Objective

To assess the extent of implementation of the 12 recommendations included in our initial audit report, Oversight of the Home Delivered Meals Program (Report 2020-N-5).

About the Program

The New York City (City) Department for the Aging (DFTA) is the City agency primarily responsible for addressing public policy and service issues for the aging. Its mission is to work to eliminate ageism and ensure the dignity and quality of life of the City’s diverse older adults, and to support their caregivers through service, advocacy, and education. DFTA is the largest agency in the federal network of Area Agencies on Aging in the United States. Its planned spending for the fiscal year ended June 30, 2023 was approximately $543 million, including $349 million and $44 million in City and State funding, respectively, with the remainder from federal and intra-City funds.

Approximately 1.76 million seniors (adults age 60 and older) resided in the City in 2019. This number is expected to increase to 1.86 million by 2040. The federal Older Americans Act requires the provision of various services for senior citizens, including access to nutrition, benefits counseling, employment opportunities, legal assistance, 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. Since fiscal year 2020, DFTA has maintained 22 contracts with 14 community-based organizations (providers) for HDML services.

In fiscal year 2023, DFTA reported that about 4 million home delivered meals were served to over 34,000 homebound seniors. HDML providers record meal deliveries and missed deliveries (e.g., client did not answer) on route sheets and enter this information in DFTA’s Senior Tracking, Analysis and Reporting System. Clients are given the opportunity to make voluntary contributions at the time of meal delivery, to be used to benefit the providers’ HDML programs.

Clients can submit meal delivery complaints (e.g., poor meal quality, unsatisfactory delivery experience, non-delivery) directly to DFTA, through the City’s Dynamics 365 citywide system (for NYC 311 complaints), or to the provider. DFTA has a performance measure to address client complaints regarding home delivered meals within 14 days of the complaint. DFTA also uses a variety of tools to determine the overall success and performance of the program, including nutritionist assessments, client satisfaction surveys, and annual provider evaluations. DFTA’s nutritionists conduct unannounced visits to each provider annually, using a “Nutrition Assessment Tool” checklist to assess food safety, cleanliness, and nutrition. In addition, satisfaction surveys are used to determine client experiences related to timeliness of delivery and quality of meals. Each year, DFTA completes provider performance evaluations in PASSPort, the City’s procurement portal. This information can be used during procurements to assist DFTA in awarding contracts.

The objective of our initial audit, issued January 20, 2022, was to determine whether DFTA was effectively overseeing the provision of home delivered meals. The audit covered the period from July 2018 through February 2021. Additionally, the audit team reviewed documentation related to DFTA’s new HDML program contracts awarded in January 2021. The audit found DFTA did not ensure that its contracted providers always delivered quality, safe, nutritious, and timely meals to the City’s seniors who depend on DFTA for nutritional needs. Moreover, DFTA did not ensure providers were only paid for meals that were actually delivered and allowed a 3% difference between the number of meals for which providers were paid compared to the number actually delivered. DFTA also could not demonstrate that it addressed all HDML complaints. The audit also found that some complaints were resolved after the 14-day period allowed, and, for a sample of five providers, a total of 27 non-compliant issues found by DFTA nutritionists in 2019 were again detected in 2020. These included roach/vermin activity and failure to prevent food contamination. In addition, DFTA’s satisfaction surveys were flawed. Most notably, clients with limited English language proficiency were excluded from participation. Further, DFTA awarded new contracts to providers with noted deficiencies.

Key Findings

DFTA has made some progress in addressing the problems we identified in the initial audit report. Of the initial report’s 12 audit recommendations, three were implemented, five were partially implemented, and four were not implemented.

Key Recommendation

DFTA officials are requested, but not required, to provide information about any actions planned to address the unresolved issues discussed in this follow-up within 30 days of the report’s issuance.