.
	7.5(1) The AAA may distribute funds received from the department to a public or private nonprofit agency for construction, acquisition, remodeling, leasing or renovation of a facility, including a mobile facility, to be a focal point for providing programs or services.
	a. 	In distributing these funds, the AAA shall obtain the approval of the commission before contracting for the construction of a facility.
	b. 	The commission may approve the construction of a facility after considering the views of the AAA and reviewing material from the AAA that documents that there are no suitable facilities available to be a focal point for service delivery.
	7.5(2) The AAA may make an award for purchasing or constructing a facility:
	a. 	If there are no suitable facilities for leasing;
	b. 	If the AAA’s budget shows that sufficient funds are or will be available;
	c. 	To meet the nonfederal share of the cost of purchase or construction of the facility;
	d. 	For effective use of the facility for the purpose for which it is being acquired or constructed;
	e. 	To pay the cost of professional and technical personnel required for the operation of facilities used to provide services to older individuals under the cost-share terms and conditions set by the department.
	7.5(3) Shared facilities. In a facility that is shared with other age groups, funds received from the Act may support only:
	a. 	That part of the facility used by older persons; or
	b. 	A proportionate share of the costs based on the extent of use of the facility for services or programs for the older individuals.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.6(231) Compliance with health, safety and construction requirements. A recipient of any award from the department for a facility housing a program or service shall comply with all applicable state and local health, fire, safety, accessibility, building, zoning, and sanitation laws, ordinances and codes including:
	1.	Rules of the state fire marshal adopted pursuant to Iowa Code chapter 17A, which apply to the occupancy type of the facility;
	2.	Applicable requirements for accessibility of the facility to persons with disabilities, including but not limited to provisions of the state of Iowa building code, the federal Americans with Disabilities Act, federal Fair Housing Act and related regulations; and
	3.	Provisions of any local building code in force in the jurisdiction in which the facility is located and any provisions of the state of Iowa building code which apply statewide. If the facility is located in a jurisdiction in which no local building code is in force, the facility shall comply with the state of Iowa building code in its entirety.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.7(231) Term of use of an acquired or constructed facility. A recipient of funds under the Act that uses these funds for the acquisition or construction of a facility housing a program or service shall comply with the requirements of the Act and other applicable federal requirements regarding the term of use of such facility.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.8(231) Restrictions.
	7.8(1) Membership fees. Payment of a membership fee shall not be required of participants in programs and services offered in facilities that receive or have received funds under the Act.
	7.8(2) Sectarian use of a facility prohibited. A facility altered, renovated, acquired, leased or constructed using funds under the Act shall not be used for sectarian instruction or as a place for religious worship.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.9(231) Information and assistance services.
	7.9(1) The AAA shall provide for information and assistance services sufficient to ensure that all older individuals within the PSA have convenient access to the services.
	7.9(2) English not principal language. In a PSA in which 3 percent of the older individual population does not speak English as the principal language, the service provider must provide information and assistance services in the language spoken by older individuals.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.10(231) Legal assistance requirements. The provisions and restrictions in this rule apply only to legal assistance providers and only when they are performing tasks covered by Section 307(a)(11) of the Act.
	7.10(1) Provider requirements. The AAA shall award funds to the legal assistance provider(s) that most fully meets the standards given in this rule. The legal assistance provider(s) shall:
	a. 	Have staff with expertise in specific areas of law affecting older individuals with economic or social needs and give priority to issues related to income, health care, long-term care, nutrition, utilities, housing, protective services, abuse, neglect, age discrimination and defense of guardianship;
	b. 	Demonstrate the capacity to provide effective administrative and judicial representation in the areas of law affecting older individuals with economic or social needs;
	c. 	Demonstrate the capacity to provide support to other advocacy efforts, for example, the long-term care resident’s advocate program or elder abuse initiatives programs;
	d. 	Demonstrate the capacity to deliver legal services to institutionalized, isolated, and homebound older individuals effectively;
	e. 	Demonstrate the capacity to provide legal assistance in the principal language spoken by clients in areas where a significant number of clients do not speak English as their principal language; and
	f. 	Coordinate the provision of legal assistance with private bar attorneys and legal services corporation state grantees.
	7.10(2) Client income disclosure. A legal assistance provider shall not require an older individual to disclose information about income or resources as a condition for providing legal assistance under this rule.
	7.10(3) Client information. A legal assistance provider may ask about an older individual’s financial circumstances only as a part of the process of providing legal advice or counseling and representation, or for the purpose of identifying additional resources and benefits for which an older individual may be eligible.
	7.10(4) Assistance allowed. Nothing in this rule is intended to prohibit an attorney or staff attorney from providing any form of legal assistance or to interfere with the fulfillment of the attorney’s professional responsibilities.
	7.10(5) Provider compliance with OAA regulations. The legal assistance provider and its attorney(s) and employee(s) shall comply with all federal and state laws, regulations and rules which govern ethical and professional conduct and the practice of law.
	7.10(6) An AAA shall not require a provider of legal assistance to reveal information protected by attorney-client privilege.
	7.10(7) The department will be responsible for the following:
	a. 	Providing for the coordination of the furnishing of legal assistance to older individuals within the state;
	b. 	Providing advice and technical assistance in the delivery of legal assistance to older individuals within the state;
	c. 	Supporting the provision of training and technical assistance for legal assistance for older individuals; and
	d. 	Assigning personnel, one of whom shall be known as a legal assistance developer, to provide state leadership in developing legal assistance programs for older individuals throughout the state.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.11(231) Disease prevention and health promotion under Title III-D of the Act. AAA shall use Title III-D funds to provide disease prevention and health promotion services and information at multipurpose senior centers, at congregate meal sites, through home-delivered meals programs or at other appropriate sites.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.12(231) Nutrition services.
	7.12(1) Purposes of the program. The purposes of the nutrition services program are to:
	a. 	Provide meals and other nutrition-related services, including outreach and education to older individuals;
	b. 	Provide information and referral services, health and human service counseling, recreation activities, and access to nutrition services to participants when services are needed; and
	c. 	Provide activities of interest to older individuals on each day the congregate meal site is open including a monthly nutrition education program under the supervision of a licensed dietitian if the nutrition education provides medically oriented information.
	7.12(2) Assessment of need. The AAA shall determine the best location for nutrition services within the planning and service area at least once during the long-range plan development cycle. The needs of the community will be considered in determining the locations for nutrition services.
	7.12(3) Inspection of congregate nutrition sites. All congregate nutrition sites shall be inspected by the department of inspections and appeals and shall have a current food service establishment (restaurant) license posted in the congregate nutrition site.
	7.12(4) The AAA shall ensure that nutrition funds are used to:
	a. 	Provide at least one meal per day in a congregate nutrition site or provide home-delivered meals based upon a determination of a participant’s need.
	b. 	Provide other nutrition services to ensure that the maximum number of eligible older individuals, with emphasis on the frail, those with greatest social and economic need, and the isolated, shall have the opportunity to participate.
	c. 	Provide nutrition screening and counseling as appropriate and nutrition education services to address assessed needs.
	7.12(5) Food assistance program. The AAA and nutrition services providers shall assist participants in taking advantage of benefits available to them under the food assistance program by providing current information to participants in both the congregate and home-delivered meals programs. Nutrition services providers shall be certified to accept food assistance as contributions for meals.
	7.12(6) Licensed dietitian. Each AAA must utilize the services of a licensed dietitian to provide technical assistance in nutrition program management and to ensure that the project provides meals that comply with the RDA/AI.
	7.12(7) The AAA shall develop procedures to:
	a. 	Ensure that food service personnel, both paid and volunteer, conform to hygienic food handling techniques and to standards given in the current edition of “Center for Food Safety and Applied Nutrition—Food Code” published by the U.S. Food and Drug Administration;
	b. 	Provide for ongoing training on safety, hygienic food handling and sanitation for both volunteer and paid food service personnel;
	c. 	Ensure that food service personnel, both paid and volunteer, are provided with job descriptions and standards of performance which shall be evaluated annually; and
	d. 	Regulate the use of foods remaining after serving at congregate meal sites.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.13(231) AOA NSIP programs.
	7.13(1) The AAA shall have an agreement with the department to receive commodities, cash or a combination of commodities and cash.
	7.13(2) The department shall allocate all food, cash or the combination of food and cash received from AOA to AAA based on each AAA’s proportion of the total number of meals served to eligible recipients in the state.
	7.13(3) The AAA shall comply with the requirements of 7 CFR §250, June 3, 1988, for participation in the AOA program.
	7.13(4) AAA electing to receive commodities shall maintain perpetual inventories of all commodities at each site and storage area and must submit an areawide inventory at least quarterly to the department within 30 days after the reporting period.
	7.13(5) AAA shall comply with provisions of state laws regarding safe and sanitary handling of food, equipment and supplies. Nutrition services providers shall accept and use foods made available by AAA.
	7.13(6) Commodities shall be consumed as food only and shall not be sold, exchanged, traded, transferred, destroyed, or otherwise disposed of for any reason without prior approval from the department.
	7.13(7) An AAA shall report the loss, theft, damage, spoilage, or infestation of commodities to the department within 5 working days to initiate claim action.
	7.13(8) An AAA that receives cash in lieu of commodities shall spend all cash received from the AOA to purchase agricultural food items.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.14(231) Nutrition performance standards.
	7.14(1) Each meal served by the nutrition services provider, whether at a congregate meal site, home-delivered or elsewhere, must comply with the current Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture, and provide to each participating older individual:
	a. 	A minimum of 33 1/3 percent of the RDA/AI as established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences, if the program provides one meal per day;
	b. 	A minimum of 66 2/3 percent of the allowances if the program provides two meals per day; and
	c. 	One hundred percent of the allowances if the program provides three meals per day.
	7.14(2) AAA shall ensure that the areawide percentage of residents with the greatest economic and social need is proportionately represented in the characteristics of individuals served in the nutrition program as outlined in 17—Chapter 6 for preference in service delivery.
[ARC 8489B, IAB 1/27/10, effective 1/7/10; ARC 0623C, IAB 3/6/13, effective 4/10/13]
17—7.15(231) Food standards. The AAA or contractor shall, when purchasing food and preparing and delivering meals, comply with all state and local health laws and ordinances concerning preparation, handling and serving food.
	7.15(1) Each AAA shall establish and implement written procedures, in consultation with a licensed dietitian, on handling foods prepared for a meal but not served. The procedures shall address which foods may be saved, which foods need to be destroyed, and instructions on cooling and storing foods for reuse.
	7.15(2) All raw fruits and vegetables and other foods utilized shall be free from spoilage, filth or contamination and must be safe for human consumption.
	7.15(3) Foods prepared, canned or preserved noncommercially shall not be used.
	7.15(4) Standardized, tested quantity recipes, adjusted to yield the number of servings needed, shall be used to achieve the consistent and desirable nutrient quality and quantity of meals.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.16(231) Food-borne illness. The AAA shall develop written procedures for handling suspected cases of food-borne illnesses. The contractor shall report the occurrence or suspected occurrence of a food-borne illness to the AAA within 12 hours. The AAA shall notify the department within 12 hours after the AAA becomes aware of the situation.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.17(231) Menus.
	7.17(1) All menus shall be planned for a minimum of four weeks, computer analyzed to ensure 33 1/3 percent of the RDA/AI is provided in each meal, certified in writing by the licensed dietitian whose services are utilized by the AAA, and submitted to the department for review at least two weeks prior to the initial use of the menu. For purposes of audit, AAA shall keep copies of the certified menus on file for a period of one year.
	7.17(2) All certified menus shall be posted in a conspicuous location in each congregate meal site and regularly provided to home-delivered meal recipients. The certified menus may be modified occasionally if the provisions of rule 17—7.15(231) are maintained and a licensed dietitian or nutrition director is consulted prior to the change.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.18(231) Special dietary needs. The AAA shall ensure that special dietary needs of program participants are met where feasible and appropriate, including the particular requirements arising from the health, religious, or ethnic backgrounds of eligible participants.
	7.18(1) The following criteria shall be used to determine feasibility and appropriateness:
	a. 	Sufficient numbers of older individuals who have special dietary needs exist to make the provision practical;
	b. 	Skills and food necessary to provide the special menus are available.
	7.18(2) Special dietary and therapeutic menus must be planned under the supervision of a licensed dietitian in accordance with a current diet manual approved by the department. Certified menus must be submitted to the department at least two weeks prior to the initial use of the menus.
	7.18(3) A written physician’s order for each older individual requesting a therapeutic diet shall be obtained prior to the older individual’s receipt of the meal and kept on file where the meal is prepared and served. The order shall be interpreted by a licensed dietitian and the individual’s physician.
[ARC 8489B, IAB 1/27/10, effective 1/7/10; ARC 0623C, IAB 3/6/13, effective 4/10/13]
17—7.19(231) Congregate nutrition services. In providing nutrition services or in making awards for congregate nutrition services, the AAA shall:
	1.	Select and designate as a site any location where meals are served in a group setting with federal AOA nutrition funds or contributions from an AOA federal nutrition program, or both;
	2.	Provide a site in as close proximity to the majority of eligible individuals’ residences as feasible, preferably within walking distance, or where transportation is available;
	3.	Provide for hot or other appropriate meals at least once a day, five or more days a week. In a county where there is a site providing meals five or more days a week, additional sites may be established which provide meals one or more days a week. Efforts shall be made and documented to the department annually to increase the number of serving days to a minimum of three days each week;
	4.	Coordinate with other community providers to arrange meals for older individuals on holidays that occur on regularly scheduled serving days and also to the general public in weather- and disaster-related emergencies, where feasible.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.20(231) Eligibility for meals at congregate nutrition sites.
	7.20(1) A person aged 60 or older and the spouse of the person, regardless of age, are eligible to participate in congregate nutrition services.
	7.20(2) Individuals providing volunteer services during meal hours are eligible to participate in congregate nutrition services.
	7.20(3) Individuals with disabilities who reside at home or reside with and accompany eligible older individuals are eligible to participate in congregate nutrition services.
	7.20(4) Individuals with disabilities who are not 60 years of age or older and who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided are eligible to participate in congregate nutrition services.
	7.20(5) Ineligible individuals may eat at a site and pay the programmatic cost of the meal, if the ineligible individual’s receipt of the meal does not deprive an eligible participant of a meal.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.21(231) Home-delivered meals.
	7.21(1) Eligibility. An older individual who is homebound by reason of illness, incapacitating disability or other cause is eligible to receive home-delivered meals. Regardless of age or condition, the spouse of an older individual may receive home-delivered meals if receipt of the meal is in the best interest of the homebound older individual under criteria set by the AAA.
	7.21(2) Individual assessment. The AAA or the home-delivered meals contractor, subject to AAA approval, shall establish and utilize procedures for the determination of an older individual’s eligibility for home-delivered meals, including specific criteria for:
	a. 	Initial assessment of the older individual’s eligibility;
	b. 	Determination of the number of days per week the older individual has a need for home-delivered meals; and
	c. 	Determination of the older individual’s need for other home-delivered nutrition services.
	7.21(3) Requirements for providers. The AAA or contractor shall:
	a. 	Provide for home-delivered meals at least once a day, five or more days a week;
	b. 	Provide for home-delivered meals to participants according to the frequency of need determined by procedures required in subrule 7.21(2). Meals may be hot, cold, frozen, dried, canned or supplemental foods with a satisfactory storage life;
	c. 	Make arrangements for the availability of meals to older individuals in weather- and disaster-related emergencies, where feasible;
	d. 	Provide other nutrition and supportive services either directly or through referral to meet the need of the homebound older individual;
	e. 	Provide monthly nutrition education for home-delivered meal recipients, to include safe food handling of the delivered meals every six months;
	f. 	With the consent of the older individual or the older individual’s representative, bring to the attention of appropriate officials for follow-up conditions or circumstances which place the older individual or the household in imminent danger. The AAA shall coordinate with other agencies to provide services to the homebound older individual to reduce dependency and cultural, social and geographic isolation caused by noneconomic factors.
The provider is not required to provide meals more than five days per week, but is encouraged to do so.
[ARC 8489B, IAB 1/27/10, effective 1/7/10; ARC 3139C, IAB 6/21/17, effective 7/26/17]
17—7.22(231) Noncompliance. When a grantee fails to meet the nutrition requirements as provided in this chapter, the department shall follow procedures outlined in 17—Chapter 4.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
17—7.23(231) Requirements for opening or closing congregate nutrition sites. The AAA shall notify the department, via electronic mail or other written notification, within 30 days of the AAA’s opening, relocating, or terminating a nutrition site. The notification must include:
	1.	Reasons for the action;
	2.	Impact on eligible individuals;
	3.	Impact on nearby meal sites; and
	4.	Impact on provision of nutrition-related services.
[ARC 8489B, IAB 1/27/10, effective 1/7/10; ARC 0623C, IAB 3/6/13, effective 4/10/13]
17—7.24(231) Evaluation of sites. The AAA shall conduct on-site evaluations on an annual basis. The reports of these evaluations shall be kept on file for three years and shall include any areas that need additional monitoring or corrective actions.
	7.24(1) At a minimum, the evaluation shall include the site’s compliance with:
	a. 	Food acquisition, handling and safety standards;
	b. 	The requirement for the RDA/AI as established in this chapter;
	c. 	Food quality and acceptability (appearance, taste, temperature and smell);
	d. 	Services provided in addition to meals, such as nutrition education and counseling as appropriate, social opportunities and other activities.
	7.24(2) The AAA shall provide each site a tool to guide food service personnel in a self-assessment to be conducted at midpoint between AAA on-site evaluations. This evaluation shall be conducted to document program compliance and to analyze areas for ongoing monitoring. The self-assessment reports shall be kept on file for three years.
[ARC 8489B, IAB 1/27/10, effective 1/7/10]
These rules are intended to implement Iowa Code chapter 231.
[Filed 5/20/82, Notice 3/17/82—published 6/9/82, effective 7/14/82]
[Filed 12/3/82, Notice 7/21/82—published 12/22/82, effective 1/26/83]
[Filed emergency 2/25/83—published 3/16/83, effective 2/25/83]
[Filed 10/19/84, Notice 8/15/84—published 11/7/84, effective 12/12/84]1
[Filed 7/10/86, Notice 5/7/86—published 7/30/86, effective 9/3/86]2
[Filed 5/1/87, Notice 2/25/87—published 5/20/87, effective 6/24/87]3
[Filed emergency 7/21/88—published 8/10/88, effective 7/22/88]
[Filed 4/26/90, Notice 2/21/90—published 5/16/90, effective 6/30/90]
[Filed without Notice 1/13/92—published 2/5/92, effective 3/11/92]
[Filed 6/26/92, Notice 4/1/92—published 7/22/92, effective 8/26/92]
[Filed 11/5/93, Notice 9/15/93—published 11/24/93, effective 12/29/93]
[Filed 11/3/95, Notice 8/16/95—published 11/22/95, effective 12/27/95]
[Filed 3/7/96, Notice 1/31/96—published 3/27/96, effective 5/1/96]
[Filed 10/15/97, Notice 9/10/97—published 11/5/97, effective 12/10/97]
[Filed 2/21/06, Notice 11/23/05—published 3/15/06, effective 5/1/06]
[Filed 8/20/08, Notice 7/2/08—published 9/10/08, effective 10/15/08]
[Filed Emergency ARC 8489B, IAB 1/27/10, effective 1/7/10]
[Filed ARC 0623C (Notice ARC 0505C, IAB 12/12/12), IAB 3/6/13, effective 4/10/13]
[Filed ARC 3139C (Notice ARC 2967C, IAB 3/15/17), IAB 6/21/17, effective 7/26/17]
1	Effective date of 20—8.42(2) delayed 70 days by the Administrative Rules Review Committee.
2	Two or more ARCs
3	Effective date of Chapter 7 delayed 70 days by the Administrative Rules Review Committee.