Objective

To determine whether the New York City Department for the Aging (DFTA) effectively oversees the provision of home delivered meals. The audit covered the period from July 2018 through February 2021. Additionally, we reviewed documentation related to DFTA’s new Home Delivered Meals program contracts awarded in January 2021.

About the Program

In testimony before the New York City (NYC or City) Council on September 20, 2021, the Executive Director of Hunter College’s Food Policy Center stated that hunger, food insecurity, and access to nutritious nutrient-dense food (e.g., fresh produce, whole grains, lean proteins) are public health crises that impact many seniors (adults age 60 and older) who live with limitations such as difficulty walking up stairs, carrying heavy items like grocery bags, and preparing their own meals.

DFTA is the City agency primarily responsible for addressing public policy and service issues for the aging. As of 2019, there were over 1.76 million seniors residing in the City, and this number is expected to increase to 1.86 million by 2040. Seniors who have difficulty preparing meals may be eligible for home delivered meals.

The federal Older Americans Act requires that grant funding be used for the provision of various services for seniors, including access to nutrition and in-home services. DFTA created the Home Delivered Meals (HDML) program to maintain or improve the nutritional status of seniors who are unable to prepare meals. DFTA contracts with community-based organizations (providers) for meal delivery services. DFTA pays providers for each meal, but only those that are actually delivered. In addition, clients can make voluntary contributions to the providers for the meals.

Meal deliveries serve an additional benefit in that, during the face-to-face transaction with the client, providers are able to assess the client’s overall wellness and condition. Specifically, providers are required to report any neglect, unsanitary conditions, and signs of abuse. However, during the COVID-19 pandemic, social distancing rules precluded the opportunity for these close-up assessments. The COVID-19 pandemic caused a severe economic slowdown, including community business closures, which could have increased food insecurity. In 2020, DFTA provided home delivered meals to nearly 4,000 more seniors than in the prior year. Without such programs, seniors would be at an even greater risk for food insecurity.

Providers are selected through a request for proposal solicitation process, which may include DFTA’s consideration of the provider’s past performance – a criterion that was included in DFTA’s 2020 RFP for HDML services. To assess provider performance, DFTA employs nutritionists who conduct unannounced provider inspections to determine food safety, cleanliness, and nutrition. DFTA also contracts with case management agencies, so that its clients have a case manager to identify their needs, connect them to services, coordinate care, and respond to and resolve any issues that arise. These case managers are required to contact their clients at least once every 2 months to check on their welfare.

Clients can submit meal delivery complaints (e.g., poor meal quality, unsatisfactory delivery experience, non-delivery) directly to DFTA or the provider. DFTA has a performance measure to address client complaints within 14 days of the complaint.

DFTA employs a variety of tools to determine the overall success and performance of the program, including nutritionist assessments, client satisfaction surveys, and annual provider evaluations. The results of these evaluations are recorded in a procurement portal, PASSPort. This information can be used during procurements to help DFTA award contracts.

In fiscal year 2020, DFTA reported that 4,663,561 home delivered meals were served to over 31,000 homebound seniors.

Key Findings

DFTA does not provide adequate oversight of its HDML program:

• DFTA did not ensure that providers were only paid for meals that were actually delivered or that client complaints were resolved timely.
• Where assessments have identified deficiencies, DFTA does not take proactive steps to ensure the issues have been corrected.
  • For a sample of providers, food nutrition and safety issues, such as vermin/roach activity and contamination, recurred from one year to the next.
  • There are no consequences, such as punitive actions, for providers that fail to correct compliance violations.
• DFTA’s satisfaction survey methodology was poorly developed, resulting in clients with limited English language proficiency being excluded from participation.
• DFTA awarded new contracts to providers with noted deficiencies because DFTA may not have considered past performance in its procurement process.

Key Recommendations

• Identify providers with recurring food safety and nutritional issues. Develop controls to ensure that these issues are sufficiently addressed to prevent future occurrences.
• Develop guidelines or protocols for conducting surveys to include seniors with limited or no English proficiency.
• Track the HDML complaints received by DFTA to ensure they are resolved within 14 days.
• Develop formal written policies and procedures regarding route review of meal delivery; include a testing protocol to determine if meals were actually delivered to clients directly.
• Ensure DFTA effectively factors in past performance when selecting providers for contracts.