Malnutrition remains a pressing issue among older adults, posing significant health risks and diminishing their quality of life. As Sen. Bernie Sanders (I-VT), Chair of the Senate Committee on Health, Education, Labor and Pensions, highlighted in a recent hearing on Older Americans Act (OAA) programs, malnutrition in U.S. older adults costs $50 billion every year. Addressing malnutrition in older adults requires policy interventions that cover all corners of care, from home- and community-based care to institutional care. It also requires policy actions from states as well as the federal government.
An important and growing development at the state level is emerging Master or Multisector Plans on Aging (MPA). Beginning with California in 2019 and most recently Utah, more than half of U.S. states are in various levels of planning or implementation on these plans. As more states move toward developing MPAs, we have a unique opportunity to incorporate nutrition and malnutrition care into the plans to ensure comprehensive support for older adults in the community.
Image from: https://multisectorplanforaging.org/
Creating a Master or Multisector Plan on Aging
We’ve been caring for people as they age for a long time, and clear data shows the need for additional aging services and support—from more accessible public transportation to community-based long-term care options. MPAs have emerged to address the diverse needs of aging across the lifespan by providing a blueprint to guide state and local policies, programs and funding.
MPAs usually start as an initiative triggered by a governor issuing an executive order (EO). In New York, Gov. Hochul issued EO 23 in November of 2022, stating, “This Master Plan for Aging will provide us with tools to ensure our aging New Yorkers have access to quality long term care in healthy, livable communities where they can thrive.”
Work then began on the development of the plan with committees and work groups tackling individual issues. The work of stakeholders is critical in all MPAs as it is through this work and the development of recommendations produced that individual issues can be elevated. New York plans to finalize and release their plan in early 2025.
Identifying Opportunities to include Nutrition and Malnutrition
This process provides a unique opportunity to incorporate nutrition and malnutrition care into MPAs to ensure it reflects a commitment to comprehensive support for aging well. To date, few MPAs reference malnutrition and it will take sustained advocacy throughout the MPA process to ensure the proper language is included. The harder work will occur after the plan is adopted and implemented.
California is a good example. Its MPA has a Protection from Poverty & Hunger initiative targeting greater assessment and coordination to provide affordable and culturally appropriate foods through food and meal programs such as congregate meals at day centers and long-term care facilities and medically tailored meals. The initiative could be expanded to include malnutrition prevention, screening, and treatment, to ensure comprehensive care for older adults.
‘California’s MPA has a Protection from Poverty & Hunger initiative targeting greater assessment and coordination to provide affordable and culturally appropriate foods.’
For those who are involved in state MPA work, it is crucial to identify the relevant committee(s) or contact(s) and advocate for including nutrition and malnutrition in the final plan. In New York, the Health and Wellness subcommittee was identified as connecting to nutrition in their recommendations, which we expect to include actions related to nutrition and malnutrition, are under review for possible inclusion in the New York MPA.
Leveraging Connections at the Federal Level
Multiple federal activities also connect nutrition to MPA work. In 2024, work began to reauthorize the Older Americans Act (OAA), which in 2025 will celebrate its 60th anniversary. The purpose of a reauthorization is to update and modernize a given law. OAA’s largest program, the Senior Nutrition Program, was updated in the 2020 OAA reauthorization to include reducing malnutrition in the program’s purpose and add malnutrition to OAA nutrition screening requirements. MPAs could both integrate the OAA Senior Nutrition Program in their blueprints and look to the OAA for nutrition and malnutrition language. Further, the historic importance of state units and area agencies on aging to the OAA also could be showcased through MPA activities.
The Interagency Coordinating Committee on Healthy Aging and Age Friendly Communities, or ICC, was created in 2020 and funded in FY2023. Earlier this year, Secretary Xavier Becerra of the Department of Health and Human Services designated the Administration for Community Living (ACL) to run the ICC. ACL also administers the OAA Senior Nutrition Program.
The ICC is expected to begin its work in early May with at least four cross-country listening sessions. While a stated goal of the ICC is to coordinate federal agency work around age-friendly communities, a more implicit outcome of the ICC work could be developing a framework for a national plan on aging with input from state programs and initiatives, including those focused on nutrition.
Two other relevant policy actions are The Strategic Plan for Aging Act, which was introduced in February in the Senate and would create a new, nationwide grant program under the OAA to incentivize and support states’ efforts to create their own strategic plans for aging (or MPAs). This Act describes malnutrition as a key aging issue, identifying the importance of “ensuring access to healthy and affordable foods and reducing food insecurity, hunger, and malnutrition.” States could include this language as they develop their own MPAs.
In addition, the next White House Conference on Aging is expected to be held in 2025, and nutrition issues have historically been included in Conference recommendations and outcomes. It is hoped both will be included in the passage into law 2024 reauthorization of the OAA.
We may be on the verge of a perfect aging public policy storm in 2024, when we connect state and federal initiatives to support the health and nutritional well-being of older adults. Most national, state, and local advocates have a stake in this and now is the time to be prepared to seize this opportunity.
Bob Blancato, MPA, is the national coordinator of Defeat Malnutrition in Washington, DC, and co-coordinator of the New York State Master Plan on Aging Coalition.
Photo credit: Shutterstock/Oleksandra Naumenko
