Vermont Legislature SmartTranscripts:

[Speaker 0]: It looks like they're talking. Representative Steady, can you mute yourself there? We're we're gonna go live. We are live. Okay. Mhmm. To House Human Services this morning. You for being here. Part of our role in the legislature is to have oversight and accountability discussions with various folks on various topics. And the legislature has provided some significant resources to the Meals on Wheels program over the last few years. And we are interested in understanding essentially what's going on with Meals on Wheels. And we've also heard about some potential statewide contract or something, I'm not sure too much about the details of it, with bank, which is really hard to say. So we just wanted to get an update on what was happening. So I'm not sure who's going first. Jason, are you going first? You're first on my list. That works. Okay. Welcome to House Human Services. And since we have people here who have not been with us previously, so we will do a quick round of introductions. Do you have a presentation? I do. Have you forwarded it to us?

[Jason Palatira (State Unit on Aging Director, DAIL)]: I have not.

[Speaker 0]: Uh-oh. What happened with Rebecca? She didn't give you the word? They

[Jubilee McGill (Member)]: were working

[Esme Cole (Member)]: on it left.

[Speaker 0]: So while you're doing that and you're getting situated, we will do a round of introductions. So I'm Theresa Wood, I'm from Waterbury. I also serve both in Fuels Four and Huntington. Hi, I'm Rey Garofano. I live in Essex and I also serve Essex Junction.

[Jubilee McGill (Member)]: Jubilee McGill. I'm from Bridgeport and also serve Middlebury, New Haven and Haybridge.

[Esme Cole (Member)]: Hi, welcome. I'm Esme Cole, I represent Hartford.

[Zon Eastes (Member)]: Hi, I'm Zon Eastes. I live in Guilford and also represent Vernon.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Hello, I'm Doug Bishop. I'm one of Colchester's representatives.

[Daniel Noyes (Clerk)]: Good morning. Dan Noyes, represent Wolcott, Hyde Park, Johnson and

[Speaker 0]: Belvidere. Represent Steady, if you wanna introduce yourself. I'm rep Steady. I'm East Milton Westford. Thank you. And then we'll go right around the outside of

[Morrison Acquire (Committee Assistant)]: the room. Brenda

[Jubilee McGill (Member)]: Steady, intern for Representative Noyes. Anne B. Horton, Executive Director of Public Fee Vermont. Caitlin Gray, Patient Circles. Kim Lubinski, Director

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: of Nutrition and Wellness at the Central Vermont Council on Aging.

[Morrison Acquire (Committee Assistant)]: Virginia Rutland, who is director of consulting. There are two points too. Sorry, Morrison Acquire, committee assistant.

[Speaker 0]: And then why don't the folks on screen introduce yourselves while we're at it?

[Angela McMahon (Director, Adult Services Division, DAIL)]: Sure, good morning. My name is Angela McMahon. I'm the director of the adult services division in Dale.

[Samantha Shanks (State Unit on Aging, DAIL)]: And I'm Samantha Shanks and I'm part of the State Unit on Aging with Jason.

[Speaker 0]: Hey. Floor is yours, Jason. So

[Jason Palatira (State Unit on Aging Director, DAIL)]: I do need to figure a way to

[Speaker 0]: I just sent you to Zoom. Like Okay. Just need to join that.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Okay.

[Jubilee McGill (Member)]: Maybe some other screen share.

[Speaker 0]: Rebecca, we keep score on this. I know. I'm just kidding you, I'm just kidding you.

[Jubilee McGill (Member)]: I know, especially this time in the season.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yeah, I don't see a Zoom link.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Do you have a presentation? Can you share your screen?

[Jason Palatira (State Unit on Aging Director, DAIL)]: Samantha, I'll forward it to you. Hey, Samantha. I just sent it to you.

[Jubilee McGill (Member)]: Okay.

[Speaker 0]: And somebody should forward it to Laurie as well. And, representative Maguire, why don't you introduce yourself? We've already done introductions.

[Eric Maguire (Member)]: Forgive me for my tardiness. Representative Eric Maguire from Rockland City. Welcome.

[Samantha Shanks (State Unit on Aging, DAIL)]: Just waiting on it to pop up in my inbox.

[Esme Cole (Member)]: And where do you know?

[Speaker 0]: Is Cheryl Gilbert going to be joining us?

[Esme Cole (Member)]: Yeah. No?

[Speaker 0]: Okay, she's in her place. Okay. Well, Jason, why don't you go ahead and get started? Samantha, when you get it, you can share your screen, and for members and other folks in the public, It'll be posted on our website eventually.

[Esme Cole (Member)]: Sounds great.

[Jason Palatira (State Unit on Aging Director, DAIL)]: I am having a little trouble connecting to the Internet, so it might be a factor, but I'll just go. Alright. So, everybody, my name is Jason Palatira. I'm the state of United Aging Director with Dale. And today I'm going to talk about the Home Delivered Meals Program and the Global Commitment Investment portion of the Home Delivered Meals Program as well. So some overview and background of the home delivered meals program. Vermont receives federal funding to provide home delivered meals, also known as Meals on Wheels. The eligible Vermonters age 60 and over. In Vermont's case, the funding passes through Dale to the Area Agencies on Aging and is then allocated to the many meal providers throughout the state, including senior centers. And in federal fiscal year 2025, Vermont received approximately $1,800,000 in Older Americans Act federal funds for home delivered meals. And in that same fiscal year, $1,000,000 in home delivered meals state general fund was converted to global commitment, adding approximately $1,400,000 in federal match, totaling about $2,400,000 in Global Commitment funding. And in that same fiscal year, f f y twenty five, 6,913 older Vermonters received 968,112 home deputant meals. Sorry, what was the number of Vermonters? Sorry, 6,913.

[Esme Cole (Member)]: In '20

[Jason Palatira (State Unit on Aging Director, DAIL)]: In federal fiscal year '25.

[Speaker 0]: Okay. I'm sorry, didn't catch the dollar amount from the Older Americans Act. It's approximately $1,800,000 Thank you. So and are there any other additional state funds that go into meals?

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yep. So there's approximately $286,000 that's also allocated for home delivered meals, which is not part of that global commitment bucket of funding. And every year, the AAAs send out satisfaction surveys for the meals, and I thought I'd share some quality feedback that the participants shared with the AAAs for FY25. So basically, across the board, the quality scores that the participants provided averaged around 90% for the meals, and those ranged from good, very good to excellent. Providing a little more detail on the global commitment HDM funding, each AAA receives this money in the form of a one year grant. They must reimburse meal provide providers at least $6.50 per meal. They must ensure that meals are provided to the most food insecure old liver monitors, such as those unable to cook, unable to obtain groceries, and those who are economically food insecure. And this aligns with federal directives to target those in greatest in socioeconomic need. You also must report the number of participants with three or more activities of daily living needs, so examples of those are bathing, dressing, and toileting. And they also must report on the number of individuals who have three or more instrumental activities of daily living needs, and that includes preparing meals, shopping, and transportation. And we also need to report data on those who are at or below the federal poverty level, and they must submit this reporting to the state unit on aging quarterly.

[Speaker 0]: So Jason, how is that done? Do they do an annual assessment? What's the mechanism for gathering that information? And do they do it for the total amount or do they only do it for those meals that are funded by the Older Americans Act since that's where the

[Jason Palatira (State Unit on Aging Director, DAIL)]: federal requirements stem It's the total amount, and the data is collected at initial assessment to determine eligibility for home delivered meals and at annual reassessment.

[Speaker 0]: Those assessments are done by whom?

[Jason Palatira (State Unit on Aging Director, DAIL)]: In some cases, the AAA staff, it does them through themselves. I think there are some AAA regions where the senior centers or meal sites do them in in collaboration with the triple a's and provide the triple a's that information. I'm not sure I'm, like, you which triple a's do what. But, yeah, that's, the general kind of system of how that works.

[Speaker 0]: And there's a is there a database, or is is this, like, paper forms? Or I mean, I'm just trying to gauge the level of workload. If we have 6,000, almost 7,000 people accessing this, that's Doing reassessments on 7,000 people every year is a pretty big job. So I'm just wondering how that is done. Think it is probably relevant to understand if it's done by the local meal providers or the AAA since the meal providers don't actually receive any money to do that.

[Jason Palatira (State Unit on Aging Director, DAIL)]: AAAs do. Yeah, I think in some cases, a senior center might collect that information via paper form. And I think in other cases, the AAAs might gather that information. Like, for example, if someone calls a AAA to try to get on the home delivered meals program and that intake staff tries to determine eligibility, then they'll go through the eligibility requirements and record that data electronically. Again, I think it's a bit of a mixed bag depending on the region. Like, I know there's one particular AAA that is trying to work closely with senior centers to get away from the paper piece of it and try to acquire more of that upfront assessment into the AAA versus having the senior centers do it. So there's some momentum going on there to tighten that up a little bit more centrally. Go

[Esme Cole (Member)]: ahead, Cole. On that subject of forms, I mean, I've heard some feedback and I know tracking and data is really important with limited funds, of course. But I've heard some feedback that some of the forms are burdensome and duplicative. Think Jacqueline was kind of alluding to where the burden of that collection is taking place. And like if it's happening in the right place and what we're asking of senior centers versus what is being asked of the AAAs. So yeah, I think I'd like to better understand the nature of what forms are required, how often and by whom, and if separate forms are needed from the senior senators versus what is being asked of the AAAs. I have other questions, but maybe I'll just start with the forms piece and the burden of that.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yeah, I think the AAAs could speak better to that. I do believe that when the intake referral assistance staff at the AAAs collect information from any older adult who might call up that's interested several types of services, I do believe that in their intake process, they collect a number of pieces of information to determine eligibility for any number of programs. So I don't believe it's necessarily just one assessment that's determining like HDMI eligibility and another determining this type of eligibility. I think there's a considered effort to collect data to determine eligibility for a number of different programs.

[Esme Cole (Member)]: And for the number of different programs, know there's a little bit of a distinction between the Convert Meals and Meals on Wheels. And I think the burden of comm reveals that is none of that is going to the triple a's, if I'm understanding correctly, and all of it is going to the senior centers. Is that right?

[Jason Palatira (State Unit on Aging Director, DAIL)]: I I think in some regions, that is the case, and that's something that Samantha and I have learned to continue to work with the the AAAs on to make sure to try to ease that burden with respect to, you know, having senior centers collect that information. But I think overall, it does need to be a collaborative collaborative effort because the senior centers ultimately are, like, on a front line. Yeah.

[Esme Cole (Member)]: We're going to dive further into that conversation about how to better streamline the practice. I have a specific question about the way funds are distributed.

[Speaker 0]: I think we're going to get back to that, so then why don't we wait till then when we Hopefully do at some point in time, we will see the presentation either on our website or on the screen.

[Samantha Shanks (State Unit on Aging, DAIL)]: Yeah. Sorry. I'm still waiting. I'm refreshing my online email and my email app, but it hasn't come through yet.

[Speaker 0]: Well, Jason was having problems connecting to the Internet here, so it might have gotten might have gotten lost in cyberspace. I don't know.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yeah. I see a BTLC secure and a BTL

[Speaker 0]: It's BT Ledge.

[Jason Palatira (State Unit on Aging Director, DAIL)]: It's a BT Ledge. Okay. So connect. Network security key.

[Speaker 0]: I don't know. Even this one will be all the guests. You won't be a public one.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Public one. Okay. Statehouse public. Yeah. I can try it. Well, Samantha, I just sent it to you again. It looks like I'm online. So

[Speaker 0]: k.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Everybody. K. Sent, so she should get it.

[Speaker 0]: He's got it now. Okay. And they can send it to you. Samantha, will you make sure to send it to Laurie? Send it to somebody so that we can get it here. After you go ahead and share your screen.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Samantha, I'm on the fifth slide, the last slide. Perfect. Okay. So

[Speaker 0]: I was just gonna say, it'd probably be good for you to just start over, to be honest. Because it's helpful for us to be able to see the numbers rather than just hear them.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Sure. So, Samantha, can you go to slide two? So this is what I was talking about earlier regarding an overview of the HCM program and some of the background at the top here, just kind of level setting. And then middle bottom here, these are the f f y 25 numbers. So the 1,800,000 in OA federal funds, and then talk about the 1,000,000 in the state g f that's converted to the build the commitment to get that approximately 1,400,000 in federal match, totaling that 2,400,000 in the global commitment funding. And then we got the numbers below for the Vermonters receiving meals and the total meals for f f y twenty five.

[Speaker 0]: So with the approximately 300,000 in state funds that goes into it, it totals up to about 4,500,000 total. That's with my little fancy math there. Think you said 200 and 286,000. Yeah, just rolled it up to 300,000 to get the Which is actually a pretty significant increase over the last few years, given that the state didn't put any funding into that. I'm remembering the language that we had around distribution, and I don't know if you're going to get to distribution about how you calculate how the state and federal funds through global commitment and the OAA are distributed, how you determine how much goes to each region. Are you gonna cover that in your presentation along the way?

[Jason Palatira (State Unit on Aging Director, DAIL)]: I wasn't necessarily going to cover the distribution. I do believe the global commitment funding bucket of funds is allocated to the AAAs according to the interstate funding formula that we use to basically, it looks at the different demographics and population numbers of older adults and some other factors in each region to determine the appropriate amount of funds to each region. So for example, individuals 85 and over in certain regions, there's more weight to providing a certain percentage of funds to regions who might have more individuals who are much older. So this is like a rather complicated formula, but that's just based on demographics and population numbers. And we distributed the global commitment funds according to that same formula.

[Speaker 0]: Go ahead, Rupesh Patel.

[Esme Cole (Member)]: Thank you. I'm wondering if you track the number of folks who maybe call and inquire, whether it's to the AAAs or the senior side of themselves about participating in Meals on Wheels and may or may not be accepted or rejected into the program based on their first answering the first three questions. I know I think you're kind of just if you don't answer the first two questions, you're kind of disconnected or something. I don't think we track that, like the amount of interests. But I'd love to hear more on your side of things if maybe I'm wrong and maybe we do actually track that because I think getting a better sense of demand could be helpful in determining the best possible strategy for funding formula. Because of course, knowing the amount of older moderates in region is really important too, but people have all kinds of varieties of different needs and levels of interest in the program. So I think that could be valuable information, but I'm just curious more about what happens when somebody calls on the phone and maybe they answer those three questions or more just to start, and if they're connected with another provider, if you can't meet that need, or if the relationship ends there.

[Jason Palatira (State Unit on Aging Director, DAIL)]: The State Unit and Agency does not track that data. It currently does not require that data from the AAAs. I'm not sure if the AAAs internally do that, but the expectation is that if someone is calling for assistance and home delivered meals comes up and for some reason they're not eligible, that the AAA will then proceed to have a deeper conversation with that individual to determine if there are other services that they might benefit from, qualify for, etcetera.

[Esme Cole (Member)]: That's helpful. Thank you. Yep. Thank you.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Samantha, the next slide, slide three. So this is the the quality feedback I was referring to from the satisfaction survey. So as you can see, like I was saying earlier, across the board, 90% satisfaction rate for those who were surveyed. And the feedback ranges from good, very good, to excellent.

[Speaker 0]: Yeah, it's a gradient. I mean, all of those are not exactly the same. Good, very good and excellent. I just, I mean, are differences. Representative Cole, look like you had a question.

[Esme Cole (Member)]: I do a little bit. I'm just wondering, I'd love more information about who was surveyed and how many folks and then, it also just sort of the I don't want to say conflict of interest, but like these meals are not guaranteed, obviously. And as budgets are tightening and demand, I think, is increasing, There's a lot at stake here. So I just want to make sure that I think it'd be easier to answer a survey if that wasn't on the line, maybe. I just want to make sure that older Vermonters completing these surveys don't think that this could impact their ability to continue access to these mails. I mean, I know that that's a stretch, but I think there may have been some feedback that that was an emotional concern.

[Jason Palatira (State Unit on Aging Director, DAIL)]: I can see that.

[Esme Cole (Member)]: Yeah, thank you.

[Jason Palatira (State Unit on Aging Director, DAIL)]: So, Samantha, Yep. Next slide. So this is what I was talking about earlier regarding the expectations within each of the grants, the $6.50 per meal minimum reimbursement rate, the focus on targeting the most food insecure individuals, and economically food insecure as well, aligning with federal directives, and the importance of collecting the information in individuals who have three or more EDL needs and three

[Speaker 0]: or more IADL needs. So how did you come up with six fifty?

[Jason Palatira (State Unit on Aging Director, DAIL)]: It's not an exact science. About two to three years ago, the SUA ran some calculations to determine what would be a decent minimum reimbursement rate that the AAAs could provide meal providers that would strike a decent balance between the ability to continue providing meals without having too much of a meal reimbursement rate, given the limited funding, obviously, while at the same time doing the best we could to keep those meal providers sustained and viable while giving some sort of decent meal reimbursement rate.

[Esme Cole (Member)]: And just to follow-up on what this includes, the $6.50 payment per meal. So that is including paperwork reimbursement rate, like in the administrative process during the meals, prep of the meal, the voluntary drivers that we have coordinating all of that. Beyond just the meal itself, which $6.50, I think it's just just wanna make sure I understand everything that that $6.50 is intended to cover.

[Jason Palatira (State Unit on Aging Director, DAIL)]: So the meal reimbursement rate itself strictly pertains to reimbursing the providers for the meal. Okay. And

[Esme Cole (Member)]: then the cost of those other factors surrounding the meal that are necessary in order to make the meal happen, how are those accounted for or who pays that cost contributes

[Jason Palatira (State Unit on Aging Director, DAIL)]: rather? The volunteer driver time is included in the meal costs, the data that we have available.

[Esme Cole (Member)]: And then the facilitation congregation meals setting up and hosting in the senior center, so those are all additional costs that are, in theory, accounted for in the $6.50 as well, including the paperwork, onboarding, making sure that the whole thing happens. I'm just curious, following the money to make this happen. Is that the extent of or is there other money that's going to the whole process, like getting these meals to the seniors?

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yeah. So AAAs can use federal funding to support meal providers with those other aspects of providing meals. AAAs can also use the federal funding support their own administrative costs and program management costs when they support new providers as well.

[Esme Cole (Member)]: And I appreciate that. So you say they can. I am curious, like, what is the pattern? What is the trend in Vermont? How much money is going? Like, if they can, how much is

[Speaker 0]: I'm just going to say, maybe more specifically, what does the department put in its grants about allowable administrative costs for this program?

[Jason Palatira (State Unit on Aging Director, DAIL)]: So the only grant per se that YESUA has with the AAAs is the Global Commitment HDM funded grant. And for this current fiscal year, there is no allotment for administrative costs or administrative costs for the AAAs. With these particular global commitment grants, the money is for meal reimbursement. Exclusively.

[Speaker 0]: And what about the older Americans? How do you deliver the Older Americans Act money?

[Jason Palatira (State Unit on Aging Director, DAIL)]: So the Older Americans Act money, it goes back to that interstate funding formula. So it's like a certain percentage of administrative money that can go to the AAAs, and it's broken down into the different Title III services or case management and things of that nature. And that's all distributed according to that formula based on the demographics that I spoke about earlier.

[Speaker 0]: And so but there's no grant? They're just No. It's it's

[Jason Palatira (State Unit on Aging Director, DAIL)]: just it's right. Correct. It's it's no grant. It's it's money that

[Speaker 0]: This payment made by Dale to them, or does it not go through Dale?

[Jason Palatira (State Unit on Aging Director, DAIL)]: It it it does it does go through Dale. I I believe it's it is on a quarterly basis. I'd would have to check with the business office on that because they're in the nitty gritty when it when it comes to, you know, working with the triple a's on providing that funding.

[Speaker 0]: Uh-huh. Yep. Seems odd, to be honest, that there's no grant. Even when pass throughing of federal funds, there's generally grants associated with that. That seems odd to me, to be honest. We don't hear that in any other place. Because there's obviously rules about how you use those federal funds, the department's accountable for it. So I would think that would be a desire to have some sort of grant agreement about those federal funds. I understand that's not currently done, but it's peculiar. Go ahead, Representative Maguire. Oh, excuse me. Representative Noyes had a question first, then Representative Maguire.

[Daniel Noyes (Clerk)]: Just for full transparency, my other job is working with the Vermont Association of Senior Centers and Meal Providers in the summertime. So that's what I do when I'm not here. So I do interact with many of these providers at the Meals Openness Program. So thanks for being here. And I just wondered if you could talk about, when you talk about the formula, it's looking at the population of individuals based on age. Do other states look at the need? So in other words, at poverty rates or nutrition, are we making sure that we're able to provide funding to sites based on the need in that community, not necessarily kind of an age? And are there Can you just speak to us? Is there a waiting list for people that come in?

[Jason Palatira (State Unit on Aging Director, DAIL)]: I can pull up that formula right now and talk about it. Because there are other factors other than age and age range that do go into the formula. So let me just pull it up.

[Daniel Noyes (Clerk)]: Because, you know, and I know with the ADLs, I often think of my own family and nutrition. I think about the easy thing for dinner is to eat some cookies. So Right? Someone, right? To eat ice cream instead of making the nutrition available that is healthy for even people that maybe have the capacity as they age. Do they cook for themselves? Do they actually think about that, the nutritional aspect, and then what impact does that have on an individual's health and ability? And I know it's really hard to say, okay, we be standing over someone's shoulder and saying, hey, you probably shouldn't eat that ice cream for dinner. But making nutritious food available to individuals as easy as possible, making it the low barrier is something I always think about. So it's not really a question, it's more just.

[Jason Palatira (State Unit on Aging Director, DAIL)]: An answer. So the formula factors in age ranges 60 to 74, 75 to 84, 85, like I mentioned earlier, and there's a little more weight to that 85 plus. 60 and over, factoring in poverty level, limited English, minority, and living alone.

[Daniel Noyes (Clerk)]: So live living alone probably good after is

[Zon Eastes (Member)]: what I was talking about.

[Speaker 0]: Okay. Ripson

[Zon Eastes (Member)]: Maguire. Thank you for being here today. Just to help hold the chair's points of beyond this, there's no brand. Mhmm. So how how is the relationship governed without a without a without a grant? What's the governance for the reporting other than word-of-mouth? That I do. I find this

[Jason Palatira (State Unit on Aging Director, DAIL)]: And there's no word of

[Zon Eastes (Member)]: what what's governing. I I my question is what's governing the relationship between the the state and the provider if there's no grant agreement.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Yeah. So twice a year, the triple a's need to provide the state unit on aging area plan updates. And those updates include progress on goals and objectives that that they're working on that, from the funding. And they also need to provide a yearly report that we then send to the federal government that provides all the data, all the expenditures, all the people that they've served under which program, etcetera, etcetera. That they have to report on, they have to provide more detail on any discrepancies from FFY to FFY of more or less than 10%. So they have to that's a federal requirement as well. So

[Zon Eastes (Member)]: there's some oversight there in that respect. But what's the documents that are used to govern that relationship? You're not using a grant agreement, those grant agreements will govern that relationship in regards to the expectations of the recipient receiving and what the requirements are to report back on how the funds are being utilized without that level of agreement, then what's the document that's being used to govern this? Yep. So as part of the

[Jason Palatira (State Unit on Aging Director, DAIL)]: state plan on aging, there are built in assurances. So it's just a number of sections that talk about what the AAAs need to do, what their expectations are as far as using the money appropriately, the different populations that they're expected to serve, priority populations and things of that nature. And that's the master document, so to speak, all those assurances that the AAAs need to abide by. I can certainly share that state plan with them.

[Speaker 0]: That's helpful. I think what you're receiving now is feedback to take back that we're familiar with state plan on aging. We reviewed it when we passed our Vermont law, and that's not a contractual agreement between the state and the provider. And typically such an agreement would reference the requirements in the state plan. But the state plan will not be the only document, if you will. So that's our feedback. So we don't need to sort of, like, pound that in.

[Jason Palatira (State Unit on Aging Director, DAIL)]: Well, just to give another example. So in the state plan that I'm currently drafting just to begin 10/01/2026, the next four year state plan, each AAA has a shared set of results based accountability measures that are both quantitative and qualitative in nature, and they need to report those to the SUA. They have done now. For example, one of them refers to case management. So the AAA case managers using Title III B funding need to report to the SUA twice a year on the clients that they're working with that have a particular set of goals, like what those goals are, progress on those goals, how many people are meeting those goals, things of that nature.

[Speaker 0]: We don't need to talk about this part anymore. I want to make sure that we get to other witnesses because we only have till noon. And we need to kind of we can move on on your presentation. You didn't get to the last slide, and I think we have one more before that. So I want to make sure that we were able to hear from Central or not.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Okay. Absolutely.

[Samantha Shanks (State Unit on Aging, DAIL)]: As I change it, I'll add too, just super quick. We do have an OEA policy and procedure manual on the Dale website too that outlines requirements for this programming so like if someone is using OAA funds to reimburse meals our OAA manual that's online outlines what metrics those meals need to meet in order to qualify for OAA funding. So there are guidelines in that document as well.

[Speaker 0]: Yep, appreciate all that. That does not negate the need for a grant agreement. Just saying. Okay, go ahead.

[Jason Palatira (State Unit on Aging Director, DAIL)]: All right, so for the last slide here, just sharing the final numbers for the Home Delivered Meals Global Commitment FY '25 grant cycle. 4,422 older Vermonters received 351,648 meals. And I thought it would be good to share where we're at for this current fiscal year with the quarter one data.

[Speaker 0]: Is is that in addition to the data you reported before? Or out of

[Jason Palatira (State Unit on Aging Director, DAIL)]: that 609 6,913, of that four forty four twenty two? Okay. So the okay. Gotcha. Thank you. So for q one thus far this year, 3,039 older Vermonters received 86,000 home delivered meals with this funding. Twenty three percent had three or more ADL needs. 82% had three or more IADL needs. 42% were at or below the federal poverty level. And like I mentioned earlier, there were no funds allocated for administrative costs for this grant cycle.

[Speaker 0]: Right.

[Daniel Noyes (Clerk)]: Any final questions for this witness? Just, are you seeing or hearing any increase in demand or the need for home delivered meals?

[Speaker 0]: Yeah, you asked about waiting lists, I didn't hear what

[Daniel Noyes (Clerk)]: you're Yeah, just really thinking about access to nutrition based on what's going on in the economy right now. Are you seeing or hearing about, it's not really quantitative data, but just how are you seeing an increase in the need? I know thinking of food shelves and access to nutrition for this population.

[Jason Palatira (State Unit on Aging Director, DAIL)]: I'm noticing an increase in demand for therapeutic meals. I can't say for certain whether or not I am noticing an increase in demand for meals in general. I honestly can't say that based on what I know right now about this situation. But I will say that there's an increasing demand and interest for therapeutic meals, so diabetic friendly, meal friendly, things of that nature.

[Speaker 0]: Last question.

[Esme Cole (Member)]: And I feel like one way to track that increase in interest would be to track the number of calls that maybe aren't even and to continue to make sure that they have care in some form or another. And my question is about the goals and objectives that we're measuring and what they're presenting in these two, I think you said biannual reports from the AAAs to DL. Are these goals and objectives designed in partnership with the senior centers or are they kind of like monetary metrics like need this cap and include it? I don't know. I just feel like it could be a little bit more Who's having control over what the goals are?

[Jason Palatira (State Unit on Aging Director, DAIL)]: It depends on if the senior centers are involved in the actual goals or not. So for example, one of the results based accountability goals for the upcoming federal fiscal year for the state plan is increasing participation in evidence based exercise programming, which obviously would involve senior centers. So that obviously needs to involve collaboration with senior centers and getting them on board and working closely with them to make sure that they have the capacity to continue providing this programming. Others, no, not so much. Case management goals, for example, that's all strictly done by the AAAs by

[Speaker 0]: the Board of Senior Centers. So I think the question is more about when you're developing a state plan and you're developing goals and each agency I'll just reference sort of like the designated agencies do. They have a requirement to go out and survey, work with other organizations in the field. And then they compile that data, and then that becomes their report back up to the state. And is that something similar that you require the AAAs to do? So when you're formulating goals for a state plan, it shouldn't just be the goals of the AAAs, it should be the goals of the people in the community that they serve.

[Jason Palatira (State Unit on Aging Director, DAIL)]: So the AAAs are required to do their own regional assessments to create their own area plans. And then in turn, as part of the State Unknown Aging's statewide assessment, we look at those area plans as well.

[Speaker 0]: Thank you. Okay, thank you so much. Appreciate you being here. Okay, now we're going hear from Central Vermont. Welcome.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Welcome. Thank you. Kim Lipinski here. I'm the Director of Nutrition and Wellness at the Central Vermont Council On Aging. Thank you for having me. I did distribute a couple of documents that I think everyone has. If anyone would like a paper copy, I did bring some paper copies for anyone.

[Speaker 0]: Good. Okay.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: First, I just want I will keep it brief since we have a just a little bit of time. First, I do wanna address a couple of questions that you brought up that I think that I can, address quickly. First, about the forms that you had asked about. Here at the Central Vermont Council on Aging, we do all of the intakes for home delivered meals at the Council on Aging, and that is to decrease the burden on our senior centers so that they aren't having to do that administrative work for us. It makes sure that anyone who comes and asks for home delivered meals is truly eligible so that we aren't having people getting home delivered meals who aren't actually eligible. And then the other thing that I would like to talk about is when people call and ask for, you know, you were talking about, you know, what about people that call and then maybe they aren't eligible? There's very few people that call that are not eligible. That doesn't happen very often. It's really rare. But if someone calls and they aren't eligible for a home delivered meal, we refer them to our community meals, which are called congregate meals. And we really encourage them to go there primarily for socialization because we take isolation very seriously, social isolation very seriously. And we want people to come out and go to our congregate meals. And so we provide them with a schedule of where those congregate meals are because they're not just in their own community, but they're in all of our communities. So it's possible to go every day of the week to a congregate meal in any community in Vermont. We give them

[Jubilee McGill (Member)]: Do have assessments for transportation?

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Transportation is very problematic, I will tell you. And I think everybody in the room knows that. There's very little funding for transportation. And transportation is really limited to people that need to go to medical appointments and critical needs. So transportation to a congregate meal is going to fall to the bottom really low on the list, unfortunately, but that is the case. Meal satisfaction surveys, I'd also like to You had asked about the meal satisfaction surveys. We go to great effort to make sure that they understand that this will not affect their service. And we send them a letter, a cover sheet, a letter with the survey that explains that. But we take it At CBC Away, we take it one step step further than that. And we include some questions on there that we ask them about, what is your favorite meal? And what is your least favorite meal? And that by including those questions, we have increased the response rate of our surveys tremendously. People love those questions. And by including those questions, we let them understand that they're participants in this program. Like, they really can help us craft our menus. And we do. We really pay attention to those surveys. And we build in the responses to those surveys into our menus. And it really, really does help. And people enjoy that. And I personally read every single survey. And I reach out to those people that give us this feedback. I call them. I write letters to them. I thank them for their responses and talk to them about that. And then I also want to talk to you about the work that we've done at CPCOA on our meal programs in the last I've been there for four years now. And I'll be really frank with you. And I'll tell you, when I started, the menus did have franks and beans on them. They weren't necessarily the greatest menus. And I came to CVC OA with a very specific goal to bring therapeutic meals to our menus. And I'm very proud to say that we now have 14 different types of therapeutic meals that people can get in Central Vermont Council on Aging's meal programs. But this took four years to develop. So the first thing I had to do was develop relationships with every one of these. We have 14 meal sites, 14 kitchens that are putting out meals. We do about 1,200 meals a day in our kitchens. When I was first hired, there were not good relationships with our kitchens. It was very much an Us and them situation between the AAA and the kitchens. And I will say it took about two years, the first two years, developing relationships with the directors of the meal sites and most importantly, with the cooks. So the cooks are probably the most important people that I work with. The cooks are the ones that are doing the really hard work, you know, making those meals, putting those meals out. They're the ones that are in there at six a. M. The cooks get there before the directors get there in the morning, you know? So I really elevated those cooks to a level that they deserve to be at and gave them training in how to prepare a meal for a diabetic. How do you prepare a meal for renal, soft foods, pureed, minced and moist, soft and bite sized, all these specialized meals that our people need. You know, and now they have confidence that they can provide these meals for our older adults because these meals are really, really important that they get these meals. And anyways, so these relationships were the basis before you can even bring training in for folks. Then the other thing I want you to know is that what we're doing with these therapeutic meals in Central Vermont is groundbreaking. I just came back from a week long conference in Chicago for Food as Medicine, a national conference. I went there to learn. I went it turned out I went there to teach. What we're doing here is not being done in almost most of the country. We are doing groundbreaking work here in Vermont with therapeutic meals. And I'm really proud of it, and we should all be proud of it. And the other thing that's happening here, or I should say is not happening, wait lists. We're one of the only states in the country that does not have a wait list in Vermont. We are serving our needs here in Vermont for Meals on Wheels. What we're not doing is funding it. Okay, so we are serving the people that need the meals. Okay, so when people call CVCOA and they say they need a meal, we can give them a meal. But our meal sites are having to fundraise for about half the cost of the meal. So the AAAs, we're giving them money for the meals. Yes, we are. We're passing the money through. We're giving them money, okay? And we're giving them all that we can, all that we're getting, all that we can, of course, with some administrative costs kept. But it's not covering the full cost of the meal. And if you look at our meal cost analysis, you can see what those costs are. So when we ask for funding, it's not that we're asking for funding to serve more Vermonters, it's that we're asking for funding to cover the full cost of the Vermonters that we're already serving. So we're really putting a burden on our meal sites. And that's what Basque Camp is talking about. Right? And that's what Maureen White at Basque Camp is talking about. And I know that you talk to Maureen, you know? I It sucks

[Speaker 0]: to me. Okay. All right.

[Jubilee McGill (Member)]: So, let's be clear.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: And I fully support my meal sites and my meal site directors. I have wonderful relationships with every single one of them, you know? And I give I give them everything I can, all the time, you know? But I want to make it really, really, really clear that they work so hard in fundraising to make up that other half of the cost of the meal. So we don't have Vermonters that are going without. We don't have wait lists. And that's a really wonderful thing. So we are serving our Vermonters. Now, what probably could do is get the word out a little better because I do believe there are Vermonters that could use Meals on Wheels that aren't asking for it. So that's a messaging problem, though. So that's something else. So there's a lot of people who have a misconception about Meals on Wheels, for example, that don't understand that it's not tied to income. It's a need based program. One of the

[Speaker 0]: things that we were wondering about is, is there some move afoot to have some statewide contract with a meal provider to deliver, I think, frozen

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: meals? Yes. But that's not with CVC OA.

[Speaker 0]: So, well, statewide would include CVC OA?

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: No. Yeah. With the other AAAs, not including CVCOA. The other four AAAs. Meaning Southwest Senior Solutions, AgeWell, and

[Speaker 0]: the Northeast So AgeWell has been doing this for a while. Right. And Southwest. Southwest has as well. Yes. So I guess I'm curious, we had invited the bank person here, but she's been come, to understand what the impact on that is for meal sites in those locations.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I think that Cheryl from Bank would speak to that better or something.

[Speaker 0]: Yeah, I know. Invited her and then we're told that you were the person.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I'm probably not the best person to talk about. So

[Esme Cole (Member)]: you're not participating in that, right?

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I haven't been privy to the details of that contract.

[Zon Eastes (Member)]: Think

[Morrison Acquire (Committee Assistant)]: Kim was asked to come just because of the work that she actually does with the providers. As far as the statewide contract, this is, I know nothing about that and I think that if that is a discussion that's going on I don't think that we have any idea that that's happening. I know that Age Well has had that for a long time and I don't know if they've been having those conversations with Gail. We just felt that Kim, the work that she's doing on the ground.

[Speaker 0]: Yeah, no, excellent work and I will, you know, I hear from my local oh, yep. Somebody Angela's back on. Thank you.

[Angela McMahon (Director, Adult Services Division, DAIL)]: Yeah. Can

[Speaker 0]: you answer that question? Jason's left and we should have asked that question while he was in the witness chair.

[Angela McMahon (Director, Adult Services Division, DAIL)]: Yes. And, you know, I I do think that bank representative of bank is best suited to answer the question, but I can tell you that what we have heard from bank is that there are existing contracts with this vendor that four out of five of the area agencies already have. And so this statewide contract would replace the individual contracts. So expand it's not where those meals are being delivered, but to have efficiency across the individual contracts to have one contract with a shared vendor.

[Esme Cole (Member)]: So it's

[Speaker 0]: not necessarily replacing any service that is currently being done by a local meal provider?

[Angela McMahon (Director, Adult Services Division, DAIL)]: That's our understanding. All had individual contracts, and the negotiation of the contract annually will be done once. And they're foreseeing some some savings across the state by having one negotiated contract with the vendor.

[Speaker 0]: Okay. And so all I I was familiar with AgeWell. I didn't realize the other three also had been utilizing this service before. Mhmm. So they the other two everybody except for Central Vermont has utilized this service before?

[Esme Cole (Member)]: Correct.

[Speaker 0]: And do do they also utilize regular meal sites, you know, like with senior centers or other meal sites, the other four? I know AgeWell does not, but I didn't know about the others.

[Angela McMahon (Director, Adult Services Division, DAIL)]: They do.

[Speaker 0]: Yeah. Okay, so it's a combination. Yes.

[Morrison Acquire (Committee Assistant)]: My understanding Northeast Kingdom has only one contract. Have the meal providers that they have just recently I think because a kitchen went away or something and they always continue to get their meals.

[Speaker 0]: Okay, well that is helpful information. Thank you. I think Dan had to stand up first.

[Daniel Noyes (Clerk)]: I just wanted, I know you've been working with some videos and helping Oh yeah. Folks with Could you just take like thirty seconds or forty five seconds to talk about that work? Because I think it's really good.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Oh, thank you. Yes. So we're working with a professional television studio and we actually have the former sous chef of the French Laundry of the Napa Valley as our training chef, doing training videos for soft food production meals. And we're doing other, we're expanding on that to do other therapeutic meal training videos. And we're making them available for professional chefs in nursing homes, hospitals, Meals on Wheels providers, anyone that's commercially preparing therapeutic meals. So we have the first three video, four videos have just been produced, but we're also on May 30, we're going back in the studio. We're producing those same videos for soft food production. These are for people that swallowing disorders and need very special foods. We're doing the same videos for caregivers. These are really important. So when people go to the hospital, go to their doctor and they get a diagnosis and they're told you need to have a puree foods or soft foods. And if you don't, you're going to aspirate and get pneumonia and you could die. I mean, there's dire circumstances if you don't get the right diet and you have to cook for your partner or yourself, these special foods. There is no training in this. There is nothing available to you. You can get a cookbook and that's about it. So we're making videos so that you can then go to our website, CBC UA's website, and learn how to prepare these foods for your caregiver or for yourself. And when I was just at this national summit this week, I was sharing about this. Everyone in the country wants these. Everyone. They do not exist. Nowhere. This is groundbreaking work that we're doing. So we're doing them for the chefs that are in nursing homes, hospitals, and Meals on Wheels programs, but we're also doing them for the caregivers.

[Esme Cole (Member)]: Thank you. And thank you for following up on some of my questions too, and for highlighting amazing accomplishments that you've had in Central Vermont. Think one of my, something that I've been thinking about all year about this is, and your testimony kind of highlighted it too, is the discrepancy between different regions of the state and what's being offered. And so I'm curious if you have feedback on how to make it more consistent. Yeah,

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I do. I have applied for congressional directed spending to advance exactly what I'm doing in Central Vermont across the state. So we'll see what happens.

[Esme Cole (Member)]: And money, of course, would be critical to make that happen, but I'm curious from a structural standpoint. I've written a plan.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I do have a Okay.

[Esme Cole (Member)]: So when we I guess There's no time to

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: go over that right now.

[Esme Cole (Member)]: I feel like there's a big disconnect in the transparency of strategy here because some of this is state directed in our policy and then we have plans coming up here and there and contracts here and there. We know of some area agency recently bought a new building in an area that doesn't even have a senior center. Just really total mishmash of how people are choosing these funds. And we are supposed to have oversight of that. And it's just, I'm like trying to find the information and it's all scattered everywhere. So, I mean, that's a wonderful, beautiful example of your taking leadership. And I really appreciate that because the impact would be profound on our seniors. But I think we need to really put our heads together about making this a really more transparent and straightforward sort of plan, a strategy plan, we all can achieve that wonderful goal that you have.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I completely agree with you, and I would appreciate any support that I could get. And I think that the formation of VANC is gonna be transformative for that and could really help bring all of the AAAs together and form some cohesion.

[Jubilee McGill (Member)]: Thank you. Yeah, not really a question. You mentioned a plan, and I know we don't have time today, but if when it's ready for more public viewing or private viewing, I'd love to take a look at it.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: Yeah, it's just something, I don't know, I'm a very, you could probably tell, I'm very ambitious. And I work on I just Nothing holds me back. And I work on things whether there's support for it or not. I'm gonna just work away. And I'd love to take a look. I'm sure others would as well. Yes. I have Vermonters, older adults in Vermont are close to my heart and I have their best interests in mind And therapeutic meals are really what I'm all about, serving people with chronic conditions the best food they can have to support them to stay at home and live the best lives they can. That's really where my interests lie.

[Jubilee McGill (Member)]: Another follow-up from Eric Maguire. Not even a question. I was just this conversation, I just wanted to point back to something we've talked a bit about. I've introduced bills kind of both bienniums and what both of you have pointed to is what about those folks who need support with hot meals or prepared meals when or they're making that choice between whether to do ice cream, it's just the option for our state to opt into the SNAP Restaurant Meals Program, which would allow seniors to use their SNAP dollars if they so choose at participating restaurants to get a hot, nutritious meal.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: I have something to say about that. The Older American Act governs the contents of the Meals on Wheels meals to make them a highly nutritious meal with requirements for protein, whole grains, vegetables and fruit.

[Jason Palatira (State Unit on Aging Director, DAIL)]: And

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: a restaurant meal is not gonna give you that. A restaurant meal is gonna be high in sodium.

[Unidentified member/chair (likely Theresa Wood)]: This is, I mean, there's different ways to design it and this just gives people choices.

[Jubilee McGill (Member)]: This is not a thing that competes with Meals on Wheels. No, but my concern is giving folks options where if they're someone who is on SNAP and if their body isn't cooperating and they can't cook a meal that day, allows them to participate in restaurants and we can design the program any way we want, where any eligible items are nutritious. There's a lot of flexibility.

[Kim Lipinski (Director of Nutrition and Wellness, Central Vermont Council on Aging)]: So they're not going to McDonald's in other Yeah, states have

[Jubilee McGill (Member)]: chosen to do that. But I always think you give folks a choice. Agree with this. And I think even giving And folks that self or I'd be happy to give you more information about the program. Thank you

[Daniel Noyes (Clerk)]: for it.

[Jubilee McGill (Member)]: It's all taking you to shoot. You work on this so much Thank a you. It's a lot

[Unidentified member/chair (likely Theresa Wood)]: of great information. Hopefully next biennium, we'll make progress on those bills. Are there any more questions? I know we're kind of into the lunch hour. I really appreciate, Kim, your testimony and everything. Thank you for being so innovative and ambitious in serving all the Vermonters. Really grateful. So committee, we are on break till 01:15 when we're going to pick up S-two 78 and hear testimony on an accolade into Canvas.